The Professional Medical Journal

Outcomes of desarda and lichenstein repair under local anesthesia in terms of operative time, pain, urinary retention, wound infection and recurrance rate.

2024-11-26T05:10:05-08:00

Objective: To compare the outcomes of Desarda repair and Lichtenstein hernioplasty under local anesthesia in terms of operative time, post operative pain, post operative urinary retention frequency, rate of wound infection and recurrence rate of hernia one year after surgery. Study Design: Prospective Comparative study. Setting: Department of General Surgery of CMA Teaching and Research Hospital which is Teaching Hospital of Azra Naheed Medical College Lahore. Period: 1^st February 2021 to 31^st January 2023. Methods: A sample size of 200 patients was calculated divided in two groups randomly having 60 patients each. Outcomes were measured and Data was collected on a predesigned proforma and was analyzed using SPSS 20 and level of significance was considered at p = ≤0.05. Results: The mean age of patients was 31.5 years with SD of ± 13.31. Wound infection rates are slightly higher (n=7, 7%) in Lichtenstein group as compared to Desarda groups done under local anesthesia (P-Value = 0.000). The operative time (37.9 minutes ± SD 10.2 minutes) was less in Lichtenstein repair as compared to Desarda repair and post operative pain 12 hours after surgery (3.90 ± SD 2.48) is higher in Lichtenstein group (P-Value = 0.000). However, recurrence after 1 year is more in Lichtenstein group (n=9, 9%). Conclusion: Desarda repair has clear advantages over Lichtenstein mesh hernioplasty in terms of less post operative pain, recurrence after one year and wound infection. However, the operative time is more in Desarda repair.

Laparoscopic vs Open Radical Nephrectomy for Renal tumors in resource limited countries.

2025-01-14T05:25:56-08:00

Objectives: To evaluate the perioperative efficacy of laparoscopic radical nephrectomy in comparison with open radical nephrectomy for the management of localized (T1bN0M0) renal cell tumor of less than 7cm. Study Design: Prospective, Comparative study. Setting: Armed force Institute of Urology (AFIU). Period: July 2020 – July 2024. Methods: 90 patients (mean age: 56 ± 2.5) with clinical stage T1bN0M0 renal cell carcinoma were treated using two different approaches i.e., laparoscopic radical nephrectomy in Group-I patients and Open radical nephrectomy in Group-II. The choice of the approach was non randomized and it was depended on patient preference and surgeon experience. Results: Mean age of the patients and mean tumor size was comparable in both groups. To assess the efficacy of both techniques, perioperative outcomes that include estimated blood loss, operative time, length of hospital stay, need of post-operative analgesics and convalesce time were compared. Patients in Group-I showed greater operative time but less estimated blood loss, shorter hospital stay, less need of analgesics and early recovery to normal activities compared to patients in group-II. Follow up of 18 months in each group showed no cancer specific mortality or local recurrence. Conclusion: Laparoscopic radical nephrectomy for clinical stage T1bN0M0 renal carcinoma is associated with better perioperative results and is more effective as compared to open radical nephrectomy approach.

Frequency of surgical site infections after emergency laparotomy.

2023-07-31T05:48:50-07:00

Objective: To find out the frequency of surgical site infections after emergency laparotomy. Study Design: Case Series study. Setting: General Surgery Unit, Hayatabad Medical Complex, Peshawar. Period: 1^st March 2022 to 31^st August 2022. Methods: Total of 173 patients were included. Patients undergoing emergency laparotomy were included in the study and were followed postoperatively for 30 days for signs and symptoms of SSIs. Sampling technique was non probability consecutive sampling. Data analysis was done on SPSS version 23 and p value of 0.005 was considered to be significant. Results: In this study of 173 patients, the mean age was 38.6 years, with a range of 19-65 years. The majority of patients were in the 18-40 years age group (64.7%), and male patients constituted 69.4% of the sample. Regarding BMI classification, 64.2% were in the normal range, while 12.7% were obese. The most common indications for emergency exploratory laparotomy were enteric perforation (24.9%), firearm injury (16.2%), and perforated appendicitis (8.1%). Surgical site infection (SSI) occurred in 33.5% of patients. Comparing SSI rates, there was no significant difference between the 18-40 years age group (35.3%) and the 41-65 years age group (41.9%). Similarly, no significant difference was found between male (36.7%) and female (26.4%) patients. The different BMI categories did not show a significant difference in SSI rates, with rates of 36.1% (Normal), 31.2% (Overweight), and 36.4% (Obese). Conclusion: The overall frequency of SSIs after emergency laparotomy was 33.5%.

