BMC Journal of Medical Sciences

Preventive Cardiology–From Risk To Resilience

2024-12-25T05:55:42+00:00

The concept of Preventive cardiology aimed to reduce the cardiovascular risk factors is charming and easy to understand but difficult to implement. Common preventable cardiac risk factors include diabetes mellitus, hypertention, smoking, obesity, dyslipidemia, sedentary and stressful life style. Evidence has shown that individuals with increased risk of cardiovascular disease (CVD) can reduce their risk of cardiovascular morbidity and mortality.¹

A recent report found that only 5% of patients with a BMI over 30 were defined as obese in a primary care-setting.1CVD will continue to be the dominant disease effecting our life expectancy.² Framingham Heart Study (FHS) was designed to know the factors that determine the development of atherosclerotic CVD (ASCVD) and this study for the first time coined the term “risk factor” for coronary heart disease. ^3-4

World Health Organization (WHO) estimates that CVDs account for approximately 17.9 million deaths each year, with ischemic heart disease and stroke contributing to 85% of this burden^.5 WHO’s “Global Action Plan for the Prevention and Control of No communicable Diseases” aim to reduce premature mortality from CVDs by 25% by 20255.According to WHO 60% of the world's cardiac patients will be in South Asian region.6In early sixties, coronary artery disease represented 4% of all cardiovascular deaths in the region, while this number increased to more than 50% in 1990.^6,7 Although heart diseases are decreasing in developed countries, but it is on the rise in low income countries. The impacts of this preventable epidemic are substantial in term of mortality and morbidity andeconomiccosts.6Gross domestic product (GDP) could increase by 4-10 percent, in terms of macroeconomics, if non communicable diseases (NCDs) were completely eliminated.⁷

By reduction of tobacco and salt over 10 years, in low income countries like Pakistan, india and Bangladesh, 13.8 million deaths could be prevented ,atacostoflessn than 0ne dollar perpersonayear^9,10

Prevention is the smartest way to achieve these goals. It is therefore important to frame a nationwide comprehensive and integrated programme. This programme should have cardio metabolic centers at tertiary care hospitals and satellite units in periphery. Social media, print media and other forums should be utilized for public awareness regarding preventive measures. Resources should be allocated for primary as-well as secondary prevention. Identification and treatment of risk factors should be done at all levels and high risk patients should be referred to cardio metabolic centers for primary and secondary prevention. by this way the cardiovascular epidemic can be prevented.

In contrast to other sub-specialties of cardiology, preventive cardiology should be open to other disciplines to provide dedicated longitudinal care. The preventive cardiology team should include not only cardiologist but include internists, endocrinologists, Nephrologists, cardiac rehabilitation expert, pediatricians, obstetrician/gynecologists, clinical pharmacists, clinical psychologists, , dietitians, nurses, and advanced practice providers.

The creation of a dedicated sub specialty aimed at preventing CVD will serve the cause.¹¹ Once preventive cardiology is developed as a separate specialty of cardiovascular medicine, hospitals will need to integrate this service.

Many initiatives have been taken in different parts of developed and developing countries.¹²

The EUROACTION preventive cardiology program reduced the risk of cardiovascular disease compared with usual care mainly through lifestyle changes by families, who together made healthier food choices and became more physically active than before the intervention. This is a model of preventive cardiology, which has been successfully implemented and assessed, and can be used, in routine clinical practice. Models have been developed in Pakistan which need to be implemented with the supportofthegovernment.^13,14

Despite advancements, challenges persist in implementing preventive measures, particularly in low- and middle-income countries where healthcare resources are limited. The advent of digital health technologies, including wearable devices and tale-medicine, offers new opportunities for personalized risk assessment and continuous monitoring.

A local guideline has been developed by Pakistan cardiac society for cardiovascular diseases. Both primary and secondary preventive interventions should be initiated simultaneously. Preventive cardiology theme should be encourage and highlighted at every forum using all available media. Strategies for prevention of heart disease should be taught in schools and colleges in easy and simple language. Preventive cardiology should be included in undergraduate and post graduate curriculum. Funds for Research and implementation of preventive measures should be allocated.

In conclusion, cardiovascular diseases rapidly increasing in the developing countries. Preventive cardiology is the most neglected part of patient care. It would be more logical to pay attention to prevention and more resources should be allocated for this purpose. In the future, the healthcare provider who wants to have the full set of competencies in preventive cardiology should undergo proper training and certification and the center that specializes in preventive cardiology must have the abilities to address this ever-expanding spectrum of patients

Lived experiences of women who have recovered from Post- Partum Psychosis: a phenomenological study

2024-12-26T04:43:42+00:00

Background: Puerperal psychosis is a psychiatric disorder that is prevalent in women in their postpartum period, although it’s not very common. It has an adverse impact on their mental health, leading to neglect of their newborns.

Objective: The objective of the study was to explore the lived experiences of women who have recovered from psychosis following childbirth.

Materials and Methods: This phenomenological qualitative study adopted an exploratory approach and was conducted at Jinnah Medical College Peshawar from July 1st to December 31st, 2023. Data was collected from 15 patients through non-probability purposive sampling. These women presented to the psychiatry OPD for follow-up visits and were previously admitted to the psychiatry unit of Jinnah Medical College, Peshawar, for postpartum psychosis. Those diagnosed cases who had recovered from postpartum psychosis were selected, and semi-structured interviews were conducted with them to explore their lived experiences in detail. The data was analyzed by manual thematic analysis.

