The Professional Medical Journal

Frequency of complications of bone transport technique using the ilizarov method in the lower extremity.

Sat, 29 Mar 2025 00:00:00 -0700

Objectives: To evaluate the frequency of complications in patients treated with the Ilizarov bone transport technique for lower extremity reconstruction. Study Design: Prospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: October 25, 2024, to January 25, 2024. Methods: Including 75 patients meeting the inclusion criteria. Ethical approval was obtained, and informed consent was secured from all participants. Patient demographics, injury characteristics, and complication details were recorded. Data were analyzed using SPSS version 26, with chi-square tests for stratified comparisons. Statistical significance was set at p ≤ 0.05. Results: Among the 75 patients (mean age 37.55±13.76 years), 64% were male, and 36% were female. The most common complication observed was pin tract infection, which occurred in 37.3% of patients. This was followed by joint stiffness in 21.3%, limb discrepancy in 17.3%, and malalignment in 12.0%. Refracture occurred in 4.0% of patients, while recurrent infection was not reported in any cases. Amputation was observed in 2.7% of patients. Age was significantly association with the rate of complications. Conclusion: For reconstructing the lower extremities, the Ilizarov bone transfer technique works well, although it has a significant risk of complications, especially pin-site infections. Preventive measures and careful observation are necessary to reduce these risks and enhance treatment results. Future research should concentrate on improving surgical methods and postoperative care to improve patient recovery.

Vitamin D assessment in asymptomatic children one month to 2 years attending a Tertiary Care Hospital's Well Baby Clinic for Immunization.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the frequency of vitamin D deficiency among asymptomatic children aged 1 month to 2 years visiting the well-baby clinic at a tertiary care hospital for immunization. Study Design: Cross-sectional study. Setting: The Well-baby Clinic of the National Institute of Child Health (NICH) in Karachi, Pakistan. Period: March 13, 2020, to September 12, 2020. Methods: The study included all asymptomatic children between 1 month and 2 years of age, with height and weight within 2 SD above and below the mean, attending the well-baby clinic for immunization. A blood sample was collected to assess serum 25 OH vitamin D levels. Frequencies and percentages were calculated for qualitative variables, including sex, feeding patterns, maternal and paternal education, sunlight exposure, socioeconomic status, and vitamin D deficiency. The mean and standard deviation (SD) were calculated for continuous variables such as age, height, and weight. Results: The mean age of the children in the study was 8.22 ± 4.77 months. A higher proportion of females (57%) were included in the study. Most mothers (72.5%) had an illiterate education status, while most fathers (47.7%) had a primary level education. A majority of children (53.7%) had over 30 minutes of sunlight exposure per week. Vitamin D deficiency was found in 17 (11.4%) of the children studied. Conclusion: Vitamin D deficiency was found to be prevalent in 11.4% of asymptomatic children aged 1 month to 2 years attending the well-baby clinic for immunization. This highlights the need for increased awareness and screening for vitamin D deficiency in pediatric populations, even in the absence of symptoms.

Frequency and indications of elective tracheostomies in patients admitted at PICU.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the frequency and indications of elective tracheostomies in patients admitted at pediatric intensive care unit (PICU) in a tertiary care hospital. Study Design: Cross-sectional study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: May 2024 to November 2024. Methods: A total of 62 children of any gender, aged 1 month to 14 years, and admitted to PICU were analyzed. Pre-designed study proforma was used to record study variables such as age, gender, PRISM-III score, admission type, disease categorization at admission. All patients admitting in PICU were closely monitored, and admitting consultant, on-board pediatric surgeon, intensivist and otorhinolaryngologist assessed the need to perform tracheostomy. Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 62 children, 35 (56.5%) were boys. The mean age of the children was 6.53±4.2 years. The mean PRISM-III score was 10.40±3.79. The most common disease categorization were neuromuscular diseases, and respiratory diseases, documented in 22 (35.5%), and 16 (25.8%) children, respectively. There were 11 (17.7%) children who underwent tracheostomy. Among 11 children undergoing tracheostomy, neurological impairments, upper airway obstruction, and cardiopulmonary indications were noted among 4 (36.4%), 4 (36.4%), and 3 (27.3%) children, respectively. The severity of illness, as per PRISM-III score, was significantly higher in children who underwent tracheostomy (p=0.023). Conclusion: The frequency of tracheostomy was 17.7% in children admitted in PICU. Patients requiring tracheostomy demonstrated significantly higher PRISM-III scores. Neurological impairments, upper airway obstruction, and cardiopulmonary complications were most common indications behind tracheostomy.