Surgical site infection in patients undergoing internal fixation for long bone fractures.

2025-01-10T05:57:21-08:00

Objective: To determine the frequency of surgical site infections in patients undergoing internal fixation for long bone fractures and to identify associated risk factors. Study Design: Descriptive Case Series. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: May 1, 2024, to October 30, 2024. Methods: A total of 78 patients meeting inclusion criteria were evaluated. Preoperative prophylaxis with cefazolin and strict aseptic measures were implemented. Patients were followed up at 2 and 4 weeks postoperatively for signs of infection. Data on demographics, implant type, and clinical outcomes were collected and analyzed using SPSS version 22. Results: Out of 78 patients, 11 (14.1%) developed SSIs. Females had a higher infection rate (19.4%) compared to males (9.5%), but the difference was not statistically significant (p=0.209). Patients with higher BMI showed a significantly increased risk (p=0.016). Tibia fractures (9.5%) and trimalleolar ankle fractures (50%) had the highest infection rates. Plate and screw implants were associated with higher SSI rates (18.2% and 71.4%, respectively; p<0.001). Conclusion: The frequency of SSI following internal fixation for long bone fractures was 14.1%, with higher rates observed in females, patients with elevated BMI, and those treated with plates and screws. Strict aseptic measures, preoperative prophylaxis, and implant selection play crucial roles in reducing infection rates. Further studies are recommended to develop local preventive guidelines.

Efficacy and safety of topical 5% dapsone gel for acne vulgaris.

2025-02-03T03:27:31-08:00

Objective: To assess the efficacy and safety of topical 5% dapsone gel in treatment of acne vulagris. Study Design: Non-Randomised Clinical Trial. Setting: Departments of Dermatology, GTTH and SIMS Lahore. Period: April, 2022 to July, 2023. Methods: A multi-centre study conducted in Dermatology Departments of GTTH and SIMS Lahore after permission from Institutional review board (Ref. No.LM&DC/ 5340-44/2022, dated 14.4.2022). Informed consent was obtained from patients for 12-week treatment with Topical 5% dapsone gel. Global Acne Assessment Score (GAAS) was calculated at 0,2,4,6,8 and 12 weeks. Efficacy was measured as percentage reduction in the number of lesions as achievement of GAAS 0 or 1 at 12 weeks. Relapse was checked on monthly follow-ups till 24 weeks. Results: A total of 90 diagnosed patients of acne vulgaris were enrolled, 12.79% males and 87.21% females; 86 patients aged 13-30 years with mean age 21.31±4.70 years continued treatment. At baseline mean inflammatory, non-inflammatory and total number of lesions were 31.36, 28.21 and 59.57 and at 12 weeks values decreased to 2.86, 6.90 and 9.58 (p-value <.001) and 47 out of 86 patients achieved success of which 17 patients showed relapse. Adverse events were erythema and dryness noted in 9% patients. Conclusion: Topical 5% dapsone gel is efficacious and safe for the treatment of acne vulgaris.

Comparison of role of in-situ fixation and modified DUNN procedure in management of severe SCFE (Slipped Capital Femoral Epiphysis).

2025-03-17T07:27:34-07:00

Objective: To compare in-situ fixation and modified Dunn procedure in stable sever SCFE by assessing radiological and functional improvement as well as complication rates. Study Design: Retrospective Observational study. Setting: GTTH, Lahore. Period: 1^st September 2023 to 29^th February 2024. Methods: A total of 32 patients were included in the study. Sixteen patients constituted each management group. The radiologic assessment of these patients included calculation of alpha (α) angle on AP and lateral views, femoral head neck offset and Southwick angle both preoperatively and on the last follow-up. Functional assessment comprised of Heyman and Herndon classification on the last follow-up. Results: The comparison of degree of improvement achieved showed that significant higher improvement in AP α-angle, Lat α-angle, head-neck offset and Southwick angle (with p<0.001 for each parameter) was achieved in the Mod. Dunn procedure subgroup. As per Heyman and Herndon classification, excellent and good outcome were more commonly seen in the group treated by Modified Dunn procedure. Most of the cases in both the management groups had an uncomplicated course Conclusion: Hence it can be concluded that the Mod. Dunn procedure is way more efficacious than in-situ fixation in terms of radiologic deformity correction as well as subsequent functional gain. At the same time the complication profile lies within the safe margins.

