The Professional Medical Journal

Prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital.

Payal Bai — 2024-11-03

Objective: To analyze the prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: Neonates of both genders aged between 1 to 28 days having confirmed neonatal sepsis were included. At baseline, demographic characteristics were noted and necessary laboratory investigations were performed. At baseline, serum procalcitonin levels were evaluated in all neonates. The prognostic value of baseline PCT was assessed by comparing its association with the mortality. Other outcome variables like need for non-invasive ventilation, mechanical ventilation, need for inotropics, and acute kidney injury were also documented. Results: In a total of 131 neonates, 76 (58.0%) were male. The median age was 2.00 days (IQR=1-7 days). The median baseline procalcitonin level was 3.17 ng/ml (IQR=0.55 to 10.34 ng/ml). Need for non-invasive ventilation, and mechanical ventilation was noted in 93 (71.0%), and 19 (14.5%) neonates, respectively. Need for inotropics was documented in 23 (17.6%) neonates. The median duration of NICU stay was 3.00 (2.00-5.00 days). Among neonates who died, procalcitonin levels were significantly higher than those who survived (p=0.015). Mortality was found to have significant association with need for mechanical ventilation (p<0.001), and need for inotropics (p<0.001). Conclusion: High serum procalcitonin was found to be a significant predictor of mortality in neonatal sepsis. Mortality was significantly associated with need for mechanical ventilation, and need for inotropics.

Effect of hospital nutrition program on growth of very low birth weight preterm babies.

Wasif Ijaz — 2024-11-03

Objective: To determine the effect of hospital nutrition program on growth of very low birth weight (VLBW) and extremely low birth weight (ELBW) babies. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of Recep Tayyep Erdogan Hospital, Muzaffargarh, Pakistan. Period: February 2024 to July 2024. Methods: Inclusion criteria were preterm newborns weighing below 1500 grams, admitted in NICU and who received total parenteral nutrition (TPN). VLBW was labeled as birth weight between 1000-1499 grams, while ELBW as birth weight <1000 grams. Hospital nutrition program included TPN plus orogastric feed or nasogastric feeding plus micronutrients. Effect of hospital nutrition program was described as effective if the baby at the time of discharge added 17-20 g/kg/day according to ESPHGAN recommendation. Results: In a total of 131 newborns, 69 (52.7%) were boys. The mean gestational age, and birth weight were 29.68±1.87 weeks, and 1024.50±144.23 grams, respectively. The mean net daily weight gain at the time of discharge was 12.77±3.63 grams. The effective hospital nutrition program was noted in 23 (17.6%) babies. Effectiveness of hospital nutrition program was significantly associated with higher birth weight (1094.78±114.41 vs. 1009.54±145.93 grams, p=0.010), very low birth weight versus extremely low birth weight (87.0% vs. 13.0%, p<0.001), head circumference ≥30 cm (87.0% vs. 53.7%, p=0.003), and gestational age > 28 weeks (87.0% vs. 57.4%, p=0.008). Conclusion: The hospital nutrition program had limited effectiveness, with only 17.6% of VLBW and ELBW infants achieving the recommended weight gain by discharge.

Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.