Comparison of high scortal incision with standard inguinal incision orchidopexy in infants and children with palpable undescended testis.

Samreen Jamil, Sadaqat Ali, Imran Qadir, Ahsan Rehman — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To compare high scortal incision with standard inguinal incision orchidopexy in infants and children with palpable undescended testis (UDT). Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Surgery, Allied Hospital Faisalabad. Period: 17-10-2020 to 16-10-2021. Methods: Two groups were randomly assigned to children diagnosed with perceptible UDT, aged 9 to 18 months. In group A, orchidopexy was performed through a high scrotal incision, while in group B, it was performed using the standard two-incision inguinoscrotal procedure. Length of surgery and hospital stay, scrotal hematoma, infection of wound, atrophy of the testicles, and secondary ascent were the variables that were used to compare the groups. Results: The children in group B had an average age of 12.18±2.59 months, while those in group A had an average age of 12.66±2.71 months. Fifty-one children (or 51% of the total) had undescended testicles on the right side, whereas forty-nine children (or 49% of the total) had them on the left. Whereas 58(58%) children had a canalicular appearance, 42(42%) showed testes at exterior ring. Both groups had significantly different mean operating times: 27.26 ± 3.93 min for group A and 34.72±3.25 min for group B (p < 0.0000). Groups A and B had significantly different mean hospital stays, with group A measuring 1.10 ± 0.30 minutes and group B 1.40±0.49 minutes (p < 0.0000). Two individuals (4% of the total) in group A and 8(16%) in group B had scrotal haematoma (p = 0.046). Three patients (6% of the total) in group A and fourteen people (14%) in group B acquired wound infections (p = 0.159). In addition, two patients (4.0%) in group A and three patients (6.0%) in group B experienced secondary ascent (p = 0.339). Conclusion: In conclusion, this study's data show that orchidopexy utilizing the scrotal incision strategy is preferable than the inguinal incision method for palpable UDT treatment.

Challenges and safety of endoscopic retrograde cholangio pancreatography among elderly patients.

Mir Nosherwan Khan, Lubna Kamani, Baseer Ahmad — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the challenges and safety of endoscopic retrograde cholangio pancreatography (ERCP) between patients of <60 years and ≥ 60 years. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: November 2022 to October 2023. Methods: All clinically suspected patients of hepatobiliary and pancreatic diseases underwent endoscopic retrograde cholangiopancreatography and followed inclusion criteria were included. Patient’s age was categorized into two age group as Group A i.e. <60 years and Group B i.e. ≥ 60 years. Patient’s data were compiled and analyzed through SPSS. P-value ≤0.05 was considered as significant. Results: In this study, ERCP was successful in 95.1% patients under 60 years however it had 96.6% success in elderly patients with age 60 or more. Malignant biliary strictures were 7.21% in group A while 11.21% in group B with P-value of 0.021. Periampullary diverticulum was 1.45% in group A while 1.74% in group B with P-value of 0.021.Post ERCP pancreatitis was 44.2% in group A and 22.2% in group B with P-value of 0.343. Preprocedure ICU admissions were 1.4% in group A and 2.9% in group B with P-value of 0.005 while postprocedure shifting of patients to ICU were 0.8% in group A and 2.9% in group B with P-value of 0.084.Length of hospital stay between two groups with p-value was 0.540. Conclusion: ERCP can be used safely and effectively in the elderly to diagnose and treat hepatobiliary and pancreatic disorders by skilled endoscopits.

