bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Results of Primary Repair Versus Ileostomy in Enteric Fever Ileal Perforation in Different Gender Groups
Authors: Bazai Ajmal Khan , Zeb Ahmad , Umar Muhammad , Hanif Muhammad , Latif Abdul , Khan Jamshed
Published: January 2023

Background: Processes of Ileostomy in patient having Enteric fever perforation with friable gut defunctions the diseased gut, change the route of the infected fecal matter, protects the intestinal repair done in septic tissues and reduces the anastomotic dehiscence. Disadvantage is that it needs further surgery for its closure, leads to Ileostomy related complications. Method: A Randomized controlled study. At BMC Hospital Bolan Quetta Started in November 2015 to May 2016. Our objectives were to compare post-operative wound infection between primary closure and Ileostomy in patients undergoing surgery for Enteric fever ileal perforation. Total One Hundred and Fifty patients who underwent Enteric fever perforation surgery were included. The surgical treatment was done as primary repair (group-A) and Ileostomy (group-B). Post-operative complications like wound infection and wound intra abdominal abscess were evaluated till 5 days of hospital stay. Comparison between 2 groups was done using chi square. Stratification was done and p-value ≤0.05 was considered as significant. Results: In group-A 47 maless and 28 femalesss and in group-B 52 maless and 23 femalesss patients were included. In group-A, 40% observed wound discharge while in group-B it was 24%. In group-A, acceptable comesis were observed for 80% cases and in group-B, it was 93.3%. Results showed significant association of wound discharge and acceptable cosmesis with the 2 study groups. Conclusion: Better results in Ileostomy group than primary repair group was significant observed in the study. Keywords: Enteric fever , Acceptable cosmesis, Wound Discharge, Intra Abdominal Collection, Ileostomy, Enteric fever Ileal Perforation
Outcome of Primary Percutaneous Coronary Intervention Among Patients of Complete Atrioventricular Block with Acute Inferior St-Elevation Myocardial Infarction
Authors: Rashid Sohail , Butt Zain Mehmood , Khan Muhammad Suleman , Afridi Muhammad Saeed , Bhatti Shahzad Majeed , Shahid Muhammad
Published: January 2023

Aim: To assess the outcomes of primary percutaneous coronary intervention among patients of complete atrioventricular block with acute inferior ST-elevation myocardial infarction Methods: We conducted an observational study of patients with CAVB and STEMI who underwent Primary PCI at interventional cardiology department, national institute of cardiovascular diseases Karachi during the period from January 1, 2022 to July 31, 2022. The primary outcomes were in-hospital mortality and CAVB resolution. Results: A total of 100 patients were included in the study. The mean age was 60.63±5.63 years, and 61% were male. The median door-to-balloon time was 89.96±17.97 minutes. In hospital mortality rate was 4%. CAVB was resolved in 93%. Conclusion: For patients with CAVB and STEMI, Primary PCI is a safe and successful treatment with a low rate of in-hospital mortality. These findings support the use of primary PCI in this patient population. Keyword: Primary PCI, CAVB, STEMI
Assess Restricted Pulmonary Function in Chronic Hepatitis C Patients at Various Phases
Authors: Rahman Faisal , Rizwan Zainab , Hameed Huma , Hussain Sohail , Habib Muhammad Saqib , Safdar Talal
Published: January 2023

Background: Chronic hepatitis C infection has both hepatic and extra-hepatic symptoms, both of which are influenced by the inflammatory response triggered by HCV. Chronic HCV induces inflammation that manifests itself in the liver and beyond. Persistent HCV infection may be associated with reduced pulmonary functions especially in patients with high viremia levels. Objective: The objective of study was to examine restricted pulmonary function in chronic hepatitis C patients during different phases. Study Design: Cross-sectional study Place and Duration: Department of Medicine Social Security Teaching Hospital Ferozepure Road Lahore. From 01.02.2022 to 30.08.2022. Methods: There were 94 cases of chronic hepatitis included in this study. After gaining the participants' informed consent, we documented their age, sex, BMI, and smoking status in detail. Patients underwent for abdominal ultrasound. The anti-HCV antibody test was run with a third-generation ELISA (Ortho HCV ELISA) kit using 3 ml of blood and pulmonary function test were performed to eavaluate restrictive lung disease. Data was entered and analyzed in SPSS 24.0 and presented as frequency and percentages. Results: Among 94 cases, 57 (60.6%) were males and 37 (39.4%) were females. Mean age of the patients was 46.9±4.53 years and mean BMI was 25.4±6.29 kg/m2. Majority of the cases 51 (54.3%) had rural residency. There were 64 (68.1%) cases had smoking history. We found that 17 (18.1%) cases had severe HCV, 45 (47.9%) cases had moderate and 32 (34.04%) patients had mild HCV. There were 37 (39.4%) cases had restrictive pulmonary function among all cases. Among 37 cases of pulmonary disease, majority had severe HCV infection. Conclusion: We concluded in this study that the patient with HCV infection had higher incidence of restrictive pulmonary disease. Majority of the patients were males and had smoking history. Severe cases of HCV mostly had restrictive disease. Keywords: HCV, Restrictive Pulmonary Disease, Males, Smoking
Nephrological and Oncological Outcomes of Nephron Sparing Surgery for Renal Tumors in Solitary Functioning Kidney
Authors: Ali Liaqat , Shah Muhammad , Shahzad Mohammad , Hayat Faiza , Hanif Mohammad , Orakzai Nasir
Published: January 2023