Muhammad Tanveer Alam — 2024-11-03

Objective: To characterize the clinical features of critically ill COVID-19 patients admitted to COVID-ICU and describe their outcomes. Study Design: Retrospective Observational study. Setting: Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Period: May 2020 to September 2021. Methods: The study aimed to investigate the clinical characteristics and outcomes of patients with confirmed or suspected COVID-19 who were admitted to the ICU. Patients in the study period confirmed or suspected COVID-19, admitted to the ICU for more than 24 hours, and committed to full treatment were included this study. Patients with COVID-19 discharged or died within 24 hours of admission were excluded. Results: The most commonly observed symptoms among the patients were shortness of breath (92.5%), fever (91.2%), cough without sputum (39.2%), altered consciousness (11.9%), and muscle aches (8.8%). Acute respiratory distress syndrome (ARDS) was identified as the most prevalent complication among COVID-19 patients, impacting 40.8% of the study population. A significant proportion of COVID-19 patients required mechanical ventilation and cardiac support. Specifically, (41.4%) of the patients required invasive mechanical ventilation, (47.4%) required non-invasive ventilation, and (26.3%) received cardiac support. Laboratory assessment showed that platelet counts varied significantly between survivors and non-survivors, with non-survivors exhibiting lower platelet counts. Gender differences were also observed among COVID-19 patients by age, with males having a higher mean age than females in all age categories, and the difference was statistically significant (p < 0.001) in all age categories except for the 30-44 years age category (p = 0.087). Age-wise recovery and mortality rates were analyzed, and the results showed that among both deceased and recovered patients, the proportion of deceased patients increased with age, while the proportion of recovered patients increased until the age range of 45-59 years for both males and females. The study found that 136 of the patients survived while 275 of the patients succumbed to the disease. Among the survivors, (31.3%) were male, and (36.2%) were female. Conclusion: The study emphasizes the importance of monitoring patients for potential complications and providing them with supportive care. Early detection and management of severe cases of COVID-19 are critical in preventing complications and improving patient outcomes.

Glycemic control and risk factors of mortality in patients with diabetes mellitus and COVID-19: A single center experience from Pakistan.

Jawahar Lal Langhani — 2024-11-03

Objective: To highlight the effect of COVID-19 and DM on each other by studying glycemic control and risk factors for mortality. Study Design: Retrospective Observational Review. Setting: Sindh Institute of Urology and Transplantation Karachi Pakistan. Period: March 2020 till March 2021. Methods: Covid-19 diagnosed patients admitted were enrolled. They were divided into DM and non-DM. Demographics, clinical variables and outcome were compared. Glycemic control during hospitalization was noted. Fasting glucose level >120 mg/dl, and random >200 mg/dl were considered as poor glycemic control. Survivors and non- survivors among DM patients were compared. Results: A total of 366 patients were included, 113(30.87%) DM and 253(69.12%) non-DM. Mean age was higher in DM group (58yrs vs 49.6yrs p <0.001). Significantly more patients with hypertension (p <0.001) and ischemic heart disease (p=0.001) developed Covid-19 in DM group. There was no difference in mortality (p = 0.295). In DM patients, the significant risk factors for mortality were age >60years, hypertension and chronic kidney disease. The mean high fasting and pre-dinner blood glucose levels at admission and day 5 were significantly associated with mortality. Conclusion: Diabetic patients with advanced age, hypertension and chronic kidney disease were associated with increased risk of death. More attention should be focused on dynamic monitoring and strict glycemic control as uncontrolled diabetes is associated with severe infection and mortality.

Association of breastfeeding and early cereal introduction with development of type 1 diabetes mellitus in children in Pakistan: Case study.

Ali Asghar Taseer — 2024-11-03

Objective: The aim of this study is to examine the association between type 1 diabetes mellitus development, breastfeeding and early cereal introduction in Pakistani children. Study Design: Case-control study. Setting: Allied Hospital in Faisalabad, Pakistan. Period: November 2023 to February 2024. Methods: Involving 220 children ranged from 2 to 10 years were selected for case (diagnosed with type 1 diabetes) and Control group (without diagnosed with type 1 diabetes). Researchers developed a questionnaire based on information about breastfeeding, cereal introduction and other factors associated with type 1 diabetes. Parents were requested to complete the questionnaire regarding their child, mother, and family. Results: The mean ages of children were slightly higher in the control group (6.2±5.5 years) compared to the case group (5.67±7.4 years). This research determined that a one-month cumulative increase in exclusive breastfeeding for the duration of the breastfeeding period decreased the individual risk by 47.8% to 13.9% less probability in type 1 DM case. Among cases, 47.8% of the children were exclusively breastfed for less than one month, which was very low, while in the control group, this proportion was lower at 30. 6%. Furthermore, more cases (22.6%) were exclusively breastfed for 6 months compared to controls (13.9%). Among cases, 45.5% of children did not consume formula, whereas in the control group, this percentage was lower at 54.2%. Additionally, a higher proportion of controls (39.8%) were introduced to the formula before 6 months compared to cases (30.0%). Cereals were introduced to 5.55% of cases and 3.12% of controls prior to six months of age. Conclusion: Children who were breastfed for a longer period of time had a lower chance of type 1 diabetes, while children who were introduced to cereal and other food at an early age had a higher risk of the disease. Extended breastfeeding lowers the risk of diabetes by offering important protective effects from birth.