Frequency of meniscal injury in patients with anterior cruciate ligament injury using magnetic resonance imaging.

2025-02-21T05:33:33-08:00

Objective: To determine the frequency of meniscal injuries in patients with anterior cruciate ligament (ACL) injury using magnetic resonance imaging (MRI) at Al-Noor Institute of Radiology/Al-Noor Diagnostic Center Shadman, Lahore. Study Design: Cross-sectional study. Setting: Al-Noor Institute of Radiology, Lahore. Period: August 2023 to February 2024. Methods: A total of 105 patients aged 18-50 were enrolled using non-probability sequential sampling. Exclusion criteria included muscular dystrophy, open wounds, metabolic bone disorders, rheumatoid arthritis, and prior surgeries. MRI scans were performed using 1.5 Tesla equipment, and meniscal injuries were assessed using standard grading protocols. Statistical analysis was conducted using SPSS version 25. Results: Among 105 ACL-injured patients, meniscal injuries were more common in older patients (73.1% in ages 31-50 vs. 49.1% in ages 18-30, p=0.012), males (67.9% vs. 37.5% in females, p=0.007), and those with a BMI >25 (70.5% vs. 47.7% with BMI ≤25, p=0.018). Conclusion: Our study highlights that age, male gender, and higher BMI significantly increase the risk of meniscal injuries in ACL-deficient patients. Early MRI diagnostics and targeted interventions are recommended for managing these risks effectively.

Pattern and burden of respiratory diseases in pediatric intensive care unit.

2024-12-03T04:53:01-08:00

Objective: To assess the pattern and burden of respiratory illnesses admitted in Pediatric Intensive Care Unit and their outcome. Study Design: Retrospective Cohort study. Setting: A closed multidisciplinary PICU with 4-S framework [system, space, stuff and staff] of a newly opened public-sector children hospital in Karachi. Period: January 1, 2023 to June 30, 2023. Methods: We retrospectively reviewed the medical records of children (1month-15yrs) with acute respiratory illnesses admitted in PICU of a newly opened public-sector children hospital during six months. Demographic data (age and gender), clinical variables (types, severity of respiratory failure, type of respiratory support and clinical outcome as alive or expired were extracted from medical records. Results: Total respiratory cases were 274(15.1%) during this study period. The median age was 9 months (IQR6-15) and 179(65.3%) were male. Acute bronchiolitis 160(58.4%) and pneumonia 50(18.2%) were the most common admitting diagnosis. Respiratory failure was observed in 42(15.3%) and needed positive pressure ventilation either as High Flow nasal cannula 32(11.7%) and MV 10(3.6%). Predictor of respiratory failure in this cohort was non-vaccination, malnutrition, abnormal chest X-ray and use of vasoactive drugs (p=0.017, p=0.418, p<0.001, p=<0.001). Mortality is associated with clinical severity (p <0.001). The case specific mortality rate was 2(0.08%). Conclusion: Acute bronchiolitis and Pneumonia were the leading respiratory illnesses with marginal mortality rate. Effective management strategies lead to significant improved outcome of children with respiratory diseases.

Diagnostic accuracy of MRSA chrom agar comparing it with cefoxitin disc diffusion method.

2025-02-24T05:53:50-08:00

Objective: To evaluate the sensitivity and specificity of MeReSa Chrom agar to detect methicillin-resistant Staphylococcus aureus in clinical specimens. Study Design: Cross sectional. Setting: Department of Microbiology, Allama Iqbal Medical College, Jinnah Hospital Lahore. Period: January 2024 to January 2025. Methods: The 525 iolates of Staphylococcus aureus was isolated from various clinical samples. Cefoxitin disc diffusion method was used to isolate MRSA. All isolates were inoculated on Chrom agar, and growth was noted after 24 and 48 hours of incubation. All isolates were later analyzed for the presence of the mec A gene through PCR. Sensitivity, specificity, positive predictive value and negative predictive value were calculated through SPSS 27.0. Results: From total 525 Staphylococcus aureus isolates, 180 were resistant to methicillin (MRSA), and the remaining 345 were sensitive to methicillin (MSSA). All 525 isolates were cultured on Chrom agar, and sensitivity and specificity were 95.5% and 97.96%, respectively, with 96.1% positive predictive value (PPV) and 97.7% negative predictive value (NPV) noted against the cefoxitin disc diffusion method. Conclusion: HiCHROM^TM MeReSa Chrom agar can be used to detect MRSA from clinical specimens due to its high sensitivity and specificity. It can operate as selective and confirmatory media for MRSA detection.