Results: Data collected showed that women who had given birth recently suffered from severe depression having melancholy and grief. Their daily behavior was greatly affected by this ailment, and they were unable to function properly and look after their babies. Eight themes were identified from the data, which were severe depression, suicidal tendency, violent behavior, hallucinations, delusional beliefs, mood swings, disorientation, and bizarre thoughts.

Conclusion: Suicidal and infanticide ideations are the important aspects of this study that can put the lives of mothers and babies in danger. This illness negatively affects women's mental health, resulting in their neglecting their newborns.

Peritoneal Closure at Caesarean Section; A Comparative Cross-Sectional Study

2024-12-27T05:03:24+00:00

Background: Cesarean section rates have been growing consistently on a worldwide scale. Peritoneal closure is important because it can help provide the best possible surgical results and recuperation after surgery. The surgical incision site could not receive enough support and protection if the peritoneal layer is not closed.

Objective: To compared the mean pain score following peritoneal closure with non-closure during Caesarean procedure.

Materials and Methods: Comparative cross-sectional study, conducted at department of obstetrics and gynecology of Hayatabad Medical Complex Peshawar. The research comprised 276 pregnant women with primigravida, who were having an elective caesarian section, categorized into two groups (Closure & Non-closure) of 138 participants in each. To prevent surgical skill bias, senior obstetricians with over three years of experience conducted Caesarean sections on both groups. SPSS (version 22) was used to enter and analyze all the data.

Results: A total of 138 with closure patients were observed in which 38(60%), 48(35%), and 7(5%) patients had mild, moderate, and sever pain respectively. While in closure group, a total 138 patients were observed in which 64(46%) had mild, 62(45%) moderate, and 12(9%) patients had severe pain. The p-values for mild, moderate, and severe pain across age groups were 0.571 and 0.681 for the non-closure and closure groups, respectively.

Conclusion: Our study highlights that peritoneum non-closure discomfort is less severe than peritoneum closure during a cesarean section. It is advised that during an emergency cesarean section, both visceral and parietal peritoneal closure can be safely skipped because the surgical result is better.

Incidence and Risk Factors Of Retinopathy Of Prematurity In Multicenter Neonatal Intensive Care Unit Patients

2024-12-26T05:07:07+00:00

Background: Retinopathy of prematurity (ROP) poses a significant risk in the management of premature infants, potentially resulting in blindness if not promptly identified and addressed.

Objective: To determine the incidence of retinopathy of prematurity among newborns in multiple neonatal intensive care units (NICUs), pinpoint the associated risk factors, and evaluate the outcomes of such cases.

Materials and Methods: A prospective observational study was done at the neonatal ICUs of Akbar Niazi Teaching Hospital, Islamabad, PAEC Hospital, Islamabad and Holy Family Hospital, Rawalpindi between April 2022 to December 2023.A birth occurring at gestational age ≤ 32 weeks and birth weight ≤ 1500 g. Infants with gestational age exceeding32 weeks or birth weight surpassing1500 g were considered eligible for inclusion if oxygen therapy exceeding 7 days. Total350 infants underwent retinal examination through indirect ophthalmoscope from fourth week after birth, with subsequent follow-ups.

Results: Among350infants; 5.1% (n=18) were diagnosed with ROP in either one or both eyes. The classification revealed55.6% (n=10) at stage 1, 27.8% (n=5)at stage 2, and 16.7% (n=3) at stage-3. There was no reported case Winthrop at stage-4 or 5.Laser ablative therapy was administered to three cases with stage-3 ROP. In univariate analysis notable relation was observed between the incidence of ROP and factors such as gestational age (p = 0.0001), sepsis (p = 0.002), oxygen therapy (p = 0.0001), and blood transfusion rate (p = 0.002).Following logistic regression, gestational age, sepsis, oxygen therapy, and blood transfusion rate continued to be significant.

Conclusion: The ROP incidence was low, with low gestational age, sepsis, oxygen therapy, and reduced blood transfusion rate identified as significant risk factors.

Spark of Hope: Unveiling the Transformative Power of ElectroconvulsiveTherapy (ECT) in Overcoming Major Depressive Disorder

2024-12-28T17:08:54+00:00

Background: Major Depressive Disorder (MDD) is a significant public health concern, characterized by persistent low mood, anhedonia, and cognitive impairments, leading to substantial morbidity. In Pakistan, the burden of MDD is exacerbated by limited access to effective treatments, particularly for patients who are resistant to conventional pharmacotherapy.

Objective: This study aimed to investigate the effectiveness of Electroconvulsive Therapy (ECT) as a treatment for Major Depressive Disorder (MDD) in Peshawar, Khyber Pakhtunkhwa, Pakistan.

Material and Methods: A quasi-experimental study was conducted from January to June 2023 at two major psychiatric Hospitals in Peshawar, Khyber Pakhtunkhwa. The sample size of 60 participants was calculated using a power analysis with an effect size of 0.8, a significance level of 0.05, and a power of 0.80. Participants were divided into the ECT group (n=30) and the control group (n=30). The ECT group received standard ECT treatment and routine care, while the control group received regular care alone. The Hamilton Depression Rating Scale (HDRS) was used to assess the severity of depressive symptoms at baseline and after the completion of ECT sessions (six weeks). The primary outcome measure was the change in HDRS scores between the two groups. .

Results: The ECT group exhibited a significantly greater reduction in depressive symptoms than the control group. After six weeks of treatment, the mean reduction in HDRS scores was high in the ECT group (09.13±1.94) compared to the control group (12.23±4.30) (p < 0.001). Likewise, the overall response rate (defined as a ≥50% reduction in HDRS scores) was significantly higher in the ECT group (75%) compared to the control group (25%) (p < 0.001).

