The Professional Medical Journal

Frequency of hyponatremia in pediatric intensive care unit at a private tertiary care hospital in Lahore.

Atika Sharif — 2025-05-01

Objective: To determine the frequency and outcome of hyponatremia among children admitted at pediatric intensive care unit at Fatima Memorial Hospital, Lahore. Study Design: Cross-sectional study. Study Setting: Pediatric Intensive Care Unit, Fatima Memorial Hospital in Lahore. Study Period: August 25, 2022 to August 24, 2023. Methods: A total of 310 patients who met the specified criteria for admission to the PICU were included in this study. Patient records were carefully reviewed, and relevant data pertaining to sociodemographic factors, diagnosis, sodium levels, and subsequent outcomes were meticulously recorded. The collected data was then inputted into SPSS version 25 for analysis. In order to assess the relationship between sociodemographic factors, diagnosis, outcome variables, and hyponatremia, a chi-square test was employed. A p-value of less than 0.05 was deemed to be statistically significant. Results: Total 310 children admitted at PICU having age 1 month to 12 years were included in study. Gender distribution showed that, 208(67.1%) were males and 102(32.9%) were females. The mean age of the children was 25.97±34.893 months. The mean serum sodium level was 137.32±6.478 mEq/L. Among 310 children admitted at PICU, 84(27.1%) had hyponatremia. The mean stay in PICU was 4.54±3.682 days and mean stay in hospital was 5.37±3.920 days. Conclusion: The incidence of hyponatremia was found to be high in the study conducted. Moreover, the occurrence of hyponatremia was significantly linked to an extended length of stay in the pediatric intensive care unit, thereby imposing an additional burden on hospital administration. The prompt identification and rectification of hyponatremia can result in a reduction in both the morbidity associated with the condition and the duration of hospitalization.

Role of shock index and pediatric age adjusted shock index as a predictor of mortality and morbidity in patients admitted at PICU.

Anum Tanveer — 2025-05-01

Objective: To determine shock index (SI), and Pediatric age adjusted shock index (SIPA), and their role in predicting mortality and morbidity in patient admitted in Pediatric Intensive Care Unit (PICI) of a tertiary care hospital of Karachi, Pakistan. Study Design: Cross-sectional study. Setting: PICU of National Institute of Child Health, Karachi, Pakistan. Period: May 2024 to November 2024. Methods: A total of 155 children of any gender, aged between 1-14 years, and admitted to PICU were analyzed. SI, and SIPA were assessed with respect to indicators like need for mechanical ventilation (MV), and inotropic agents, need of blood transfusion within 24 hours, and duration of PICU stay. In-hospital mortality was also documented. Results: In a total of 155 children, the mean age was 7.18±3.71 years, while 78 (50.3%) were boys. The most common presenting complaints included difficulty breathing, and fever, in 49 (31.6%), and 48 (31.0%) children, respectively. Mechanical ventilation was required more frequently in children with abnormal SIPA scores (p=0.004). The need for inotropic support also showed significant association with abnormal SIPA scores (p=0.003). Children with abnormal SIPA scores had significantly longer PICU stays (p=0.013). Mortality rates were significantly higher among children with abnormal SI scores (p=0.026), and abnormal SIPA scores (p=0.003). Conclusion: This study underscores the clinical utility of SIPA as a reliable predictor of adverse outcomes in critically ill pediatric patients. Compared to SI, SIPA demonstrated superior predictive strength for key morbidity indicators, including mechanical ventilation, inotropic support, extended PICU stay, and mortality.

Spectrum of clinical manifestations of renal tubular acidosis in children presenting at a Tertiary Care Hospital.