Functional outcome of lumbar discectomy by fenestration technique in lumbar disc prolapse.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To evaluate the functional recovery, particularly in in terms of pain relief and resuming work, in patients with lumbar disc prolapse treated with the fenestration technique. Study Design: Prospective study. Setting: Doctors Hospital and Medical Center, Lahore, Pakistan. Period: 1^st April 2024 and 30^th September 2024. Methods: A total of 50 patients with clinical signs of lumbar intervertebral disc prolapse, unresponsive to conservative treatment, underwent fenestration discectomy. Functional outcomes were assessed using the 'Back Pain Functional Score (BPFS) This score is utilized to assess the impact of back pain on a person’s ability to perform daily activities. It evaluates the functional limitations caused by back pain and tracks recovery progress, especially before and after surgical interventions, and the (PROLO): The PROLO system assesses recovery by focusing on two aspects: economic independence and functional ability. Each aspect is rated from 1 to 5, and the combined score helps determine the patient's overall recovery status over time. Rating scale, measuring both preoperative functional and economic status as well as six-month postoperative outcomes. Wadell's score system was employed to differentiate organic from non-organic signs, and surgical success was determined using McNab's criteria. Results: Low back pain is a widespread and disabling condition globally. Sciatica, caused by lumbar disc prolapse, affects approximately 4-6% of the population. Fenestration discectomy, a surgical technique, offers advantages such as reduced operation time, less blood loss, and fewer postoperative complications without compromising spinal stability compared to traditional laminectomy. At the six-month follow-up, 42 patients (84%) showed good outcomes, and 8 patients (16%) had fair outcomes according to BPFS and PROLO scales, with no cases classified as poor. The PROLO scale also revealed that 84% of patients resumed their prior occupations, while 76% reported complete pain relief. Statistical analysis demonstrated a significant association between functional outcomes and both patient age (p=0.089) and duration of symptoms (p=0.098), with younger patients (below 30) and those with symptoms lasting less than six months exhibiting better recovery. Conclusion: The fenestration technique proved effective in managing lumbar disc prolapse, showing significant improvements in terms of pain relief and return to work at six months post-surgery. Factors such as older age, prolonged symptom duration, and psychological issues were associated with poorer functional outcomes.

Frequency of polyp recurrence after endoscopic sinus surgery with nasal polyposis.

Midrarullah, Bilal Khan, Khurshid Anwar, Faisal Khan, Irfanullah, Arsalan Adil — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the frequency of polyp recurrence after ESS in patients with chronic rhinosinusitis with nasal polyps. Study Design: Descriptive study. Setting: Department of ENT, Hayatabad Medical Complex, Peshawar. Period: May 14, 2023, to May 14, 2024. Methods: A total of 179 patients aged 18–60 years with bilateral nasal polyps were enrolled using purposive non-probability sampling. Exclusion criteria included antrochoanal polyps, cystic fibrosis, and prior surgery within three months. Data were analyzed using SPSS, with frequencies, percentages, and chi-square tests for stratified comparisons. Results: Of the participants, 63.7% were aged 20–40 years, and 36.3% were aged 41–60 years. Males constituted 62.6%, and females 37.4%. Postoperative pain was reported in 27.9%, while 31.8% experienced polyp recurrence. Recurrence rates were not significantly associated with age (P = 0.217) or gender (P = 0.658). Conclusion: ESS remains an essential treatment for chronic rhinosinusitis with nasal polyps. However, recurrence continues to be a clinical challenge, with a recurrence rate of 31.8% observed. Improved adherence to postoperative care and anti-inflammatory therapies may help mitigate recurrence.

Comparison of APRI, FIB-4 and fibroscan for detecting chronic liver disease severity among chronic Hepatitis B Patients in Pakistan.

Rana Ahsan, Mansoor ul Haq — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To compare aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), and fibroscan scores in evaluating severity of chronic liver disease (CLD) in chronic hepatitis B (CHB) patients. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: 11^th July 2024 to 10^th January 2025. Methods: A total of 250 patients aged 18 years or above, and presenting with CHB were analyzed. Necessary laboratory investigations and Fibroscan evaluation were performed for the assessment of APRI and FIB-4 scores and fibrosis confirmation. Predictive ability of all scores was determined by plotting receiver operating characteristic curve (ROC), and determining area under the curve (AUC). Youden index was applied for the calculation of the optimal cut-off value of the score. Results: Total 22.0% were female and 78.0% were male patients. Median (IQR) scores for APRI, FIB-4, and Fibroscan were 0.74 (0.35-2.20), 1.32 (0.90-2.90), and 9.10 (5.30-16.00). The AUC indicates that the APRI score (AUC=0.980) is a better predictor of CLD severity than the FIB-4 score (AUC=0.929). The optimal cutoff for APRI score was 0.789 (sensitivity=85.3%, specificity=100%), 0.662 (sensitivity=92.2%, specificity=92.6%), and 0.858 (sensitivity=78.3%, specificity=100%). Conclusion: In CHB patients, APRI seems an excellent tool for determining the severity of CLD and showed the highest association with FibroScan results.

