Journal of Peoples University of Medical & Health Sciences Nawabshah. (JPUMHS)

CHALLENGES IN PUBLIC HEALTH SYSTEMS: ADDRESSING INEQUITIES IN RURAL AND REMOTE AREAS

Anwar Ali Jamali — Tue, 31 Dec 2024 00:00:00 +0100

As long as urban & underserved zones
through rational right of entry to
healthcare facilities is solitary of the chief
problems fronting worldwide community
well-being schemes. Significant strategies
for undertaking these matters comprise
talking
healthcare
discriminations,
leveraging tools identical telemedicine, &
emerging robust vaccination plans. To
decrease the healthcare breach &
assurance
that
entirely
populaces,
irrespective of place, have admittance to
eminence care in an appropriate way, these
problems necessity be logically spoken.

ESTABLISHING NORMAL REFERENCE RANGES FOR WHITE BLOOD CELL AND PLATELET COUNTS IN ADULT MALES: A REGIONAL STUDY IN MUZAFFARABAD DISTRICT.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Many studies have established normal reference values for hematological
indices in various populations, but these values can be influenced by factors like sex, age,
ethnicity, and socio-environmental conditions. It is crucial to develop specific reference
values for each population. For the Pakistani population, existing hematological reference
values are based on Western populations and may not be suitable. OBJECTIVE: To
determine normal reference values for white blood cells and platelets for adult male
population in district Muzaffarabad. METHODOLOGY: This cross-sectional study took
place in District Muzaffarabad from July 2022 to February 2023, involving 384 healthy adult
men, selected through stratified disproportionate random sampling. Data was collected
through a structured questionnaire. The collected blood samples were analyzed using the
Sysmex Hematology Analyzer KX21, Japan. Reference values for Total Leukocyte and
platelets count were established and compared with existing reference values. RESULTS:
The mean age of 29.11 years, about 71.87% n=276 were from rural areas, 44.27% n=170
belonged to the lower socioeconomic class, 66.67% n=256 had completed high school
education. The mean Total Leukocyte count TLC was 7,579/µl, with a range of 4,280 to
10,380/µl, while the mean platelet count PLT# was 284,271/µl, ranging from 195,891 to
365,678/µl. The independent t-test revealed no statistically significant differences in the mean
Leukocytes and Platelets across different age groups, areas of residence, education levels, and
socioeconomic statuses p>0.05. CONCLUSION: Normal reference values for TLC and
Platelets for adult male population in district Muzaffarabad are different from the reference
values which are currently used.

MICROSCOPIC ANALYSIS AND CLINICAL SYMPTOM CORRELATION IN OVARIAN AND UTERINE CONDITIONS: A RETROSPECTIVE INVESTIGATION.

Tue, 31 Dec 2024 00:00:00 +0100

ABSTRACT
BACKGROUND: Women frequently suffer from ovarian and uterine conditions that impact
their health, such as fibroids, endometriosis, and ovarian cysts. Fibroids are present in around
66.5% of women having a hysterectomy, but non-neoplastic lesions are more prevalent.
OBJECTIVE: To investigate the relationship between clinical symptoms and microscopic
analysis in patients with uterine and ovarian abnormalities. METHODS: The retrospective
cross-sectional study was conducted between September 2023 and September 2024 at
Hayatabad Medical Complex, Peshawar. A total of 118 patients, who had fibroids and
abnormal bleeding were included in the study. Microscopically, the thickness, width, and
length of the uterus and ovaries were measured. Correlation analysis was performed using
SPSS version 22, p<0.05 was considered statistically significant. RESULTS: Among the 118
individuals, symptoms such as irregular menstruation, pelvic pain, and abnormal bleeding
were prevalent. Significant correlations have been found between the left ovary's dimensions;
there was a high connection p=0.01 between its thickness, width, and length. Similarly, there
were associations between clinical symptoms and uterine dimensions, including length
mean=10.962cm, SD±9.5, p=0.01, width p<0.01, and thickness p=0.01. The presence of
fibroids, with an average length of 1.386cm, was also strongly correlated with symptoms
p=0.01. CONCLUSION: The strong correlation between ovarian and uterine dimensions and
associated symptoms indicates their potential as valuable diagnostic indicators for
reproductive health. Incorporating dimensional data into clinical assessments could lead to
more personalized treatment approaches and improved symptom management.

ANTIOXIDANT AND ANALGESIC ACTIVITY OF TOTAL FLAVONOIDS OF FORSSKAOLEA TENACISSIMA.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Total flavonoids of Forsskaolea tenacissima was screened for possible antioxidant
and analgesic activities. It was an attempt to isolate total flavonoids from the aerial parts of plant and
subject it for further pharmacological screenings. METHODS: Whole plant of Forsskaolea
tenacissima was collected from Institute of basic medical sciences, Khyber medical university and the
voucher specimen was sent in to the pharmacology department. Hot plate method, writhing method
and tail immersion methods were used to investigate the possible analgesic activity and DPPH was
used for the determination of antioxidant activity of Forsskaolea tenacissima while ascorbic acid
was used as a reference. RESULTS: Mice were divided into six groups and the lethality was zero
percent in animals of first three groups while there was 25 %, 50 % and 100 % lethality in animals of
group 4 to group 6 respectively. Total flavonoids of Forsskaolea tenacissima has analgesic activity
which is ascertained by the hot plate, writhing, and tail immersion procedures. The antioxidant
activity was less than the EC50, or 37.20 percent, at a concentration of 62.5µg/ml. Which gradually
increases and it reached to 74.10 % at 1000 µg/ml which shows that the plant has antioxidant
activity. CONCLUSION: The study shows that the total flavonoids of Forsskaolea tenacissima has
antioxidant activity as well as analgesic activity mediated through Hot plate method, writhing
method and tail immersion methods. Crude methanolic extract's initial phytochemical tests that the
plant includes flavonoids, which may be what give it its antioxidant properties.

PREVALENCE AND HISTOPATHOLOGICAL PATTERN OF HELICOBACTER PYLORI IN PATIENTS PRESENTING WITH GASTROINTESTINAL SYMPTOMS: A CLINICAL STUDY.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Gastritis, peptic ulcers, and the possibility of developing into cancer are
among the gastrointestinal conditions that are significantly influenced by Helicobacter pylori
H. pylori. This study aimed to evaluate the prevalence of H. pylori and its associated
histopathological findings in patients with gastrointestinal symptoms. OBJECTIVE: To
assess the prevalence of H. pylori and association with histopathological findings among
gastrointestinal symptomatic patients. METHODS: A descriptive cross-sectional study
conducted at Khyber Teaching Hospital, Peshawar. About 310 patients were enrolled using
non-probability convenient sampling technique. H. pylori stool antigen testing and
histological analysis of stomach biopsy samples were examined. Data collected was analyzed
by SPSS version 22, with p <0.05 considered significant. RESULTS: In this study, 310
patients were assessed, comprising 171 females 55.2% and 139 males 44.8%. The highest
infection rates were observed in the age groups of 31 to 45 18.3% and 19 to 30 15.0%, with
an overall positive rate of 16.4%. Histopathological analysis revealed that 134 patients
43.23% had chronic non-specific gastritis, while 140 cases 45.16% presented with
Helicobacter pylori-associated pangastritis. There was a significant correlation of H. pylori
with histopathological severity was observed p=0.012. However, no significant association of
stool antigen test with age p=0.946 and gender p=0.377 was observed. CONCLUSION:
Pangastritis and chronic gastritis are the main symptoms of the extremely common
Helicobacter pylori infection. Early identification and treatment are essential to prevent
complications, even though severe results such as MALT lymphoma are uncommon.
Controlling the risks of infection requires routine screening.