Anmol — 2025-05-01

Objective: To determine the spectrum of clinical manifestations of renal tubular acidosis (RTA) in children. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: October 2023 to September 2024. Methods: A total of 124 children aged 1 month to 12 years, and presenting with RTA were analyzed. Demographic, clinical, laboratory and imaging parameters were noted. Chi-square test, and independent sample t-test were applied for the comparison of data, taking p < 0.05 as statistically significant. Results: In a total of 124 children, 72 (58.1%) were male. The most frequent presenting complaints were loose stool, failure to thrive, and dehydration, noted in 71 (78.9%), 65 (72.2%), and 42 (46.7%) children, respectively. Bone deformities were observed in 50 (40.3%) children. Renal ultrasound revealed structural abnormalities, and urolithiasis in 12 (9.7%), and 40 (32.3%) children, respectively. RTA types were distal, and proximal in 90 (72.6%), and 34 (27.4%) children, respectively. Gender was found to have significant association RTA types (p=0.032). Comparison of laboratory parameters evaluation with respect to RTA types revealed significant patterns for chloride (p=0.005), and sodium (p=0.003). Conclusion: Distal RTA was the most common form of RTA. Loose stool, failure to thrive, and dehydration were the most common presenting features, while urolithiasis and structural abnormalities were identified in a significant proportion of children.

Large bore ultrasound guided vascular access: Single tertiary center experience.

Ali Raza — 2025-05-01

Objective: To share our ultrasound guided experience and demonstrate the need for implementation of ultrasound guided access in interventional cardiology and structural heart disease training programs in Pakistan. Design: Non-randomized, Cross Sectional Observational study. Setting: The study was conducted at Peshawar Institute of Cardiology. Period: January 2022 to June 2024. Methods: We conducted a retrospective study about the patients who underwent ultrasound guided vascular access for cardiac intervention from January 2022 to June 2024 at our center, Peshawar Institute of Cardiology, Pakistan. We categorized the patients on the basis of size / French of the delivery sheath. Patients who had a delivery sheath size of more than 6 French were classified as large bore access. Results: A total number of 89 patients underwent cannulation for various cardiac procedures, all had large bore access sheaths / devices. All had ultrasound guidance used for access site puncture. Forty-eight patients underwent transcatheter aortic valve replacement with 14F or 16F equivalent sheaths, one underwent balloon aortic valvuloplasty for severe aortic stenosis with 8F sheath and 40 patients underwent coarctation of aorta stenting with 14F sheaths. Conclusion: This study demonstrates the safety and efficacy of using of ultrasound for vascular access at a local center for percutaneous cardiovascular procedures requiring large bore arterial access.

Single dose hydrocortisone for optimized wound healing post tooth-extraction in diabetic patients: A randomized clinical trial.

Rimsha Rasheed — 2025-05-01

Objective: To determine the effectiveness of a single dose corticosteroid injection after tooth extraction among controlled diabetic patients to improve wound healing. Study Design: Randomized Clinical Trial. Setting: Department of Oral and Maxillofacial Surgery, Madinah Teaching Hospital (MTH) Faisalabad. Period: March 01, 2024 to June 30, 2024. Methods: Prior to each patient's tooth extraction, randomization and group assignment was carried out using computer software Research Randomizer. Signed informed consent from each patient was obtained. A total of 85 patients were included in the study. These patients were divided into two groups control group and the group treated with hydrocortisone injection. Wound healing post extraction on the 6^th day was assessed by Landry Healing Index. Data analysis utilized SPSS software and Independent sample t-test was applied for comparison between groups. A significance level of ≤0.05 was used to determine statistical significance. Results: The results obtained were statistically significant as the corticosteroid treated group showed higher Landry healing index score of 2.84 than 2.40 of the control group which indicated the least effective healing. Conclusion: This study concluded that single dose corticosteroid was effective to improve wound healing post extraction in controlled diabetic patients.

Diagnostic accuracy of Ottawa rules in diagnosing ankle fractures among patients taking X ray as gold standard.

