The Professional Medical Journal

Paternal depression in Pakistan: An overlooked concern.

Khadeeja Ishtiaq — 2025-01-11

Paternal depression, though gaining global attention, remains a largely overlooked issue in Pakistan, where cultural norms and societal expectations often discourage fathers from expressing emotional vulnerability. This commentary examines the prevalence, risk factors, and consequences of paternal depression in Pakistan, drawing comparisons with international studies. Emerging evidence suggests that paternal depression in Pakistan may be more prevalent than previously thought, with similar rates found in other low- and middle-income countries. Key risk factors identified include financial stress, relationship difficulties, and lack of social support, all of which are particularly pronounced in Pakistan’s socio-economic and cultural context. The impact of paternal depression extends beyond the father, influencing family dynamics, child development, and maternal mental health. Children of depressed fathers are more likely to experience behavioral and emotional challenges, while the mother’s mental health may also deteriorate due to the added burden. This paper advocates for increased awareness, culturally sensitive interventions, and the integration of mental health screenings for fathers within maternal and child health services. Addressing paternal depression is crucial for improving family well-being, child development, and long-term public health outcomes in Pakistan.

Pulmonary function testing patterns in patients recovering from COVID-19, a prospective observational study.

Bughdad Khan — 2025-01-11

Objective: To determine the frequency of abnormal pulmonary function tests and their pattern after four weeks in patients recovering from COVID-19. Study Design: Survey-based Cross Sectional Observational study. Setting: COVID 19 Isolation Ward, Khyber Teaching Hospital, Peshawar. Period: June 23, 2021, to December 21, 2021. Methods: This study was conducted on 183 patients aged 18 – 70 years of either gender having severe or critical COVID-19 pneumonia necessitating admission to COVID-Unit were enrolled using a non-probability consecutive sampling technique. Discharged patients of COVID-19 were called for follow-up after 4 weeks of discharge, and a pulmonary function test was done to determine the frequency of abnormal pulmonary function tests and their pattern after COVID infection. Results: In our study total of 183 patients were enrolled with a mean age of 36.3±14.6 years. There were 53% male and 47% female patients. The mean height was 155.06 ± 13.3cm, the mean weight was 71.4±11.2 kg, and the mean BMI was 29.7±5.8kg/m2. Abnormal pulmonary function tests were present in 32.8% of patients. Among these patients, 49 (81.6%) had restrictive patterns, while 11(18.3%) patients had an obstructive pattern on spirometry. Conclusion: Patients infected with COVID-19 showed deranged lung function, with most patients having a restrictive type pattern 4 weeks after being discharged from the hospital.

Real world experience of acute pulmonary embolism presented to a dedicated tertiary cardiac care center.

Mohammad Waleed — 2025-01-11

Objective: Pulmonary embolism is an uncommon disease with clinical presentation ranging from completely asymptomatic to hemodynamic instability and cardiopulmonary arrest. In this article we intend to highlight incidence, management and outcomes of disease in patient presenting to a tertiary cardiac center with acute pulmonary embolism. Study Design: Observational Cross-sectional study. Setting: Peshawar Institute of Cardiology, Peshawar. Period: 1^st Sept, 2022 to 31^st August 2023. Methods: All patients who underwent in-hospital Computed tomography pulmonary angiogram (CTPA), at out center. We collected data of all patient who were with CTPA proven pulmonary embolism via non-probability convenient sampling method. We accessed our local radiology and clinical databases for data collection. The collected data was integrated in SPSS version 23 for statistical analysis. Results: A total of 33 patients with CTPA proven pulmonary embolism were included out of which majority of patients were intermediate risk i.e., 20(71.4%). Management strategy used mainly was anticoagulation 27(81.8%). Regarding outcomes, 3(9.1%) expired while 30(90.9%) patients were discharged home successfully. Conclusion: Pulmonary embolism is not as uncommon as previously thought. A proper workup for its diagnosis and risk factors identification specially in young patients will not only improve management strategies but also quantify future risk of recurrence. Management of intermediate risk patient poses problems; this class of patients need strict monitoring for any clinical deterioration. Among these patients’ careful selection for thrombolysis to avoid deterioration has to be balanced with high risk of bleeding. In some high bleeding risk group catheter-based therapy may be an option.

Patterns of dengue rash in patients presenting with dengue fever in emergency.

