BMC Journal of Medical Sciences

Analysis of indications of caesarean section: A retrospective study in a tertiary care hospital, to curb the rising caesarean section rate

Syeda Sitwat Fatima, Shandana Bawar — Wed, 20 Dec 2023 00:00:00 +0000

OBJECTIVE: To examine the indications leading to the overall escalation of Caesarean Section(CS) rate in our population and to put forward strategies/interventions where possible practically to curb the escalating rates of CS in a tertiary care hospital.

MATERIAL AND METHODS:

This Retrospective Cross-sectional study was conducted in obstetrics department of Lady Reading Hospital Peshawar, for a period of 1 year from January 2021 till December 2021. The data was collected from hospital’s clinical records of the women who had CS delivery during the study period. Required information was entered into a structured Proforma. Data was analyzed on SPSS version 21.

RESULTS:

During the study period n=7376 women delivered in the obstetrics unit A, of Lady Reading Hospital. Out of these n=1679(22.76%) were Caesarean Sections. The number of Primary CS were n=1021(60.81%) while n=658(39.18%) were repeat CS. It was found that most of the CS n=1066(63.49%) were Emergency CS while n=613(36.51%) were Elective CS.

The most common indication for CS was Repeat CS in women with history of previous CS deliveries n=658 (39.19%).The 2^nd most common indication was fetal distress n=302(18.04%) followed by Labour progress disorders n=235(13.99%).

CONCLUSION:

Majority of the women who underwent CS had the history of previous CS deliveries. It is the need of the day to educate the obstetricians and counsel/encourage women in antenatal period regarding the safety of procedures like externat cephalic version (ECV), trial of labour after caesarean section (TOLAC)and vaginal birth after caesarean section (VBAC), to reduce repeat CS in our setup.procedures like External Cephalic Version (ECV), Trail of Labour after previous Caesarean-Section (TOLAC) and Vaginal Birth after previous Caesarean Section (VBAC), if we want to reduce repeat CS in our setup. Moreover, CTG should be used only in high risk pregnancies/labours. Furthermore, adherence to WHO Labour Care Guide and skills and drills for reviving instrumental delivery in carefully selected cases may curb the escalating rate of CS.

Axial Length Changes in Myopic Population in North West Pakistani Population

Wed, 20 Dec 2023 00:00:00 +0000

Objective: to determine Axial length changes in myopic population in North West Pakistani population

Materials and Methods: One hundred patients examined through informed consent attended the eye outpatient department DHQ Abbotabad ranging in age from 10-40 years. SPSS v 23 was used to calculate the results.

Results: One hundred patients were examined through informed consent 49 were male, and 51 were female. The right eye's mean spherical error was -7.29 D, and the left eye's mean spherical error was -7.27 D. Mean axial length of the right eye was 25.50 mm, and the main axial length of the left eye was 25.62 mm. A negative correlation was found between AR reading and axial length in both the right and left eyes.

Conclusion: The results of our investigation show that axial length and refractive error are directly correlated, suggesting that more significant axial length modifications may need to be carefully considered when considering refractive procedures.

Prevalence of Metabolic Syndrome in patients with psoriasis

Wed, 20 Dec 2023 00:00:00 +0000

Objective: The study was planned to determine the frequency of metabolic syndrome in patients with psoriasis.

Place and duration of study: This study was conducted over a period of 6 months at the department of General Medicine, PAF Hospital, Islamabad, Pakistan from 1st January 2022 to 30 June 2022.

Materials and Methods: A total of 100 patients diagnosed with psoriasis using non-probability consecutive sampling were included in the study. Patient’s complete history was taken and thorough clinical examination was carried out at the time of inclusion. This included the age, height, weight, blood pressure, waist circumference and duration of disease. Patients were advised fasting blood sugar, fasting triglycerides and fasting high density lipoproteins. Metabolic syndrome was diagnosed if patients had ≥3 out of 5 criteria for the modified version of National Cholesterol Education Program Adult Panel III.

Results: Out of 100 patients of psoriasis, 37 (37%) patients had metabolic syndrome while 63 (63%) had no metabolic syndrome. The mean±SD of all the parameters of metabolic syndrome were found raised in psoriatic patients than normal values both in male and females. No correlation was found between prevalence of MetS and duration of disease (p=0.16).

Conclusion: There is a high prevalence of metabolic syndrome in psoriatic patients that can lead to high cardiovascular events. Hence the patients having psoriasis must be screened on yearly basis for these controllable risk factors to reduce incidence of CV morbidity and mortality.

Using the Relevant Condition at Death (ReCoDe) classification system for Classifying Stillbirths in a Tertiary-Care Hospital

Saida Abrar, khwaja Fawad, shehzadi saima hussain — Wed, 20 Dec 2023 00:00:00 +0000

Objective: To find the different causes of stillbirths at our institution, using the Relevant Condition at Death (ReCoDe) classification system.