Israr Ahmad — 2025-05-01

Objective: To determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in diagnosing ankle fractures among patients, with X-ray imaging as the gold standard. Study Design: Cross-sectional study. Setting: Emergency Department of Lady Reading Hospital, Peshawar. Period: 1^st January 2024 to 30^th June 2024. Methods: 286 cases patients aged 18 to 60 years, presenting with ankle twisting and pain within 6 hours, were included. Exclusion criteria included patients unable to answer the Ottawa questionnaire or those refusing X-ray imaging. Following informed consent, patients were assessed using the Ottawa Ankle Rules and underwent X-ray imaging. The results were classified into true positives, false positives, true negatives, and false negatives. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The mean age of participants was 36.73±6.7 years, with 67.13% males and 32.86% females. Ankle fractures were more common on the right side (62.93%). Among normal radiographs, 55.24% were correctly classified, while 18.18% were false positives. In patients with radiographic fractures, 23.77% were correctly identified. The sensitivity of the Ottawa Rules was 95.18%, while specificity was 56.67%. The positive predictive value was 68.72%, and the negative predictive value was 92.16%. Sensitivity was high in both males (92.73%) and females (94.55%), though specificity was lower in males (42.86%) compared to females (56.10%). Conclusion: The Ottawa Ankle Rules demonstrated high sensitivity for detecting ankle fractures but lower specificity.

Developmental dysplasia of hip (DDH): Role of assessing the geographical prevalence in Pakistan for screening to minimize the late presentation of DDH.

Farman ul Haq — 2025-05-01

Objective: To assess the prevalent regions of Pakistan for screening to minimize the late onset of DDH. Study Design: Retrospective study. Setting: Department of Orthopaedic & Spine Center, Ghurki Trust Teaching Hospital, Lahore. Period: January 2015 to December 2021. Methods: All the infants and children less than 15 years of age of both genders with the diagnosis of DDH at GTTH, Prime and Mercy Teaching Hospital, Mercy Teaching Hospital, Peshawar and Prime Teaching Hospital Peshawar from who received the surgical treatment (open and close reduction with or without acetabular osteotomy) were included in the study. The medical history of patients including age, gender, anatomical site, and geographic locations were retrospectively analyzed. All the data were entered and analyzed using Excel and SPSS software Version 22. Results: A total of 1390 were analyzed and diagnosed with DDH among these more than half of the children 1017(73.1%) were females while fewer than 373(26.8%) were males. The average age of children at the time of diagnosis was 4.5 years ranging from 6 months to 15 years. Almost half of the patients 960(69.1%) were diagnosed between the age of 1 to 5 years. More than half cases769(55.3%) had unilateral DDH than bilateral DDH 301 (21.7%). In this study, we assessed the majority of cases 20.3% cases were from Quetta, 10.5% from Peshawar, and 9.5% were from Lahore. Conclusion: DDH is a problem that ranges from minor acetabular dysplasia to irreversible hip dislocation. Depending on the health facilities, screening programs for early detection differ across the world. Due to lack of screening, late presentation of DDH is common and swaddling is another risk factor of it. Physical examination should be highly valuable in diagnosing early DDH, especially in Khyber Pakhtunkhwa and Balochistan's various cities as these are highly deprived areas where health services are inadequate and the prevalence of late diagnosis is very high. Awareness should be done among parents regarding safe methods to safely swaddle their infants.

Common electrolyte imbalance in neonates presenting with acute kidney injury in NICU.

Talha Ahmed Siddiqui — 2025-05-01

Objective: To determine common electrolyte imbalance among neonates admitting in neonatal intensive care unit (NICU) with acute kidney injury (AKI). Study Design: Cross-sectional study. Setting: The NICU of National Institute of Child Health (NICH), Karachi, Pakistan. Period: 13^th August 2024 to 30^th January 2024. Methods: A total of 196 neonates of either gender and admitted in NICU with AKI were evaluated. At the time of enrollment, demographical and clinical information were noted. Neonate’s blood was drawn upon their admission in NICU for laboratory investigation in which their electrolyte profile was investigated. Data was analyzed using IBM-SPSS Statistics, version 26.0. For all inferential statistics, p<0.05 was noted. Results: In a total of 196 neonates, 104 (53.1%) were boys and 92 (46.9%) girls. The mean age, and birth weight were 7.24±6.08 days, and 2.35±0.56 kg, respectively. Prematurity was noted in 69 (35.2%) cases. Sepsis, and respiratory distress were identified 108 (55.1%), and 80 (40.8%) neonates, respectively. Socio-economic status was low among 180 (91.8%) cases. Acute kidney stage was 1, 2, and 3 among 118 (60.2%), 37 (18.9%), and 41 (20.9%) neonates, respectively. Electrolyte imbalance was noted among 123 (62.8%) neonates. The most frequent electrolyte imbalance was dysnatremia, and dyskalemia, noted in 94(47.9%), and 37 (18.9%) neonates, respectively. Electrolyte imbalance was significantly associated with prematurity (49.6% vs. 11.0%, p<0.001), and higher stages of AKI (p=0.012). Conclusion: This study highlighted a high prevalence of electrolyte imbalances, particularly sodium and potassium disturbances, among neonates with AKI admitted to the NICU.