Extent of iron induced organ damage in patients with hematological disorders.

Syeda Azka Waqar — 2024-11-03

Objective: To determine the extent of iron induced organ damage in patients of Haematological disorders who are transfusion dependent, presenting in the emergency department of SZH, Lahore. Study Design: Cross Sectional study. Setting: Department of Emergency, Shaikh Zayed Hospital, Lahore. Period: December 25, 2020 to June 24, 2021. Methods: A total of 100 patients aged 10-60 years, of both genders, diagnosed with haematological disorders, and receiving multiple blood transfusions were included in this study. Demographic details were noted including name, age, sex, diagnosis, duration of receiving transfusions and number of transfusions received per month. Patients were evaluated clinically for organ damage including pulmonary, hepatic, renal, and cardiac organs using Denver MOF score. Results: Mean age of patients was 35.33±14.27 years. Mean duration of receiving transfusion was 6.69±2.71 months. There were 67 (67%) males and 33 (33%) female patients. Primary diagnosis was Autoimmune Haemolytic Anemia (AIHA) in 18 (18.00%) patients, Aplastic anemia in 34 (34%) patients, Thalassemia in 37 (37%) patients and Myelodysplastic syndrome (MDS) in 11 (11%) patients. Multiple organ damage was found in 23 (23%) patients. Pulmonary damage was diagnosed in 21 (21%) patients, hepatic damage in 21 (21 %) patients, renal damage in 20 (20%) patients and cardiac damage in 15 (15%) patients. Conclusion: There is a high frequency of multi-organ damage in patients of Haematological disorders requiring chronic blood transfusions. In this study, multi-organ damage was diagnosed in 23% patients requiring chronic blood transfusion.

Prediction of outcomes of acute variceal hemorrhage in cirrhotic patients using platelet albumin bilirubin (PALBI) score.

Salimah Anwar Jussa — 2024-11-03

Objective: To determine the predictive ability of “platelet albumin bilirubin (PALBI)” scores in assessing outcomes among acute variceal hemorrhage (AVH) patients. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital. Period: September 2022 to September 2023. Methods: Cirrhotic patients with upper gastrointestinal bleed of either gender of age at least 18 years were included. Patients with malignancies and unwilling to participate were excluded. Patients were enlisted with their written informed consent. Data was analyzed using IBM-SPSS version 26. Results: Total 300 patients were enrolled into the study with mean age of 59.9 ± 10.4 years and majority were males (73.7%). According to endoscopic findings, small, medium and large esophageal varices (EV) were seen in 9%, 28% and 63% patients respectively. Rebleeding was seen in 27.7%. On multivariable model, none of the score including “Child-Turcotte-Pugh (CTP)” score, “Model of End-stage Liver Disease (MELD)” score, “albumin-bilirubin (ALBI)” score and PALBI score were found to be associated with rebleeding. During the study in-hospital mortalities were seen in 10.3% cases. In multivariable regression analysis, when adjusted for confounders, prediction score MELD and PALBI were found to be linked with in-hospital mortality. Conclusion: The present study found that PALBI predicting in-hospital mortality even after adjusting other confounders. However, PALBI was not a promising marker for prediction of re-bleeding.

Diagnosis of cystoid macular edema by comparison of pre-operation and post-operation macular thickness calculated by optical coherence tomography (OCT) after cataract extraction surgery with and without pre-operative use of NSAIDS.