Conclusion: This study provides evidence of ECT's effectiveness as a treatment option for MDD in Peshawar, Khyber Pakhtunkhwa and demonstrated a substantial reduction in depressive symptoms and a higher response rate compared to routine care alone.

Maternal and Perinatal Outcomes of Induced Labor for Breech Presentations

2024-12-28T17:25:51+00:00

Background: Inducing labor for breech presentation is a relatively harmless and effective approach when carefully chosen for the right cases regarding both maternal and perinatal outcomes.

Objective: To determine safety of induction of labor in women with breech presentation with respect to maternal and perinatal outcomes.

Material and Methods: This descriptive case series included Para 1-5 with single alive fetus, frank or complete breech with flexed head after 37 weeks. Labor induced with prostaglandin E2 vaginal pessary either alone or with balloon catheter combination. Maternal outcomes (postpartum hemorrhage, postoperative fever, perinatal trauma and hospital stay of > 24 hrs) and neonatal morbidity APGAR scores (A/S) of <7, Neonatal Intensive Care Unit admission, any trauma and mortality were recorded.

Results: The study showed about 43 (86%) of women between age group of 18-35 years and 37(74%) with parity 1-3. Emergency cesarean section observed in 7 (14%) while vaginal delivery in 43(86%) cases. Maternal adverse outcomes observed were PPH in 4(8%) (P= 0.50), postoperative fever3 (6%) (P =0.68), perinatal trauma 2(4%) (P =0.68), and hospital stay 9(18%) cases (P =0.84).Observed neonatal outcomes were A/S of < 7 in 5(10%) (P =0.07), Neonatal Intensive Care Unit admission in4( 8%) (P =0.59), injury to humorous in 1(2 %)P =0.64)case.

Conclusion: Induction of labor for term breech showed no statistically significant change in feto-maternal outcomes with regard to mode of delivery

Evaluation of Maternal and Fetal Outcomes in Caesarean Delivery Utilizing Vacuum Assistance following Pelvimetry: A Cross- Sectional Study

2024-12-28T17:38:26+00:00

Background: The use of Caesarean section has greatly increased globally in the past decades, exceeding the threshold recommended by WHO even when done medically or for elective purposes.

Objective: To evaluate the maternal and fetal outcomes in caesarean delivery utilizing pelvimetry and vacuum assistance.

Material and Methods: This cross-sectional study was done in a HBS General Teaching Hospital, Islamabad with 180 pregnant women as subjects. The study was approved by the IRB. 80 C-sections were done using vacuum assistance following pelvimetry. All the patients were given planned C-sections because of no uterine activity and amniotic fluid.
Results: No significant differences were observed between the two groups in terms of mean age, parity, or mean birth weight. The results also demonstrated that there wasn't a significant difference in how much blood the mothers lost between the two groups (p=0.07). However, the size of the cut made in the mother's womb (uterine incision) was noticeably different between the two groups. There weren't any differences between the babies in the two groups when it comes to their health scores (Apgar scores) at one and five minutes after birth (p=0.06). Additionally, there wasn't a difference in the number of babies who needed special help breathing (neonatal resuscitation) or who needed to be admitted to a special care unit (SNCU) (p=1.01).

Conclusion: Vacuum-assisted Caesarean delivery is more effective than manual extraction in minimizing blood loss, uterine incision extension, and maternal discomfort during Caesarean section

Puerperal Sepsis In Women: Frequency And Risk Factors: An Experience At Tertiary Level Hospital

2024-12-28T17:50:18+00:00

Background: Puerperal sepsis remains a significant contributor to maternal morbidity and mortality, particularly in low-resource settings. Despite advancements in maternal care, factors such as inadequate prenatal care, anemia, prolonged labor, and cesarean deliveries increase susceptibility. This study explores the frequency and risk factors of puerperal sepsis in a tertiary care hospital, highlighting critical areas for intervention to improve maternal health outcomes.

Objective: To assess the frequency and risk factors of puerperal sepsis.

Material and Methods: A cross sectional study was conducted at department of gynecology, Lady Reading Hospital, Peshawar from January 2023 to February 2024, on 157 patients who delivered within 42 days. We determined the frequency and risk factors of puerperal sepsis. We did not include patients with malaria, dengue fever of typhoid. Chi Square test was used for assessing association.

Results: The mean age of participants was 29.36±6.38 years, with a puerperal sepsis frequency of (9.6%). Significant risk factors included cesarean delivery 9 (60%), bacterial infection 14 (93.3%), anemia 13 (86.7%), postpartum hemorrhage 12 (80%), prolonged labor 8(53.3%), booked status 11 (73.3%), and rural residence 12 (80%), all showing notable associations (p < 0.05).

Conclusion: The study highlights that puerperal sepsis remains a significant concern, influenced by modifiable risk factors such as anemia, uncooked status, and rural residence. Strengthening antenatal care, improving postpartum monitoring, and addressing systemic gaps in maternal healthcare can reduce its burden and improve outcomes.

Frequency of Infra Orbital Nerve Paresthesia Following Zygomati Comaxillary Complex Fractures Among Tertiary Care Hospital Patients in OMFS OPD

2024-12-28T18:06:07+00:00

Objective: The objective of the study was to investigate the frequency of infraorbital nerve Paresthesia following ZMC fractures treated with open reduction and internal fixation.