Comparison of arterial and venous blood gases in patients with COPD (Chronic Obstructive Pulmonary Disease) and CLD (Chronic Liver Disease).

Javeria Sajjad — 2025-05-01

Objective: To Determine Correlation between mean Venous and Arterial Blood Gases in patients with COPD and CLD. Study Design: Cross Sectional Descriptive study. Setting: Department of Internal Medicine (MW6) and Accident and Emergency Department of PIMS, Islamabad. Period: 3^rd September 2021 to 3^rd March 2022. Methods: The study included 110 patients with COPD and CLD who were hospitalized to MW6 and the Emergency Department. The correlation sample size calculator was used to determine the sample size. Consecutive Non-Probability Sampling was the method used to choose samples. Patients with COPD and CLD who were older than thirty years, regardless of gender, were included in the study; however, patients with other metabolic disorders, such as diabetic ketoacidosis, lactic acidosis, a history of poisoning, etc., were not. Results: The average age of patients was 66.3 + 13.6 years and male were 79 (71.8%). Samples were taken from arteries and veins of each patient and pH was calculated. The average pH1 (arterial) level was found to be 7.41 + 0.68 mg/dl whereas the average pH2 (venous) level was 7.35 + 0.76 mg/dl in current study. Conclusion: Venous blood gas analysis cannot be used in place of arterial blood gas analysis due to the differences in pH levels. In many clinical circumstances, venous pH, PCO2, and bicarbonate cannot replace their arterial equivalents.

APRI (AST to Platelet Ration Index) and (Fibrosis-4 Index) Performance to assess liver fibrosis against predefined fibroscan values in chronic Hepatitis C Virus Infection.

Rana Ahsan — 2025-05-01

Objective: To compare the performance of Fibrosis-4 index (FIB-4), and the AST to platelet ratio index (APRI) versus Fibroscan in chronic hepatitis C virus (CHCV) infection. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 250 patients aged 20-70 years, and having CHCV were analyzed. APRI and FIB-4 scores were calculated according. The discriminative ability of APRI, and FIB-4 was evaluated drawing area under the curve (AUC) utilizing receiver operating characteristic (ROC) curve. Based on the optimal cut-off value, the sensitivity and specificity of both scoring systems were computed. Results: For a total of 250 patients, the median scores for APRI, FIB-4, and Fibroscan were 0.63 (0.39-1.05), 2.33 (1.13-3.60), and 9 (5.50-23.92), respectively. Fibrosis stages were noted as 98 (39.2%) F0-F1, 18 (7.2%) F2, 30 (12%) F3, and 104 (41.6%) F4. The AUC indicated that the FIB-4 score was a better predictor of chronic severity than the APRI score (AUC=0.994 vs AUC=0.866) among CHCV patients. The optimal cutoff for the FIB-4 score was 2.440 (sensitivity=92.5%, specificity=100%), 1.550 (sensitivity=100%, specificity=91.4%), and 2.565 (sensitivity=85.1%, specificity=100%). Conclusion: In the context of chronic HCV infection, FIB-4 was better than APRI at differentiating between individuals with and without severe fibrosis and cirrhosis.

Frequency of benign vocal cord lesions in patients presenting with hoarseness of voice.