CLINICAL OUTCOMES OF COMPRESSION ALONG WITH ULTRASOUND GUIDED FOAM SCLEROTHERAPY IN THE MANAGEMENT OF VENOUS ULCERS: A PROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL, PESHAWAR.

Tue, 31 Dec 2024 00:00:00 +0100

ABSTRACT
BACKGROUND: Ultrasound-guided foam sclerotherapy UGFS has been demonstrated to
be as successful as open surgery in the management of venous ulcers. OBJECTIVE This
study aimed to evaluate the clinical outcomes of compression along with ultrasound guided
foam sclerotherapy in the management of venous ulcers. MATERIAL AND METHODS:
This eighteen-month prospective observational study was conducted from July 2022 to
December 2023 with a follow up period of one year at a Tertiary Care Hospital in Peshawar.
Patients were recruited through non-probability convenience sampling. Prospective
assessments were conducted on patients with superficial truncal venous incompetence and
active venous leg ulcers CEAP clinical class C6 diagnosed through clinical evaluation and
findings from doppler ultrasound. Baseline clinical, imaging, and demographic data were
gathered before the the standard procedure of compression therapy and ultrasound guided
foam sclerotherapy. The time frame from the intervention to the complete healing of the ulcer
and the rate of ulcer recurrence throughout the one-year follow-up period were the main
outcome measures RESULTS: The study included 33 individuals aged 40-50, with a mean
age of 43 ± 5 years. The gender distribution was 19 men 57.6% and 14 women 42.4%. By the
end of the one-year follow-up period, 26 patients 78.8% had fully healed ulcers, three
patients 9.1% had incomplete healing, with ulcers showing moderate improvement but not
fully healing. Four patients 12.1% had unhealed ulcers, indicating no progress during the
research period. Ulcer recurrence was reported in one patient 4% who had previously healed
ulcers. The healed ulcers had an average size reduction of 80% ± 5%. The average time for
healing was 14 ± 3 weeksvCONCLUSION: The results of this study concluded that, treating
venous ulcers with compression therapy and ultrasound-guided foam sclerotherapy together
significantly improves healing rates, reduces ulcer size, and enhances patient quality of life.
The beneficial result of this study encourages the use of this combination therapy strategy in
clinical settings for improved patient care.

KI67 IMMUNOSTAINING'S DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE IN GESTATIONAL TROPHOBLASTIC DISORDERS: A RETROSPECTIVE STUDY.

Tue, 31 Dec 2024 00:00:00 +0100

ABSTRACT:
BACKGROUND: Gestational trophoblastic diseases GTDs are rare gynecological disorders
caused by abnormal trophoblastic progression. Subtypes include complete moles,
partial moles, and hydropic abortions frequently share physical characteristics, challenging
diagnosis. Ki67, a nuclear proliferation marker, has emerged as a viable tool for improving
diagnostic accuracy and determining prognosis. OBJECTIVE: The aim of this study is to
examine the diagnostic and prognostic impact of Ki67 immunostaining for classifying GTD
subtypes and predicting high-risk patients, such as persistent trophoblastic disease PTD and
choriocarcinoma. METHODOLOGY: A retrospective descriptive study was carried out
from January to December 2023 in Lady Reading Hospital, Peshawar. In terms of
1,012 placental biopsy samples, 197 19.5% were diagnosed with GTDs, comprising 150
complete moles, 45 partial moles, and two unusual cases of choriocarcinoma and enhanced
placental site reactivity. Fifty cases were chosen for Ki67 immunostaining. Staining intensity
0 to 3+ and extent 0 to 4+ were evaluated and classified, and statistical analyses were done to
link findings to clinical outcomes. RESULTS: In 85% of cases complete moles revealed high
3+ Ki67 staining, with 70% showing a diffuse >50% extent. Partial moles showed moderate
2+ staining in 33.3% cases. However, hydropic abortions were primarily negative. All PTD
and choriocarcinoma cases had significant and diffused Ki67 staining. CONCLUSION:
Ki67 immunostaining is an effective technique for distinguishing GTD subtypes and
detecting high-risk cases. Its integration into standard diagnostic techniques, combined with
supporting markers, has the potential to improve GTD management, particularly in resource
constrained settings.

ACUTE TOXICITY AND RELAXANT ACTIVITY OF TOTAL FLAVONOIDS OF FORSSKAOLEA TENACISSIMA.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Abdominal spasms have historically been treated with the whole plant of
Forsskaolea tenacissima. Thus, the study's goals were to identify the safe dosage range,
identify the mechanism or mechanisms behind Forsskaolea tenacissima's therapeutic usage
for gastrointestinal spasms, and extract the plant's total flavonoids. METHODS:
Forsskaolea tenacissima's total flavonoids were examined for potential antispasmodic
efficacy in isolated rabbit jejunal preparations after an acute toxicity research was conducted
to establish the safe dosage range prior to in vivo tests. RESULTS: With comparable EC50
values of 4.22 ± 0.849 mg/ml and 0.607 ± 0.0306 mg/ml, total flavonoids from Forsskaolea
tenacissima decreased both spontaneous and high K+-induced contractions in isolated rabbit
jejunal preparations. The concentrations used were 0.01, 0.03, 0.1, 0.3, 1.0, 3.0, 5.0, and 10.0
mg/ml. The mechanism was verified by constructing a calcium curve in the decalcified rabbit
jejunal preparation with and without verapamil 0.1, 0.3 µm. The EC50 value of the total
flavonoids in Forsskaolea tenacissima is -2.55 ± 0.00 at 0.1 mg/ml, whereas the control has
an EC50 value of -2.80 ± 0.00. In the presence and absence of 0.1 µM verapamil, the
corresponding EC50 Log Ca++ M values are 1.71 ± 0.07 and -2.45 ± 0.00, respectively. This
suggests that the total flavonoids of Forsskaolea tenacissima follow voltage-gated calcium
channels for calcium influx since the right shift of Verapamil and the test sample's total
flavonoids right shifts are comparable. CONCLUSION: According to the study,
Forsskaolea tenacissima's total flavonoids have antispasmodic action that may be mediated
via voltage-gated Ca++ channel blockage, and the safe dose is 100 mg/kg. This gives the
plant a solid pharmacological foundation for its potential medical application in treating
intestinal spasm.