Adil Rouf — 2024-11-03

ABSTRACT… Objective: To compare mean macular thickness after cataract extraction surgery with and without pre-operative NSAIDs. Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, Madinah Teaching Hospital, Faisalabad. Period: 21-10-2022 to 20-04-2023. Methods: Total 640 patients (320 in each group) were involved in the study. In group-A patients received one drop of NSAID three times a day for one day prior surgery. In group-B, patients not received NSAID. Results: Results showed that there was a total 395 males and 245 females. Mean age of the patients was 48.24±5.54 in group A and 47.05±5.20 in group B. Comparison of macular thickness showed that thickness was 215.69±14.20 in group A and 227.99±06.09 in group B. There was a significant difference in macular thickness of two groups (P <0.001). Conclusion: In conclusion, preoperative usage of NSAIDs revealed statistically significant (p0.001) and clinically relevant benefits in avoiding macular edoema and preserving visual acuity in patients undergoing cataract surgery as compared to the non-NSAIDs group.

Comparison of mean postoperative decrease in hemoglobin level in patients undergoing transurethral resection of prostate with and without preoperative intraprostatic epinephrine.

Hafeez Sohaib Ahmad Warraich — 2024-11-03

Objective: To determine and compare the mean decrease in hemoglobin level from the baseline value in patients undergoing TURP with and without preoperative intraprostatic epinephrine injection. Study Design: Analytical Cross Sectional study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Nov 2023 to Feb 2024. Methods: After ERC approval and taking informed consent a total of 40 patients with enlarged prostate and scheduled for TURP, having comparable baseline clinical and laboratory characteristics such as age, preoperative prostate size and baseline hemoglobin were enrolled in the study & were divided in two equal numbered groups called group A and group B, each having 20 patients in it. Before performing monopolar TURP group A patients were given 200mcg of intraprostatic epinephrine injection diluted in 20ml of normal saline (10ml in each right & left lobe) under transrectal ultrasonic guidance via the transperineal route, while no such intervention was done before TURP in group B patients. One pint of whole blood was transfused to the patients of both the groups intraoperatively and blood samples were sent to laboratory on 1^st post-operative day to determine the postoperative hemoglobin levels of patients of both the groups. Data was entered on the designated pro forma for analysis. Results: Postoperative hemoglobin levels were significantly higher in group A patients (mean and S.D 11.83 ±1.01 g/dl) as compared to the group B patients (mean and S.D 11.00 ± 1.06 g/dl) with a p value of 0.015, and hence drop of hemoglobin levels from the baseline values were lower in group A patients (mean and S.D 1.28 ± 0.89 g/dl) as compared to the group B patients (mean and S.D 2.31 ± 0.98 g/dl), confirming a statistically significant difference with p value of 0.001. Conclusion: The hemorrhage associated with TURP can be decreased significantly by giving preoperative intraprostatic epinephrine injection. This is a clinically safe technique that can not only reduce the postoperative blood transfusion requirements but can also allow the operating surgeon to resect more tissue within the desired time thus increasing the efficacy of TURP.

Comparison of outcomes of index and interval laparoscopic cholecystectomy in mild biliary pancreatitis.

Hamza Babar — 2024-11-03

Objective: To compare the outcomes of index and interval laparoscopic cholecystectomy in mild biliary pancreatitis in terms of duration of hospital stay. Study Design: Randomized Controlled Trial. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: January 2023 till June 2023. Methods: Patients were being admitted with acute biliary pancreatitis and undergoing either index or interval cholecystectomy. BISAP scoring system was used for severity of ABP and mild cases were included. Study outcomes in both groups (index and interval cholecystectomy) were determined. For quantitative variables mean and standard deviation were calculated. Frequency and percentages were used to describe qualitative variables. Results: Total of 70 patients divided into two groups were included in this study. Mean age of the study population was 40.44+/-7.90 years. Fifty-three percent of the population had BMI in the overweight category. Mean BISAP score was 1.11+/-0.80. All of the patients included in the study had mild acute pancreatitis. The length of hospital stay was significantly associated with timing of surgery with p-values 0.045. Conclusion: The surgical outcomes of index and interval cholecystectomy in acute mild biliary pancreatitis are comparable. However, early cholecystectomy has shorter duration of hospital stay.

Post operative outcomes of del-nido cardioplegia in adult cardiac surgery.