Bilal Khan — 2025-05-01

Objective: To determine the prevalence and associations of benign vocal cord lesions with demographic, clinical, and lifestyle factors. Study Design: Cross-sectional study. Setting: Department of ENT, Hayatabad Medical Complex, Peshawar. Period: April 4, 2023, to October 4, 2023. Methods: A total of 245 patients aged 40–60 years with hoarseness of voice were included. Patients with malignant vocal cord neoplasms or recent surgical interventions were excluded. Clinical, radiological, and endoscopic evaluations were performed to diagnose BVCLs. Data on demographic and clinical factors were collected and analyzed using SPSS version 23.0, with p ≤ 0.05 considered significant. Results: The mean age of participants was 42.38 ± 12.79 years, with an average disease duration of 4.39 ± 1.84 months. BVCLs were present in 41.6% of patients. Males had a higher prevalence (43.4%) compared to females (35.7%). Among social classes, prevalence was 41.2% in poor, 40.8% in middle-class, and 43.1% in rich individuals. Diabetes mellitus showed a significant association with BVCLs (p = 0.044), while other factors such as age, hypertension, smoking, and tobacco usage were not significantly associated (p > 0.05). Conclusion: Benign vocal cord lesions are prevalent, with significant associations observed with diabetes mellitus. Routine screening for BVCLs in high-risk populations and interventions to address modifiable risk factors are recommended.

A comparative analysis: Success rates of Endoscopic Endonasal versus External Dacryocystorhinostomy with silicon tube.

Amber Khalid — 2025-05-01

Introduction:

Dacryocystorhinostomy (DCR) is a standard surgical treatment for nasolacrimal duct obstruction. it can be performed via external (E-DCR) or internal (EE-DCR) approaches, with each offering distinct advantages. E- DCR is well-established with high success rates but requires a longer recovery time. EE-DCR, being minimal invasive, Offers a faster recovery and better cosmetic outcomes, though requires longer recovery time. This study compares the anatomical and functional outcomes of EE-DCR and E-DCR with silicon tube.

Setting:

This study was conducted at Ziauddin Hospital, Karachi, over a period of 5 years, from 1^st July 2019 to 30^th June 2024. Ethical approval was obtained from institutional review board (Ethical approval code: 9330924AKOPT, dated October 28, 2024.)

Material and Methods:

A total of 140 patients were included, divided into two groups of 70 each, EE-DCR and E-DCR. Inclusion criteria were patients aged 18-70 with nasolacrimal duct obstruction and a follow-up of at least one year. Data was analyzed using SPSS version 23, with significance level of p < 0.05. Outcomes such as nasolacrimal duct patency and symptom improvement were assessed during follow-up at 1^st day, 1^st week, 1^st month, 3^rd month, 6^th month and 1 year.

Results:

The mean age of patients was seen as 42.43 ± 10.9 years in EE-DCR and 49.00 ± 9.01 years in E-DCR group. Anatomical success rates for both groups at 3, 6 and 12 months were comparable, with no statistically significant difference (p-value > 0.05). At 3rf month, 87.14% of the EE-DCR patients and 91.43% of E-DCR patients showed nasolacrimal duct patency. Similarly, functional success rates were assessed showing 84.29% of EE-DCR and 87.14% of E-DCR patients were symptom- free at 3^rd month.

Conclusion:

Both EE-DCR and E-DCR are effective treatments for nasolacrimal duct obstruction.EE-DCR offers advantages like faster recovery and fewer complications, while E-DCR remains reliable for complex cases.

Keywords: Dacryocystitis, External Dacryocystorhinostomy, Endonasal Endoscopic Dacryocystorhinostomy

Assessment of patients with platelet to white blood cell ratio associated with long term adverse outcomes in patients with acute deterioration of chronic liver disease presenting in Tertiary Care Hospital of Karachi, Pakistan.