Material and Methods: This case series study, conducted at Mayo Hospital's Oral and Maxillofacial Surgery Department over six months, enrolled 75 cases using consecutive sampling. Surgical management included open reduction and internal fixation, with follow-up assessments at specified intervals. Data analysis was performed using SPSS for a comprehensive evaluation to document the frequency of infraorbital nerve Paresthesia and recovery outcomes post-ZMC fractures and surgical intervention.

Results: In this study, the results revealed that 33.33% (n=25) were between 41-50 years being the majority of patients in this study, common age was calculated as 37.43+3.78 years, 62.67%(n=47) were male and 37.33% (n=28) were females, frequency of infraorbital nerve Paresthesia following ZMC fractures revealed in 70.67%(n=53) cases while 29.33%(n=22) had no findings of the morbidity, we recorded frequency of functional nerve recovery in patients with Paresthesia after performing open reduction and internal fixation among 53 cases who developed the morbidity and found 62.26% (n=33) who had functional nerve recovery while rest of 37.74%(n=20) had no recovery.

Conclusion: The frequency of functional nerve recovery is high among patients with Paresthesia treated with open reduction and internal fixation.

Frequency and Associated Factors of Cor-Pulmonale among Asthma Patients: A Cross-Sectional Study at Tertiary Care Hospital

2024-12-28T18:24:04+00:00

Background: Cor pulmonale, a severe complication of poorly controlled asthma, may involve both adults and children, significantly worsens patient outcomes but remains under-recognized. Its impact on quality of life a survival underscores the need for data on the frequency and risk factors; this study addresses a critical gap aiming to guide early detection and better management strategies.

Objective: The current study was conducted to explore the Frequency of Cor-Pulmonale among asthma patients at a tertiary care hospital

Material and Methods: The current cross-sectional study was conducted at the Department of Pulmonology, Khalifa Gul Nawaz Teaching Hospital (KGN), MTI Bannu, a tertiary care Hospital from August 2022 to January 2023. Patients presented with asthma for the last year aged 16-60 years were included in the study while those having existing cardiac diseases were excluded from the study. Cor-Pulmonale data was collected by operational definitions and annotated by the researcher on specifically created Proforma. Data was analyzed through SPSS version 20. After the stratification chi-square test was applied, p =0.05 was considered statistically significant.

Results: Among 134 patients enrolled in the study, 26.1% (29) were found to have cor pulmonale. The mean age of the participants was 37.22±13.29 years. The majority of the participants were male (71.6%) 55.9% were under 40 years of age and 59 (44.0%) patients were above 40 years of age. A family history of asthma was present in 20.1% of cases. Stratification analysis revealed no significant association between cor pulmonale and age, gender, family history, or asthma duration (p >0.05).

Conclusion: These findings highlight the notable frequency of cor pulmonale among asthma patients, especially in male and younger populations, irrespective of demographic and clinical characteristics

Keywords: Cor-Pulmonale, asthma, pulmonary hypertension, cardiopulmonary complications

Silent Signals: Exploring ECG Abnormalities in Asymptomatic Healthcare Professionals at MTI Bannu

2024-12-28T18:38:12+00:00

Background: Electrocardiography (ECG) plays a vital role in diagnosing cardiovascular diseases, a leading global health burden. Healthcare professionals, due to occupational stresses, may have an increased risk of cardiovascular abnormalities, particularly in resource-limited settings like Pakistan. Understanding ECG patterns in this group is essential for targeted interventions.

Objective: To determine the frequency of ECG patterns in asymptomatic healthcare professionals at MTI Bannu.

Materials and Methods: This descriptive cross-sectional study included 185 asymptomatic healthcare professionals, in three allied hospitals of Medical Teaching Institutions (MTI) Bannu. Data were collected using a closed-ended questionnaire and analyzed with SPSS version 26. ECG patterns were recorded with a portable ECG machine.

Results: Among the participants, 143 (77.3%) exhibited normal ECG patterns. Of 45 doctors, 40 (88.8%) had normal ECGs, while 5 showed abnormalities, including sinus arrhythmias (4.4%) and bradycardia (2.2%). Among 45 medical students, 31 (68.9%) were normal, with abnormalities including right axis deviation (11.1%) and early repolarization (4.4%). Of 57 paramedics, 45 (78.9%) had normal ECGs, while abnormalities included sinus tachycardia (1.8%) and premature ventricular contractions (3.5%). Among 38 support staff, 34 (89.5%) were normal, with abnormalities observed in 4 participants (10.5%).

Conclusion: A notable proportion of healthcare professionals, despite being asymptomatic, exhibited ECG abnormalities such as arrhythmias, bradycardia, and hypertrophy. These findings highlight the importance of regular ECG screening in this population to facilitate early detection and intervention for potential cardiovascular risks.

A Histopathological Study on Carious Permanent Teeth in the Population of Jalalabad

2024-12-28T19:07:41+00:00

Background: Dental caries is an irreversible, multi-factorial disease that is ranked among the top most prevalent diseases. It involves the dissolution of inorganic components and the decomposition of the organic components of the tooth. It may extend from the enamel surface towards the inner structures in a horizontal, vertical, or oblique manner resulting in pain, sensitivity, and even extraction of the affected tooth.

Objective: To determine the histological classification and extent of dental caries on ground sections of the permanently extracted teeth.