Camparison of efficacy of cryotherapy plus oral zinc sulphate versus cryotherapy alone in treatment of viral warts.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To evaluate the efficacy of combining oral zinc sulphate with cryotherapy versus cryotherapy alone in the treatment of cutaneous warts. Study Design: Randomized Controlled Trial. Setting: Department of Dermatology, PNS Shifa Hospital, Karachi. Period: October 2023 to June 2024. Methods: Patients aged 18–65 years with cutaneous warts and no prior treatments were included. Exclusions were patients with systemic illnesses or hypersensitivity. Group A received oral zinc sulphate (10 mg/kg/day for 8 weeks) combined with weekly cryotherapy, while Group B underwent cryotherapy alone. Efficacy was assessed after 12 weeks based on complete wart resolution. Chi-square tests compared efficacy, and descriptive statistics were used for demographic analysis. Results: Significantly higher efficacy (58.7%) was observed in Group A compared to Group B (36%; p = 0.004). Both groups were demographically similar with no statistical differences in age, gender, or disease duration. Conclusion: The combination of oral zinc sulphate with cryotherapy significantly improves treatment outcomes for cutaneous warts compared to cryotherapy alone, highlighting zinc's potential as an effective, accessible, and cost-efficient adjunct therapy. Further research is recommended to establish broader clinical guidelines.

Clinical utility of the liver frailty index for predicting sarcopenia in chronic liver disease patients with hepatocellular carcinoma.

Lubna Kamani, Attique Rahman, Muhammad Ali, Mehreen Akmal — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the accuracy of liver frailty Index (LFI) to predict sarcopenia in patients of chronic liver disease (CLD) with hepatocellular Carcinoma (HCC). Study Design: Cross-sectional study. Setting: Outpatient Department of the Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: August 2022 to February 2023. Methods: A total of 110 patients aged 45-70 years, having CLD with HCC were analyzed. Frailty was classified on the basis of LFI as robust (< 3.2), prefrail (3.2-4.4), and frail (≥ 4.5). Muscle atrophy was evaluated by skeletal mass muscle index (SMI) evaluated through CT scan at L3 region. Results: In a total of 110 patients, 62 (56.4%) were male. The mean age was 57.93±6.86 years. The mean LFI was 3.93±0.76. Forty-five (40.9%) patients were classified as frail. The distribution of frailty was not significantly with respect to gender (p=0.649), or CLD type (p=0.788). Child Pugh classification (p<0.001), and HCC staging (p<0.001) were found to have significant association with frailty. Sarcopenia was documented in 74 (67.3%) patients with HCC. Gender (p=0.183), BMI (p=0.533), and CLD types (p=0.448) were not found to have any significant association with sarcopenia. Child-Pugh classification (p<0.001), and HCC staging (p<0.001) were having significant association with sarcopenia. Frailty was found to depict significant linkage with sarcopenia (p<0.001). Conclusion: Frailty, as assessed by LFI, shows a strong association with sarcopenia, independent of gender and CLD type. Child-Pugh classification and HCC stage were identified as important predictors of both frailty and sarcopenia.

Antimicrobial resistance in febrile neutropenia. Are we left with some options?