Baseer Ahmad — 2025-05-01

Objective: To determine the low and high values of platelet to white blood cell ratio (PWR) in patients experiencing acute deterioration of chronic liver disease (CLD) at a tertiary care hospital and assess their association with predicting long-term (28-day) adverse outcomes such as death. Stud Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: April 2024 to December 2024. Methods: A total of 195 patients of both genders with age between 40 to 65 years, and admitted with acute deterioration of CLD were analyzed. Calculation of PWR was done within 24-h of admission according to clinical variables. Platelets counts were divided by WBCs findings to calculate the PWR. The 28-days adverse outcome (mortality) was evaluated for association with PWR level. Cox proportional hazard regression analysis was done to see association of PWR level with adverse outcome. P≤0.05 was considered as significant. Results: Among 195 patients, 115 (59.0%) were male. Significant associations of PWR with gender (p<0.000), hepatic encephalopathy (p<0.000), GI bleeding (p=0.010), bacterial infection (p<0.000), and survival status (p=0.019) were found. A higher probability of low PWR was observed in individuals with bacterial infections compared to those without (aOR=3.546, p=0.001). Conclusion: Association of 28-day outcome (death) was observed with low ratio of PWR among patients who are suffering with cirrhosis and acute decompensation.

One-Year Outcomes of St. Jude Medical (SJM) Mechanical Valve Replacement: Mortality and morbidity analysis in a resource-constrained Cardiac Centre.

Yasir Bilal — 2025-05-01

Objective: To determine the mortality and morbidity rates at one year in patients with rheumatic heart disease undergone St. Jude Medical mechanical heart valves replacement. Study Design: Retrospective Cohort study. Setting: Peshawar Institute of Cardiology (PIC), a newly established cardiac centre located in Peshawar. Period: January 2021 to January 2023. Methods: Data were extracted from the hospital's Electronic Medical Records (EMR) and Health Management Information System (HMIS) of 208 adult patients (≥18 years) who underwent mechanical valve replacement (aortic, mitral, or double valve) using St. Jude Medical Master series prostheses between 2021 and 2023 and analyzed with was SPSS version 26.0. Results: Mechanical valve replacement was performed on 208 patients with a median age of 41 years (IQR: 32–52) and a median BMI of 24.1 kg/m².A total of 102 individuals (40.0%) had their mitral valves replaced. The most frequent reasons for readmission within a year were bleeding in 8 patients (3.8%) and pericardial effusion in 9 patients (4.3%). All cause mortality including operative mortality rate at one year was 9%. Conclusion: Although mechanical valve replacement is still a viable option for patients with rheumatic heart disease, it is linked to high rates of death and morbidity in settings with limited resources in developing nations.

Impact of metformin versus dietary interventions on placental morphology in women with gestational diabetes mellitus.

Amber Salman — 2025-05-01

Objective: To evaluate the effects of dietary control and Metformin on placental morphology in women with Gestational Diabetes Mellitus (GDM). Study Design: Clinical study. Setting: Services Hospital Lahore and Shaikh Zayed Hospital Lahore. Period: June 2023 till June 24. Methods: A total of 56 women with GDM were enrolled after providing informed consent. Of these, 28 women with blood sugar levels of 140 mg/dl or less were assigned to Group B (2500-3000 kcal/day diet and 30-minute walks three times a week) and were placed on dietary control. The remaining 28 women with blood sugar levels greater than 140 mg/dl were assigned to Group C, where they were managed with a diet and Metformin (500 mg TDS). A control group (Group A) consisted of 25 healthy pregnant women. Placental tissue samples were collected and analyzed for morphology after delivery. Results: Group B exhibited heavier placentas with more extensive villous immaturity, charangoids, and syncytial knots. In contrast, Group C showed signs of fibrinoid necrosis and calcification. Significant differences in placental and cord widths were observed in Group B compared to Group A, while only cord width differed significantly in Group C compared to Group A in gross morphology. Light microscopy revealed the presence of charangoids, infarction, and syncytial loops in Group B, along with increased villous maturity. Charangoids and syncytial knots were observed in Group B compared to Group C, with minimal differences noted between Group C and Group A in placental width. Conclusion: Metformin demonstrated more favorable effects on placental morphology compared to dietary control, with results comparable to those observed in normal pregnancies.