Frequency of urinary tract infection in children with constipation.

2025-02-17T04:55:20-08:00

Objective: To determine the frequency of urinary tract infection in children with constipation. Study Design: Cross Sectional Study. Setting: Department of Pediatrics PNS Hafeez Hospital Islamabad. Period: 1^st November 2023 to 30^th April 2024. Methods: A total of 141 male and female children with constipation were enrolled in the study. Urine analysis of all enrolled patients was performed on a centrifuged sample of urine. Urinary tract infection as per operational definition was noted. Results: Age range in this study was from 1 to 12 years with mean age of 5.354±2.39 years and mean duration of constipation was 5.709±1.46 months. Male patients were 44.7% and females were 55.3%. Urinary tract infection was observed in 31.9% patients. Conclusion: In conclusion, this study demonstrates an association between chronic constipation, especially functional constipation beginning in childhood.

Biochemical abnormalities and its correlation with outcome of diabetic ketoacidosis in children.

2025-02-04T04:40:34-08:00

Objective: To determine biochemical abnormalities and its correlation with outcome of diabetic ketoacidosis (DKA) in children requiring hospital admission. Study Design: Cross-sectional study. Setting: Department of Pediatric Intensive Care Unit and Endocrinology, National Institute of Child Health, Karachi, Pakistan. Period: 29^th August 2024 to 30^th January 2025. Methods: A total of 209 children of either gender, aged 1 to 16 years, diagnosed with DKA, and requiring hospital admission were analyzed. At the time of admission, domographics, along with presenting symptoms and features were noted. Necessary laboratory investigations were carried out based on the hospital protocol and common biochemical abnormalities like electrolyte abnormalities, abnormal serum creatinine, blood urea nitrogen (BUN), and osmolality level were noted. Results: In a total of 209 children admitted with DKA, 120 (57.4%) were female. The mean age was 10.12±3.56 years. Electrolyte abnormalities were documented in 149 (71.3%) patients. Newly diagnosed T1DM (p=0.018) was found to have significant association with electrolyte abnormality. Abnormal serum creatinine was identified in 16 (7.7%) patients, and associated with altered consciousness (p<0.001), lethargy (p=0.010), and mortality (p=0.016). Abnormal BUN was identified in 33 (15.8%) patients, and associated with abdominal pain (p<0.001), difficulty in breathing (p<0.001), fever (p=0.011), vomiting (p=0.027), DKA severity (p=0.001), and mortality (p=0.001). Abnormal osmolality level was identified in 170 (81.3%) patients, and associated with polydipsia (p=0.039), vomiting (p=0.038), and DKA severity (p=0.009). Conclusion: Our study highlights the high prevalence of biochemical abnormalities in children with DKA and their significant correlation with disease severity and outcomes.

Comparison of Semi-continuous Technique and interrupted technique for replacing mitral valve replacement (MVR) in terms of Cross-clamp Time.

2024-11-23T03:08:03-08:00

Objective: To compare the cross-clamp times between the semi-continuous and interrupted techniques for mitral valve replacement. Study Design: Retrospective Cohort study. Setting: Peshawar Institute of Cardiology Tertiary Cardiac Centre in Lower Middle-Income Country with high rheumatic heart disease burden. Period: January 2021 to June 2024. Methods: The patients were divided into two equal groups: Group I patients underwent semi-continuous technique for mitral valve replacement, and Group II underwent interrupted technique. All patients older than 18 years with isolated mitral valve replacement for rheumatic mitral disease (confirmed either with gross features or biopsy) were included. Results: A total of 110 patients were included in the analysis, consisting of 46 males (41.8%) and 64 females (58.2%). The mean age of the cohort was 39.8 years (SD = 11.5), with a mean body mass index (BMI) of 23.3 (SD = 4.2). The mean cross-clamp time for the semi-continuous technique was 68.75 minutes (SD = 22.2), which was significantly lower than the mean cross-clamp time of 91.7 minutes (SD = 27.3) for the interrupted technique. Conclusion: Study showed that the semi-continuous sutures gave a similar outcome to the interrupted sutures, with significantly better operative time regarding cross-clamp time without increasing mortality.

Effect of carnitine supplementation on inflammatory biomarker in hemodialysis patients.