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To assess the pathogenic organisms, antibiotic sensitivity and resistance patterns in patients with FN having hematological malignancies. Study Design: Prospective Cross-sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation. Period: February 2023 to July 2024. Methods: Samples from 650 febrile neutropenia patients of either gender were collected adopting non-probability consecutive sampling technique. As per Clinical and Laboratory Standards Institute (CLSI) recommendations the organisms were isolated and identified by routine biochemical tests. The antibiotic sensitivity profile was determined by Kirby Bauer method. Results: Microbiologically confirmed infectious events were recorded in 311 cultures. The majority (232; 74.6%) of the patients had infections due to Gram negative bacteria (GNB). The most prevalent GNB was Escherichia coli (37.5%) followed by Klebsiella pneumonia (15.5%). Overall 16 (5.1%) bacterial isolates were XDR and 15(4.8%) were MDR. Most MDR and XDR strains were GNB and E. coli appeared as the most resistant in blood and urine cultures. Furthermore, E. coli were highly resistant to Fosfomycin (87.5%) and Amox-Clav (79.5%) whereas good sensitivity to colistin (79.5%), and amikacin (61.36%) was observed. Pan resistance was exhibited by 2 hypervirulent isolates of K. pneumoniae. In blood cultures, high resistance to methicillin (56.6%) was observed with S. epidermidis making it a clinically significant pathogen. Conclusion: Most bacterial isolates were resistant to penicillin, cephalosporins and quinolones used as part of empirical treatment of febrile neutropenia. Prudent use of antibiotics may be the best preventive strategy to the spread and emergence of antibiotic resistant GNBs.

Frequency of folate deficiency in chronic kidney disease patients on maintenance hemodialysis.

Muhammad Waheed Sohail, Zarak Khan, Mavish Arif, Aimal Khan, Muhammad Israr — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the frequency of folate deficiency in chronic kidney disease patients on maintenance hemodialysis presenting to Nephrology OPD of Khyber Teaching Hospital Peshawar. Study Design: Descriptive, Cross sectional. Period: 11^th January 2021 to 10^th July 2021. Setting: Department of Outpatient Nephrology, Khyber Teaching Hospital, Peshawar. Methods: A total of 142 patients diagnosed with CKD on dialysis sessions were selected for the study in a consecutive sampling manner and observed for folate deficiency. Results: The mean age group of our sample was 45.6+ 7.4 years of which 42.2% male patients and 57.8% female patients. The mean duration of dialysis (months) was 9.2+ 5.1 months. Folate deficiency in dialysis patients were recorded in 69.7 % of patients. Conclusion: Folate deficiency is very common in our dialysis dependent population. Its deficiency could be due to multiple factors including malnutrition, drugs and dialysis itself. It is important to routinely screen dialysis dependent population for this potentially reversible complication to prevent damage. We recommend further multicenter studies to detect this observation and to form comprehensive guidelines to prevent our patients at risk.

Usefulness of albumin bilirubin platelet score as a predictor tool for risk esophageal varices in patients with compensated cirrhosis presenting in a Tertiary Care Hospital.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the accuracy of albumin bilirubin platelet (ALBI-PLT) score to predict risk esophageal varices in patients presented with compensated cirrhosis in tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: February 2024 to August, 2024. Methods: Total 165 Patients of both genders were included. The albumin-bilirubin (ALBI) grade and platelet count were added to determine the ALBI-PLT score. The esophageal varices were expected as “present”, when ALBL-PLT score >3. Data were compiled and analyzed using IBM-SPSS Statistics, version 26.0. Receiver operating characteristic (ROC) curve analysis of ALBI score grades and ALBI-PLT score grades was used for detection of the cutoff value. Sensitivity, specificity, and predictive values were calculated for the cut off. Results: In a total 165 patient, 149 (90.3%) had esophageal varices. Among these 165 patients, 57 (38.3%) had amall esogphageal varices. Mean ALBI, and ALBl-PLT were 0.017±0.300, and 4.28±0.75 respectively. ALBl-PLT was found to have excellent ability to diagnose patients with and without esophageal varices based on the ROC (AUC=0.916). The sensitivity, and specificity for ALBl-PLT ≥2.0, ALT-PLT≥3.50, and ALBl-PLT≥4.50 were 100% and 0%, 89.3% and 87.5%, and 51.7% and 100%, respectively. Conclusion: This study demonstrates that ALBl-PLT score was found to have excellent ability to diagnose patients with and without esophageal varices.

Reversal of insulin resistance by HCV clearance through direct-acting antiviral treatments in chronic hepatitis C patients.