Alvia Saad — 2025-01-11

Objective: Patterns of Dengue Rash in Patients Presenting with Dengue Fever in Emergency. Study Design: Descriptive study. Setting: Emergency Department, Ziauddin Hospital. Period: September 2022 to October 2022. Methods: The sample size of study was n=250. The study was conducted in dengue endemic months on patients presenting in emergency department with confirmed dengue fever patients with serological testing positive of either gender and age 14yrs-60yrs with different clinical manifestations of dengue fever. All the patients with other febrile illness associated rash like measles, previous dermatological conditions were excluded from the study. Results: The mean age of the patients was 35.68±10.7 yrs. The frequency of males and females was n=129:121 (51.6%:48.4%). Mostly the patients presented from 20-35yrs of age were n=137 (54.8%), 36-50yrs n= 86(34.4%), n= 27(10.8%) for 51-60yrs of age. Of total cases enrolled, n=40 patients presented with an atypical rash resembling morbilliform n=10, n= 12 present with itchy rash with red patches of skin and raised border, n= 8 with itchy papular shutter cock resembling rash, and n=10 with isolated rashes involving only palms and soles with moderate to severe pruritus. Conclusion: Increasing incidence and emergence of different strains are associated with atypical rash further serotype testing for other types in dengue are required.

The 30 days readmission among patients with upper GI bleeding and its causative factors: An experience of tertiary care hospital in Karachi.

Narjis Raza — 2025-01-11

Objective: To determine frequency and factors causing 30 days readmission rate among patients of upper gastrointestinal bleeding (UGIB) at a tertiary care hospital. Study Design: Prospective Cohort study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: July 2023 to June 2024. Methods: A total of 192 patients of either gender, aged 18 years or above, and admitted in hospital with UGIB were analyzed. Patients demographic, clinical and laboratory data were gathered. The final study outcome variable was 30 days all cause readmission. Data was entered in SPSS version 26 to perform statistical analysis. Results: Total 192 patients were studied mean age of 54.9 ± 13.2 years. Most of patients were males (80%). Presenting symptoms included melena (39.4%), hematemesis (47.4%) and drowsiness (5.7%), vomiting (4.2%), fever (2.1%) and SOB (2.1%). Readmission rate was 20.8%. Causes of readmission are rebleeding (80%), infection (2.6%) and electrolyte imbalance (1.6%). Increasing sodium levels were also associated with lower readmission risk. Increasing INR was associated with increasing readmission risk. Conclusion: This study concludes that 30 days readmission rate among UGIB patients is noticeably high. Rebleeding, infections, and electrolyte imbalance were the most common factors behind readmission among UGIB patients.

Optimizing patients’ outcomes: A comparative study of angiography and angioplasty procedures.

Shams ul Islam — 2025-01-11

Objective: To compare angiography and angioplasty, assess how they affect patient outcomes, and pinpoint variables that could maximize each procedure. Study Design: Retrospective Cohort study. Setting: Afridi Medical Complex (AMC). Period: Jan. 2021 to Jan 2022. Methods: Comparing the outcomes of patients who underwent coronary angiography and those who underwent percutaneous coronary intervention (PCI), commonly referred to as angioplasty. Patients included adult patients aged 18 years and older who were diagnosed with CAD and underwent either coronary angiography or angioplasty procedures. Those with incomplete medical records, emergency revascularization, and concomitant procedures such as coronary artery bypass grafting (CABG) were excluded. Results: A total of 150 patients were included in this study, with a mean age of participants (57 ± 15.345), male predominance 67% compared to females 33%. Of the total population, 19.3% presented with dyslipidemia. Comparative analysis of angiography and percutaneous coronary intervention (PCI) procedures reveals notable differences in outcomes and complications. Cardiogenic shock was significantly more frequent in the PCI group 3.5% compared to the angiography group 2%, with a p-value of 0.04 indicating statistical significance. Conclusion: In conclusion, while angioplasty offers significant advantages in terms of symptom relief and functional outcomes, the role of angiography in diagnostic precision cannot be understated. Both procedures have distinct benefits and risks, and their use should be tailored to individual patient needs.

A comparative study of efficacy and safety of combination of Indacaterol and Tiotropium versus Conventional Combination Formoterol Budesonide & Tiotropium in moderate to severe COPD.