INTRACRANIAL AND INTRAORBITAL EXTENSION OF ALLERGIC FUNGAL RHINOSINUSITIS IN PATIENTS PRESENTING AT TERTIARY CARE HOSPITAL.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Allergic fungal rhinosinusitis AFRS is a distinct subtype of chronic
rhinosinusitis CRS, affecting approximately 5%–10% of cases. It occurs due to an
exaggerated immune response to fungal colonization, leading to persistent inflammation.
Unlike typical fungal infections, AFRS develops in immunocompetent individuals who
exhibit strong allergic reactions. Diagnosis is typically confirmed through sinus surgery, and
treatment involves both medical management and surgical intervention. OBJECTIVE: This
study aimed to assess the frequency of intracranial and intraorbital extension in AFRS
patients. METHODS: A cross-sectional study was conducted in the ENT Department of
Shaikh Zayed Hospital, Lahore, from January to July 2018. Patients aged 20–60 years with a
confirmed diagnosis of AFRS were included. Demographic details, disease duration, and
comorbidities such as diabetes and hypertension BP >140/90 were recorded. Data analysis
was performed using SPSS version 20. RESULTS: The study included participants with a
mean age of 41.23 ± 9.27 years, with males making up 59% of cases. Diabetes was observed
in 43% of patients. Intracranial extension was present in 39% of cases, while intraorbital
extension was more common, occurring in 73%. A significant association was noted between
diabetes and intraorbital extension p < 0.05, as well as between prolonged disease duration
and intracranial extension p = 0.03. CONCLUSION: The high prevalence of intraorbital
extension in AFRS highlights the need for early detection and timely intervention. Prompt
management is crucial to prevent severe orbital and neurological complications. Further
research is needed to refine diagnostic and treatment approaches for better patient outcomes.

EVALUATING THE RISK OF PRE-ECLAMPSIA IN PREGNANT WOMEN WITH HYPEREMESIS GRAVIDARUM IN THE SECOND TRIMESTER.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Hypertensive disorders of pregnancy, particularly pre-eclampsia, are a
leading cause of maternal and neonatal mortality. Hyperemesis gravidarum HG in the second
trimester has been linked to abnormal placentation, potentially increasing the risk of pre
eclampsia. OBJECTIVE: To determine the frequency of pre-eclampsia in patients diagnosed
with hyperemesis gravidarum in the second trimester. METHODS: Using a descriptive
cross-sectional research design, the study was conducted for six months at the Obstetrics and
Gynecology Department of Lady Reading Hospital in Peshawar, Pakistan. During their
second trimester, 100 pregnant women with hyperemesis gravidarum were enrolled. By
assessing their demographic, medical, obstetric, and pre-eclampsia indicators, research data
was gathered from pregnant women who were diagnosed with hyperemesis gravidarum in the
second trimester. Analysis of the data was done using SPSS version 21. RESULTS: On
average, each participant in this research was 27 years old standard deviation: 10.88. While
34% of research participants had already given birth twice, 66% had only experienced one
pregnancy. Pregnancy duration for research participants was less than 12 weeks, with a
standard variation of 5.94 weeks. In the second trimester, 47% of women who experienced
hyperemesis gravidarum went on to develop pre-eclampsia. CONCLUSION: According to
the study, pregnant women who have hyperemesis gravidarum during the second trimester
are more likely to develop pre-eclampsia. These findings highlight the significance of
regularly monitoring expectant mothers and initiating therapy for these individuals as soon as
possible.

ENDOMETRIAL HYPERPLASIA IN OBESE PATIENTS OF REPRODUCTIVE AGE PRESENTED WITH ABNORMAL UTERINE BLEEDING.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUNG: Abnormal uterine bleeding AUB is commonly reported at the
gynecological OPDs as approximately 1 in every 3 patients in these OPDs reports about this
complaint OBJECTIVES: This Study aimed to determine the frequency of endometrial hyperplasia
in obese patients of reproductive age with abnormal uterine bleeding. METHODS: This cross
sectional study was carried from 1st of March 2023 to 31st July 2023 at the Department of
Gynaecology and Obstetrics District Head Quarter Hospital, Mardan. A total of 213 women between
the ages of 18-40 years with BMI≥ 30 kg/m2 with complaint of abnormal uterine bleeding were
included in this study. Endometrial thickness was assessed through transvaginal ultrasonography.
Endometrial hyperplasia was diagnosed when ultrasonography showed quite 7 mm thickness of
endometrium within two days after the end of menstruation. Statistical analysis was done using IBM
SPSS Version 25. RESULTS: The Mean age was 29.36±6.52 years, range from of 18-40 years. The
mean BMI was 32.83±2.27 while mean parity was 1.73±1.26. Results of transvaginal ultrasonography
show the presence of endometrial hyperplasia in 13.15% of these obese women. BMI stratification
ratio showed higher in patients endometrial hyperplasia BMI≥35 than patients with BMI˂35 although
the difference was not statistically significant. CONCLUSION: The obese women consulting for
abnormal uterine bleeding in their reproductive age have a considerable risk for the development of
endometrial hyperplasia and must be assessed for its diagnosis.

FETAL OUTCOMES OF LABOUR INDUCTION AT 40 AND 41 WEEKS OF GESTATION.

Ayesha Nasir1, Zule Huma2, Rubab Ahmad3, Humaira Aman4, Heema5, Alia Jehan6 — Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Labor induction is frequently carried out between weeks 40 and 41 of
pregnancy in order to enhance outcomes for both the mother and the fetus and to lower
perinatal problems. Objective of the study to assess the frequency of fetal outcome of labour
induction at 40 and 41 weeks of gestation. MATERIALS AND METHODS: This cross
sectional study was carried out from 1st of March 2023 to 31st July 2023 at DHQ Mardan. The
study comprised 188 pregnant women who had labor induction at 40 and 41 weeks of
gestation. The statistical analysis was carried out with SPSS version 26. RESULTS: The
mean age in this study was 30.52±6.54 years. Among these women 124 65.96 % were in their
40 gestational week while 64 34.04% were in their 41 gestational week. Number of
primigravida was 113 60.11% while multigravidas were 75 39.89%. C-section was
performed in 39 20.74% cases while 149 79.25% were vaginal deliveries. The results of
primary outcomes of the study showed significantly increased adverse fetal outcomes such as
admission in NICU 32.81 Vs 16.13%, p=0.008, meconium aspiration syndrome 26.56 Vs
14.52%, p=0.044, fetal distress 28.12 Vs 15.32%, p=0.05, macrosomia 18.75 Vs 8.06,
p=0.03, asphyxia 18.75 Vs 8.87, p=0.05 and still birth 6.25 Vs 0.80 % , p=0.027 in Group-B
compared to Group-A. CONCLUSIONS: There is a significant increase in adverse fetal
outcomes between 41-42 weeks compared to between 40-41 weeks of gestation. Induction of
labour after 40 week is advisable for improved fetal health.

PNEUMOCYSTIS PNEUMONIA IN PATIENT INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS.