Methodology: This was a cross-sectional study that included 421 cases, complicated by stillbirth after 24 weeks of pregnancy at the Department of Obstetrics and Gynecology, Lady Reading Hospital, between January to December 2021. A structured proforma was used to gather data on their age, gestation, booking status, parity, mode of delivery, fetal weight, body mass index, maternal diabetes, pre-eclampsia, thyroid dysfunction, and the information related to stillborn babies, and findings of placental and umbilical cord examination.

Results: The stillbirth rate in the Obstetrics department during the study period was53 per 1000 births. About 78.4% of cases were coded after the application of ReCoDe classification, while 21.61% of cases were labeled as unexplained.The majority of the cases were in the age group 18-35 years, 205 (48.6%), with most women having a spontaneous vaginal delivery, 321 (76.2%), un-booked status, 353 (83.8%), and a BMI >30, 251 (59.6%). The fetal causes were most common,144 (34.20%), with fetal growth restriction contributing to the most common fetal cause, 101 (23.99%). Maternal causes contributed to 99 (23.5%) of stillbirths, with pre-eclampsia the most commonly associated maternal condition, 36 (8.55%).

Conclusion: Classification of stillbirths using ReCoDe classification is simple and, practical to use, especially in low-resource settings, with the ability to identify underlying cause in the majority of cases

Effect of Slimming Drips on Body Mass Index and Physical Appearance of Obese Population

Attiya Tareen, Uzma Dost Muhammad Rajar, Asher Mashhood — Wed, 20 Dec 2023 00:00:00 +0000

Objective: The purpose of this study is to determine the effects of slimming drip approach by mixing cartinex 1g/5ml, Liponex 300gm/12ml and Arginex 5g/10ml with a 500ml of normal saline being administered to patients for twice a week and to determine its effects on Body Mass Index and physical appearance of patients after one month of intervention.

Study Design : A quasi experimental study

Study Setting: Out Patient department of dermatology Clinic of Isra University Hospital, Hyderabad.

Methodology: A total number of n=400 participants were recruited. Informed consent was taken prior to induction and initial body mass index in kg/m²was monitored.

Results: The findings of this study had revealed that slimming drip had significantly p<0.005 reduced the body mass index of the participants where the mean values of BMI before the start of treatment were 38.12±4.85kg/m²that had been reduced to 34.49±5.36 after one month of treatment.

Conclusion: The study had concluded that slimming drip treatment had produced a beneficial effects on hormonal levels and patient’s appearance.

Frequency of Ischemic Heart Disease and Diabetes Mellitus in Patients having ultra-sonographic Non-Alcoholic Fatty Liver Disease

Azmat Ali, Muhammad Umair Janjua, Abdur Rahman Butt — Wed, 20 Dec 2023 00:00:00 +0000

Background: Non-alcoholic fatty liver disease is one of the most common liver conditions globally.

Objective: This study was aimed to assess the frequency of ischemic heart disease & diabetes mellitus in patients having Fatty Liver disease.

Methods: This was cross-sectional study. It was carried out in the department of internal medicine KRL Hospital, Islamabad from May 2022 to October 2022. Patients aged 18 years and above having ultrasonographic evidence of fatty liver disease were included. All subjects were evaluated for the presence of Diabetes Mellitus and Ischemic Heart Disease. Prior ethical approval was obtained from hospital committee. Data was analysed using SPSS version 21.

Results: This study included 250 patients. 66% were female and 34% were male. Age range from 18 to 80 years with a mean of 49± 4.5. 175 (70%) had Grade I fatty liver disease on ultrasound, 63(25.2%) had Grade II fatty liver disease while 12 (4.8%) had Grade III fatty liver disease. Diabetes Mellitus was present in 145(58%) while Ischemic Heart Disease was found in 75(30%).

Conclusion: A significant relation was found between underlying fatty liver disease and Diabetes Mellitus and Ischemic Heart Disease. In view of above findinglifestyle changes becomes inevitable in all patients having underlying Fatty Liver Disease

Pattern of OCD Symptoms in Muslim Patients in Tertiary Care Hospital

Sher Ayub, Hussain Ahmad — Wed, 20 Dec 2023 00:00:00 +0000

Objectives: To find the pattern of OCD symptoms in Muslim patients.

Methodology: This study was conducted at the department of psychiatry Khalifa Gulnawaz Teaching Hospital Bannu, Pakistan from January 2022 to December 2022. Those who fulfilled the DSM criteria for obsessive compulsive disorder were included in the study. Those patients who were suffering from medical or neurological illness were excluded from the study.

Results: Ninety-Five Muslim patients (68 males and 27 females) fulfilled the DSM criteria for obsessive compulsive disorder. The mean age of the group was 25.88+7.39. The main themes of obsessions and compulsions were religious (62%), contamination (22%), and orderliness (16%).

Conclusion: This study demonstrates the role of religion in the development of numerous obsessions and compulsions, which may be useful in the early detection and treatment of obsessive compulsive disorder in our culture. Furthermore, in Islamic culture, the implications of these findings on non pharmacological therapeutic methods like exposure and response prevention (ERP) and cognitive behavior therapy (CBT) could be considerable.