Saif ur Rahman — 2025-01-11

Objective: To compare the efficacy and safety of indacaterol with tiotropium versus conventional formoterol/budesonide with tiotropium combination in patients with moderate to severe chronic obstructive pulmonary disease. Study Design: Randomized Controlled Trial. Setting: Department of Pulmonology, PIMS Hospital, Islamabad. Period: January to August 2019. Methods: This study has recruited 88 patients between the ages of 40 – 70 years with complaints of moderate to severe degrees of COPD. The population was randomized and divided into two groups. Group A patients were instructed to use indacaterol 150mcg and tiotropium 18mcg DPI once a day and Group B patients were instructed to use formoterol/budesonide (12/400) DPI twice daily along with tiotropium 18mcg DPI once daily. Patients were followed up for improvement in FEV 1 with spirometry at 4 weeks and 8 weeks. The efficacy of both treatments was ascertained by estimating percentage improvement in FEV1 from baseline at 4 and 8 weeks and compared in both groups. Results: In total, there were 88 participants divided into two equal groups. At 4 weeks after the initiation of therapy, the mean FEV1 in group A was 1.98 L ± 0.52 SD and it was 1.89 L ± 0.53 SD in group B (p=0.429). At 8 weeks after the initiation of therapy, the mean FEV1 in group A was 2.01 L ± 0.53 SD and it was 1.91 L ± 0.52 SD in group B (p=0.419). Among the age group 40- 55 years, at 4 weeks, the percentage improvement in FEV 1 from baseline was 16.65% ± 7.62 SD in group A and it was 6.04% ± 3.57 SD in group B (P=0.001). At 8 weeks, the percentage improvement in FEV 1 from baseline was 18.12% ± 7.56 SD in group A and it was 7.56% ± 3.47 SD in group B (P=0.001). Among the age group 56-70 years, at 4 weeks, the percentage improvement in FEV 1 from baseline was 15.56% ± 7.19 SD in group A and it was 7.25% ± 3.08 SD in group B (P=0.001). At 8 weeks, the percentage improvement in FEV 1 from baseline was 17.21% 7.13 SD in group A and it was 8.78% ± 3.17 SD in group B (P=0.001). Conclusion: The results indicate that the fixed dosage of indacaterol and tiotropium has provided a better prognosis in increasing FEV1 and improving lung function.

Spectrum of microorganisms identified in diabetic foot ulcers; Latest trends in underdeveloped countries.

Syeda Hina Abbas — 2025-01-11

Objective: To see the common microorganisms infecting diabetic foot ulcers in a tertiary care hospital of Sindh, Pakistan. Study Design: Cross Sectional Descriptive study. Setting: Department of Medicine Civil Hospital, Karachi. Period: June 2023 to November 2023. Methods: It included 102 patients of all ages and gender, who consented to participate and presented with diabetic foot ulcer. Their demographic data and data of isolated microorganism obtained from wound were recorded and analyzed in SPSS version 24. Results: There were 102 patients in our study who visited OPD as case of DFU and consented to take part in study. Mean age was 57.19 ±11.68 Years 24- 90- years patients were included. The highest number of patients 65 (63.7%) were in the 46-65 years age group, followed by the age group of more than 65 years with 21 (20.6%) of the patients. There were 31 (30.4%) females and 71 (69.6%) patients were males. The ratio of male-to-female participants was 2.2:1. Wagner grade of lesion was 40 (39.2%) were in grade 2 followed by 23 (22.5%) grade Mean age of patients who develop infection in their diabetic foot ulcer i.e. DFI was 56.64 ± 11.62 Years 24- 90- years. Patients were included. The highest number of patients 48 (64.4%) were in the 46-65 years age group, followed by the age group of more than 65 years with 17 (22.7%) of the patients. There were 25 (33.3%) females and 50(66.7%) patients were males. Mean duration of diabetes was 3.83 ±1. Wagner grade of lesion was 27(36%) were in grade 2 followed by grade 3 and 4 which was 18(24%) each. Among the 75 cases from which pathogens were isolated 46(61.3%) were monomicrobial and 29(38.7%) were Polymicrobial. Based on gram staining, 70.67% were gram negative isolates 18.67%were gram positive isolates and 10.67% mixed gram positive and negative isolates. Overall, pseudomonas auraginosa was commonest microbe isolated (41.3%) followed by Klebsiella which is 17.33%. MRSA was commonest among gram positive organism isolated from wound. Conclusion: Diabetic foot ulcers predominantly get infected by Gram negative bacteria. Proper hygienic practices must be encouraged. Appropriate educational programs targeting awareness for diabetes and related complications must be developed to prevent DFU in this cohort of population.