Abdul Hameed1, Muhammad Bilal2, Imran Khan3, Mian Fareezuddin4, Yaseen Khan5 — Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: A serious opportunistic lung infection, pneumocystis pneumonia PCP
primarily affects people with weakened immune systems, such as those who are HIV
positive. Even with improvements in prevention and antiretroviral treatment, PCP still has a
major impact on morbidity and death, particularly in environments with limited resources.
The aim of study is to determine the frequency of Pneumocystis pneumonia in patients with
human immunodeficiency virus HIV presenting to a tertiary care hospital. METHODS: We
conducted a cross-sectional study at the Department of Internal Medicine, Lady Reading
Hospital, Peshawar, from October 9, 2021, to April 9, 2022. A total of 150 HIV-positive
patients, aged 18 to 75 years, took part in the study. To focus on PCP alone, we excluded
those with other major health conditions such as tuberculosis, diabetes, kidney or liver
disease, or those who were pregnant or using long-term steroids. Each patient underwent a
clinical examination and relevant tests to check for PCP. RESULTS: The average age of the
participants was 39.92 ± 14.09 years. PCP was diagnosed in 55 patients 36.7%. It was
significantly more common in individuals with CD4 counts under 200 cells/mm³ p < 0.001
and in those who had gone longer without HIV treatment p = 0.02, recurrent non-PCP
pneumonia p = 0.002, and unexplained fever lasting ≥2 days p < 0.001 were all significantly
associated with PCP. There was no statistically significant correlation between genders wise
p = 0.45 and also Age groups p = 0.51. CONCLUSION: More than a third of the HIV
positive patients in our study had PCP. These results stress the need for early detection and
proper care to prevent serious outcomes in vulnerable individuals.

STAFF NURSE' KNOWLEDGE REGARDING HIV/AIDS AT A TERTIARY CARE HOSPITAL, NAWABSHAH.

Tue, 31 Dec 2024 00:00:00 +0100

ABSTRACT
BACKGROUND: HIV/AIDS prevalence is rising in Pakistan. To care for infected patients,
nurses must possess the necessary skills. The domain in which nurses provide care is influenced
by their knowledge and attitudes. Assessing nurses' knowledge, attitudes, and practices is
therefore crucial. OBJECTIVES: To assess staff nurses' HIV/AIDS-related knowledge,
attitudes, and practices METHODS: 200 staff nurses were picked using a convenience sample
technique in a cross-sectional, quantitative study design. The data was gathered via a 20-item
questionnaire. Items 06, 07, and 07 about knowledge, attitudes, and practice were included in
this KAP survey. IBM SPSS. 23 was utilized for data analysis. RESULTS: 194 97%, people
answered this questionnaire. 101 52.07% of the 194 responders were female. The knowledge
of the 55 28.9% and 66 35.1% participants was good to excellent. 125 participants 64% felt
that nurses have a fundamental right to be aware of the status of patients with HIV/AIDS, and
97 participants 50% strongly agreed that they are afraid of becoming infected when caring for
an infected patient. Although they were terrified when executing invasive interventions, nurses
were also at ease with non-invasive care techniques. CONCLUSION: Although nurses today
know more about HIV/AIDS, there has always been concern about patient-to-nurse virus
transmission. To lower the risk of illness transmission, nurses must participate in an appropriate
infection control training program.

EMERGENCY MANAGEMENT OF CHEST TRAUMA REQUIRING INTUBATION: CLINICAL OUTCOMES AT PUMHS NAWABSHAH.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Morbidity and mortality from chest trauma, in particular, is a major
contributor and occurs especially in low- and middle-income countries LMICs. Emergency
tracheal intubation continues to be a cornerstone of airway management for critically injured
patients, but outcomes are variable depending upon the type, timing, and complications of
intubation. This study assesses the clinical outcomes of emergency intubation in chest trauma
patients treated at PUMHS Nawabshah. METHODS: This is a cross-sectional study with
120 patients with chest trauma who need emergency intubation. Demographics, mechanisms
of injury, time to intubation, method direct vs. video laryngoscopy, complications, mortality
and hospital length of stay were noted. Chi-square tests, Kaplan-Meier survival analysis and
logistic regression were used to identify predictors of mortality. RESULTS: Male patients
made up the majority of patients 76.7% and the commonest mechanism of injury was road
traffic accidents 60%. There was a significant increase in mortality with delay to intubation,
from 5% 5–10 minutes to 16.7% >20 minutes p=0.045. Although in widespread use 75%,
direct laryngoscopy was associated with higher rates of hypoxia 20% than video
laryngoscopy. Airway trauma patients averaged 11.5 days in the hospital and complications
with hypoxia and hypotension prolonged hospital stay. Time to intubation and length of stay
were identified as significant predictors of mortality p<0.01 by logistic regression.
CONCLUSION: Chest trauma patients require timely intubation and effective airway
management to improve outcomes. There are efforts to decrease delays and operator
proficiency in advanced airway techniques to reduce complication and mortality.

OUTCOMES OF SURGICAL AND NON-SURGICAL MANAGEMENT OF SEVERE PANCREATITIS A CROSS-SECTIONAL STUDY AT PUMHS.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Severe acute pancreatitis SAP is a life-threatening condition associated
with high morbidity and mortality, particularly in resource-limited settings. Surgical and non
surgical management strategies remain pivotal in SAP care, with limited data available in the
regional context. OBJECTIVE: This study aimed to compare the outcomes of surgical and
non-surgical management of SAP, including mortality, complications, and length of hospital
stay, at Peoples University of Medical and Health Sciences PUMHS, Nawabshah.
METHODS: A cross-sectional study was conducted, including 400 patients diagnosed with
SAP based on the revised Atlanta classification. Demographics, management type,
complications, mortality, and hospital stay data were analyzed. Statistical tests, including chi
square and logistic regression, were applied to determine associations and predictors of
outcomes. RESULTS: Of the 400 patients, 61.5% received non-surgical management, while
38.5% underwent surgical intervention. Mortality was significantly higher in the non-surgical
group 25% compared to the surgical group 12.5% p < 0.05, particularly among males.
Complications such as organ failure and infections were more common in non-surgical
patients 28.8% in males vs. 15.5% in females. Surgical management demonstrated improved
outcomes, with reduced mortality and comparable hospital stays. Disease severity scores
were critical predictors of mortality and prolonged recovery, while gender differences
influenced complication rates. CONCLUSION: Surgical management significantly improves
outcomes in SAP patients with severe complications. Early disease stratification, timely
interventions, and infrastructure development for minimally invasive techniques are essential
for optimizing SAP care in resource-limited settings.