Ajab Khan — 2024-11-03

Objective: To evaluate the post-operative results for defibrillator use, length of hospital stay, and ionotropic support in adult patients who underwent cardiac surgery in Del-Nido Cardioplegia. Cardiac enzymes and potassium levels are measured before and after surgery in adult cardiac surgery patients in order to look for arrhythmias. Study Design: Observational Cross-sectional study. Setting: Afridi Medical Complex, Peshawar. Period: October 2022 to March 2023. Methods: 50 Patients were selected randomly by using Non-Probability Convenient sampling method technique. Results: In our study the mean age of patients was (50.92 ±9.429). Cardiac enzyme level post-op after 24 hours (67.3540±23.21292). Potassium level post-op group (4.5590± .65033), and length of hospital stay (8.58±1.486). Post operative outcomes shows significant association p value <0.05. Conclusion: This study concluded that Del Nido Cardioplegia is an intented and brief arrest of heart function, especially in cardiopulmonary Bypass surgery. Better myocardial protection is provided by Del-Nido Cardioplegia and it is very safe and effective process. It Provide good post operative outcome as are available in different literature reviews preceding our study.

The anatomical relationship between recurrent laryngeal nerve and inferior thyroid artery in thyroidectomy patients.

Rizwan Ali Qaiser — 2024-11-03

Objective: To identify the anatomical relationship of recurrent laryngeal nerve with inferior thyroid artery. Study Design: Prospective Clinical study. Setting: Department of Surgery, Kishwar Fazal Teaching Hospital. Period: July 2019 to February 2023. Methods: Total 64 patients underwent subtotal thyroidectomies for proven benign goiters were enrolled. Results: Out of these 64 patients, 8 were male and 56 were female, male to female ratio 1:7 with median age 34 years. In 64 patients, 128 dissections were performed and in all patients (RLN) and its relation with Inferior Thyroid Artery (ITA) was identified. On right side of neck in 63 (98.43%) patients out of 64 (100%) patients RLN found deeper to ITA and in one (1.56%) patient it was found superficial to ITA. On left side of neck in 61 (95.31%) patients out of 64(100%) patients it was deeper to ITA and in 3 (4.68%) patients the nerve was superficial to ITA. Identification of RLN was difficult in 16 (12.5%) dissections and the reason was adhesions and huge multinodular goiter. Conclusion: During thyroid surgery, the connection between RLN and ITA is significant to surgeons. When it comes to RLN security, visible anatomical identification is still the gold standard.

Comparison of outcome of Simple Excision vs Limberg Flap of pilonidal sinus in terms of post operative pain, operative time, wound infection and hospital stay.

Muhammad Aqeel — 2024-11-03

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1^st September 2021 to 1^st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical & Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 & 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = <0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay.

Frequency and outcomes of parathyroid preservation in total thyroidectomy.

Rashid Ahmad — 2024-11-03

Objective: To determine the frequency and its outcome of parathyroid preservation in total thyroidectomy. Study Design: Case Series study. Setting: Department of Otorhinolaryngology, HMC, MTI, Peshawar. Period: 23^rd June 2022 to 23^rd Dec 2022. Methods: A total of 246 patients who underwent thyroidectomy were included in the study and followed up to determine the preservation of parathyroid gland, hypocalcaemia and recurrent laryngeal nerve injury. Results: The mean age of the sample was 37.7 + 12.3 years. There were 52.8% male patients and 47.2% female patients. 28.9% of patients had thyroid nodule and subtotal thyroidectomy was the most performed procedure Parathyroid gland preservation was recorded in 72%. On follow up, hypocalcemia was recorded in 16.3% and recurrent laryngeal nerve injury in 20.3%. Conclusion: Hypocalcemia and RLNI are significantly common after thyroidectomy. Hypocalcemia was significantly high in patients with low non preserved parathyroid gland. More research on high sample size and addressing other effect modifiers are recommended with intervention to preserve parathyroid gland.

Resurgence of vaginal route of hysterectomy: Comparison based outcomes of abdominal and vaginal hysterectomy.