2023-12-29T06:23:42-08:00

Objective: To determine the effect of carnitine supplementation on Inflammatory biomarker (C reactive protein) in hemodialysis patients. Study Design: Randomized Control Trial. Setting: JPMC Hospital, Karachi and PNS Shifa Hospital, Karachi. Period: 01-12-2022 to 30-04-2023. Methods: The hemodialysis patients were selected from the dialysis center and the controls were taken from nephrology wards. L- Carnitine supplementation was given to the hemodialysis patients. Hemodialysis patients were further subdivided into 2 groups, Intravenous group in which the subjects were given intravenous L-Carnitine supplementation and the Oral Group which constituted patients who received oral L-Carnitine supplementation. Results: In intravenous group the mean hemoglobin before supplementation was 9.9 (SD=±1.1) units and after treatment it was 10.5 (SD=±1.2) units. The change in hemoglobin was considered statistically significant with p<0.01. In oral group the mean hemoglobin before supplementation was 10.2 (SD=±1.1) units and after treatment it was 10.3 (SD=±1.1) units, the mean difference was not statistically significant with p=0.05. Conclusion: L-Carnitine supplementation demonstrated a significant reduction in CRP levels, with intravenous administration showing greater efficacy. These findings suggest the potential therapeutic value of L-Carnitine in mitigating inflammation and oxidative stress in CKD patients, offering a promising avenue for improving their overall health and reducing the risk of cardiovascular complications. Further research and clinical trials are warranted to explore the full extent of these benefits and optimize treatment strategies.

Heamatological and biochemical parameters with different serological status in dengue patients.

2025-04-14T06:22:29-07:00

Objective: To compare the hematological and biochemical parameters of dengue patients within different serological markers. Study Design: Cross Sectional study. Setting: Carried out in a Tertiary Care Hospital at Rawalpindi. Period: August 2023 to December 2023. Methods: Of 250 seropositive dengue cases Hematological analysis was done by Mindray 3000 plus. For biochemical analysis Beckman &coulter, AU480 was used. Subjects were distributed into seven serogroups (NS1 positive, NS1+IgG, NS1+IgM positive, IgM positive, IgG positive, IgG+IgM, NS1, IgM+IgG and triple positive). Results were analyzed using SPSS software, ANOVA test was used, and means were compared in different groups. P value of <0.05 was considered as significant. Results: A total of 178 (71%) among study group were male. Mean age was found to be 37±13.8 years. NS1 antigen either in isolation or in combination was positive in 80%of patient at the time of presentation. The most affected parameters among the whole study cohort were low mean platelet count (81.90±49.2) and higher mean value of ALT (92.81±75.07). The mean value of haematological and biochemical parameters were studied in different serological groups. No significant difference of mean haemoglobin and platelet was observed in between different serological groups however Mean TLC differ significantly within these subgroups (p value = <0.05). The Mean values of various biochemical parameters did not exhibit any significant difference within the different serological groups. Conclusion: Dengue is more prevalent in young population and in males. Thrombocytopenia and elevated ALT levels were most common laboratory finding observed in these patients. NS1 was the most frequent marker at the time of presentation. Only Mean TLC (p value = <0.05) was observed to be significantly different in between different serological groups.

Comparison of anterior cervical decompression fusion versus anterior cervical corpectomy with paramesh in central cord syndrome patients.

2024-12-07T04:42:06-08:00

Objective: To compare ACDF and ACCP in terms of neurological recovery and postoperative pain among CCS patients presenting at a tertiary care hospital, Karachi, Pakistan. Study Design: Prospective Cohort study. Setting: Department of Orthopedics, Dr. Ziauddin Hospital, Karachi. Period: February 2021 to March 2023. Methods: Patients diagnosed with CCS, presenting within 6 weeks of the index injury of age 45 to 60 years of either gender were included in the study. Group 1 included patients who underwent ACDF and Group 2 included patients who underwent ACCP. Patients in both groups were followed up to 2 years post-surgery. Outcomes were neurological outcome and pain. Data was analyzed using SPSS version 23. Results: There were no significant baseline differences between groups in terms of age, gender, hypertension, or diabetes. Neurological improvement was observed in 68% of the ACCP group compared to 32% in the ACDF group (p=0.025). However, 59.2% of ACDF patients reported significant pain relief, compared to 40.8% of ACCP patients (p=0.011). There were no significant readmissions or morbidity in either group. Conclusion: ACCP offers superior long-term neurological outcomes, while ACDF provides better postoperative pain relief. The choice of procedure should be based on individual patient needs, balancing neurological recovery and pain management considerations. Further multicentre studies are needed to generalize these findings.