Material and Methods: In this cross-sectional study, Participants were selected according to the inclusion criterion of the study; the sample teeth were collected, sterilized, decalcified, and ground with a slow hand-piece, lathe, and sandpaper to achieve 3-4mm thickness. Conventional H&E stain was used for tissue staining followed by light microscopy for reporting the observed cases.

Results: Caries were more prevalent (84%) in the dentin-pulp complex. Males (77%) were more commonly affected as compared to females and the most common age group for caries development was 7-12 years. Mandibular molars were predominantly affected by dental caries, in permanent teeth, followed by maxillary molars.

Conclusion: It can be concluded that the extent of dental caries is significantly associated with the path of decomposition of the inorganic and organic matrix of the tooth.

Morphological Study of Gentamicin-Induced Testicular Toxicity and Protective Effects of Zinc in Adult Albino Mice

2024-12-28T19:20:07+00:00

Background: One of the drugs of the amino glycoside group, known adverse effects are nephrotoxicity, ototoxicity, and neuromuscular paralysis. Zinc, a transitional metal and best source is meat, fish, whole grain cereals, and dairy products. Zinc protects tissues against free radicals and oxidative stress. Used in fertility, pneumonia, osteoporosis, wound healing, regulating immune function, and decreased risk of senile chronic diseases with no significant side effects.

Objective: Gentamicin effects on testicular structure and sperm parameters in mice. Zinc reversal effects are the focus of the current study.

Material and Methods: An experimental animal-based study done in Veterinary Research Institute Peshawar, for 6 months from June 2019 to December 2019. Fifteen albino mice were collected and sorted into groups. B-1, B-2, C-1 and C-2 were experimental groups, A-1 was control group. Zinc was administered as 1-2mg/kg orally, whereas Gentamicin was administered in two dosages of 50mg/kg intraperitoneally and 75mg/kg. Mice were sacrificed after 2 weeks. Testis was collected, and kept in formalin; slides were made and observed through the light microscope.

Results: Gentamicin-induced structural alterations in experimental groups were sloughing, vacuolation, gaps formation in the somniferous epithelium, atrophic changes, nuclear pyknosis, indicated by tubular shrinkage in a few tubules, decreased somniferous tubules and somniferous epithelium. Zinc nullified these effects when used simultaneously with Gentamicin.

Conclusion: The study evaluated the impact of Gentamicin on the health outcomes of the participants. Additionally, oral supplementation of zinc at 1-2 mg/kg provided a crucial variable that allowed researchers to explore potential protective effects against Gentamicin-induced toxicity. The methodologies reveal pharmacological interactions, and emphasize dosage and administration routes in experimental design, paving the way for future research to improve therapeutic strategies and health outcomes.

Gender Impact on the Outcomes of Laparoscopic Cholecystectomy

2024-12-28T19:32:14+00:00

Background: Laparoscopic cholecystectomy is now considered the preferred treatment for symptomatic gallstone diseases, establishing itself as the gold standard method.

Objective: The study was designed to evaluate the effect of gender differences on laparoscopic cholecystectomy outcomes after adjusting for potential causes of conversion.

Material and Methods: This retrospective cross-sectional study was conducted at PAC Hospital, Kamra, and PAF Hospital, Islamabad from January to December 2022. A total of 105 patients between ages 18-50 years, either gender, who underwent elective laparoscopic cholecystectomy were included. The outcomes such as age, body mass index, duration of surgery, and length of hospital stay were measured using the independent t-test.

Results: There were 62% females (n=65) and 38% males (n=40) who had laparoscopic cholecystectomy. Patients were on average aged 47.82±10.63 years old. The mean body mass index of patients was 27.1±2.02 kg/m². The duration of surgery was 62.52±2.66 minutes on average for males, and 54.72±1.94 minutes on average for females; this difference was significant (p= 0.0001). Hospital stays after surgery were comparable across the genders, at 1.96±0.90days for males and 1.95±0.92 days for females (p =0.901). There was no discernible variation in conversion between the genders.

Conclusion: Apart from the longer operative time required for male laparoscopic cholecystectomy, this study did not find gender as an independent risk factor for poor outcomes after laparoscopic cholecystectomy.

The Burden Of Congenitial Heart Disease In Children Born To Consanguineous Parents

2024-12-28T19:42:09+00:00

Background: Consanguineous marriages have been a longstanding tradition across various global communities for millennia. The prevalence of such marriages fluctuates among nations and is typically linked to various demographic factors including religion, educational attainment, socioeconomic status, geographic location, population density, and whether individuals reside in rural or urban environments. The prevalence of congenital heart disease among cousins’ marriages has been a topic of interest due to its potential association with genetic factors. Hence, studying congenital heart disease in offspring of consanguineous couples is crucial for enhancing clinical and public health strategies.

Objective: This study aimed to determine the frequency of congenital heart disease in children born to consanguineous parents.

Material and Methods: In this cross sectional study, total of 100 children born to consanguineous parents were included , which was carried out Pediatric Medicine Department, Mardan Medical Complex from 20 November 2021 to 20 May 2022. Echocardiography was done in the cardiology department of all the included children to detect any congenital heart defect. Data was collected for congenital heart disease according to operational definitions.

Results: The mean age of children born to consanguineous parents was 4.25±2.46 years (range:1-15years). Male children constituted 62% and females 38%, with no significant association between CHD prevalence and gender (p=0.963). Congenital heart disease was observed in 15% of children born to parents in cousin marriages. Among CHD cases, arterial septal defects (ASD), ventricular septal defects (VSD), and Tetralogy of Fallot (TOF) were most common. Stratification by age, gender, and parental education revealed a higher prevalence of CHD among children of uneducated parents (28.1%) though this was not statistically significant (p=0.87)

Conclusion: It was found that cousin marriage is a risk factor for congenital heart defects in children.