Introduction: Renal cell carcinoma accounts for 90% of all cases of kidney cancer. The major treatment option available is radical Nephrectomy with 93% survival rate. In the literature, partial nephrectomy, nephron sparing surgery and cryoablation all have been mentioned with similar effects. The unavailability of cryoablation in a third-world country like Pakistan has forced urologists to undergo Nephron Sparing Surgery. Objective: To assess the nephrological and oncological outcomes of nephron sparing procedures in individuals with single functioning kidney and renal tumor. Methodology: This retrospective study was piloted at the Department of Urology & Transplantation, Institute of Kidney Diseases Peshawar for duration of eight years from 2012 to 2020. There were 45 patients enrolled in our study. All the required information was collected on a predesigned Performa. Data analysis was carried out by using IBM SPSS version 24. Results: In the current study, 45 patients with a solitary functioning kidney and renal tumor were selected. There were 39 (86.67%) males and 6 (13.33%) female patients in our study. The serum urea and creatinine levels in 44 (97.78%) patients were normal, while one patient had a preoperative creatinine level of 3.1mg/dl. Oncocytoma was the only tumor in which creatinine levels were improved after surgery. Only one patient with T3 disease developed liver metastasis and died after 38 months of surgery with normal urea and creatinine levels. There had been no recurrence, progression, or metastasis in 44 patients (97% percent). Conclusions: Nephron sparing surgery is equally effective in terms of Nephrological and Oncological outcomes in patients having solid renal tumors in solitary functioning kidneys. Keywords: Nephrological, Oncological, Outcome , Renal tumors, Clear cell carcinoma
The Usage and Attitude Towards Aspirating Dental Syringe, A Cross Sectional Study of Dental Practitioners in Khyber Pukhtunkhwa
Authors: Din Tajud , Jehan Soulat , Haya Rida Ul , Sardar Tariq , Khan Muhammad Salman , Ilyas Ayesha
Published: January 2023

Objective: The aim of the study was to determine the usage and attitude toward aspirating dental syringes among dental practitioners in Khyber Pakhtunkhwa province of Pakistan. Study design: Descriptive, cross sectional Place and Duration: Rural Health Centre Koghuzi, February 2021 to May 2022. Methodology: A cross sectional conducted on dental practitioners in Khyber Pakhtunkhwa. A purpose developed, self-administered questionnaire was used to collect data. It included both open and close ended questions. SPSS version 23 was used and data were analyzed using Chi-square test. Results: 40.7% of respondents were qualified as specialist and the 59.3% were general practitioners. Only 31.6% of the dental practitioners have dedicated aspirating syringe available to them. Overall only 6.9% of the dental practitioners practice aspiration in all injection types. Most respondents agree that use of aspirating syringes contributes to safety of local anesthesia but only few think they had complication in their practice resulting from use of non-aspirating syringes. Most respondents think the might consider using aspirating syringes in the future. Conclusion: Despite the generally positive attitude towards aspirating syringes, few dental practitioners have dedicated aspirating syringe available to them and even few actually practice aspiration during local anesthesia. Keywords: Attitude, Local anesthesia, Aspiration, Aspirating dental syringes,
To Demonstrate Challenges in Treating Infratentorial Brain Tumors in Pediatrics at the Children’s Hospital and Institute of Child Health, Lahore
Authors: Shafiq Muhammad , Riaz Shazia , Ahmad Safwan , Rehman Laeeq Ur , Goraya Amber , Hussain Mehvish
Published: January 2023

Objective: To demonstrate challenges in treating infratentorial Brain tumors in pediatrics at The Children’s Hospital and Institute of Child Health, Lahore Methodology: This Descriptive observational study was done at the Department of Pediatric Hematology & Oncology at CH&UCH Lahore from August 2021 to February 2022. Sixty-four newly diagnosed patients of infra-tentorial tumors were enrolled by using non-probability, consecutive sampling technique. Main variables of study were age, parents education, socioeconomic status, traveling distance, TLS, stagging workup, Histopathology, Treatment, and Outcome . SPSS version 23.1 was used for data analysis. Test of significance was applied taking p value ≤0.05 as significant value. Results: In this study, the mean age of children was 7.14 ± 3.76 years. Out of 64 children, 35 (54.7%) were males and 29 (45.3%) females Forty three (67%) patients belong to rural area and 21 (32%) from urban area. In our study population, Father of 24 (37.5%) patients and mother of 38 (59.37%) patients never attended school. Fifty six (87.5%) patients belong to low income socioeconomic status while 8(12.5%) patients from middle income status. Thirty four (53.12%) patients had a travelled for more than 200KM. Lag time 1 (patient interval) was <2 weeks in 43 (67.2%) cases, and 2-4 weeks in 20 (31.3%) cases. Lag time 2 (referred interval) was noted as <1 Month in 19 (29.7%) cases, and <2 Months in 26 (40.6%) cases. Lag time 3 (treatment interval) was noted in <1 Month in 2 (3.1%) cases, and <2 Months in 6 (9.4%) cases, but in 48 (75.0%) cases lag time 3 was not applicable. Out of 64 cases, cure with Gross Total Resection was noted in 5 (7.8%) cases, residual tumor in 21 (32.8%) and palliation in 37 (57.8%) cases. Practical implication: The aim was to demonstrate all the challenges in treating Infratentorial tumors and start awareness in the doctor community specially GPs for proper and timely reffral,aware families about the danger signs and symptoms that could be brain tumor. Conclusion: Advanced disease presentation is common, infra tentorial brain tumors are always challenging and has the least favorable outcomes amongst all pediatric tumors. Delayed diagnosis due to cultural and financial barriers and lack of care at primary health care level and poor referral to oncology units owing to deficient health care system are the major contributory challenges for management and poor outcomes. Keywords: lag time, infra-tentorial tumors, challenges, Pediatrics
Sensitivity and Specificity of Color Duplex Ultrasound Measurement in the Estimation of Internal Carotid Artery Stenosis
Authors: . Asadullah , Satiwan Kavita , Mahar Sumera , Faham Muhammad , Hameed Marya , Zafar Hamid
Published: January 2023