Functional outcome of limb sparing surgery of shoulder girdle tumors after free vascularized fibular flap.

Syed Asif Shah — 2025-01-11

Objective: To share the functional outcome of free vascularized fibular flap for shoulder reconstruction using Toronto Extremity Salvage Score (TESS). Study Design: Descriptive Cross-sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2023. Methods: All the patients presented with biopsy proven sarcoma involving proximal humerus were included in this study. Informed consent for data collection was obtained. Patient data regarding demographics, tumor location, extent of lesion, reconstruction and complications was collected from patient records. Six month follow up was done to assess functional recovery of the patient. Toronto Extremity Salvage Score (TESS) was used 6 months post-operatively to assess recovery of the patient using TESS questionnaire. Patient data was analyzed in using an open source software, GNU PSPP version 2.0.0. Results: A total of 11 patients were included in this study. Mean age of the patients was 15±3.5 years. Eight patients (72.7%) were male while 3 (27.3%) were female. Two patients has post-operative bleeding and 1 patient had fracture of fibula. Average TESS score was 61±7.71 years. Eight patients (72.7%) reported a good TESS score while 4 (27.3%) patients scored poor on TESSS Questionnire. Conclusion: Reconstruction of shoulder in sarcoma patients is a complex problem. Both prosthetic and biological reconstructive options present their own set of issues. In our experience, the use of free vascularized fibular flap (FVFF) presents a much better option with lower rate of infection and on average good Toronto Extremity Salvage Score (TESS) Scores.

Inguinal hernia: A hereditary disorder.

Imamuddin Baloch — 2025-01-11

Objective: To determine that inguinal hernia is an inherited disease running in families. Study Design: Prospective Observational. Setting: Surgical Unit I & III of Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Period: June 2017 to May 2022. Methods: A total of 1590 patients of inguinal hernia who presented to surgical OPD or emergency of GMMM College were included in the study. A detailed history was taken and examination done. Important parameters noted were age, gender, occupation, family history of inguinal hernia, degree of relative with inguinal hernia, type of inguinal hernia, primary or recurrent Hernia. Results: Out of total 1590 patients, 1499 (94%) were males and 91 (5.75%) females with male to female ratio of M: F=16.47:1 (Figure-1). Age ranged from 6 to 81 years with mean age of 52.32±15.25 years (Table-I). Out of 1590 patients, 1558 (97%) patients had primary while 32 (3%) had recurrent hernia. Out of 1590 patients, 1081 (68%) patients had direct hernia whereas 509 (32%) had indirect hernia; 843 (53%) were right sided, 722 (45.4%) left sided and 25 (1.6%) were bilateral hernia. Out of 1590 patients, 1312 (82.52%) had positive family history of inguinal hernia whereas 278 (17.48%) had negative family history for inguinal hernia. Out of 1312 with positive family history 971 (74%) patients had first degree relative with hernia, while 341 (26%) had 2nd degree relative with hernia (Table-II). Out of 32 cases of recurrent inguinal hernia, 22 (68.8%) had positive history of 1st degree relative with hernia, 9 (28.1%) had second degree relative with hernia whereas only 1 (3.1%) had negative family history for hernia. Conclusion: Our study concludes that family history of inguinal hernia poses a significant risk for developing hernia.

Efficacy of tamsulosin in patients with lower urinary tract symptoms due to benign prostate enlargement and having intravesical prostate protrusion.