Role of Repeat CT Scan Brain in Mild to Moderate Head Injury

Sohail amir, Haris Hameed, Shahid Ayub, Farzana Begum — Wed, 20 Dec 2023 00:00:00 +0000

Objective: The goal of the research is to determine the responsibility of repeat strategy of CT scan brain from temperate to medium type of injury in the head.

Material and Methods: The situation gives importance to the retrospective examination of the patients who appear in the neurosurgery section at Hayatabad Medical Complex in the Peshawar emergency department. The study comprised 1055 patients with a GCS of 8 or higher who received medical care in the settings of a hospital after passing the repeat strategy of CT scan during patient stay at the hospital. Details about the physical analysis, history of the patient related to their medical terms, and patient demographics were collected, as well as CT scans. The most common symptoms were destruction attributes of neurological conditions, intervention requirements of neurosurgical aspects, and radiological worsening.

Results: The three-year study period highlights the 3456 population of patients associated with the condition of injury in the head and they brought to the emergency area of the hospital, and 1055 patients were able to attain the comprehensive standard. 39.5 years represents the average age of the patients, while 67.7% of the patients were men (n=715). 2743 quantity of Scans were analyzed on 1055 individuals having an average capacity of 2.6 scans in each patient. The result discussed the parameters including the involvement of all the patients who went under the aspect of the 2^nd repeat strategy of CT scan after the starting the implantation of abnormal CT scan. The study group contained 95 patients (9.0%) with radiological deterioration, 40 patients (3.7%) with neurological deterioration, and 110 patients (10.4%) with neurosurgical intervention.

Conclusion: The responsibility of the repeat strategy of CT scan for the head is to identify the initial disturbing signs of brain disorder before the destructive nature of the neurological condition. The approaches will aid in supporting the treatment for providing better consequences.

Effect of Chronic Kidney Disease on Thyroid Function

Wed, 20 Dec 2023 00:00:00 +0000

Background: Chronic kidney disease results in downturn of glomerular filtration rate, which brings about nephropathic effect. The intensitifying nephropathy muddles the thyroid functions and turns down the iodide clearance, thus expedites the hypothyroidism.

Objective: The study aimed to link the chronic kidney disease with hypothyroidism.

Material and Methods: Our study design was cross-sectional. Chronic kidney disease patients were selected for thyroid profile (triodothyronine, thyroxine and thyroid stimulating hormone) testing. Statistical analysis was consummated on collected data, to check out the correlation between CKD and hypothyroidism.Chronic kidney disease is refers to by continuing urine defects structural irregularities or reduced excretory renal function connotative a loss of proper working nephrons.

Results: We enrolled 105 patients suffering from CKD. Of them 62 were male patient and 43 were female. Our analysis concluded that 49, of whome 30 were male and 19 were female, had hypothyroidism. 23; 16 male and 7 female, were having subclinical hypothyroidism and low T3 was seen in 33 individuals, comprising of 16 male and 17 female patients.

Conclusion(s): It is evident, that there is substantial effect of CKD over thryroid function, as hypothyroidism, subclinical hypothyroidism and low T3 syndrome is more frequent in CKD patients. To fend off CKD, the thyroid function is needed to be kept under observation, so that good prognosis could be gained.

Factors Associated with Treatment Outcomes in Patients with Pulmonary Tuberculosis

Wed, 20 Dec 2023 00:00:00 +0000

Objectives: The objective of this study was to determine the frequency of factors leading to poor treatment outcome in patients with pulmonary tuberculosis.

Study Design: The study design was cross sectional.

Place and Duration of the study: This study was conducted over a period of 1 year at the department of General Medicine, PAF Hospital Islamabad, Pakistan from 1st September 2021 to 31 August 2022.

Patients and Methods: A total of 100 patients with poor treatment outcome of pulmonary TB treatment registered at department for the above mentioned period were included through consecutive sampling. Record was extracted from TB treatment card and medical record registers. Patient’s socio demographic, clinical investigation and treatment data were taken. Major factors associated with pulmonary TB treatment outcomes were found by applying frequency and percentage.

Results: The mean age of patients in this study was 31.98±9.55 years. Most of the patients belonged to younger age groups between 18-37 years (73%). Male gender was dominant with 63% of total population. Dominant factors in these patients with poor treatment outcome with statistical significance were poor educational status (84%), low economic status (72%), low knowledge of TB (64%), difficult accessibility to hospital (65%), being single (61%) smoking (61%) and no adherence to treatment (52%).

Conclusion: In conclusion, keeping in mind the fact that success rate of pulmonary TB in Pakistan is still lower than the target of 85%, factors that contributes most to the poor treatment outcome and are addressable by the medical community must be kept under keen focus to improve the treatment out comes

Comparison of Dry Eye Syndrome in North West Pakistani Diabetics and Non-Diabetics Population

Wed, 20 Dec 2023 00:00:00 +0000

Background: Due to rising life expectancy and anticipated older population expansion, the impact of dry eye syndrome (DES) will keep growing. Early investigations have indicated that the most frequent symptoms of diabetic retinopathy, or DR, are connected to problems with the ocular surface in general and dry eye in specific.