Arif Rahim Khan, Shahnawaz Hassan Gardezi, Ali Raza — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To assess the effect of direct active antiviral treatment on insulin resistance reversal in hepatitis C genotype 3 patients achieving sustained virologic response. Study Design: Case-control study. Setting: Department of Medicine, Nishtar Medical Hospital, Multan. Period: May 2024 to October 2024. Methods: A total of 100 hepatitis C genotype 3 patients with advanced liver fibrosis being considered for treatment with DAAs were selected for study. Patients were divided into cases i.e. 50 patients treated with DAAs and the control group i.e. 50 patients left untreated. Blood plasma and serum samples were collected prior to treatment initiation, after treatment completion, and at 3-month follow-up to check insulin and glucose levels in cases. In the control group, patients were assessed at the start of the study (Time 0) and at the 3-month follow-up. Results: HCV clearance was achieved in all patients and 47 patients (94%) achieved SVR. Hepatic stiffness in cases was 20.07 ± 10.21 kPa before the start of treatment and 19.78 ± 8.5 after treatment and significantly lower at follow-up (13.34 ± 7.9) (p<0.001). A significant association between HOMA-IR and HCV-RNA levels was noted at baseline and a trend was found for hepatic stiffness (p=0.069) and BMI (p=0.060). Conclusion: HCV clearance through direct-acting anti-viral treatment improves or reverses insulin resistance in Hepatitis C genotype III patients reducing the risk of diabetes mellitus, advanced liver fibrosis metabolic syndrome, and cardiovascular events.

Polyhydramnios: Heterogeneity in presentation at tertiary care hospital.

Tasneem Azhar, Iram Aslam, Nadia Sharif, Uzma Manzoor, Saadia Bano, Uzair Iqbal — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To determine the presentation and outcome of polyhydramnios in pregnancy at a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, Independent University Hospital Faisalabad. Period: 1-Jan-2020 to 31-Dec-2022. Methods: All the cases diagnosed as polyhydramnios after confirmation on ultrasonography by measuring single deepest vertical pool were included. Results: The total number of patients included in the study were 80. The patients having age <35 years were 62 (77.5%) while the patients having age > 35 years were 18 (22.5%). 16 patients (20%) were primigravida while 64 patients (80%) were multigravida. The patients with Mild polyhydramnios were52 (65%), moderate polyhydramnios 21 (26.5%) and with severe polyhydramnios 7 (8.7%). The various maternal complications were as preterm labour in 11 patients (13.7%), gestational diabetes mellitus 8 patients (10%), Pre-PROM 7 patients (8.75%), PIH and its complications 3 patient (3.75%) and Placental abruption 2 patients (2.5%). while 49 patients (61.25%) had no complications. Regarding mode of delivery 13 patients (16.3%) were delivered vaginally while 67 patients (83.7%) underwent caesarean section. Fetal outcome was quite good. There were normal alive babies 67 (83.75%), anomalous 9 (11.25%) and 4 babies (5%) were diagnosed as IUD. Conclusion: In the present study, polyhydramnios had diversity in its presentation and maternal versus fetal outcome was associated with degree of polyhydramnios.

Health professionals' knowledge and attitude towards patient confidentiality and associated factors.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To evaluate health professionals' attitudes, knowledge, and related variables regarding patient confidentiality. Study Design: Institution Based Cross-sectional study. Setting: Gomal Medical College Affiliated Hospitals. Period: June-September 2024. Methods: Using the stratified random sampling approach, 213 people made up the sample. Bi-variate and multi-variate binary logistic regression analyses were done. Odds ratio, with 95% confidence level and P value were calculated. Results: Among 213 participants, 71.4% had good knowledge of confidentiality. Most of doctors 175(82.2%) said that the patients’ confidentiality should be maintained and governed by law. While 68.5% with satisfactory attitude towards patients’ confidentiality. Doctors working at positions of AP and above (AOR = 6.83 CI= [0.784-59.53]) have good knowledge about patient confidentiality. For factors associated with doctors’ attitude towards patient confidentiality, AP and above post level with (AOR=12.29, CI = [1.335-113.3]) have satisfactory attitude towards patients’ confidentiality and was highly significant. Those having satisfactory knowledge with (AOR=0.275, CI= [0.141-0.538]) were highly significant for attitude. Conclusion: this study revealed that 71.4% participant had satisfactory knowledge and 68.5% had satisfactory attitude towards patient confidentiality and those having satisfactory knowledge of confidentiality had satisfactory attitudes.

The influence of various inducement offered by pharmaceutical companies on the prescription behavior of general medical practitioners of South Punjab.