Background: Stroke is that the world's leading reason for death and major incapacity. Arterial sclerosis is answerable for over half-hour of all ischemic strokes. Plaque morphology has recently been discovered to assist within the prediction of arterial sclerosis clinical behavior and stroke risk. Purpose: The goal of this study was to gauge the frequency and diagnostic exactitude of artery Doppler imaging to detect arterial blood vessel pathology. Methods: This cross-sectional study was conducted in Combined Military Hospital, Peshawar from1st August 2019 to 31st March 2020. A total of 120 patients were randomly selected. The inclusion criteria was having ischemic cerebrovascular stroke. Doppler ultrasound was performed in every patient by a consultant radiologist. Doppler ultrasound findings were compared with Carotid artery stenosis reports. Results: Mean age in this study was 63.07±3.76 years. Mean duration of disease was 1 year ±3.32 months. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Doppler Ultrasound were 89.5, 76.20, 45.5, 93.88 and 76.9% respectively. The areas under the ROC curves ranged between 0.89 and 0.90 for the laboratory A device and between 0.90 and 0.92 for the laboratory B device. In laboratories A and B, the areas under the ROC curves for ICA PSV were 0.90 and 0.92, respectively. Similar effects were observed when occlusion-affected patients were omitted (0.89 to 0.91, laboratory A; 0.90 to 0.93, laboratory B). Despite the fact that the diagnostic accuracy of the two devices was equivalent, two points on the ROC curves corresponding to the same cut point were infrequently near. Practical implication: The study compared the techniques of Doppler ultrasound for the diagnosis of carotid artery stenosis in patients and measured the best predicted percent angiographic stenosis differed between two vascular laboratories and paved the way for clinicians to focus of the diagnosis of carotid artery stenosis by DU. Conclusion: With the advancement in technology, the accuracy of carotid artery stenosis diagnosis has significantly improved over the decades. From measuring the narrowing carotid artery diameter to evaluating the increased velocity field near the obstruction/lesion site, the identification of additional parameters to characterize plaque vulnerability has become more important in the carotid artery. Keywords: Angiography; Carotid artery stenosis; Cerebrovascular ischemia; Doppler ultrasound sensitivity.
Pregnancy Outcomes of Women in Two Health Institutes; A Cross-Sectional Study in Pakistan
Authors: Munawar Asima , Mustafa Khadeeja , Arif Sohaib , Atteeq Romesa , Usman Fizzah , Bhatti Emama
Published: January 2023

Background: Complications that could be fatal can affect nearly 15% of pregnant women. As a result, it will be helpful to direct the appropriate intervention if a high-risk pregnancy is identified early on. Objectives: This study was aimed to ascertain the outcomes of pregnancies among pregnant women. Methods: In this study, age groups of 20-40 years of women were involved, among them, 60 women from each hospital participated. The majority of women were from rural areas. The occupation of majority of women husband in DHQ was farming (33.33%), followed by laborer (40%), teaching (16.65%) and trading (10%), while majority of husbands of patients in KTMC were laborer (38.33%) followed by farming (36.66%), teaching (13.33%) and trading (11.66%). Results: The normal weight of children in DHQ and KTMC was recorded 75 and 68.33%, respectively. In DHQ and KTMC, 50 and 38.33% children born alive, respectively while 26.66 and 35% abortions occurred, respectively. Neonatal outcome was linked to pregnancy complications and perinatal morbidity. Practical implications: This study focused on the neonatal health and the pregnancy outcome of the pregnant women. Improvement in vaginal birth, improvement of neonatal birth weight but caesarean section in high-risk mothers was analyzed in this study. Conclusion: The majority of maternal morbidities could be avoided if the mother had access to timely and appropriate healthcare during her pregnancy. As a result, proper care and prompt referral can help reduce perinatal mortality and morbidity and possibly improve maternal outcomes. Keywords: Pregnancy; Outcomes; Complications; Low birth weight; prenatal care
Healthcare Associated Inadvertent Intra-Arterial Injection as a Cause of Acute Limb Ischemia
Authors: Memon Fahad , Barlas Mohammad Fahad Tariq , Saleem Areeba , Panhwar Waryam , Rajper Najam Uddin , Rehman Khalil U , Khan Ayesha
Published: January 2023