Objectives: To compare Dry Eye Syndrome in North West Pakistani Diabetics and Non-Diabetics.

Material and methods: this study is conducted on 50 cases and 50 controls at eye OPD from 5th October, 2018to 5th December 2018 by Convenience sampling technique. After that patient ocular and systemic history were taken and check previous clinical records if present. Anterior segment examination was carried out with a slit lamp. Fluorescein staining and schirmer test was carried out for diagnosing the dry eye syndrome. Patients were classified as having clinically dry eyes if their tear film was less than 10 mm, and as very dry if it was less than 5 mm. To assess the staining, fluorescein stain was utilized as a diagnostic dye. Dry eyes were regarded as having more than three fluorescein-stained cells. Chi-Square analysis, EPI Info 16, and SPSS were used to examine the data.

Results: In this research study, there were 50 cases of diabetes and 50 controls (control), were analyzed to look into the relationship between Dry Eye Syndrome with Diabetes mellitus. Dry Eye syndrome was present in 12 (24%) patients, 05 (33.3%) were males and 07 (66.6%) were females. Dry Eye Syndrome was present in 26(52%) patients, 12 (36.6%) were males and 14 (63.6%) were females. Odd ratio for case and control was calculated by applying Chi-Square test which was 7.90 at 95% of confidence level (Cl) with a P value of 0.004943 assuming a P value of <0.05 level of significance.

Conclusion: Dry eyes and diabetes seem to go together frequently. Type I diabetes is more likely to cause a milder degree of dry eye, but type 2 diabetes is more likely to cause mild to moderate dry eye.

Efficacy of Oral Methotrexate in the treatment of Plaque Psoriasis in a local population

Wed, 20 Dec 2023 00:00:00 +0000

Background: Plaque psoriasis constitutes around 90% of psoriasis prevalent in the world. It’s medically introduced as well demarcated erythematous plaques with coarse silvery scales predominantly involving extensor surfaces of the knees, elbows, sacrum, scalp, nails and sites of injury. Methotrexate has been widely used to treat psoriasis and associated arthritis, it is mainly used to treat plaque psoriasis in patients not responding to topical therapy. Systemic therapy is required for patients who don’t respond to topical or where there is extensive disease. These include photochemotherapy, ciclosporin, biological agents.2,9 Various studies show methotrexate as an efficient drug to treat plaque psoriasis by reducing inflammation, and reducing cell proliferation by exerting its immunosuppressant effect.

Objective: To determine the safety and efficacy of methotrexate in treating plaque psoriasis.

Materials and Methods: The interventional descriptive single-arm pre and post-study was conducted in the department of dermatology Fauji Foundation Hospital Rawalpindi from August 2018 to January 2021. This research was approved by the ethical review committee of the hospital. One hundred forty two patients between 15 to 60 years of age suffering from plaque type psoriasis with PASI score of >8 were included in the study after taking the informed consent. Oral methotrexate in a dose of 10 mg/week was given for 8 weeks to patients from dermatology outdoor and Indoor. (PASI 6 or greater).Baseline blood counts, blood urea nitrogen, serum creatinine, electrolytes, alkaline phosphatase, alanine aminotransferase and chest Xray to rule out latent tuberculosis. They all got cured through a methotrexate dosage of 10mg that was adjusted between 5 mg to 25 mg based on individual conditions. Outcomes were measured as Psoriasis Area Severity Index PASI and Disease Activity Score DAS 28 for patients having psoriatic arthritis.

Results: Of all the participants 116(81.1%) were female and 26 (18.2%) were male whereas mean age of participants was 41.6 years. The mean pretreatment and post treatment PASI score shows significant drop from baseline (13.01+6.02) to eight weeks post treatment (5.4+3.2) which is statistically significant (P=<0.05). The change in percentage of PASI from baseline was analyzed by the Wilcoxon signed ranks test after 8 weeks (t=17.29) ie PASI 75 was achieved in more than 50% of participants. There was a marked improvement in the DAS28 score of participants having Psoriatic arthritis. Regarding Psoriatic arthritis, Table 6 shows that 26 out of 29 (96.29%) patients had moderate Psoriatic arthritis with DAS 28 score of less than 5 while 1(3.7%) patient had mild and 2(7.4%) had severe joint disease of greater than 5.1 DAS 28 score before methotrexate treatment. However majority ie 17/29 (62.9%) achieved complete remission in joint disease after 8 weeks of methotrexate treatment while a small number 2/29 (7.4%) still had DAS 28 score of upto 5.1 or moderate remission while none had high score of DAS28 of greater than 5.1 after 8 weeks.