Saif ur Rehman, Waqar Jeelani — Sat, 29 Mar 2025 00:00:00 -0700

Objective: General medical practitioners (GMPs) were surveyed to describe their opinion regarding the visits of medical representatives (MRs) and the offers of pharmaceutical companies. Study Design: Cross-sectional. Setting: Department of Behavioral Sciences, CMH Multan Institute of Medical Sciences, Multan. Period: July 2024 to December 2024. Methods: A study was conducted on the sample of 154 GMPs working in different private clinical settings of South Punjab. The questionnaire evaluated the impact of 16 different types of inducements offered by the MRs on the prescription behavior (PB) of GMPs. Results: Out of 154 physicians, 66.23% and 61.69% feel that they may change their prescription of the medicine by “dropping the literature” and “dropping the drug samples” by the MRs, respectively. Other inducements significantly affecting PB were sponsorship for local conferences and seminars (59.1%), organization of medical camps (57.1%), personal liaison with MRs (55.8%), subscription of journals (54.5%), and small gifts like pens and pads (53.2%). Generally, there was no significant relationship between the effect of inducements on the PB of GMPs and their personal characteristics. Conclusion: There was an overall tendency of enjoying the inducement by GMPs. The most effective activities to affect PB were providing the drug literature and physician’s samples.

Parents, Screens and outdoor play: Unpacking beliefs and practices for preschoolers in Karachi.

Saima Mehmood, Ibtisam Qazi, Danish Abdul Aziz, Farah Naz Qamar — Sat, 29 Mar 2025 00:00:00 -0700

Objective: To explore parental beliefs and practices regarding the regulation of screen time and outdoor playtime among children aged 2-5 years in a densely populated urban setting in Pakistan. Study Design: Descriptive Cross-sectional study. Setting: In the Outpatient Clinics of (Secondary & Tertiary Care Setup) of a Private Hospital in Karachi. Period: July 2022 to December 2022. Methods: Interviews were conducted with 314 parents of children aged 2-5 years. Primary measures included parental practices and beliefs about screen time and outdoor playtime. Sociodemographic characteristics, parental practices, and beliefs were analyzed using frequencies and percentages; screen time durations were reported as means with standard deviations. Multivariate logistic regression was used to identify predictors of screen exposure. Results: A total of 69.4% of parents agreed that screen time for children under 5 years should be restricted to under 2 hours daily. Among participants, 60 parents (19.1%) reported no screen exposure for their children. Around two-third of parents (66.6%) used smart devices to occupy children during household tasks, and 68.2% believed these devices positively impacted learning, vocabulary, and responsiveness. More children had under 60 minutes of outdoor playtime on weekdays. Conclusion: This highlights a disconnect between parental awareness of screen time guidelines and actual practices, alongside limited outdoor play. Majority of the parents understood the need to regulate screen exposure, however Positive parental engagement to promote balanced screen use and increased physical activity is essential.

Clinical outcome of lumbar discectomy by modified fenestration vs traditional laminectomy and discectomy in lumbar disc herniation.

Sat, 29 Mar 2025 00:00:00 -0700

Objective: To compare clinical outcomes of modified fenestration versus traditional laminectomy and discectomy for lumbar disc herniation (LDH). Study Design: Comparative study Setting: Neuro Spine Unit, Capital Hospital, Islamabad. Period: March 2020 and March 2023. Methods: 50 patients (32 males, 18 females) with LDH unresponsive to conservative treatment underwent surgery at RIHS and Capital Hospital CDA. Group A (n=25) received conventional laminectomy and discectomy, while Group B (n=25) underwent discectomy by modified fenestration. Clinical outcomes were assessed over a 12-month follow-up. Results: Group B showed superior clinical outcomes, with greater relief from back and leg pain, reduced numbness, and improved neurological function compared to Group A. Two cases of intraoperative CSF leakage required dural repair, and five patients experienced postoperative wound infections, managed per culture sensitivity results. The study is relatively small sample size and limited follow-up duration may affect the generalizability of the findings. This study highlights the effectiveness of the modified fenestration technique in LDH management, contributing to the growing body of literature on minimally invasive spine surgery and offering valuable clinical insights for neurosurgeons. Conclusion: The modified fenestration technique yielded better clinical outcomes in terms of pain relief, neurological improvement, and spinal stability after 12 months.