ENDOMETRIOSIS AND ITS CONSEQUENCES ON FERTILITY AND QUALITY OF LIFE – A HOSPITAL-BASED CROSS-SECTIONAL STUDY AT PMCH NAWABSHAH.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Endometriosis is a disabling gynecological disorder that affects about
10% of reproductive-aged women globally, with far-reaching effects on fertility and quality
of life QoL. Although the condition is worldwide in its prevalence, information from low
resource settings such as Pakistan is limited. METHODS: Hospital-based cross-sectional
survey of 360 women aged between 18–45 years having clinically or laparoscopically
diagnosed endometriosis. Structured questionnaires for collection of data regarding
demographic parameters, fertility background, severity of pain visual analog scale, VAS, and
QoL Endometriosis Health Profile-30, EHP-30. Severity of the disease as per revised
American Society for Reproductive Medicine ASRM criteria was categorized. Analysis of
data performed by using SPSS version 26, wherein p<0.05 were considered significant.
RESULTS: Participants' mean age was 29.4 ± 6.2 years, and 62.5% had reported infertility
65.8% primary, 34.2% secondary. Severe pelvic pain VAS ≥7 was found in 58.3% of the
participants, which was associated with advanced ASRM stages III/IV. QoL scores reflected
significant impairment in pain 68.2 ± 12.4, emotional well-being 54.7 ± 15.2, and social
functioning 49.3 ± 14.8. Advanced endometriosis ASRM III/IV was highly linked with
infertility OR = 4.2, 95% CI: 2.8–6.3, p<0.001, and decreased socioeconomic status was
associated with delayed diagnosis OR = 2.1, 95% CI: 1.4–3.2, p=0.008. CONCLUSION:
Endometriosis has a major impact on fertility and QoL in women of Nawabshah, with
diagnostic delays compounding disease burden. The implications of our findings underscore
the need for enhanced diagnostic protocols, multidisciplinary management, and patient
education in low-resource environments to forestall long-term sequelae.

PREVALENCE OF PREHYPERTENSION AND HYPERTENSION AND THEIR ASSOCIATION WITH BODY MASS INDEX IN YOUNG FEMALE ADULTS OF HYDERABAD, PAKISTAN.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Prevalence of prehypertension and hypertension has been reported as the
cause of concern among young females. Higher blood pressure can have adverse outcomes
among females. The increase in the prevalence of overweight and obesity has been the major
factor for the increase in systolic and diastolic blood pressure. BMI has been used to measure
overweight and obesity. This study is focused on the prevalence of prehypertension and
hypertension among young female adults who are residing in Hyderabad, Pakistan. This
study was conducted in female adults in the selected areas of Hyderabad Pakistan. The data
was obtained by interview-based questionnaire. The data was collected only during the
morning timing from 8.30 am to 10.30 am to have consistency in the data, the weight and
height were measured as the standard protocols using the weight in kilograms and height in
centimeters. BMI was calculated for the subjects using the standard formula. The Blood
pressure was measured using the sphygmomanometer. The data was analyzed using the
statistical software SPSS 22. All the ethical measures were kept into consideration before the
collection of the data. Prevalence of hypertensions was higher 36% followed by hypertension
7.8% among the studied female subjects. The prevalence of hypertension was 17.6%and the
prevalence of prehypertension was 27.2%. The prevalence of prehypertension and
hypertension was significantly higher χ=1.78, P < 0.05 among the overweight and obese
female adults. Similarly the BMI showed a positive significant correlation with both SBP
r=0.401, P < 0.001 and DBP r= 0.443, P < 0.001. This study concludes the higher prevalence
of prehypertension and hypertension among young female adults. The BMI showed a positive
correlation with SBP and DBP. This is alarming and further study is needed to find out the
intervention strategies. This study will help in making public health policies

IMPACT OF ANESTHESIA ON BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS DURING GENERAL SURGERY.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Hypertension is a significant risk factor for increased mortality during
anesthesia. Withdrawal from antihypertensive medications can lead to complications like
anxiety, rebound hypertension, myocardial infarction, and death. OBJECTIVE: This study
aimed to evaluate the effects of anesthesia on perioperative blood pressure management in
hypertensive patients undergoing general surgeries. METHODOLOGY: A prospective
observational study was conducted at federal government Polyclinic hospital PGMI, from
April 2023 to March 2024. Seventy hypertensive patients aged 40–65 years undergoing
elective general surgery under general anesthesia were included. BP was measured
preoperatively, intraoperatively, and postoperatively, with fluctuations recorded. Key factors
observed included blood loss, anesthesia drugs, haemodynamics heart rate, systolic and
diastolic blood pressure, antihypertensive medication use, and fluid consumption. SPSS
version 27 was used for data analysis. RESULTS: The mean patient age was 56.4 ± 8.7
years, with 65% males. Pre-induction SBP was 145.9 ± 10.6 mmHg and DBP 90.5 ± 7.3
mmHg. Intraoperative BP dropped significantly, with a mean SBP decrease of 18.5 mmHg p
< 0.01. Hypotension occurred in 35% of patients, requiring vasopressors, while 12%
experienced hypertension. Postoperative BP stabilized in 65% of patients. Beta blocker use
was significantly associated with lower postoperative heart rates p = 0.034, while diuretics
showed a trend toward lower heart rates but did not reach significance. CONCLUSION:
General anesthesia led to significant BP fluctuations in hypertensive patients, with 35%
experiencing hypotension. Beta blocker use was effective in controlling postoperative heart
rate.

IMMUNE DYSREGULATION IN PEDIATRIC RECURRENT TONSILLITIS: A CASE-CONTROL STUDY ON IMMUNE PROFILES AND INFLAMMATORY MARKERS.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Recurrent tonsillitis, characterized by repeated tonsillar inflammation,
significantly affects children's quality of life, leading to missed school days, sleep
disturbances, reduced participation in daily activities, and emotional distress, and is
frequently linked with immune dysfunction. Limited data from developing countries like
Pakistan hinders understanding its immunological basis, specifically variations in immune
response in the pediatric age group. This study explored the association between recurrent
tonsillitis and immune dysregulation to guide diagnosis, treatment, and prevention strategies.
OBJECTIVES: The study aimed to investigate the association between immune
dysregulation and recurrent tonsillitis in children focusing on immunological profiles and
mechanisms. STUDY DESIGN: Case-control study SETTING & DURATION:
Department of ENT, Hameed Latif Teaching Hospital Lahore, from 25-6- 2024 to 25-11-
2024. METHODS: In this study, 152 participants were included. Among these participants,
102 children were diagnosed with recurrent tonsillitis cases, and 50 healthy controls of
similar age groups were enrolled using consecutive sampling. The calculated sample size at
50% probability, with a 5% margin of error and 95% confidence interval; participants were
categorized into specific age groups 3–5, 5–8, 8–10, and 10–12 years to capture variations
across different growing ages of Pediatrics. Immune parameters assessed were white blood
cell count WBC, neutrophils, lymphocytes, monocytes, eosinophils, plasma IgG, IgA, and
IgM levels. Statistical analysis was performed using SPSS version 25, with significance at p
< 0.05. RESULTS: The mean age of participants was 7.5 ± 2.887 years. Children with
recurrent tonsillitis had significantly higher WBC counts 12,770 cells/µL in cases vs. 6,500
cells/µL in controls and elevated neutrophil, lymphocyte, and monocyte counts, suggesting
heightened immune response. Serum IgG levels were significantly elevated in cases 1330
mg/dL compared to controls 1015 mg/dL, and serum IgA levels were also significantly
higher, indicating an ongoing inflammatory response and immune dysfunction.
CONCLUSION: This study highlights immune dysregulation as a key factor in pediatric
recurrent tonsillitis. Elevated WBC, neutrophil, lymphocyte, monocyte counts, and serum
IgG and IgA levels suggest elevated inflammatory response. Comprehensive immunological
evaluation can aid in adopting preventive and effective strategies for management and
prevention.