Mubashra Naz — 2024-11-03

Objective: To determine the preferable route of hysterectomy by comparing the intra-operative and post-operative complications of non descent vaginal hysterectomy with abdominal hysterectomy. Study Design: Randomized Control Trial. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: January 2022 to December 2022. Methods: Forty cases of each vaginal and abdominal hysterectomy were enrolled for study. Outcome was measured by recording intra-operative and post-operative complications in both groups. Results: Time of surgery, postoperative pain, postoperative blood transfusion, wound infection, febrile morbidity and duration of hospital stay were significantly less (p value 0.0001) in the non descent vaginal hysterectomy compared to abdominal hysterectomy. Conclusion: Non descent vaginal hysterectomy is a safe and cost effective approach when compared to abdominal rout due to less intra and post operative morbidity particularly in settings where facilities and expertise for laparoscopic surgery are lacking.

Urinary tract infection and associated risk factors among pregnant women at a tertiary care hospital.

Iram Aslam — 2024-11-03

Objective: To determine prevalence of UTI in pregnant women and its associated risk factors at a tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Gynae & Obstetrics Independent University Hospital, Faisalabad. Period: 1-10-2022 to 31-3-2023. Methods: All pregnant patients visiting gynae OPD (5280) were enrolled for study. Mid-stream urine sample was taken and analyzed. UTI was diagnosed if >10 pus cells / HPF were seen. Inclusion Criteria: All pregnant females attending antenatal clinic during study period. Exclusion Criteria: Women with chronic renal disease. History of antibiotic treatment in last one week, Congenital renal abnormality. Patients on immuno suppressive therapy. Results: The prevalence of UTI in our study was 28%. In this study 593 patients (40%) were <20 years of age, 258(17%) were in 21-30 years age group, 246 (16%) were 31-40 years and 381(26%) were >40 years of age. In our study 526 (35%) were primigravidas, 249(17%) were G2, 272(18%) were G3 and 431 (29%) were G4 or above. In this study 698 (47%) patients were in first trimester, 320(22%) were in second trimester, 460(31%) in third trimester. Among risk factors 245 patients (16%) were anemic and 421(28%) were diabetic. Conclusion: The Prevalence of UTI in pregnant female of independent university hospital Faisalabad is quite high. Anemia and diabetes are major associated risk factors. Owing to its association with a number of complications, UTI needs to be diagnosed and treated promptly to lessen perinatal and maternal morbidity and mortality.

Frequency of Ceftazidime-Avibactam resistance in Pseudomonas aeruginosa: Experience at a Tertiary Care Hospital.

Mahnoor Chaudhry — 2024-11-03

Objective: To isolate Pseudomonas aeruginosa from different clinical samples and determine the antimicrobial activity of Ceftazidime/avibactam against these isolates. Study Design: Prospective Cross-sectional study. Setting: Pathology Laboratory of Lahore General Hospital, Lahore. Period: July 2023 to June 2024. Methods: One hundred thirteen Pseudomonas aeruginosa were identified from different samples Bacterial identification was done by gram staining, bench tests, and API20NE. The antimicrobial sensitivity testing of the causative bacteria was conducted, using commercially available discs, by Kirby Bauer disc diffusion assay and reported in accordance with Clinical & Laboratory Standards Institute (CLSI) 2022. Results: Out of 113 resistant strains of Pseudomonas aeruginosa obtained from different clinical samples Ceftazidime/avibactam was only sensitive to 43.4% of strains and resistant to 56.6% of them. Conclusion: According to the findings of this study, Pseudomonas aeruginosa, a nosocomial organism is isolated from many different clinical samples. The findings of this study also indicate that even a new combination antibiotic fails to show sensitivity in more than half of the isolates. This is a frightening situation that places stress on avoiding the misuse of antibiotics and following anti-microbial stewardship.

Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

Faisal Niaz — 2024-11-03

Objective: To compare the mean time for analgesic requirement of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Combined Military Hospital, Kharian. Period: 1^st July 2022 to 1^st January 2023. Methods: A total of 60 patients with 30 patients in each group undergoing elective c section were included in the study. Patients were counselled about VAS scoring system before procedure. Time (in minutes) for first rescue analgesia and requirement in 24 hours was noted. Results: Mean time required for first analgesia was 143.966±8.15 minutes in group A as compare to 86.400±7.08 minutes in group B (p=0.000). Conclusion: Our study has concluded that TAP block is a promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries.