Background: The present study aimed to determine the outcome of healthcare related inadvertent intra-arterial injection as a cause of acute upper limb ischemia in terms of limb function and salvageability. Methods: A retrospective observational study was undertaken at the Department of Vascular and Endovascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute Of Trauma, Karachi between 1st January 2020 to 31st December 2021. All patients who presented with ischemia secondary to inadvertent intra-arterial injection between the ages 18-70 years were included in the study. Files of the patients were reviewed and data was gathered to fill proformas. Follow up of the patients was reviewed for up to four months. Acute limb ischemia, limb salvageability, and limb function was assessed post-treatment. Results: In 14 (46.67%) no amputation occurred, 5 (16.67%) had minor amputation while 11 (36.67%) had major amputation. Seriousness of presenting symptoms was significantly associated with major amputation (p = 0.022). The majority of the patients who presented with pain, discoloration, sensory loss, motor loss, and gangrene had major amputations i.e. 4 (36.4%). memory loss was significantly associated with major amputation [8 (72.7%); p<0.0001]. Gangrene was also significantly associated with major amputation [8 (72.7%); p=0.002]. Conclusion: A number of mechanisms, including direct artery damage, arterial spasm, toxicity from the drug, embolism can result in ischemia following intra-arterial drug injection. In order to avoid such incidents and to make prompt diagnosis, healthcare providers should broaden their awareness of typical local injection practices, phases of injection drug use and the hazards connected with it. Keywords: Acute limb ischemia, gangrene, Injections, Intra-Arterial, Ischemia
Efficacy and Safety of Xelox in Comparison with Folfox in Metastatic Colorectal Cancer
Authors: Baqai Tooba Imtiaz , Haider Ghulam , Abro Nargis Aalam , Rani Berkha , Kumari Reeta , Anzar Javeria , Abbas Kiran
Published: January 2023

Background: The study aimed to evaluate efficacy and safety of Xelox in comparison to Folfox chemotherapy for metastatic colorectal cancer. Methods: A quasi experimental study was undertaken at the Department of Oncology, Jinnah Postgraduate Medical Center between April 2022 to November 2022. All the patients coming to oncology department JPMC with confirmed diagnosis of metastatic colorectal cancer of age 18 years and above were included. All data were recorded in a predefined proforma by the researchers. Patients’ age, gender, and comorbidity, family history, and clinical characteristics were noted. The primary endpoints were the overall response rates and the frequency of adverse effects. Results: A total of 200 patients were enrolled with a mean age of 40 ± 14.38 years. There were 100 participants in the Xelox group while 100 participants in the Folfox group. About 45 (45%) in the Xelox group and 62 (62%) in the Folfox group reported adverse effects of the chemotherapy (p=0.015). The rate of neutropenia grade III/IV was greater in the Folfox category than the Xelox. Hand foot syndrome was significantly more frequently reported in the Xelox group than the Folfox group 22 (48.89%) and 18 (29.03%); p=0.036, respectively. Oral mucositis was also more frequently reported in patients taking Xelox than Folfox [20 (44.44%) vs. 15 (24.19%); p=0.023]. There was no significant statistical difference between Xelox and Folfox in terms of patient overall response rates. Conclusion: According to the study, there are no appreciable differences between Xelox and Folfox chemotherapy in terms of overall response rates among patients with colorectal cancer. However, overall, patients taking Folfox reported significantly higher rates of adverse effects with the exception of hand foot syndrome and oral mucositis which was more frequent in the Xelox group. Keywords: colorectal carcinoma, chemotherapy, xelox, folfox, Capecitabine, Oxaliplatin, fluorouracil
Results of Open Incisional Biopsy and Core Needle Biopsy of Bone Tumors
Authors: Sardar Syed Bakht , Ali Abbas , Saeed Kamran , Rehman Manqoosh Ur , Maqsood Amjad , Askari Raza
Published: January 2023

Objective: The goal of this research was to assess the diagnostic efficacy of open vs percutaneous core needle biopsy (CNB) for musculoskeletal malignancies. Study Design: Retrospective study Place and Duration: This retrospective study was conducted at Department of Orthopaedic, Khyber Teaching Hospital Peshawar during the period from April, 2022 to September, 2022. Methods: There were 96 patients were presented in this study. All patients with a primary bone or soft tissue tumour suspected of being malignant who receive a percutaneous CNB or open biopsy and subsequently develop a tumour were included. Patients were equally divided in two groups. Group I had 48 patients and received open incisional biopsy and group II received core needle biopsy in 48 cases. Fischer’s test was used to compared outcomes among both groups. SPSS 23.0 was used to analyze all data. Results: We found that 28 patients in group I and 30 patients in group II were males. Mean age of the cases in group I was 51.6±7.48 years and in group II mean age was 54.7±10.34 years. As per anatomical distribution, lower extremity was the most common in both groups followed by trunk and upper extremity. In our study favorable outcomes were obtained by CNB in bone sarcoma in terms of diagnostic accuracy, NPV, PPV, sensitivity and specificity as compared to open biopsy but difference was insignificant and in soft tissue sarcoma open biopsy showed a significant good result with p value <0.005. Conclusion: Results from our study showed that the percutaneous biopsy approach was only slightly less effective than open biopsy for soft tissue tumours, whereas the open biopsy technique was more effective for bone tumours. Keywords: Soft tissue sarcoma, Bone sarcoma, Open Biopsy, Core Needle Biopsy
Comparative Analysis of Cystolithalopexy and Percutaneous Cystolithotripsy in Senior Pediatric Population Aged 6 to 15 Years
Authors: Ahmad Tariq , Khan Sher Wali , Tayyib Muhammad , Khalily Mohammad Yasir
Published: January 2023