Conclusion: The outcome of this study has shown that the effective way to treat plaque psoriasis is through methotrexate which is efficient in treating coexisting psoriatic arthritis which is one of the important commodities associated with plaque psoriasis

Is Salmonella Typhi Becoming a Superbug? A Cross-Sectional Study of the Antibiotic Sensitivity

Wed, 20 Dec 2023 00:00:00 +0000

Objective: To determine the antibiotic sensitivity patterns of Salmonella typhi in blood cultures of the patients attending a tertiary care hospital.

Material & Methods: This cross-sectional study was conducted in the Department of Internal Medicine, Hayatabad Medical Complex, Peshawar, Pakistan for a period of one year from 1^st August, 2021 till 30 August, 2022. All adult patients of either sex, belonging to the province of Khyber Pakhtunkhwa, Pakistan between 18 to 70 years of age, whether admitted through casualty or the outpatients, having a history of fever for the past 07 days and no prior history of admission or use of antibiotics in past one month were included.

Results: The mean age of the patients was 47 ± 5.6 years with females 59.2 % (320) and the males 40.7 % (220). A total of 540 blood cultures showed a growth of Salmonella Typhi out of requested 857 cultures representing a positive culture yield of 63%. The total numbers of MDR cases were 83.6% whereas the XDR cases were 3%. The antibiotics sensitivity was 100% to Carbepenems, Tigacycline, Colistin and Polymixin, whereas between 27.7% to 16.4% in the cephalosporin class and only 16.4% to the flouroquinolones.

Conclusion: The antibiotics resistance against Salmonella Typhi is on the upswing and calls for effective programs of antibiotics stewardship, development of indigenous updated antibiotics guidelines in line with the local sensitivity patterns and actions to avert the spread of infection.

Variation of Normal Hepatic Artery Doppler Indices Post Living Donor Liver Transplant

Wed, 20 Dec 2023 00:00:00 +0000

Background: Due to the lack of deceased donors, adult-to-adult living donor living transplant (LDLT) has emerged as the procedure of first choice among liver transplantation procedures in most Asian countries. Hepatic artery complications can lead to graft ischemia and are one of the most frequent causes of graft loss in the immediate postoperative period. Ultrasonography, including doppler evaluation, is the established initial imaging modality of choice for early detection and follow-up screening of vascular complications.

Materials and Methods: This retrospective cohort study was carried out at the Pakistan Kidney and Liver Institute and Research Centre (PKLI)and spanned from 01/07/2021 to 31/12/2021. Patients above 16 years of age who had undergone LDLT were included. Hepatic artery peak systolic velocities (PSV), resistive indices (RI), and acceleration times (AT) were documented intra operatively and then for 5 consecutive days. Follow-up scans were performed at 2 weeks, 4 months, and 6 months after the transplant. SPSS version 20 was used for statistical analysis.

Results: A total of 91 patients were included in the study. The minimum age was 17 years and the maximum age was 73 years with a mean age calculated to be 45 years. Approximately 79% of patients were males and 21% were females. A PSV of as less as 15 cm/s and as high as 267 cm/s was recorded with normal waveforms. A minimum RI of 0.44 and a maximum of 0.89 was observed. A minimum AT of 0.01 seconds and a maximum of 0.07seconds were noted.

Conclusion: A wide range of hepatic arterial velocities can be encountered following LDLT without clinically significant out comes. The hepatic arterial velocities normalized within 4 to 6 months following LDLT. Hepatic artery RI values of 0.44 to 0.89 can be observed without any complications.

Continuous Versus Intermittent Furosemide Dosing Regimen in the Treatment of Acute Decompensated Heart Failure

Wed, 20 Dec 2023 00:00:00 +0000

Objective: To compare continuous versus intermittent (bolus) infusion of furosemide in patients with acute decompensate heart failure (ADHF) in terms of length of hospital stay, urine output per day and change in serum creatinine levels.

Duration: Six months (01-09-2021 to 28-02- 2022)

Setting: Cardiology department District Head Quarter Teaching Hospital (DHQ-TH) Bannu.

Subjects and Methods: Eighty two (n=82) adult patients of either gender, between age 50years to 70 years were enrolled and equally divided into Group A (continuous Furosemide infusion) and group B (intermittent Furosemide dosing). Outcome of the therapy were duration of hospital stay, changes in serum creatinine and daily urine output.

Results: Mean length of hospital stay was significantly shorter (5.8±2.4 days versus 6.9±2.3, p=0.04), urine output per 24 hours was higher (2796.3 ml ± 365.9 SD and 2720.7 ml ± 647.6 SD, p=0.517) and mean change (rise) in serum creatinine was significantly higher (0.41 mg/dL ± 0.26 SD and 0.27 mg/dL ± 0.32 SD respectively, p=0.027) in continuous infusion group when compared with intermittent dosing group.

Conclusions: Treatment with continuous infusion of furosemide resulted in higher urine output per 24 hours, a higher rise in mean serum creatinine and a shorter duration of hospital stay as compared to treatment with intermittent dosing regimen.