Exploring Polycystic Ovarian Disease and Its Clinical and Biochemical Characteristics in Young Females

2024-12-28T19:50:33+00:00

Background: The most contentious endocrine disorder affecting women worldwide is called PCOS, or polycystic ovarian syndrome. Compared to women in the UK, where the incidence of PCOS is between 20% and 25%, Pakistani females had a higher prevalence of 52%.One major limitation of previous community studies was the lack of biochemical and clinical screening.

Objective: To investigate the clinical and biochemical characteristics of polycystic ovaries (PCO) and associated factors, such as insulin, LH, FSH, oestradiol, testosterone, free testosterone, and SHBG in young women.

Material and Methods: This prospective study was conducted at the Department of Biochemistry, Central Park Medical College, Lahore, from August 1, 2023, to February 1, 2024. Women attending hospitals were informed about the study and underwent ultrasonography to identify PCO. The study included 201 women diagnosed with PCO as the case group and 233 healthy women as the comparison group. After obtaining consent, participants completed questionnaires and underwent hormonal and biochemical analysis. Data were analyzed using SPSS version 26.

Results: The average age of the control group was 25.83 ± 4.6 years, while the PCO group had an average age of 27.12 ± 5.52 years, with a significantly higher BMI (p = 0.001). Women with PCO showed increased insulin resistance, higher LH, and oestradiol levels, and reduced FSH. Testosterone levels and free testosterone index did not differ significantly between groups.

Conclusion: A significant proportion of women with infertility issues in Pakistan exhibit PCO. Insulin resistance is a key factor in PCO, and effective management of insulin levels may reduce the risk of developing PCOS.

Diagnostic Accuracy of Fine Needle Aspiration Cytology In Palpable Breast Lump Taking Histopathology As Gold Standard

2024-12-28T20:04:28+00:00

Background: Problems in the breast can present themselves in different ways like pain in the breast, discharge from nipples, cystic lesions and most commonly a lump. Breast lump is of great concern to the patients and is also challenge to the diagnostic acumen and judgment of the surgeon. This will be beneficial in early diagnosis and treatment, reducing its morbidity and mortality more over this study will provide us with local statistics of the magnitude of breast lump and this will open window for further research.

Objective: To determine the diagnostic accuracy of FNAC of breast lump with the histopathology as a gold standard in diagnosis of breast cancer.

Material and Methods: The current study was conducted at Department of General Surgery, Khyber Teaching Hospital, Peshawar for six month (from 2/7/2019 to 27/01/2020). A total of 179 women were observed in which women presenting with palpable breast lump, in age between 35 years to 60 years were included. Fine-needle aspiration cytology (FNAC) of the patients with breast lump was performed with 22-gauge needle, mounted on a 10-ml syringe. Excision biopsy was done for small tumors or lump found benign on fine needle aspiration cytology and histopathology of mastectomy. Histopathological slides of corresponding cytological cases were correlated. The collected data was entered and analyzed in SPSS version 22. Sensitivity, specificity, positive predictive value and negative predictive value of FNAC were calculated.

Results: Our study shows that among 179 patients, mean age was 53 years ± 10.45. FNAC had sensitivity 90.22%, specificity 80%, PPV 99.36%, NPV 19.04% and diagnostic accuracy was 89.94% in the diagnosis of breast lump keeping histopathology as a gold standard.

Conclusion: Our study concludes that Fine needle aspiration cytology (FNAC) is a simple, safe and minimally invasive diagnostic test that is accurate in detecting breast lumps, with a high correlation rate to histopathology. When used in conjunction with histopathology, FNAC can ensure an accurate diagnosis and appropriate management of breast lumps.

Assessment of Serum Uric Acid to Albumin Ratio as A Prognostic Indicator for Short - Term Mortality in Acute Kidney Injury: A Prospective Study

2024-12-28T20:13:06+00:00

Background: Acute kidney injury is diagnosed via rapid increase in renal function parameters. Hyperuricemia have been associated with acute kidney injury and result in increased mortality.

Objective: To assess the uric acid to albumin ratio as a prognostic indicator for short-term mortality in acute kidney injury.

Material and Methods: This observational prospective cohort study was conducted in the Department of Nephrology at Akbar Niazi Teaching Hospital from November 2023 to February 2024. 80 patients, aged 18 and above who presented to the emergency service, developed acute kidney injury, and subsequently received follow-up and treatment.

Results: 80 patients having themean age of 58.35±14.18 years (35% female and 65% male) were assessed. The mean uric acid to albumin ratio was 3.57±1.6 mg/g in the non-survivor group and 2.84±1.2 mg/g in survivor group (p=0.001).The optimal cutoff for the uric acid to albumin ratio correlated with mortality was found to be 2.5 mg/g, with specificity 82% and sensitivity 78%.The 30 days cumulatively survival rate for the low was 88.1% ± 3% and high uric acid to albumin ratio was 66.3% ± 4%.The assessed survival time was 25.6 days (95% CI: 24 to 30) for the low uric acid to albumin ratio group and 21.5 days (95% CI: 20 to 23) for the high uric acid to albumin ratio group.

Conclusion: The study observed a clear relationship between 30 days mortality and the uric acid to albumin ratio at the initial manifestation in AKI patients, independent age, and clinical findings.