Background and Objectives: To compare cystolithalopexy and percutaneous cystolithotripsy in children 6 to 15 years based on complications. Methodology: The study includes 100 patients under the age of 6 to 15 years age, split into two groups called Group-A (45) and Group B. (55). Included were those patients with stones that were smaller than 20 mm in size (on average, 14 mm). Patients in Group-A received cystolithalopexy therapy utilizing a ureteroscope and a pneumatic lithoclast assisted by a Dormia basket. Patients in Group B received percutaneous cystolithotripsy therapy. Results: The age range of the 100 male pediatric patients ranged from 6 to 15 years (mean age 8 years). The average length of stay in the hospital was 2.5 days for patients in Group A and 3 to 8 days for patients in Group B. Patients in Group-A exhibited higher rates of urinary tract infections (8%) and urethral injuries (22%), residual stones (1%), enlarged bladders (2.2%), urinary retention (4.4%), and fever (13.33%). While in Group B, 18% of the members experienced urinary tract infections, 5% wound infections, 4% hematuria, 7% bladder size enlargement, and 27% fever. In each Group, urine retention was 7%. Conclusion: Pediatric male patients with vesicle calculus respond substantially better to cystolithalopexy because it requires less invasive surgery, leaves no scar, and has fewer complications. Keywords: Bladder Calculus, Comparison, Cystolithalopexy, Ureteroscope, Pneumatic Lithoclast, Dormia basket, percutaneous cystolithotripsy.
Effect of Covid Pandemic Upon Utilization of Contraceptive Services
Authors: Bibi Razia , Shams Ghazala , Anbreen Fauzia , Fateh Reema
Published: January 2023

Background and Aim: The coronavirus illness (COVID-19) is a public health disaster on a worldwide scale. The present COVID 19 epidemic will cause significant interruption to healthcare systems long after it has passed its peak. Sexual and reproductive health (SRH), including contraception, must be viewed as a critical service. The aim of the present study was to assess the COVID pandemic effect upon utilization of contraceptive services. Methods: This epidemiological study was carried out on 1284 women at risk of unplanned pregnancy whose longitudinal data was collected from June 2021 to 31 November 2021 in Gynae & Obs department of Hayatabad Medical Complex Peshawar and KMU Institute of Medical Sciences, Kohat. Baseline details, association of contraceptive dynamics with COVID-19 experiences, and causes for contraceptive non-use were measured outcomes during COVID pandemic. Our key outcome was the dynamics of contraceptive usage classified into four groups: a) persistent non-use, b) persistent use, c) adoption, and d) cessation. Secondary outcomes were contraceptive uptake, cessation, and switching. Factors such as socioeconomic status, reproductive health, and COVID-19 status have been associated with contraceptive behavior. Sociodemographic details consist of age, education, residency, and parity. Results: Of the total 1284 unplanned pregnancy women, during COVID-19, no changes in contraceptive status was seen in 64.8% women, whereas those who responded were much more inclined to adopt a device 26.2% than to discontinue 9.0%. The majority of women who shifted contraceptives were using more efficient techniques than the one they used before the pandemic. In Pakistan, higher contraceptive protection was connected with economic insecurity due to COVID-19. Among all the cases, non-contraceptive users 9.1% (n=117) had cited COVID-19-related causes for not utilizing contraception. Conclusion: The present study concluded that contraceptive status among the majority of women with unexpected pregnancy during COVID pandemic unaltered their contraception status, and adoption was more acceptable to women than discontinued techniques. COVID-19 was mentioned by a minority of women for not using the vaccine, highlighting the significance of extending safe forms of service delivery amid health crises. Keywords: COVID-19, Pandemic, Contraception services
A Comparison of Amniotic Fluid Index versus Single Deepest Pocket Method in Terms of Maternal and Perinatal Outcome in Late Term Pregnancies
Authors: Anbreen Fauzia , . Abeer , Fateh Reema , Hanif Sadia , Bibi Razia
Published: January 2023

Background: Over diagnosis of isolated oligohydramnios is associated with increased obstetrical intervention without improving maternal and perinatal outcome. Objective of this study is to evaluate two methods of amniotic fluid volume assessment regarding obstetrical intervention frequency and its effect on maternal and perinatal outcome. Materials and Methods: This prospective study was conducted at a Private Hospital of Dera Ismail Khan and Khyber Teaching Hospital, Peshawar from 1st January 2017 till 31st December 2019. All pregnant patients with singleton, un-complicated pregnancy with period of gestation from 41 weeks to 41 weeks 6 days, live fetus were included in the study. Women who met the eligibility criteria were assigned to two different techniques of amniotic fluid assessment, first amniotic fluid index( AFI) method and second single deepest vertical pocket(SDVP) method. Data was recorded on a specially designed proforma. The socio-demographic variables were age in years, parity. Continuous variable was measured on numerical scale and expressed as mean and SD. Research variables were maternal outcome and perinatal outcome in terms of oligohydramnios frequency, induction of labour, caeserean section, fetal distress, NICU admission, A/S < than 7 at 5 minutes. Chi-sq test of significance was applied. Results: A total of 160 patients met the inclusion criteria. In first group 30 (37.5%) and in second group18 (22.5%) had oligohydramnios. In AFI group 10 (33.3%) and in SDVP group 3(16.66%) had caesereans section. Induction of labour was 30(37.5%) in AFI group and 18(22.5%) in SDVP group. These results were statistically significant with a p value less than .05 at 5% significance level. Fetal distress, A/S < than 7 at 5 minutes, NICU admission results were not statistically significant for two groups. Conclusion: SDVP technique gave less abnormal results, less intervention with no significant difference in maternal and perinatal outcome. Keywords: Amniotic fluid, Oligohydramnios, Caesarean section.
Progressive Coil Penile Tourniquet Syndrome: Single Center Experience with 26 Cases at Department of Pediatric Urology at the Institute of Kidney Diseases MTI Hayatabad Peshawar
Authors: Shah Sayed Ghafar , Khan Muhammad Kamran , Asad Ali , Ullah Naqib , . Irfan , Khan M Asif
Published: January 2023