DISTRIBUTION OF CATARACT BY AGE GROUPS, SEX, RESIDENCY AND LITERALITY IN POPULATION OF DISTRICT DERA ISMAIL KHAN

Nargis Noman, Tahir Orakzai Orakzai, Danish Zafar, Adnan Khan — Wed, 20 Dec 2023 00:00:00 +0000

Background: Cataract is an age related condition in which lens of the eye becomes opaque leading to visual disability. It is one of the principal causes of preventable blindness and visual impairments worldwide which is responsible for nearly half (47.8% or 17.7 million) of the population worldwide.

Objective: Our study is to assess the distribution of cataract in older adults, gender, literality and residency of cataract patient in district Dera Ismail Khan, Pakistan.

Materials and Methods: The descriptive cross-sectional study was conducted in the department of Community Medicine, Gomal Medical College DIK from May 1, 2022 to May 30, 2022. Data was collected from the file/card number of the patients who underwent proper eye examination for the cataract disease. According to Raosoft SPSS sample size calculator for the said population with confidence interval of 95%, margin of error 5% and response rate of 50%, our sample size should not be lower than 385. Demographic variable including in our research project is gender, age groups and resident (as rural or urban)in population of DI Khan.

Results: Out of a sample of 408 patients with cataract, the distribution was higher for patients above 50 than 50 or below and higher for female than male patients. Unilateral were more than bilateral cataracts .The distribution of cataract was higher in the periphery than the city patients.

Conclusion: Cataract is still one of the challenges as public health issue worldwide. Timely diagnosis and proper management can definitely alter the disease outcome and can decreases the burden of disables on the society. Prevalence of disease increases with aging especially after age of 50. Knowledge about the disease distribution, health care planers can plan for future prioritization of resources accordingly.

Changing Trends of Uterine Rupture Cases Over Three Decades

Laila Zeb, Salma Zeb, Sumaira Yasmeen — Wed, 20 Dec 2023 00:00:00 +0000

Background: Uterine rupture is associated with significant maternal and neonatal morbidity and mortality.

Objective: The study described the causes of uterine ruptures concerning maternal morbidity and fetal outcomes. Causes of ruptured cases from the same setting were compared between the years 2001, 2011, and 2021.

Materials and Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital (LRH), Peshawar. Forty-three women who had been diagnosed with uterine rupture were included in the study. Information on age, parity, causes of rupture, surgical management, maternal morbidity, and outcome of the fetus, was recorded on a predesigned proforma. Repair procedures, STAH (subtotal abdominal hysterectomy), and internal iliac artery ligation were performed as per requirements.

Results: Sixty two 62.8% of women fell in the 35 years and above age group. Mostly (62.8%) were grand multigravida. The commonest cause of uterine rupture was mishandled labor by traditional birth attendants (44.2%) and followed closely by scar dehiscence (37.2%). The commonest procedure (58%) was STAH. Eighty one percent81.4% of women had no complications. Sixty seven percent (67.4%) of fetuses died due to complications and 32.6% survived. Causes ‘mishandled by untrained attendants' (44.2%) and ‘previous C-section scar’ (37.2%) were recorded with increased percentages in 2021. More cases of direct trauma (8%) and obstructed labor (32%) were reported in the year 2001, as compared to other years.

Conclusion: The percentage of rupture of the uterus was lower (0.56%) in 2021, as compared to 2001 and 2011. The negligence of traditional delivery attendants contributed significantly to the mismanagement, resulting in morbidity and mortality in women and their fetuses. Complications should be checked if healthcare professionals scrupulously follow established standards and surgical procedures are conducted by a competent physician

Frequency of Lower Urinary Tract Symptoms with Irritable Bowel Syndrome and Their Associated Factors among Women at Urogynecology and Gastroenterology Clinic

Saida Abrar, Raheela Mohsin — Wed, 20 Dec 2023 00:00:00 +0000

Objective: To determine the lower urinary tract symptoms (LUTS) in females with irritable bowel syndrome (IBS) and to find the effect on their Quality of Life (QoL) using the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) Questionnaire.

Methodology: This study included 140 female patients, 80 as cases with diagnosed IBS by the Rome III criteria while 60 without IBS as controls from Urogynecology clinics among which 45 patients had a≤ stage-II pelvic organ prolapse and 15 patients had idiopathic microscopic hematuria. LUTS were evaluated using BFLUTS Questionnaire.

Results: The two groups did not significantly differ in demographic except a high body mass index (BMI) in the IBS group (p-value 0.002). The IBS group also had a significantly higher frequency of chronic hypertension, interstitial cystitis, and chronic depression (p-value 0.02, 0.03, and 0.03 respectively). There was a high frequency of LUTS symptoms in patients with IBS, frequency (p-value <0.001), urgency urinary incontinence (p-value <0.004), hesitancy (p-value <0.02), straining to void (p-value <0.001) and intermittency (p-value <0.001). Also, IBS significantly affected sexual activity (p-value < 0.001) and quality of life especially, daily tasks (p-value <0.01).