Prevalence of Subclinical Hypothyroidism in Pregnant Females in Three Trimesters: A Cross-Sectional Study

2024-12-28T20:20:31+00:00

Background: Subclinical hypothyroidism (SCH) in pregnancy is associated with multiple adverse obstetrical and fetal outcomes i.e. preterm labor, miscarriage, fetal distress& preterm birth. The present study was therefore planned to identify high occurrence rate of SCH positive cases (Pregnant females coming to ANMC & Hosp for antenatal care) & to highlight that TSH screening should be included in routine antenatal screening.

Objective: To identify SCH cases in pregnancy, coming for antenatal workup in Al Nafees medical college & Hospital Islamabad, Pakistan.

Material and Methods: In this study random screening of 150 pregnant females for serum TSH levels was done. Females were divided in to three equal groups i.e. 50 females in each trimester. Serum TSH levels was done by ELISA and American thyroid association guidelines (ATA) for TSH levels was taken as reference values.

Results: The data obtained from this study indicated that 34.7% positive SCH cases. Mean and SD of study variables i.e. age, parity and Hb were also compared in three trimesters which showed insignificant variation.

Conclusion: It was evident from our study results that SCH is prevalent in our local population. This study reinforces that TSH screening should be included in routine antenatal screening. This will help us to avoid maternal and fetal adverse outcomes associated with SCH as documented in various studies on thyroid disorders.

An Association of Iron Deficiency Anemia with Acute Gastroenteritis among Children: A cross sectional study

2024-12-28T20:28:04+00:00

Background: Iron deficiency anemia (IDA) and acute gastroenteritis (AGE) are prevalent conditions among children globally, affecting health outcomes significantly.

Objective: To determine the association between iron deficiency anemia and acute gastroenteritis among children through a cross-sectional study.

Material and Methods: In this six-month cross-sectional study, a total of 180 children presenting with symptoms of acute gastroenteritis (AGE) at Al Syed Children Hospital, Mardan, KP, Pakistan were included. Associations between IDA and various factors were analyzed using chi-square tests, with a significance level set at p < 0.05.

Results: Significant associations were observed across several parameters among acute gastroenteritis (AGE) and iron deficiency anemia (IDA) patients. The majority of children with AGE were aged less than 2 years (60.8%), while children with IDA showed a similar distribution (59.8%), with a statistically significant p-value of 0.03. Male children were more prevalent in both AGE (69.7%), IDA (54.7%) groups, though gender distribution did not show statistical significance (p=0.98). Family income levels below 20,000 BDT were more common among children with AGE (63.5%), IDA (62.4%), although not statistically significant (p=0.16). Cow’s milk ingestion was significantly associated with IDA (48.7%) compared to AGE (80%), with a p-value of 0.001. Furthermore, children with moderate malnutrition exhibited a significantly higher prevalence of IDA (50.4%) compared to AGE (82.2%), also with a p-value of 0.001.

Conclusion: Iron deficiency anemia (IDA) is prevalent among children with acute gastroenteritis (AGE), with notable contributing factors including age below 2 years, cow’s milk ingestion, and moderate malnutrition.

Frequency of Metabolic Syndrome Among Patients With Type 2 Diabetes Mellitus

2024-12-30T07:10:37+00:00

Background: The most common risk factors of diabetes mellitus ,includes ethnicity, family history, obesity, metabolic syndrome, behavioral factors, such as physical inactivity, diet containing higher amount of saturated fat and carbohydrates and relatively lower number of fruits and vegetables, smoking, alcohol consumption and sleep duration. Out of these, obesity is directly related to metabolic syndrome and insulin resistance.

Objective: To determine the frequency of metabolic syndrome among patients with type 2 diabetes mellitus.

Material and Methods A total of 260 patients were examined. Sample size was calculated with WHO sample size calculator using a reference study with 58% metabolic syndrome type 2 diabetes patients (confidence level= 95%, and margin of error=6%).

Results: The results were analyzed as: Distribution of age among 260 patients was observed as n= 30-40 Years 48(18.5%), 41-50 Years 86(33.1%) 51-60 Years 64(24.6%) 61-70 Years 62 (23.8%). Mean age was 49.12 years with standard deviation ±2.142 Gender-wise distribution of 260 participants was analyzed as n=260 Gender Wise Distribution Male 182(70.0%) Female 78(30.0%). Distribution Metabolic syndrome among typeII diabetic patients was 201(77.3%).

Conclusion: This study indicates that metabolic syndrome poses a serious health risk to Pakistani diabetes patients, who are more likely to have problems like cardiovascular disease and early death. The predictor's female gender, age in the 50–60 age range, residency in an urban area, and single status are all changeable. Therefore, health authorities should offer these most at-risk diabetes patient subpopulations specific interventions including lifestyle changes.

Role Of Fine Needle Aspiration Cytology In Differentiation and Management of Solitary Thyroid Nodule.

2024-12-30T09:05:21+00:00

Background: Solitary thyroid nodule, 4% of adult population, is common finding in patients. This needs close attention to differentiate between cyst , benign or malignant neoplasm.

Objective: To see the cytological differentiation of different solitary thyroid nodule and to manage simple thyroid cyst by aspiration of the cyst fluid.

Materials and Methods In this Descriptive study, which was carried out in Pathology department, Khalifa Gul Nawaz Teaching Hospital Bannu.KPK, Pakistan from January, 2014 to December, 2019 Total of 58 STN were aspirated. Aspiration obtained using aseptic technique and slides prepared, stained, mounted, labeled and reported by Pathologist. The data was analyzed by using a Statistical Package for Social Sciences (SPSS) version 20 for frequencies with percentages and mean with standard deviation..