Suaiba Ali — 2025-01-11

Objective: To study the efficacy of Tamsulosin in patients with IPP due to BPE. Study Design: Descriptive study. Setting: Department of Urology, Madinah Teaching Hospital Faisalabad. Period: Oct 2020 to April 2021. Methods: After approval from ethical review comity and informed consent a total of 96 male patients between the ages 50-90 years who had LUTS due to benign prostate enlargement of ≥30g were included in the study. Patients with no IPP or having uncontrolled hypertension / diabetes were excluded from the study as well as those having LUTS due to any other etiology e.g. neurogenic bladder or bladder stone. IPSS was calculated for all the patients and entry was made in the research pro forma. All patients received Cap. Tamsulosin 0.4 mg at bedtime for 2 weeks. On follow up in outpatient department, IPSS was calculated again and any improvement of 3 points of the IPSS score was taken as significant and as an evidence of efficacy of Tamsulosin. All the data including any complication was collected and secured on the pro forma. Results: Pretreatment and post treatment mean IPSS was calculated to be 19.54 ± 5.87 and 17.27 ± 4.29 respectively. Frequency of efficacy of Tamsulosin in patients with Intravesical prostatic protrusion due to benign prostatic enlargement was recorded in 42.71% (n=41) whereas 57.29% (n=55) had no efficacy. Stratification with regards to grade of IPP shows that 12 of 25 cases of grade I, 19 of 40 cases in grade II and 10 of 31 cases in grade III had efficacy, p value was 0.23. Conclusion: We concluded that tamsulosin is effective in patients with intravesical prostatic protrusion due to benign prostatic enlargement, however, further trials are required to validate our results.

Pterional craniotomy-induced temporalis muscle dysfunction: A neurosurgical exploration and functional implications in Tertiary Care Hospitals.

Aurangzeb Kalhoro — 2025-01-11

Objective: To highlight which surgical dissection of temporalis muscle is associated with temporalis muscle dysfunction. Study Design: Retrospective Comparative Cross-sectional Study. Setting: Liaquat University of Medical and Health Sciences, Jamshoro. Period: March 2018 to February 2023. Methods: All patients were included in study who came with complain of temporalis muscle dysfunction and previously had craniotomy. The patients those were included in this study were those who came for craniofacial pain or referred from maxillofacial department and had craniotomy done previously in our department or any other tertiary setup. Results: Total numbers of 54 patients were included in study with mean age 43.55 year with predominated male 55.6%. Cerebral tumor (50%) and trauma (42.6%) was the most common pathologies that were addressed. Submusclar technique was used in 50% of patients, the most common presentation was pain (74%) and most cases presented with in less than 3 months (51.8%). Conclusion: Subfacial technique is associated with less percentage of temporalis muscle dysfunction as compare to other surgical technique which is not statistical significant.

Correlation between grade of the tumour and HER2NEU status in breast cancer.

Faiza Mahar — 2025-01-11

Objective: To evaluate the distribution of histological grades of breast cancer and its association with HER2/neu expression. Study Design: Cross-sectional study. Period: March 2024 to August 2024. Setting: Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Methods: Patients diagnosed with breast carcinoma, with complete records for molecular subtype and hormone receptor status, and no history of recurrent, metastatic, or multiple cancers. Exclusion criteria were patients who refused participation, had benign lesions, or received neoadjuvant chemotherapy prior to presentation, were analyzed. Demographics, tumor site, histological grade, stage at diagnosis, and hormone profile of the patients were documented using a structured questionnaire. Results: In a total of 286 patients, 233 (81.5%) were over 40 years old, while 164 (57.3%) were overweight or obese. There were 257 (89.9%) patients who belonged rural areas of residence. The family history of breast cancer was noted among 42 (14.7%) women. A significant percentage of participants were HER2/neu positive, with expression varying across different tumor grades. Almost all patients with Grade I, Grade III, and Grade IV tumors were HER2/neu positive (100%, 99%, and 100%, respectively), while a slightly lower percentage was observed in Grade II tumors (95.9%). Conclusion: The nearly ubiquitous HER2/neu positivity observed across most tumor grades, with only a slight reduction in Grade II tumors, underscores the high prevalence of HER2/neu expression in this population. Routine HER2/neu testing in Pakistani breast cancer patients seems important, irrespective of tumor grade, for prognosis and treatment decisions.

Relative Efficacy of Magnetic Resonance Cholangiopancreatography (MRCP) versus Ultrasound (USG) in detection of obstructive jaundice.