Conclusion: Patients with IBS have a higher frequency of storage and voiding LUTS, and it negatively affects their sexual and overall quality of life. Thus it is possible that both share some common underlying pathology and patients with IBS should be screened for LUTS and provided comprehensive care.

Potential Effect of Nigella Sativa Tablets on Fatty Liver Disease in Rats

Wed, 20 Dec 2023 00:00:00 +0000

Objective: This prospective study was conducted to explore the effects of crushed seeds of Nigella savita dietary supplementation on fatty liver disease in rats.

Materials and Methods: This study was conducted on 16-18 months male Sprague dawley rats weighing 150-170 gm. Animals were randomly assigned into three (03) groups; Group-I served as (Control group, C) received standard diet; Group-II served as (Liver Fatty group, F) that received diets having high % age of fructose (60% fructose w/w), Group-III (Fatty liver/Nigella sativa F/NS), fed fructose diet along with Nigella sativa tablets (1.6g/kg diet) to get daily intake of Nigella sativa at rate 170 mg/kg body weight. The daily food intake and weekly body weight of the animals were recorded. After receiving respective drugs for 06 weeks following parameters such as Therapy; Body Mass index (BMI Body weight final), total cholesterol, liver weight, LDL-C, HDL-C, vLDL-C, serum glucose, Adiponectin, bilirubin, insulin, AST, ALT and TNF-, were measured. HOMA-R calculation was used to determine insulin resistance. Furthermore, kidneys, livers and brains histopathalogical examination was also taken out.

Results: The weight of visceral body fat increased significantly in group II (F group) compared to group I (C group), but it dropped significantly in group III (F/NS group) compared to group II (F group). The serum level of glucose, HOMA-R, bilirubin, LDL-c, TNF-, vLDL-c, AST, ALT and insulin level significantly increased in both F and F/NS groups and a significant decrease in serum adeponectin level occurred as compared to C group. However, the serum levels of adeponectin increased in the F/NS group compared to the F group, and there was a substantial drop in glucose insulin, total cholesterol, HOMA-R, TNF-, LDL-c, vLDL-c, AST, ALT, and bilirubin. Histopathological examination of F group indicates vascular congestion in kidney and liver, renal tubular necrosis, hepatocytes and localized cerebral haemorrhage while the histology appearance in the F/NS group was nearly normal.

Conclusion: Animals receiving crushed tablets of Nigella sativa along with fructose diet produced significant attenuation in level of total cholesterol, serum glucose, insulin, TNF-α, LDL-c, HOMA-R, AST, bilirubin and ALT and a significant rise in adiponectin level in fatty liver disease in old tested animals.

Occupational Variations in Vitamin D Status and its Correlation with Serum Lipids in Varying Glycemic Control Groups

Zaheer Abbas, Umair Waqas, Abid Ali Ali — Wed, 20 Dec 2023 00:00:00 +0000

Objective: The study focuses on the evaluation of the difference between the serum vitamin D₃ levels, on the basis of sunlight exposure, in indoor and outdoor individuals and to find out the correlation between serum 1,25-OH-D and serum lipids of varying glycemic control subjects.

Methodology: We enrolled 221 participants. The serum 1,25-hydroxy-D₃ was quantitated by immuno-fluorescence method. Blood HbA1c amount was analyzed by high performance liquid chromatography. Serum levels of cholesterol, triacylglycerols, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol were estimated by spectrophotometric analysis. Very low-density lipoprotein cholesterol was computed using the Friedewald equation. The Statistical Package for Social Software 20.0 was chosen to statistically analyze the collected data.

Results: A significant dissimilarity in the levels of sun-born vitamin, the calcitriol, was calculated, among the sun-exposed and non-exposed group. The mean vitamin D value was measured higher in sun-exposure group than non-exposed to sun. There came to be known the interlink between glycemic control and vitamin D quantity. Serum vitamin D had an inverse relationship with serum cholesterol, triglycerides, LDL-C and VLDL-C, but a positive relation with HDL-C.

Conclusion: The present expanding insufficiency and deficiency of vitamin-D₃ is bringing about the peril of prevalent dyslipidemia and poor glycemic control, hence jeopardizing the health of people. The current unforeseen falling off serum vitamin D levels in the principal part of the population, is needed to be overseen and treated accordingly

Coincidence of obstructive lung disease and obesity at PAF Hospital Islamabad

Faiqa Latif, Asif Niaz, Muhammad Tahir, Afsheen Ishfaq — Wed, 20 Dec 2023 00:00:00 +0000

Objective: To look for presence of obesity in patients presenting with obstructive lung disease and factors associated with obesity in these patients

Study Design: Comparative Cross-sectional Study

Setting and Duration Of Study: Medicine and Pulmonology Department Pakistan Air Force Hospital Islamabad. From March 2022 to May 2022

Patients and Methods: A prospective study was conducted on 150 patients suffering from obstructive lung disease diagnosed by consultant pulmonologist on the basis of clinical and spirometry parameters. Body mass index was calculated in all the patients by WHO formula and they were classed as normal, overweight or obese depending upon body mass index. Factors like age, gender, tobacco smoking and ethnicity were associated with presence of obesity among the study participants.