Results In this study the mean age was 34.4±11.7 years and the age range was from 15 to 70 years. The most common age group was 36-45 years followed by 46-55 years. .Male to female ratio was 2:1.5. The most common lesion was simple cyst 36(62.06%), followed by follicular lesions 18(31.03%), papillary carcinoma 03(5.17%) and anaplastic carcinoma 01(1.72%). It was simple serous cyst which had low frequency of reappearance 21.73% followed by simple hemorrhagic cyst 40% and colloid cyst 66.6% after six month follow up.

Conclusion: Simple cyst was the commonest lesion followed by follicular lesion. Aspiration can be considered as first line procedure for diagnosis and treatment of solitary thyroid cyst as most of these disappeared for six months after complete aspiration.

Acute toxicity, anthelmintic and antispasmodic potential of bark of Ailanthus altissima (Mill)

2024-12-30T10:53:01+00:00

Background: : Medicinal plants have been gaining significant attention in recent years due to their rich repository of biologically active compounds, which serve as a foundation for new drug discoveries. Furthermore, the plant’s antiviral properties underscore its importance as a valuable resource in medicinal research.

Objective: This study aims to screen and determine mode of action of relaxant activity of extract of bark of Ailanthus altissima, which is traditionally used in treatment of gut spasms. The study also focuses on anthelmintic activity against round worms and tape worms.

Material and Methods: Ailanthus altissima (A. altissima) hydro-methanolic extract was tested against tape worms at three distinct concentrations: 100 mg/ml, 200 mg/ml, and 400 mg/ml i.e.,Raillietina spiralis)and round wormsi.e,Ascaridia galli using albendazole and piperazine citrate as standard anthelmintic. A.altissimawas tested in isolated rabbits’ jejunal preparations for possible antispasmodic activity in concentrations 0.01, 0.03,0.1,0.3,1.0,3.0,5.0 and 10 mg/ml. To explain its possible mode of actions, the test samples were tried in similar concentrations against 80mM KCl-induced contractions. Concentrations Response Curves (CRC)weremadewith and without test samples using verapamil as standard calcium channel blocker. Acute toxicity testing was also carried out to establish an acceptable dosage range. Preliminary phytochemical screenings were also performed.

Results: Raillietina spiralis was found more sensitive to A.altissimain concentration 40 mg/ml as compared to Ascaridia galli which has a relative index of 1.3 for paralysis. LD50 for A. altissimawas 1500 mg/kg. With EC50 values of 1.65 0.12 mg/mL & 0.82 0.13 mg/mL (n=3), A. altissima suppressed both spontaneous as well as high K+-induced contractions. A.altissimashifted the CCRCs to right like that of verapamil.

Conclusion: The study shows that Ailanthus altissimapossesses anthelmintic and antispasmodic effects through inhibition of calcium channel blockade that confirm its traditional uses as anthelmintic and antispasmodic.

Compare the Effects of Infiltration of Bupivacaine in Liver Bed with Preperitoneal Nerve Block in Laparoscopic Cholecystectomy

2025-01-20T06:22:11+00:00

Background: Laparoscopic cholecystectomy is now considered the preferred treatment for symptomatic gallstone diseases, establishing itself as the gold standard method. Nevertheless, pain remains the sole grievance responsible for delaying discharge.

Objective: To compare the effectiveness of bupivacaine infiltration into the liver bed and peritoneal cavity in reducing pain after laparoscopic cholecystectomy.

Material and Methods: This prospective comparative study was done at the Department of General Surgery of Akbar Niazi Teaching Hospital, Islamabad. The study included 100 patients who were admitted for elective laparoscopic cholecystectomy between June and November 2023.Patients were consecutively assigned to received either bupivacaine preperitoneal nerve block. After gallbladder was removed, 20 ml bupivacaine 0.5% was administered in liver bed. For preperitoneal nerve block bupivacaine 0.5% was infiltrated into port sites to block the preperitoneal nerves. Postoperative pain assessment was conducted at 1, 6, 12, and 24 hours utilizing the Visual Analog Scale (VAS).

Results: The mean patients ages were43.88±7.8 years. Postoperative mean VAS at 1, 6 and 12 hours were decreased in Bupivacaine compare to preperitoneal nerve block (p ≤ 0.05). Postoperatively no difference was observed in VAS at 24 hours between the patients (p ≥ 0.05). The total doses mean of SAID utilized in first 24 hours postoperatively were lower in Bupivacaine patients than in preperitoneal nerve block patients (p ≤ 0.05).

Conclusion: The infiltration of bupivacaine in the liver bed following laparoscopic cholecystectomy effectively reduces pain as compare to preperitoneal nerve block. This straightforward, cost-effective technique should be adopted to diminish early postoperative pain in all elective cases.

Fetus in Fetu in 12 Month Old Child: A Rare Case Report and Review of Diagnostic Challenges

2024-12-28T20:35:29+00:00

Fetus in fetu (FIF) is an exceedingly rare congenital anomaly, with an incidence of approximately 1 in 500,000 births. This case report presents a 12-month-old female with fever, vomiting, and abdominal pain. Initial imaging suggested intussusceptions, but a more detailed analysis revealed a highly organized mass, later identified as FIF upon surgical removal and Histopathological analysis. This report outlines the clinical presentation, differential diagnoses, and surgical intervention for FIF, highlighting the need for prompt and accurate diagnosis.