Incidence of vaginal birth after previous cesarean section and fetal outcomes in a tertiary care hospital in Peshawar.

2024-12-31T04:51:28-08:00

Objective: To determine the frequency of vaginal birth after one cesarean section, along with fetal outcomes. Study Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics at Hayatabad Medical Complex, Peshawar, Pakistan. Period: January 2024 to July 2024. Methods: Women aged 20-40 years, history of one previous lower segment CS, and presenting in spontaneous labor with gestational age between 32 and 41 weeks, were analyzed. All women underwent a trial of labor in the labor room, with successful vaginal births after CS (VBAC) were noted. For those women who had unsuccessful attempts, were transferred to the operating room for emergency CS. Successful VBAC cases were monitored, and key fetal, and maternal outcomes were recorded. Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 149 women, the mean age, and gestational age were 27.62±4.93 years, and 37.81±1.67 weeks, respectively. VBAC was successful in 93 (62.4%) women. The mean duration of labor in successful VBAC, and unsuccessful VBAC were 8.96±7.20 vs. 11.67±8.40 hours (p=0.039). The body mass was significantly higher among women who underwent CS (p=0.031). Low birth weight (p<0.001), Apgar score <7 at 1 minutes (p=0.014), and NICU admission were significantly more among women were unsuccessful in undergoing VBAC. In terms of maternal outcomes, infection was significantly more common among women who were unsuccessful in VBAC (p=0.025). Uterine rupture occurred I 2 (3.6%) women who were unsuccessful in VBAC (p=0.014). Hospital stay was above 3 days in 5 (5.4%) women who had VBAC (p=0.030). Conclusion: This study highlights relatively high VBAC success rate with favorable maternal and fetal outcomes. Unsuccessful VBAC was associated with prolonged labor, increased maternal complications, and poorer neonatal outcomes.

Comparison of outcome in patients undergoing elective cesarean delivery with intravenous acetaminophen versus placebo.

2025-01-09T05:02:55-08:00

Objective: To see effect of IV acetaminophen in post caesarean delivery to control pain in cases with general anesthesia. Study Design: Randomized Controlled Trail. Setting: Department of Obstetrics and Gynecology, University Teaching Hospital, Gujranwala. Period: Aug 31, 2019 till April 30, 2020. Methods: All cases meeting inclusion criteria was enrolled and underwent elective cesarean section. Then they were randomly divided to receive either 15 mg/kg intravenous acetaminophen (n = 146) or normal saline (n = 146) fifteen minutes before endotracheal intubation. Pain was measured after 6 hours of C-section. SPSS version 22 was used to analyze the data. Results: The mean age of cases in group-A was 26.59 ± 4.95 years and in group-B was 26.44 ± 4.72 years. The mean gestational age in group-A and group-B was 39.54 ± 1.19 weeks and 39.38 ± 1.08 weeks. The mean pain in group-A was 4.98 ± 1.01 and in group-B was the mean pain was 6.18 ±1.30. The mean pain in group-A (acetaminophen group) was statistically lower than group-B (placebo), p-value < 0.001. Conclusion: It is concluded that IV acetaminophen is effective in controlling the pain in cases with general anesthesia after caesarean delivery. Hence in future this non-opioid analgesic without potential adverse effects can be used. This will surely reduce the analgesia requirement and hospital stay.

Comparison of spinal anesthesia at L3-L4 versus L4-L5 in obstetric patients undergoing Cesarean section at South east hospital and research center.

2025-01-22T02:33:06-08:00

Objective: To compare the efficacy and safety of spinal anesthesia at the L3-L4 versus L4-L5 intervertebral spaces in obstetric patients undergoing elective C-sections. Study Design: Prospective, Randomized Controlled Trial. Setting: South East Hospital and Research Center Islamabad. Period: January 2023 to December 2023. Methods: Included the patients who were scheduled for elective C-sections. The main outcomes included the onset and the duration of sensory block, the degree of sensory blockade achieved, intraoperative hemodynamics, control of postoperative pain, satisfaction of mothers. Results: The results indicate that lumbar spinal anesthesia at L3-L4 given to patient results in quicker sensory block when compared to L4-L5 (L3-L4, 65% within 5 mins. Vs. L4-L5, 3.4%) while the effective duration of L4-L5 group was longer (87% between 2 – 2.5 hrs). In addition to this, L3-L4 spinal block achieved a higher level (T4) of sensory block compared to L4-L5 which recorded a lower incidence of hypotension with the L3-L4 group experiencing hypotension at 61.7% compared to only 2% in the L4-L5 group. Conclusion: This study indicates that higher levels of the spinal anaesthsia can be attained quicker with the L3-L4 approach but better and longer analgesia is achieved with the L4-L5 level and without compromising hemodynamic stability. This information will be important to the clinicians in determining the best spinal anesthetic level for elective and emergency Cesarean section surgeries enhancing safety of the patients and improving the results.