Aneeqa Noor — 2025-01-11

Objective: To compare the relative efficacy of Magnetic Resonance Cholangiopancreatography (MRCP) versus ultrasound (USG) in detection of obstructive jaundice. Study Design: Prospective Cohort study. Setting: Department of Radiology, Pakistan Air Force Hospital, Islamabad. Period: September 2023 to March 2024. Methods: A total of 144 consecutive patients, irrespective of age and gender, with clinical and laboratory features of obstructive jaundice that were referred to the radiology department for further evaluation were included. All patients underwent USG followed by MRCP, and their findings were compared using surgery/histopathology/ERCP as the gold standard for the final diagnosis. Results: This study enrolled 144 patients with obstructive jaundice, split into two age groups: 18-50 years (47.22%) and 51-89 years (52.77%). The gender distribution includes 78 males (54.16%) and 66 females (45.83%). Common symptoms were jaundice (27.08%), weight loss (26.38%), abdominal pain (23.61%), and fever (22.91%). Among the patients, 65.28% were diagnosed with positive obstructive jaundice. Diagnostic comparison between ultrasound (USG) and magnetic resonance cholangiopancreatography (MRCP) showed MRCP's superior sensitivity (100%), specificity (90.91%), positive predictive value (96.67%), negative predictive value (100%), and diagnostic accuracy (97.50%) compared to USG. Conclusion: Obstructive jaundice slightly affects older adults more than younger individuals and shows a slight male predominance. The symptoms vary, necessitating comprehensive diagnostic approaches. MRCP outperforms USG in all diagnostic metrics, establishing it as a more reliable tool for accurately detecting obstructive jaundice. This underscores the need for accurate diagnostic and therapeutic strategies to manage this condition effectively.

Unveiling the impact of neurodevelopmental disabilities on intra family dynamics: A phenomenological exploration.

Fareeha Latif — 2025-01-11

Objective: To explore perceived intrafamily challenges and experiences of having a child with neurodevelopmental disabilities and provide a multifacet impact of having NDD on three familial subsystems: Parental, Spousal and Sibling subsystem. Study Design: Descriptive Exploratory Phenomenological Design was utilized. Setting: The Children’s Hospital & Institute of Child Health, Lahore. Period: September 2022 to January 2023. Methods: Qualitative research method was used in current study. Sample X three families having a child diagnosed with NDD were included. Purposive sampling was used, with the inclusion of all members of the families. Families having only one child with NDD were included in the study. Results: Thematic analysis found two superordinate themes i.e. family role and societal factors, with five major themes i.e. father, mother and sister factors, coping strategies and family support. Conclusion: Families having autism spectrum disorder children had relatively more stress than families of having children with other developmental disabilities. Mothers were reported to face more emotional reactions than fathers. Spirituality and spouse support was considered the most effective coping by mothers. Siblings faced mixed feelings in the presence of a child having NDD. Society needs awareness, acceptance, and sensitivity towards these families. More rehabilitation and treatment services need to be developed in Pakistan.

Magnitude of depression and anxiety in patients with irritable bowel syndrome: A comparative cross-sectional study.

Attique Rahman — 2025-01-11

Objective: To find out the magnitude of depression and anxiety in patients with irritable bowel syndrome (IBS) presenting at a tertiary care Gastroenterology clinic of Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi, Pakistan. Period: February 2022 to July 2022. Methods: Patients of both genders, aged 18 – 50 years and newly diagnosed IBS patients (as per ROME-IV criteria) were assessed. Patient’s attendants, hospital staff, and students without any symptoms of IBS were taken as healthy controls. Non-probability, consecutive sampling technique was adopted. Depression and anxiety were determined using hospital anxiety and depression scale (HADS). The collected data was entered and analyzed using IBM-SPSS Statistics, version 26.0. Chi-square test was applied to compare data taking p<0.05 as significant. Results: This study was conducted on 110 IBS and 110 healthy controls. The mean age of the IBS group was 32.81± 1.12 years while that of the healthy group was 37.60 ± 1.08 years. There were 47 (42.7%) males and 63 (57.3%) females in IBS group while 72 (65.5%) males and 38 (34.5%) females in healthy groups. The prevalence of anxiety was 52.7% and that of depression was 49% according to HAD Scale in IBS group (p<0.001). Conclusion: A strong association of IBS with anxiety and depression was noted, highlighting the necessity of screening for these disorders in gastrointestinal clinics.

Pattern of skin diseases in patients attending pediatric outdoor patient of a Tertiary Care Hospital of Bahawalpur, Pakistan.