THE ROLE OF PEER-ASSISTED LEARNING IN ENHANCING CLINICAL COMPETENCE AMONG 3RD-YEAR AND FINAL YEAR MBBS STUDENTS: A PROSPECTIVE STUDY.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Peer Assisted Learning PAL has acquired noticeable quality as an
instructive methodology that encourages understudy cooperation. By participating in peer
drove educating, students build up their mastering and foster fundamental clinical abilities.
Be that as it may, the effect of PAL on working on clinical skill, especially among third-year
and final year MBBS students, stays a region requiring further investigation. OBJECTIVES:
This study planned to assess the viability of Peer Assisted Learning PAL in upgrading
clinical skill, explicitly focusing on clinical thinking, correspondence, and cooperation among
third-year and last year MBBS students at Suleman Roshan Medical College Tando Adam.
METHODS: A prospective cohort study was directed with 85 third-year and last year MBBS
students. The PAL mediation included peer-drove case conversations and pretending
meetings more than one semester. Pre-and post- assessments were utilized to quantify
enhancements in clinical skill. Students input was likewise gathered to evaluate their
impression of the PAL approach. RESULTS: The Findings showed prominent enhancements
in clinical thinking 83.95%, communication skills 74.07%, and collaboration 82.72%
following the mediation. Developmental evaluations uncovered huge score increments p <
0.001. Criticism reviews showed that 88% of students felt more certain about performing
clinical assignments. CONCLUSION: The study highlights PAL as a powerful apparatus in
clinical training, encouraging dynamic commitment and cooperative learning. Integrating
PAL into the educational plan can improve clinical abilities and advance an understudy
focused learning climate.

THE EFFECTIVENESS OF OPEN BOOK ASSIGNMENTS IN ENHANCING PHARMACOLOGY LEARNING AMONG 3RD YEAR MBBS STUDENTS: A COMPREHENSIVE STUDY.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Pharmacology, a basic subject in the clinical educational program, gives
clinical understudies the primary information expected to grasp drug components, remedial
mediations, and the clinical use of pharmacology. Traditional assessment strategies in
pharmacology frequently center on remembrance, which might restrict further
comprehension. Open-book assessments OBAs have arisen as an educational instrument to
upgrade decisive reasoning and perception. This study investigates the adequacy of OBAs in
working on pharmacological information, decisive reasoning, and clinical application among
third-year MBBS Students. OBJECTIVES: This study expects to survey the effect of open
book tasks on pharmacology learning results in third-year MBBS students, with a specific
spotlight on their capacity to orchestrate data, apply pharmacological standards in clinical
settings, and work on scholastic execution. METHODS: A cohort of 100 third-year MBBS
students at Suleman Roshan Medical College Tando Adam took part in the review from
September 2023 to January 2024. Understudies were allotted open-book assignments
focusing on clinical pharmacology situations. Pre-and post-assessment tests were directed to
assess the improvement in information, while subjective overviews were utilized to survey
understudy fulfillment and saw learning results. RESULTS: 86 students finished the surveys.
Huge upgrades were seen in the student’s capacity to apply pharmacological standards in
clinical situations p < 0.001. Student’s fulfillment with OBAs was high, with 82% of
understudies revealing a superior comprehension of pharmacology and better groundwork for
clinical practice. CONCLUSION: Open-book assessments offer a creative way to deal with
pharmacology training that advances decisive reasoning, upgrades clinical thinking, and
adjusts better to certifiable clinical practice. This study proposes that OBAs ought to be
coordinated into the pharmacology educational program to supplement conventional learning
techniques and support long-term retention.

THE IMPACT OF FLIPPED CLASSROOM ON ENHANCING PHARMACOLOGY EDUCATION AMONG 3RD-YEAR MBBS STUDENTS.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Flipped Classroom FC is a creative academic methodology that shifts
traditional learning standards by having students engage with content outside the classroom,
frequently through web-based sources, and afterward apply this information in dynamic, in
class works out. While the viability of FC has been investigated in different disciplines, its
part in improving pharmacology training in medical colleges remains generally understudied.
OBJECTIVES: This study means to assess the adequacy of the flipped classroom model in
upgrading pharmacological information, decisive reasoning, and clinical application among
third-year MBBS students at Suleman Roshan Medical College Tando Adam. METHODS:
A cohort of 90 third-year MBBS understudies took part in this review. Students were taught
pharmacology through the flipped study hall approach for a semester, with pre-class web
based learning modules followed by interactive in-class exercises. Pre-and post-assessment
scores and surveys on students’ perceptions were utilized to assess the adequacy of the
flipped homeroom. RESULTS: The study showed huge enhancements in pharmacology
information, with a post-evaluation score increase from 68% to 85%. Students reported high
satisfaction with the flipped classroom approach, with 75% of students agreeing that it
upgraded how they might interpret pharmacology and 70% revealing increased engagement.
CONCLUSION: Flipped classroom is an effective teaching strategy for pharmacology
training in MBBS students. It upgrades student’s commitment, encourages dynamic learning,
and further develops clinical critical thinking skills. This approach ought to be coordinated
into the pharmacology educational plan to help further learning and utilization of
pharmacological ideas.

PREVALENCE AND RISK FACTORS OF PRE-ECLAMPSIA AMONG EXPECTANT MOTHERS: A CROSS-SECTIONAL STUDY AT A HOSPITAL SETTING

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Pre-eclampsia continues to be a leading cause of complications during pregnancy, especially in low- and middle-income regions. OBJECTIVE: This study was conducted to determine how widespread pre-eclampsia is and to identify contributing risk factors among women receiving antenatal care at a tertiary-level hospital. METHOLOGY: Employing a cross-sectional approach, information from 384 participants was gathered via interviews, clinical evaluations, and reviews of patient records. Data analysis was done using SPSS version 26. RESULT: The findings revealed a prevalence rate of 8.7%. Notable associations were identified between pre-eclampsia and factors such as maternal age, parity, BMI, and a personal or family history of hypertension. CONCLUSION: These results highlight the importance of early identification and intervention for at-risk pregnant women to improve maternal and neonatal outcomes.

FACTORS AFFECTING THE QUALITY OF LIFE OF PATIENT DIAGNOSIS WITH BREAST CANCER PATIENTS: A CROSS-SECTIONAL STUDY.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: The objective of the study was to identify the quality of life and associated factors. METHODOLOGY: The study was conducted in the two tertiary care hospitals of Khyber pukhtankhwa Pakistan from April to July 2024 using analytical cross- sectional study design, and the study participants were the patient diagnosed with breast cancer and completed treatment of chemotherapy or surgery and continuous their followup in out-patient department. The sample size of the study was 170, while sampling technique was convenient. The data was collected through valid and reliable questionnaire. The data was analyzed through SPSS 24 as descriptive and inferential statistics. RESULTS: The overall quality of life of the study participants was average having means score of 2.4 ± 0.19. In domains high mean score belong to physical P-WB 2.9 ± 0.36, then emotional E-WB 2.8 ± 0.41, and social S-WB was 2.5 ± 0.26, while the minimum mean score belongs to F-WB F- WB 1.38 ± 0.37. Age group 50 and above mean score, married, no education, housewives, diabetic mellitus, stage 3 cancer, low monthly income, and patient having surgery well-being of the majority of the domains were perform better than their comparing categories. CONCLUSION: The study concluded that the QOL of patient diagnosed with BC is affected, but moreover the F-WB of the patient is more affected more. The socio- demographic characteristics such as age, marital status, stages of cancer and treatment is closely linked and associated with QOL.