Changes in intraocular pressure (IOP) after uncomplicated phacoemulsification in diabetic vs non-diabetic patients.

2025-02-14T02:48:23-08:00

Objective: To assess the frequency of type 2 diabetes mellitus (T2DM) in patients undergoing phacoemulsification and compare mean changes in IOP postoperatively between diabetic and non-diabetic individuals. Study Design: Descriptive Case Series. Setting: LRBT Eye Hospital, Lahore. Period: May to November 2024. Methods: The study enrolled 100 cataract patients aged 40 to 65 years. Participants were categorized as diabetic (HbA1c >7%) or non-diabetic. Preoperative and postoperative IOP measurements were obtained via Goldmann applanation tonometry. Phacoemulsification was performed under topical anesthesia, and postoperative care followed a standardized protocol. Data analysis utilized SPSS version 25.0, with t-tests and chi-square tests determining statistical significance. Results: Among 100 patients, 55% had T2DM. Preoperative mean IOP was 18.00 ± 0.82 mmHg in diabetic and 18.00 ± 0.83 mmHg in non-diabetic patients (p=0.900). Postoperatively, mean IOP was 15.91 ± 0.87 mmHg in diabetic and 15.93 ± 0.84 mmHg in non-diabetic patients (p=0.451). The mean IOP reduction was 2.09 ± 0.29 mmHg in diabetics and 2.07 ± 0.25 mmHg in non-diabetics (p=0.786), indicating no significant difference between groups. Conclusion: Phacoemulsification significantly reduces IOP in both diabetic and non-diabetic patients, with no statistically significant differences between the groups. Diabetes, in the absence of advanced retinopathy, does not impair surgical outcomes. Routine postoperative IOP monitoring is recommended.

How severe is burnout among postgraduate medical trainees? A cross-sectional study at HMC, Peshawar.

2025-01-22T00:17:14-08:00

Objective: To assess the prevalence and dimensions of burnout among postgraduate medical trainees at HMC, Peshawar, focusing on senior residents within general departments. Study Design: Cross-sectional study. Setting: Hayat Abad Medical Complex. Period: March 2023 to June 2023. Methods: Involving 105 postgraduate trainees in their fourth year of training using the Copenhagen Burnout Inventory (CBI). Data analysis was performed using SPSS. Results: Mean total burnout score was 51.6, with differences observed based on age and gender. Personal, work-related, and client-related burnout scores were 54.21, 51.75, and 49.0, respectively. Specialty-wise, burnout varied significantly, with higher rates observed in surgical and allied specialties. Conclusion: Burnout remains a significant concern in healthcare settings, necessitating further exploration of its relationship with quality of care. Interventions aimed at mitigating burnout should be prioritized to promote trainee well-being and enhance patient care quality. Study's limitations, including its single-center focus and exclusion of trainees from other years, warrant consideration in future research efforts.

Comparison of Sublay Vs Onlay Mesh Hernioplasty in terms of operative time, complications and recurrence.

2025-02-26T05:17:08-08:00

Objective: To compare the efficacy of Sublay vs Onlay for ventral hernias in prevention of complications. Study Design: Comparative study. Setting: Government Teaching Hospital Shahdara, Lahore. Period: December 2021 to March 2023. Methods: After approval from ethical committee, total 110 patients of ventral hernias having defect size more than 2 cm were selected and divided equally into Sublay(S group) and Onlay (O group), 55 in each group. The sample size was determined by using WHO sample size calculator. Incisional and recurrent hernias were excluded. Age, sex, seroma, wound infection, operative time, length of stay and recurrence were recorded and analyzed by SPSS version 24 after taking consultation with statistician also. Results: Out of 110 patients, 93(84.5%) were female and 17(15.5%) were male. Age range was 25 years to 70 years. Mean age in S group was 46 years and 47years in O Group. Average operative time was 85 minutes in O Group and 123 minutes in S Group with minimum 45 mins in O group and 150 minutes (maximum) in S Group with p-value of 0.00 which was significant. Seroma was formed in 28 patients (25.5%) with 18 in O Group and 10 in S Group, with p-value insignificant. Infection, Length of stay and recurrence were also statistically insignificant. Conclusion: Both Sublay and Onlay mesh hernioplasty are associated with wound complications equally but operative time is remarkably less in Onlay mesh hernioplasty.