Objective: This study was conducted to know the causes of penile tourniquet injury, its complications and awareness about the condition to prevent its devastating outcomes. Methods: this study was completed in five year (2017-2022) at Institute of Kidney Diseases MTI Hayatabad Peshawar. The injuries were graded ‘as described by Bashir and El-Barbary. Results: this study is composed of 26 Patients. . The mean age of patients was noted seven years (6.93years) with range 2.3years to 11years. Human hair was found constricting agent (09 patients). All of the patients were circumcised. In most patients a delay in diagnosis of more than five weeks was noted. Conclusion: Penile tourniquet injury in children can cause devastating range of injuries from mild glans edema to penile amputation. The knowledge of such conditions/injuries can easily diagnose the condition and prevent its complications.
Comparison of Outcome between Percutaneous Aspiration, Incision and Drainage In Case of Lactational and Non-Lactational Breast Abscess
Authors: Shah Syed Irfan Ali , Rasheed Sadia , Rehman Wali Ur , Shaikh Kashan , Hamid Faran , Azam Zaini
Published: January 2023

A breast abscess is a localised collection of purulent material within the breast. Its first-line treatment was incision and drainage under general anaesthesia. But it prolonged the morbidity, whereas aspiration developed as a less invasive solution to the problem. Therefore, this study was conducted to compare the outcome of breast abscess management with both aspiration and incision and drainage techniques. It comprised 60 patients presented at LRH, Peshawar and LUMHS, Jamshoro, (July 2021 to December 2021). The mean age of the presented gyne patients was 34.78+10.55 years. Females with breast abscesses were allocated into two groups carrying 31 and 29 patients in lactational and non-lactational phases, respectively. Results revealed that post-surgical complications including scarring, breast asymmetry, mammary fistula and sepsis were significantly higher (p<0.05) in patients treated with incision and drainage as compared to the aspiration-managed women. Therefore, percutaneous aspiration was found more successful and effective than incision drainage. Keywords: Breast scarring; Mammary fistula; Pus drainage; Surgical complications.
Severity of Hyponatremia and its Influence on Various Complications of Decompensated Chronic Liver Disease
Authors: Qaiser Muhammad Affan , Baig Muhammad Asif , Syed Imran Ali , Shah Syed Hammad Wajid Talha , Butt Nazish , Najmi Farah
Published: January 2023

Objective The study quantified the occurrence and intensity of hyponatremia in decompensated chronic liver disease patients Study design: Descriptive Cross sectional study Place and Duration: Department of Gastroenterology, Centre for Liver Diseases, Holy Family Hospital (CLD, HFH) for a total 6 months duration Methodology: Patients aged 13-75 years, both male and female presenting with Clinical, biochemical, and Ultrasonographic findings of cirrhosis were included in this study. Patients' ages, genders, levels of serum hyponatremia, rates of complications, Child-Pugh scores, and other contextual data were recorded in a standardized proforma. The tests were conducted in the hospital's lab, and a pathologist looked over the results. Results: Among 120 study cases, 72 (60 %) patients were male and 48 (40 %) were female patients. The mean age was 50.83 ± 10.50 years; ranging from 30 years to 70 years. Of these 120 study cases, 32 (26.7 %) were from rural areas while 88 (73.3 %) were from urban areas, 35 (29.2%) were poor, 69 (57.5%) were middle income and 16 (13.3%) were having rich socioeconomic status. Child-Pugh class B was noted in 77 (64.2 %) and Child-Pugh class C was noted in 43 (35.8%) of our study cases. The mean serum sodium level was 131.25 ± 4.34 mmol/L ranging from 118 mmol/L to 141 mmol/L and hyponatremia was noted in 64 (53.3%) of our study cases. Mild hyponatremia was noted in 12 (10%), moderate hyponatremia in 28 (23.3%) and severe hyponatremia in 24 (20%) of our study cases. Hepatic encephalopathy was noted in 16 (13.3%), spontaneous bacterial peritonitis in 36 (30%), variceal bleeding in 44 (36.7%) and Hepatorenal syndrome in 24 (20%). Conclusion: Our study found that people with liver cirrhosis were more likely to be hyponatremic than those without the condition. Hyponatremia was associated with being older age, having problems, and being labelled as a Child-Pugh class C. It was also revealed that the number of problems was strongly correlated with the degree to which the hyponatremia had progressed. Nurses, doctors, and anybody else providing care for cirrhotic patients should all keep a close check on their patients' sodium levels. Keywords: Hyponatremia, liver cirrhosis, Serum Sodium, Child-Pugh
Comparison between Different Anaesthesia Techniques for Protecting Renal Function in Children Undergoing Radical Nephrectomy
Authors: Ali Khan, Muhammad Baqir , Nazeer Tahir , Zeeshan Usman , Ahmed Rizwan Munir , Bhutto Amanullah , Banaras Faizan
Published: January 2023