META-ANALYSIS: RATE OF DEPRESSION IN INDIVIDUALS SUFFERING FROM HEPATITIS C VIRUS HCV FROM PAKISTAN.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: In Pakistan, HCV has emerged as an important public issue, with millions
afflicted and suffering from numerous physical and mental health problems. Out of all
psychiatric disorders, depression is one of the most widely diagnosed illness in patients
suffering from HCV, but as far as Pakistan is concerned, no prevalence study has been done
at a national level. AIMS AND OBJECTIVES: The aim of this study is to analyze the level
of depression among HCV patients in Pakistan, by using data from multiple studies, and
conduct a comprehensive meta-analysis. The goal is to also demonstrate the impacts of
depression on the selected population and recommend measures for more effective clinical
management and policy formulation. METHODOLOGY: The studies were retrieved from
electronic databases which include PubMed, PakMediNet, Google scholar, and other relevant
websites. Studies focusing on depression prevalence in patients suffering from HCV in
Pakistan were included. Random-effects model was used to analyze the pooled prevalence
estimates and I² statistic was used to determine the degree of heterogeneity. RESULTS: 15
selected studies included 6832 patients suffering from HCV. The accepted rates of prevalence
of depression were 34.5% 95% CI: 30.1%-38.9%. Depressive rates were between 22.4% and
46.8%. Results exhibited high heterogeneity I² = 78%.Sensitivity analysis verified the
stability of the results. CONCLUSION: Depression is a notable comorbidity among
Pakistani HCV patients, impacting more than one-third of the population. The high
prevalence indicates the importance of routine mental health screening and inclusion of
psychological interventions in HCV management protocols.

MORTALITY OUTCOMES IN HEPATORENAL SYNDROME: AN ANALYSIS OF RISK FACTORS AND PREDICTIVE SCORES AT TERTIARY CARE HOSPITAL.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Hepatorenal syndrome HRS is one of the severe complications of end
stage liver disease with an overall prognosis for poor functional renal failure. Despite
significant advances in diagnosis and management, the mortality rate has remained
surprisingly high. Many factors, such as systemic inflammation, infections, and comorbid
conditions, further worsen the disease process. In risk stratification, scoring systems such as
MELD and Child-Pugh scores help predict this. OBJECTIVES: This study aims to assess
mortality outcomes in patients with HRS, determine associated risk factors, and examine the
utility of predictive scores for prognostication. MATERIAL AND METHODS: A cross
sectional survey of 387 patients admitted with HRS in a tertiary care institution was
conducted. Demographic data, clinical presentation, biochemical parameters, and prognostic
scores MELD and Child- Pugh were obtained. Substratification was done according to the
HRS subtypes HRS-1 and HRS-2, and on severity scores. Mortality outcomes are subjected
to regional and international studies analyses. RESULTS: Of 387 patients, 56.84% had HRS
1 and 36.17% had HRS-2. The overall mortality rate was 54.78%. Higher mortality was
associated with advanced age, HRS-1, elevated MELD scores >19, and comorbidities such as
diabetes and infections. Patients with MELD >19 had a 48.32% mortality rate. Child-Pugh
Class C showed the highest mortality at 37.98%. Female patients exhibited slightly higher
mortality rates than males at 56.68% and 53.47%, respectively. CONCLUSION: Mortality
among HRS patients remains a fatal complication of liver disease, with comorbidities and
severity of the clinical manifestation influencing mortality. MELD and Child-Pugh scores are
essentially useful tools in risk assessment. Early intervention to prioritize transplantation is
also significant for better outcomes.

COMPARISION OF OUTCOME OF CHEWING GUM VERSUS WITHOUT CHEWING GUM IN POSTOPERATIVE ILEUS AFTER INTESTINAL SURGERY AT TERTIARY CARE HOSPITAL.

Tue, 31 Dec 2024 00:00:00 +0100

OBJECTIVE: To associate the outcome of chewing gum in competition with without
chewing gum in Postoperative Ileus patients after intestinal surgery. It causes gasses
distention, nausea, vomiting, and even pain. After abdominal surgery. INTRODUCTION:
Postoperative Ileus POI is a well-known problem after surgery of abdomen, causing
discomfort and delays in bowel movements1. Chewing gum has appeared as a fresh & modest
modality for declining postoperative ileus & enhance bowel movemets2. Chewing gum is a
cost-effective intervention thought to increase bowel motility by stimulating more secretions
and neural signaling to the digestive tract.3. PLACE AND DURATION OF STUDY: study
was conducted at department of surgery LUMHS hospital at Hyderabad and jamshoro, for
one year starting from the month of January 2023 to the December 2023. MATERIAL AND
METHODS: A total number of 208 subjects who achieved the criteria for inclusion &
admitted in surgical ward LUMHS, Jamshoro were counted in current research after taking
informed permission. The subjects were haphazardly assigned in the direction of either in A
group chewing gum & B group without gum chewing were asked to record immediate time
of feeling bowl sounds, passing flatus or stool, first time of feeling hunger and time of
discharge from hospital which was assessed on post 30 minutes of chewing gum after surgery
three times in a day. Entirely the composed statistics were moved into the proforma designed
at the completion & used by electronic means for investigation determination.RESULTS:
The mean age of A group was 35.53±13.46 & B group was 40.06±12.62 years. In the gender
distribution, A group includes 104 individuals, with 61.5% males and 38.5% females. In
contrast, B group has 104 individuals, with 66.3% males and 33.7% females. Comparison of
outcomes showed mean ± SD for first passage of flatus in 57.32±26.48 in A group and
71.09±28.85 in B group, with highly significant P-value 0.0001, first passage of stool was
86.65±37.56 and 102.28±41.64 with P=0.005, appearance of the first bowel sound had a
mean ± SD of 39.67±18.04 and 48.07±17.87, P= 0.001, first onset of the feeling of hunger
66.98±31.32 and 3 93.19±38.84 having P=0.0001 while the length of hospital stay was
8.24±1.91 in A group and 9.04±2.15 in B group , with P= 0.005. CONCLUSION: This
study concluded that patients who chewed gum A group with those who did not B group
following intestinal surgery, it was observed that chewing gum appeared to accelerate the
recovery of bowel function, promote an earlier return of appetite, and result in shorter
hospital stays. This suggests that gum chewing may be a beneficial intervention for reducing
the impact of Postoperative Ileus in this patient population.