Frequency of in-Hospital complications in patients with acute inferior wall myocardial infarction with and without thrombolysis.

2025-03-17T07:00:20-07:00

Objective: To compare the frequency of in-hospital complications in patients with acute inferior wall myocardial infarction with and without thrombolysis. Study Design: Descriptive study. Setting: Department of Cardiology, Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology, Lahore. Period: 1^st August 2024 to 31^stJanuary 2025. Methods: A total of 100 patients, aged between 35 and 65 years, either gender, presenting with acute inferior wall myocardial infarction (IWMI), were enrolled in the study from the emergency department. Those patients presenting within 12 hours of symptom onset received thrombolytic therapy, while those presenting after 12 hours did not receive thrombolysis. The patients were admitted to cardiology wards and observed for five days. During indoor follow-up, they were examined for complications such as congestive heart failure, cardiogenic shock, stroke, atrial fibrillation, and mortality. Results: The average age was found to be 51.28±7.86 years. The most frequent comorbidity was anemia in 61 patients (61%), followed by smoking in 56 patients (56.0%), and dyslipidemia in 54 patients (54.0%). Diabetes affected 52 patients (52%); on the other hand, 48 patients (48%) were hypertensive. Family history of IHD was recorded in 50 patients (50.0%). The incidence of in-hospital complications was highly significant and differed between thrombolysis and non-thrombolysis patients. More cases of congestive heart failure were found among the non-thrombolysis patients, who were 24 (72.7%) as compared to 9 (27.3%) in the thrombolysis group (p<0.001). Similarly, cardiogenic shock was observed in 18 (72.0%) non-recipients and 7 (28.0%) recipients (p<0.001). Non-recipients had much higher rates of AV blocks at 36 (75.0%) compared to 12 (25.0%) among those receiving thrombolysis (p<0.001). Patients who were not treated with thrombolysis more often suffered from mitral regurgitation: 35 (67.3%) vs 17 (32.7%) among thrombolysis patients, p<0.001. The right ventricle failure was also associated with a majority of the non-recipients 34 (77.3%) compared to thrombolysis recipients where this occurrence was only present in 10 (22.7%), p < 0.001. No difference was reported concerning stroke between both groups 1 (50.0%) vs. 1 (50.0%), p = 0.794. Atrial fibrillation was more frequent in non-thrombolysis patients 28 (66.7%) vs. 14 (33.3%), p<0.001. Conclusion: In conclusion, the results show that of the patients with acute inferior wall myocardial infarction, the majority, 59%, underwent thrombolysis, which is thus very frequently used in the treatment of this kind of patient. Our findings suggest that in-hospital complication rate was significantly reduced in patients who underwent thrombolytic therapy as compared to the ones who did not receive thrombolysis.

Epidemiology and emergency management of firearm injuries presenting to Tertiary Care Hospital.

2025-01-04T05:02:22-08:00

Objective: To analyze the demographic, clinical, and management characteristics of firearm injuries to inform prevention strategies and optimize trauma care. Study Design: Retrospective Cross-sectional study. Setting: Lady Reading Hospital, Peshawar. Period: 15/4/2021 to 25/12/2021. Methods: including 147 patients with firearm injuries admitted. Data on demographics, injury characteristics, management strategies, and outcomes were collected from medical records. Statistical analysis was performed using SPSS version 25.0, with associations assessed through Chi-square tests. Results: The study population had a mean age of 35.2 ± 12.4 years, with 80% being male. Assault was the leading cause of injury, accounting for 62.5% of cases in males and 33.3% in females. Accidental injuries were more common in females (50%) compared to males (25%). Head and neck injuries were most prevalent, observed in 50% of females and 37.5% of males. Surgical intervention was required in 60% of cases, while 40% were managed conservatively. Significant associations were found between gender and anatomical location (p=0.02), as well as between age and cause of injury (p=0.02). Conclusion: Firearm injuries predominantly affect young males, with distinct gender- and age-based patterns. Males experienced a higher proportion of assault-related injuries, while females had more accidental injuries, emphasizing the need for gender-specific prevention strategies, including firearm safety education and community-based violence prevention programs. Younger individuals were disproportionately affected by head and neck injuries and assault-related incidents, underscoring the importance of age-specific interventions.