Background and Aim: Most primary renal neoplasms are caused by renal cell carcinomas (RCCs). There is a high risk of morbidity and mortality following radical nephrectomy due to acute kidney injury (AKI). It is crucial to detect and prevent this complication as early as possible. The present study aimed to anesthesia comparison after radical nephrectomy for kids: a study with different anesthesia techniques. Patients and Methods: This retrospective study was carried out on 84 children of the age up to 12 years undergoing radical nephrectomy in the department of Anaesthesiology, Chaudhary Muhammad Akram Hospital (CMA) Lahore during three years, from August 2019 to July 2022. Prior to study conduction, ethical approval was taken from research and ethical committee. Patients were allocated to three different groups: Group-D (Dexmedetomidine group), Group-C (Caudal group), and Group-P (Placebo group). Children were evaluated by taking history, physical examination, and laboratory examinations such as liver function, CBC, kidney functions, and coagulation profile. SPSS version 28 was used for data analysis. Results: A total of 84 children investigated with different anesthesia techniques. Each group was assigned 28 children undergoing radical nephrectomy. A significant difference did not appear between the three groups in terms of serum creatinine at any of the times of measurement. Group D showed significant lower values for cystatin C and NGAL compared with group C and group P regardless of the measurement period. In all three studied groups, there were no significant differences in age, gender, or weight of the patients (p> 0.05). Comparatively to the other two groups, the Dex Group had significantly higher urine output, more sedation, and lower objective pain scores. Conclusion: Clinical prediction schemes using cystatin C and NGAL biomarkers showed that dexmedetomidine prevents AKI in children undergoing renal replacement therapy. The Dex Group had significantly higher urine output, more sedation, and lower objective pain scores as compare to the other two groups. Furthermore, dexmedetomidine provides renal protection and sedation as well as analgesia. Keywords: Radical nephrectomy; Dexmedetomidine; Cystatin C; Children
Plasma Lipid and Lipoprotein Concentrations in Pregnancy Induced Hypertension
Authors: Bukhari Syeda Rabia , Firdus Alia , Jalal Sadaf , Yusuf Lamia , Israr Surraya , Bhutto Amanullah
Published: January 2023

Background and aim: Variation in serum lipid profile is associated with hypertension. Abnormal lipid profile directly affects the endothelial dysfunction and significantly associated with atherosclerotic cardiovascular diseases. Hypertension is the pregnancy toxaemia associated key feature which is considered to be caused by vasospastic phenomena in placenta, kidney, brain, and uterus. The current study aimed to assess plasma lipid and lipoprotein concentrations in pregnant women with hypertension (PIH). Methods: This study was conducted on 66 (36 PIH cases, 30 control cases) age matched women in the Department of Obstetrics and Gynecology, Moulvi Ameer Shah Memorial Hospital, Peshawar from October 2021 to June 2022. The criteria for preeclampsia were proteinuria, and proteinuria after pregnancy, hypertension, edema, and reversal of hypertension. Subjects' fasting venous blood samples were collected. Plasma was isolated from heparine anticoagulated blood. In a preservative bottle (500 mg/1000 mL urine) of Na2B4O7, urine was collected after 24 hours. Urine and plasma were kept at -80°C until the assay. Total cholesterol levels, HDL-C, and triglyceride were enzymatically measured. The amount of spectrophotometric and malondialdehyde was measured for plasma lipid peroxidation. SPSS version 26 was used for data analysis. Results: There was a significant increase in proteinuria, mean diastolic, and systolic pressure of preeclampsia patients than the control group. Total triglyceride, malondialdehyde (MDA), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (apo-B) in a study group were significantly higher as compared to control. Whereas the study group had lower high density lipoprotein cholesterol (HDL-C) than that of control group. The total cholesterol concentration, plasma protein, gestational age, apo-A, and hemoglobin had no statistical significance in both groups. Conclusion: The present study suggested that abnormal lipid metabolism, high triglycerides, specifically LDL-C and lipid peroxides, and low HDL-C concentrations, may lead to the vascular dysfunction and preeclampsia is associated with oxidative stress. There are only minor differences in lipoprotein concentrations and serum lipid between PIH women and women with uncomplicated pregnancy. Keywords: Plasma lipid, Lipoprotein concentration, Pregnancy-induced hypertension
Risk Factors for Surgical Site Infection Following Cesarean Delivery
Authors: Bukhari Syeda Rabia , Gul Momy , Asad Umber , Yusuf Lamia
Published: January 2023

Background and Aim: Obstetrics' most common surgery is the cesarean section. The most common cause of hospitalization is surgical site infection, which increases morbidity and mortality. Postpartum infection is most commonly caused by cesarean section. The present study aimed to determine the several risk factors for surgical site infections after caesarean birth. Patients and Methods: This case-control study was conducted on 874 women underwent cesarean section in the department of Obstetrics and Gynecology at Moulvi Ameer Shah Memorial Hospital, Peshawar from January 2022 to September 2022. Patients were categorized into study group and control. A case is a patient who developed surgical site infections (SSI) after undergoing cesarean section surgery, while a control is a patient who had the procedure before or after SSI wasn't developed. Using the bivariate and multivariate logistic regression methods, infections on the patients were detected based on physical examination, laboratory reports, and post-operative follow-ups. Data analysis was done in SPSS version 28. Results: Of the total 874 cesarean cases, the prevalence of surgical site infection after cesarean section was 84 (9.6%). The age wise distribution of cases with SSI were as follows: 12 (14.3%) in 15-25 years, 62 (73.8%) in 26-35 years, and 7 (8.3%) in >35 years. Among 84 cases, the incidence of superficial type and deep incisional type was 80 (95.2%) and 4 (4.8%) respectively. The incidence of SSI diagnosis within 10 and after 10 postoperative days were 57 (67.9%) and 27 (32.1%) respectively. Among SSI diagnosed cases, the prevalence of normal, overweight, and obese patients were 16 (19%), 40 (47.7%), and 28 (33.3%) respectively. The prevalence of primipara was 72% (n=60) in SSI group. Out of total SSI cases, the incidence of primary and repeated CS was 74 (88.1%) and 10 (11.9%) respectively. In the SSI group, 45.2% (n = 38) out of total cases had medical complications like hypertension, diabetes, anemia, hypothyroidism, autoimmune diseases like scleroderma and SLE, and fever. Conclusion: The present study concluded that the prevalence of surgical site infection after cesarean section was 9.6%. The chances of surgical site infection after cesarean section increase as one gets older, obese, suffers medical complications while pregnant, goes into labor during a cesarean section, and has more than five PV examinations. Obstetricians should take precautions to avoid preventable risk factors. Keywords: Surgical site infection, Risk factors, Cesarean section
Diagnostic Accuracy of Elastography to Differentiate Between Malignant and Benign Lymph Nodes of Neck and Head Region Taking Histopathology as Gold Standard
Authors: Baig Hina , Azam Muhammad Shafiq Ul , , Akram Aysha , Ali Asim , Asim Aisha , Younas Rabia
Published: January 2023