Correlation between MRI and conventional radiographic findings in evaluation of osteoarthritis.

Aneeqa Noor — 2024-11-03

Objective: To evaluate the diagnostic accuracy of X-rays in detecting osteoarthritis (OA) in comparison to MRI. Study Design: Cross-sectional study. Setting: The Fauji Foundation Hospital, Rawalpindi. Period: August, 2023 to March, 2024. Methods: Total 350 patients consented to clinical interviews, physical examinations, standing radiographs, and MRIs. Standing, semi-flexed posteroanterior radiographs of the knees were obtained with proper alignment to accurately detect joint space narrowing. Manual measurements of joint space width were conducted by a blinded orthopedic surgeon using the Kellgren-Lawrence grading system. Data analysis was performed using SPSS 23, with frequencies, percentages, means, and standard deviations calculated for relevant variables. Diagnostic accuracy was assessed using a 2x2 table. Results: Of the 350 patients, 61.1% were up to 60 years old, and 38.9% were over 60 years old. Among those with positive MRI results, 70.1% also had a positive X-ray, while 29.6% did not. Cohen's Kappa was 0.377, indicating fair to moderate agreement. Sensitivity was 54.3%, specificity 82.4%, positive predictive value 70.1%, and negative predictive value 70.4%, with an overall diagnostic accuracy of 70.3%. Conclusion: X-rays demonstrated high specificity and moderate predictive values, but low sensitivity, suggesting that some OA cases may be missed if relying solely on X-rays.

Comparison of the outcome of dynamic hip screw versus proximal femoral nail for treatment of intertrochanteric femoral fractures among elderly patients.

Muhammad Tabish Saleem — 2024-11-03

Objective: To compare the outcome of DHS versus PFNA for treatment of intertrochanteric femoral fractures (IFFs) among elderly patients. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 2-03-2022 to 2-09-2022. Methods: In total 90 patients fulfilling inclusion criteria were registered after approval from the ethical review committee of the hospital. Every patient provided written informed consent. Patients were allotted to each group (Group A = PFNA, Group B = DHS) using lottery method. Patients were operated upon by a single surgical team. Data was obtained VIA questionnaires designed for pre- operative period, immediate post-operative period, 1 and 3 months follow up. Patients were interviewed and evaluated by blind researchers at each stage. Harris hip score was used to assess the functional outcomes. Results: In 90 patients (45 in each), 36.2% (n=17) were male in PFNA group and 63.8% (n=30) in DHS group and 65.1% (n=28) were female in PFNA and 34.9% (n=15) in DHS group, p=0.011. Mean age of PFNA group was calculated as 66.00± 3.41 years and mean age of DHS group was 66.80±3.71 years (p=0.714). Distribution of BMI was 28.14+6.20kg/m2 in PFNA group and 27.47+6.24kg/m2 in DHS group, p=0.612. Distribution of Harris hip score at 1 month was 31.11+4.08 in PFNA group and 30.11+4.18 in DHS group, p=0.254 and Harris hip score at 3 months was 88.68+1.23 in PFNA group and 81.68+0.95 in DHS group, p=0.000. Conclusion: We concluded that PFN is superior to DHS in treating Boyd and Griffin type II intertrochanteric fractures of femur. It’s only a matter of time that PFN becomes the new gold standard for these fractures.

Neurotrophic keratitis caused by trigeminal nerve palsy secondary to a cerebellopontine angle epidermoid cyst: A rare case presentation.

Shahid Abbas — 2024-11-03

Neurotrophic keratitis (NK) is a rare corneal disorder characterized by decreased corneal sensitivity and impaired corneal healing due to damage or dysfunction of the trigeminal nerve. We present a case of NK caused by trigeminal nerve palsy secondary to a cerebellopontine angle (CPA) epidermoid cyst. The patient exhibited corneal epithelial defects, persistent corneal ulceration, and decreased corneal sensation. Prompt diagnosis and management of the underlying brain lesion were crucial for successful treatment of the disease.