Sohail Shahzad — 2025-01-11

Objective: To determine the pattern of skin diseases among patients visiting the Pediatric outpatient department of tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Outpatient, Combined Military Hospital, Bahawalpur, Pakistan. Period: August 2023 to February 2024. Methods: Children up to age of 12 years, attending the outpatient department for skin disorders were included in the study. Consultants with Postgraduate qualifications in Pediatrics made the diagnosis & consultations from Dermatology department were also obtained. Results: A total of 300 patients were included in the study, consisting of 60% males and 40% females, with a mean age of 2.29 years (± 1.19 years). The age group distribution indicated that 34% of participants (n=102) were under 1 year of age, while 27.3% (n=82) were between the ages of 6 to 10 years. Infectious diseases and infestations were the most prevalent skin conditions, affecting 66.36% of participants. This was followed by eczema (n=46,15.33%), hypersensitivity (n=22,7.33%), and disorders of sweat and sebaceous glands (n=23,7.66). Among the infections, bacterial infections were the most common (23%), followed by fungal infections (18.33%) and viral infections (6.3%). Conclusion: Infections and infestations together constituted 66.36% of the cases. Bacterial infections, along with scabies and fungal infections were the most common disorders observed followed by eczematous disorders. Education regarding good hygiene and proper care can eventually help.

Medication errors in pediatric intensive care unit and measures to improve it.

Zara Shafqat — 2025-01-11

Objective: To ascertain the prevalence of medication mistakes among pediatric patients who are hospitalized to the critical care unit at Fatima Memorial Hospital in Lahore. Study Design: Cross-sectional study. Setting: Pediatric Intensive Care Unit, Fatima Memorial Hospital, Lahore. Period: December 2022 to December 2023. Methods: 131 health care workers and patients were interviewed and medication errors were categorized accordingly. Medication error was labeled as errors arising in prescribing, administration, and transcribing of medicines by the healthcare staff to the patients admitted to PICU. Data was entered and analyzed in SPSS version 25. Results: In this study, the average age of health care workers was 34.26 ± 9.07 years. Out of 131 candidates, 71 (54.2%) were males and 60 (45.8%) were females. Among them, 36 (27.5%) were doctors, 45 (34.4%) were nursing staff and 50 (38.2%) were technicians. The total work experience was 9.60 ± 5.96 years. The average age of children admitted in ICU was 7.31 ± 3.68 years. Out of 131 candidates, 64 (48.9%) were males and 67 (51.1%) were females. Out of 131 patients, medication error was noted in 27 (20.6%) cases. The most common type of medication error was prescription error [12 (9.2%) cases], followed by administration error [8 (6.1%)] and transcription error [7 (5.3%)]. Conclusion: The occurrence of medication error is although less in local setting, but not negligible. So further trials should be done and interventions should be made to lessen don the medication errors.

Effectiveness of liver biopsy in diagnosing liver diseases using a five-point diagnostic scale among pediatric population.

Quratulain Ahmed Alvi — 2025-01-11

Objective: To determine the effectiveness of liver biopsy using a five-point scale for establishing the diagnosis of underlying liver diseases in children with unexplained derangement of liver function tests. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health Karachi, Pakistan. Period: 1^st February 2024 to 30^th July 2024. Methods: A total of 221 patients were enrolled setting the inclusion criteria as children of either gender of age up to 14 years with deranged liver function tests and unexplained diagnosis warranting liver biopsy, or those in whom ultrasound abdomen and CT scan findings indicated liver diseases requiring biopsy for diagnosis. A 5-point scale was used for confirming the diagnostic yield of the liver biopsy. Results: In a total of 221 children, 120 (54.3%) were male. The median age was 3.00 (1.30-6.00) years. The most common diagnosis at the time of admission were chronic liver disease, glycogen storage disease, and Neimann-Pick disease, 102 (46.2%), 53 (24.0%), and 21 (9.5%) patients, respectively. For CLD, the sensitivity and specificity were 55.4%, and 90.8%, respectively. Chronic liver disease with portal hypertension showed a sensitivity of 82.4% and specificity of 100%, while neonatal cholestasis exhibited 100% sensitivity and specificity. Glycogen storage disease also demonstrated high sensitivity and specificity at 94.3% and 98.2%, respectively. Conclusion: The five-point scale used in our study provides a comprehensive framework for interpreting biopsy results and guiding clinical management.

Frequency of urinary tract infections and antimicrobial susceptibility profile among pregnant females.