Background: The analysis of superficial lymphadenopathy in the cervical, axillary, and inguinal regions is vital in planning therapy for patients. Elastography is a technique currently being used for the evaluation of lymph nodes by means of evaluating tissue elasticity. In medical practice, shear wave-based and strain elastography techniques are being utilized. Strain elastography can be used to assess types of elasticity. Colors inside and around the nodes are estimated in the first place and then a 4-5 scale scoring system is used to score them visually. The present study aimed to assess the diagnostic accuracy of elastography in distinction between malignant and benign lymph nodes of the neck and head region, taking histopathology as the gold standard. Methods: This study was carried out on ninety-six (96) patients of either gender with lymph nodes in the head and neck region admitted to Children Hospital and University of Child Health Sciences Lahore and Mardan Medical Complex. Patients with proven histopathology and gone through surgery in the head and neck region were excluded from the study. Each patient was subjected to the high-resolution elastography with a 7.5 MHz linear array probe. A consultant radiologist performed the elastography in the presence of the researcher and noted the lymph node types. The histopathology report was compared with the findings of elastography. Results: High-resolution elastography was conducted on each patient enrolled in this study and their results were categorized into two distinct groups’ namely positive elastography and negative elastography. In the positive group, malignant lymph node diagnoses were supported in 51 patients by elastography. Out of which 46 were true positive cases and 5 were false-positive cases with no malignant histopathology. Similarly, in elastography, negative patients, only 3 cases were false negative and 42 cases were true negative. The overall diagnostic precision, specificity, negative predictive value, positive predictive value, and sensitivity of elastography was found to be 92%, 89.10%, 92.80%, 89.40%, and 94%, respectively, in order to differentiate malignant lymph nodes from benign lymph nodes in the neck and head region, taking histopathology as the gold standard. Conclusions: The present study demonstrated that elastography is a favorable and invasive technique for the diagnosis and differentiation of malignant lymph nodes from benign lymph nodes with high diagnostic accuracy. It may help in selecting surgical procedures for lymph nodes in the neck and head region. Keywords: Elastography, Sensitivity, Malignant Lymph Nodes.
Knowledge about Negative Effects of Bottle Feeding on Babies’ Dental Tissues Amongst Mothers
Authors: Amer Fatima , Rizvi Darain Zahra , Sadiq Muhammad Shairaz , Aldhafeeri Raid M , Alanazi Zidan M , Alenzi Tahani H , Malik Aiman
Published: January 2023

Background: Bottle feeding affects the hard tissues of babies in a negative manner. Overall health of infants is also affected by regular bottle feeding. It also results in development of certain harmful habits and increasing use of pacifiers when bottle feeding exceeds 0-6 months. Many detrimental changes occur in the dental tissues of infants due to bottle feeding. Infant feeding practices are an important factor influencing malocclusion in deciduous dentition, which can have long-lasting negative outcomes on oral health-related quality of life. Objective: To assess the awareness in mothers regarding bottle feeding and its adverse dental effects in babies and to find out the general feeding pattern among mothers. Study Design: Descriptive cross sectional study. Study Duration: Study was conducted on feeding mothers in Lahore during a period from November 2020 to February 2021. Methodology: In this study 350 mothers participated. The inclusion criteria consisted of women having at least 1 baby less than 2 years of age. Questionnaire was printed in English and Urdu and filled by mothers. Prior to the actual data collection process at non-sampled Kebeles, the questionnaire was pre-tested on 5% of the sample size, and adjustments were made as necessary. The short questionnaire was collected on same day. Data was analyzed using SPSS version 23 (IBM SPSS Statistics, version 23, USA). Chi square test was used to compare frequencies amongst groups. A p value of <0.05 was set as the level for statistical significance. Results: The results showed that age distribution of mothers included in this study were between 20 to 50 years with 20 to 29 being highest 186 (53.3%). Two hundred and eleven (60.3%) were housewife and one hundred and thirty-nine (39.8%) were working women. Feeding pattern showed that 41% women were breastfeeding their child, 9% were bottle feeding and 50% were using both methods of feeding. Practical implication: In order to identify issues and find solutions to prevent illness and stunted growth, it is important to regularly monitor breastfeeding patterns and feeding practises in mothers. That’s why current study was planned to assess the awareness in mothers regarding bottle feeding and its adverse dental effects in babies and to find out the general feeding pattern among mothers. Conclusion: It is concluded that bottle feeding is more common among women, which is having deleterious effects on both dental and skeletal tissues of babies. Knowledge among mothers related to dental problems as an implication of bottle feeding is generally quite lacking. There needs to be more educational efforts made in order to prevent the dental problems in infants. Keywords: Infant feeding, Breast feeding, bottle feeding, dental, altered occlusion, deciduous dentition, feeding pattern, nutritional demand, tooth decay, discoloration