Results: Out of 150 patients of obstructive lung diseases,85 (56.7%)were male and 65 (43.3%) were female. Mean duration of illness in our target population was 4.63±7.831 years. Out of total study participants, 47 (31.4%) had obesity while 103 (68.6%) did not show obesity and had body mass index less than 30 kg/m². Chi-square analysis revealed that tobacco smoking had statistically significant relationship with presence of obesity among the target population (p-value-0.001).

Conclusion: Around 1/3^rd of patients suffering from obstructive lung diseases had comorbid obesity as well. Patients who were tobacco smokers were more at risk of having obesity as compared to those who did not smoke tobacco.

Comparison of topical 5% Permethrin with topical 10% Sulphur in the treatment of Scabies

Aleena Nasir, Abdul Haseeb Khan, Sara Sarwar, Mahnoor Farooq, Najia Sajjad — Wed, 20 Dec 2023 00:00:00 +0000

Objective: To compare the efficacy of topical 5% Permethrin and topical 10% Sulphur in the treatment of Scabies.

Design: Randomized controlled trial.

Place and duration of study: This study was conducted at the Department of Dermatology, Combined Military Hospital, Abbottabad, Pakistan, from March 2022 to September 2022.

Patients and methods: A total of 60 patients coming to outpatient department and diagnosed with scabies mites were randomized into two equal groups of 30 patients. Diagnosed patients on odd serial number were allocated to group A, treated with application of topical 5% Permethrin cream twice with one week interval, while patients reporting on even serial number were allocated to group B, treated with 10% Sulphur ointment and were told to apply this for two or three weeks. All patients were followed up at the intervals of 1, 2 and 4 weeks. Primary outcome was the comparison of efficacy of 5% Permethrin cream and 10% Sulphur ointment for the treatment of Scabies.

Results: At the first follow-up after 1 week, the efficacy of Permethrin was significantly higher (63.33%) compared to Sulphur group where no patient was cured (p< 0.001), while at 2^nd follow-up after 2 weeks, the efficacy of Permethrin was 100%, while it was 43.33% in sulfur group (p< 0.001). However at the end of 3^rd follow-up after 4 weeks, efficacy of both treatments was 100%.

Conclusion: The topical application of 5% Permethrin and 10% Sulphur was equally effective in 4 week time, however Permethrin cream showed faster cure in the treatment of Scabies

Frequency of Postnatal Depression after Normal Vaginal Delivery in a Tertiary Care Hospital

Laila Zeb, Ayesha Nawaz — Wed, 20 Dec 2023 00:00:00 +0000

Background: Postnatal depression (PND) is considered as an important health problem in modern societies.Most of the women nation-wide have access to skilled birth attendants. Postpartum depression) is a neglected area of maternal health care in developing countries like Pakistan.

Objective: To determine frequency of postnatal depression after normal vaginal delivery in patients reporting to Lady Reading hospital, Peshawar

Methodology: This Descriptive Cross Sectional study was conducted in Department of Obs & Gynae, MTI-Lady Reading Hospital, Peshawar from 22 June, 2021 to 22 Dec, 2021 Post-natal depression was assessed through Edinburgh postnatal depression scale (EPDS) with cut-off value of above 12 was labeled as positive for postnatal depression.

Results: As per frequencies and percentages for post-natal depression, 46 (15.2%) patients had post-natal depression after normal vaginal delivery.

Conclusion: This study concluded that Post-Natal depression is prevelant amongst women having normal vaginal delivery without any risk factors as well.

Parameters for Identifying Stress among Doctors in Mardan Medical Complex: A Cross Sectional Study

Sajid Khan, Arshad Khan, Muhammad Usman — Wed, 20 Dec 2023 00:00:00 +0000

Objective: To evaluate the common causes of stress among doctors of Mardan Medical Complex.

Materials and Methods: This study was conducted at the Mardan Medical Complex. Totally 95 doctors were enrolled. This was a questionnaire base study. The Questionnaire was filled by the doctors and data was analyzed by using SPSS Software Version 23.

Results: Out of total 95 enrolled doctors, 63 were male and 32 were female doctors with mean age of 41.45 ± 8.19 years. The most common age group was 31-40 years, followed by the age group of 42-50 years and the least number of age group was < 50 years. The most common parameters identified by doctors was sleep deprivation and Lengthy Working Hours followed by other causes such as High Patient Volume, External /Political Interference, Senior’s Pressure/High Expectations/Work Targets, Night Duties and Phone calls during Night/Early Morning. Stratification on the basis of gender and age group were done.

Conclusion: It is concluded that stress is a hurdle that the doctors faces in different pattern. For better performance the doctors should take proper sleep and manage the time to overcome the stress. Also avoid Phone calls during Night/Early Morning