Efficacy and safety of Infliximab biosimilar, REMSIMA® in treatment of chronic plaque psoriasis.

Nabigha Khalid — 2025-05-01

Objective: To assess the efficacy and safety of REMSIMA®, a biosimilar of infliximab in treatment of chronic plaque psoriasis. Study Design: Non-randomized Clinical Trial. Setting: Departments of Dermatology, GTTH and SIMS Lahore. Period: April, 2022 to July, 2023. Methods: A multi-centered study conducted in Dermatology Departments of GTTH and SIMS Lahore after permission from IRB (Ref. No. LM&DC/ 5366-67/2022 dated 14.4.2022). Informed consent obtained for treatment with REMSIMA 120mg S/C given at 0,1,2,3,4,6,8,10 and 12 weeks. PASI was calculated at 0,4,8 and 12 weeks. Efficacy was measured as achievement of PASI-75 at 12 weeks. Relapse was checked on monthly regular follow ups till 24 weeks. Results: A total of 51 diagnosed patients of chronic plaque psoriasis were enrolled (1 was lost to follow-up, 1 had continuous fever, 1 discontinued due to elevated LFT’s) 48 continued the treatment (72.9% males, 27.1% females) with age 18-59 years. Disease duration was >10 years in 20 patients and <10 years in 28 patients. Prior systemic treatment was taken by 75% patients. Average PASI was 22.50 at baseline. Results at 12 weeks post-treatment showed that PASI-75 was achieved by 93.75% patients with average PASI being 1.24 (p<0.001). Adverse events were noted in 4 (8.3%) patients i.e 3 had recurrent upper respiratory tract infections and 1 patient had dizziness and sweating post 1^st dose. Relapse was observed in 5 patients. Conclusion: Remsima is efficacious and safe, although expensive but the patient can be shifted to cost-effective therapy once the disease is controlled.

Assessment of oral health indices and heart rate variability in relation with oral and cardiovascular health.

Syeda Gulrukh Shah — 2025-05-01

Objective: To explore the relationship between oral health and cardiovascular health. Study Design: Cross Sectional Analytical study. Setting: Dental OPD, Baqai Dental College Karachi, Pakistan. Period: Jan 2023 – May 2023. Methods: The study participants older than 18 years were voluntarily recruited. Heart Rate Variability (HRV) recordings were taken for six minutes by applying HRV sensors either on index finger or ear lobe in relax sitting position according to the choice of study subjects. Dental health of participants DMFT and PDL indices were calculated, and the results were compared with HRV variables. Results: There was a significant increase in frequency of decayed, filled and missing teeth in older aged male and female participants. The periodontium of young participants were more healthier. Heartrate variability results show higher sympathetic predominance in participants with increased DMFT and PDL scores. Moreover, stress index and internal coherence levels is low with age in both male and female groups. Conclusion: Findings from this study suggest that participants with dental problems (tooth decay and poor oral health) have high sympathetic predominance and low Heart rate variability and poor cardiac health status. This study highly suggest the relation between poor oral health association with mortality of cardiac diseases.

Perception among gastroenterologists to artificial intelligence in a low middle income setting.

Lubna Kamani — 2025-05-01

Objective: To determine the perception among gastroenterologists to artificial intelligence (AI) in a low middle income setting. Study Design: Cross Sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: June 2023 to June 2024. Methods: Study included 200 participants. The perception of participants regarding AI was evaluated through self-administrated questionnaire. Scores for questions were coded as 1,2,3,4 and 5. Participants entered their responses regarding use of AI. The perception of participants regarding AI was considered positive when participants achieved a composite score ≥4. Data were analyzed using IBM-SPSS Statistics version 26.0. P-value ≤0.05 was considered as significant. Results: Among study participants, 155 (77.5%) were male. Mean age was 34.61±7.41 years. There were 115 (57.5%) residents/fellows, followed by 58 (29%) consultants. Thirty (15.0%) respondents said that they have used AI, among them 22 (73.3%) had used this for at least 10 times. Positive opinions were noted by 94 (47%) gastroenterologists in our investigation. Significant association between gastroenterologists' perceptions of AI with gender (p=0.000), the total number of endoscopies performed each week (p=0.009), and use of AI (p=0.002) was documented. Male gastroenterologists were found more likely to have positive perceptions, (OR=2.079, p=0.039). Compared to gastroenterologists over 35 years, those under 35 were less likely to have a positive perception. (p=0.075, OR=0.571). Conclusion: Gastroenterologists showed positive perspectives towards AI. This study discovered a significant association between gastroenterologists perceptions of AI with gender, total number of endoscopies performed each week, and use of AI.