Alia Waheed — 2025-01-11

Objective: To assess the frequency of UTIs in pregnant females. Study Design: Cross-sectional study. Setting: Department of Gynae and Obstetric, Akhter Saeed Trust Hospital, Lahore. Period: September 2023 to February 2024. Methods: The study was conducted on 300 urine samples collected from pregnant females. Firstly, the urine samples were analyzed for routine examination. A urine culture was performed on CLED agar. The antimicrobial susceptibility testing was done by using the modified Kirby-Bauer method. The obtained results were recorded and analyzed by using SPSS 25.0 software. Results: The mean age of pregnant females was 26.7±4.510. Among 300 urine samples, 120 samples showed positive growth on CLED agar. The growth of Escherichia coli (38.33%) was the highest among them followed by Pseudomonas aeruginosa (25.00%), Candida species (20.09%), and Klebsiella species (16.66%). Conclusion: The overall frequency of UTI in pregnant females was high and, in this study, it was reported to be 40.00%.

Frequency of abruptio placentae in preterm premature rupture of membranes.

Aneela Mumtaz — 2025-01-11

Objective: To determine frequency of abruptio placentae in preterm premature rupture of membranes. Study Design: Analytical Cross-sectional Description. Setting: Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar. Period: April 23, 2021 to April 23, 2022. Methods: We enrolled 326 patients aged 18 to 35 years, all of whom had singleton pregnancies and presented with preterm premature rupture of membranes (PROM) that occurred less than 48 hours prior to their presentation. These assessments were conducted in both the outpatient and emergency departments to confirm instances of preterm PROM, identified by the pooling or leakage of amniotic fluid in the backside of vaginal vault or from the cervix during examination. Patient follow-up extended from their admission into the Obstetric suite until delivery. Abruptio placentae was diagnosed in cases where a normally positioned placenta separated after 28 weeks of gestation. This diagnosis was supported by ultrasound findings and clinically by symptoms such as painful abdomen during physical examination, whether bleeding per vagina is present or not (between 200 to 400 ml) and the presence of retroplacental clots post-delivery. Results: In our research of 326 patients, 35% (approximately 114 patients) were experiencing their first pregnancy (primigravida), while 65% (approximately 212 patients) had been pregnant before (multigravida). The research found that 6% of the total patients (about 20 patients) experienced placental abruption. This indicates an important correlation of preterm premature rupture of membranes and placental abruption. Regarding the gestational period, 124 patients (38%) were under 34 weeks of gestation, whereas 202 patients (62%) were over 34 weeks. The age distribution was also analyzed: 147 patients (45%) were between 18 to 25 years old, and 179 patients (55%) were between 26 to 35 years old. The average age was 31 years with A measure of variability of ± 9.74. After applying the post-stratification chi-square test, we obtained a P value of ≤0.05, indicating statistical importance. Conclusion: Preterm premature rupture of membranes is associated with a 6% risk of abruptio placentae.

Exploring the undergraduate medical students’ satisfaction with the urinary catheterization workshop and the factors affecting it; A Cross-sectional Survey.

Abdul Rashid — 2025-01-11

Objective: To assess the satisfaction level of final year medical students with urinary catheterization workshop and the factors affecting it. Study Design: Cross-sectional study. Setting: Wah Medical College, Wah Cantonment. Period: October 15th, 2023 to January 15th, 2024. Methods: Satisfaction level and factors for its improvement were assessed by using a questionnaire after conducting a mandatory workshop on the skill of urinary catheterization. All the 90 final-year MBBS students present on the day of the workshop were included in the study using purposive sampling technique. The data was analyzed by using SPSS version 25. Fisher's exact test was applied to assess the association of gender with satisfaction level of students considering a p-value lesser than 0.05 as significant. For the open-ended questions, quantitative content analysis was performed. Results: The mean age of the students was 23.6+1.1 years. 82.2% of the participants had a very high satisfaction level with the workshop. Difference was observed when the satisfaction level of the students was assessed across gender (p-value=0.02). 45.6% of the students rated the workshop as good in all domains. The identified factors that can improve satisfaction with the workshop include the provision of refreshments, making smaller batches for teaching, providing feedback after skill performance and giving more time for practice. Conclusion: The majority of the students were highly satisfied with the workshop. Around half of the participants regarded the workshop as good in all domains but the students identified some factors for the improvement of satisfaction level with the workshop.