Comparison of ultrasound guided intraarticular shoulder injection and suprascapular nerve block versus ultrasound guided intraarticular shoulder injection in pain management of frozen shoulder patients.

Hajra Shuja — 2025-05-01

Objective: To compare ultrasound guided intraarticular shoulder injection and suprascapular nerve block versus ultrasound guided intraarticular shoulder injection in pain management of frozen shoulder patients. Study Design: Quasi Experimental study. Setting: Department of Anesthesia and Pain Medicine, Shaikh Zayed Hospital, Lahore. Period: Sep 2023 to Feb 2024. Methods: Patients aged 18 years and above presenting with symptoms consistent with frozen shoulder, confirmed through clinical evaluation and imaging studies. Patients with history of shoulder surgery, concomitant shoulder pathology were excluded. Participants were allocated to two groups: Group A received ultrasound-guided intraarticular shoulder injections, while Group B underwent a combination of ultrasound-guided intraarticular shoulder injections and suprascapular nerve blocks. The primary outcome measure was pain intensity assessed using the Visual Analog Scale (VAS) at baseline and follow-up intervals (2nd day, 1st week, 2nd week, and 4th week post-intervention). Secondary outcome measures included passive and active range of motion (ROM) of the shoulder joint assessed using a goniometer at corresponding time points. Collected data were processed and analyzed using IBM SPSS, version 27.0. Results: Mean age of patients in Group A was 50.04 ± 12.45 years and that of Group B was 50.60 ± 11.64 years with majority of them being females in both groups. Mean duration of the condition was 3.65 ± 1.08 months and 3.36 ± 1.31 months in Group A and B, respectively. At the time of enrollment into the study, the mean VAS score in Group-A was 7.20 ± 1.12 and in Group-B was 7.12 ± 0.93 without any statistical difference (p=0.784). On the 2nd day, Group A exhibited a significantly lower mean VAS score compared to Group B (p = 0.004). Statistically significant improvement in active as well as passive ROM was recorded following intervention in both the groups. This improvement was observed in all directions of motion. At first follow-up (2nd day) following intervention the improvement in passive and active abduction, flexion and extension were comparable in the two groups (p>0.05). Conclusion: In conclusion, our study highlights the significant advantage of Group A over Group B in achieving greater passive range of motion post-surgery, particularly evident in abduction, flexion, extension, internal rotation, and external rotation. These findings emphasize the potential benefits of tailored rehabilitation protocols in optimizing functional outcomes following shoulder surgery.

Osteonecrosis of hip in COVID-19 survivors; A case series study.

Awai Nawaz Khan — 2025-05-01

Osteonecrosis or avascular necrosis (AVN) of the hip, is a condition where bone degenerates over time due to a disruption in blood supply. After Covid-19 pandemic, lots of complication secondary to covid-19 were reported, one of them is hip AVN, the Covid-19 induced hip AVN resulted as complication of Covid-19 and not a complication of steroids used in these patients. It is a case series consist of 4 cases that were Covid-19 survivors and presented with hip pain and diagnosed as BL hip AVN with history of steroid used in suboptimal doses that has not been reported to cause hip AVN. After confirmation of diagnosis as covid induced hip AVN and rule out other possible causes of hip pain, we did core decompression in 3 patients bilaterally and in 1 patient unilaterally and unilateral Total hip replacement in 1 patient as treatment modality. In covid-19 survivor with hip pain, Covid-19 induced hip AVN must be keep in mind as differential diagnosis.