FREQUENCY AND RISK FACTORS OF BREAST CANCER AMONG YOUNG AND MIDDLE-AGED WOMEN.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Breast cancer is the leading cause of cancer related deaths worldwide and
becoming more common in Pakistan. Trend is now shifting to young and middle-aged
women. Data is limited in this regard from Pakistan. That is why this study aims to determine
the prevalence and risk factors of breast cancer among young and middle-aged women.
METHODS: A prospective observational study was conducted in the department of
Gynecology & Pathology for a period of 8 months from March 2024 to October 2024 at
Peoples University of Medical and Health Science for women, Shaheed Benazirabad. All the
suspected women of young age 18 to 35 years and middle age ≥36 to 55 years groups were
included for breast cancer frequency and associated risk factors. RESULTS: A total of 213
patients were included for final analysis. Significant proportion of patients with age more
than 35 years middle age were diagnosed with carcinoma of breast. Patients who had late
marriage 30.43±7.02 years, patients belong to middle socioeconomic background n = 164,
76.99%, patients with no children n = 8, 3.75%, patients with positive family history of breast
cancer n = 32, 15.02%, and patients who had early menstruation were more likely to have
breast cancer, p value <0.05. CONCLUSION: Breast cancer is common among middle aged
women but young women also show an increase in its frequency. Late marriages, early
menstruation, and positive family history of breast cancer are the leading causes of carcinoma
of breast observed in our study

A META-ANALYSIS ON THE IMPACT OF HIV, MALNUTRITION, AND SMOKING ON THE RISK OF PULMONARY TUBERCULOSIS.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Pulmonary tuberculosis PTB remains a major global health challenge,
especially in low- and middle-income countries. There are many factors contributing to the
risk of developing PTB, among which HIV infection, malnutrition, and smoking catch the
most attention. It is pertinent to understand these factors' combined impact on PTB risk for
better prevention and intervention strategies. AIMS: The aim of this meta-analysis was to
evaluate the impact of HIV infection, malnutrition, and smoking on the risk of developing
pulmonary tuberculosis by synthesizing data from studies conducted globally. METHODS:
A systematic search was made on PubMed, Scopus, and Google Scholar's databases for
studies published from 2000 up to 2023. Studies assessing the relationship among HIV,
malnutrition, smoking, and incidence of PTB were included in the analysis. The effect sizes
were calculated, and odds ratios or relative risks were extracted and pooled using a random
effects model. The extent of heterogeneity was assessed using I2. RESULTS: A significant
association for an increase in developing pulmonary tuberculosis due to HIV infection,
malnutrition, and smoking were analysed. The maximum risk was observed in people
infected with HIV plus malnutrition; smoking was found to have moderate risk.
CONCLUSION: HIV, malnutrition, and smoking are major modifiable risk factors for
pulmonary tuberculosis that can be targeted for intervention in reducing the global burden of
PTB; targeted interventions can greatly reduce the incidence rates of PTB. Causes of these
conditions must be prioritized in public health strategies so as to reduce their burden on TB
incidence.

COMPARATIVE EFFICACY OF URSODEOXYCHOLIC ACID AND DEXAMETHASONE IN REDUCING SEVERE PRURITUS IN PATIENTS WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a hepatobiliary condition
associated with impaired bile acid flow, which results in heavy maternal pruritus and an increased
risk of adverse fetal outcomes such as preterm birth and stillbirth. Ursodeoxycholic acid (UDCA)
is the first-line therapy, which reduces levels of bile acids and alleviating symptoms. In some cases
a poor response to UDCA necessitates additional therapies. Dexamethasone, a corticosteroid, had
been proposed as an alternative, however its use during pregnancy remains controversial and
concerns exist regarding both its efficacy and safety. OBJECTIVE: To compare the efficacy and
safety of ursodeoxycholic acid (UDCA) and dexamethasone in reducing severe pruritus in
pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP). MATERIAL &
METHODS: This was a comparative, prospective study carried out in the Gynecology
Department of Hayatabad Medical Complex, Peshawar, from June 2022 to May 2023. A total of
155 pregnant women with ICP whose diagnosis was based on clinical presentation of pruritus and
elevated serum bile acid levels (>10 µmol/L) after the 20th week of gestation were included in this
study. RESULTS: VAS pain scores decreased significantly in both groups over 4 weeks, however
Group A (UDCA) diminished to a greater extent at all time points. At Week 1, the VAS score in
Group A was lower than in Group B (6.2 ± 0.9 in group A vs. 7.1 ± 1.0 in group B). By Week 4,
Group A mean VAS pain score decreased to 2.1 ± 0.6 and was significantly lower than Group B
3.9 ± 0.8. CONCLUSION: In patients with ICP, UDCA showed substantially superior efficacy
compared to dexamethasone with respect to severe pruritus and serum bile acid levels. The UDCA
group had better maternal and fetal outcomes, as well as a more favorable safety profile confirming
its place as the first-line therapy for ICP management.

RISK FACTORS AND OUTCOME OF OLIGOHYDRAMNIOS: OUR EXPERIENCE AT A TERTIARY CARE HOSPITAL.

Nafeesa Ghani1, Chandnee Rehman2, Nazia Noushin3, Noreen Afsar4, Samra Bashir5 — Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Oligohydramnios, the condition of having less than the normal volume of
amniotic fluid, is a complication of 1-5% of pregnancies. It is associated with high risks of
perinatal morbidity and mortality. It has many causes, often related to maternal factors like
hypertension, diabetes, post-term pregnancy, and premature rupture of membranes PROM.
Data with regards to the risk factors and neonatal outcomes in our region still seems
incomplete despite its significance in clinical practice. OBJECTIVE: To evaluate the risk
factors associated with oligohydramnios and analyze its impact on perinatal outcomes at a
tertiary care hospital. METHODS: This prospective observational study was carried out at
the Department of Obstetrics & Gynecology, Hayatabad Medical Complex Peshawar, from
1st March 2021 to March 2022. Total 152 pregnant women with oligohydramnios AFI ≤5 cm
or SDP <2 cm at ≥28 weeks gestation was enrolled. Data on demographics, risk factors,
ultrasound findings, delivery mode, and neonatal outcomes were recorded on a predefined
proforma. Statistical analysis was performed using SPSS 25.0. RESULTS: The mean
maternal age was 27.4 ± 4.8 years; 64.5% of women were aged 20–30 years. Hypertensive
disorders 30.3% were the most frequent maternal risk factor, followed by post-term
pregnancy 21.1% and PROM 18.4%. Isolated oligohydramnios occurred in 25.7% of cases.
Abnormal Doppler flow was found in 29.6%. Cesarean section was the commonest delivery
mode 58.6%, often due to fetal distress. Adverse outcomes included low birth weight 40.1%,
NICU admission 25.0%, low Apgar scores 14.5%, stillbirth 3.3%, and early neonatal death
2.0%. Hypertensive disorders, PROM, and abnormal Doppler flow were significantly
associated with poor perinatal outcomes. CONCLUSION: The presence of oligohydramnios
represents a high risk for negative perinatal outcomes, especially when linked with
hypertension, premature rupture of the membranes PROM, and abnormal fetal Doppler
ultrasound results. Early diagnosis and corrective actions are crucial in decreasing
complications and enhancing neonatal results.

PREVALENCE AND RISK FACTORS OF PEDIATRIC APPENDICITIS: A SURGICAL REVIEW AT PUMHS NAWABSHAH.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Appendicitis which describes vermiform appendix inflammation occurs
as one of the most frequent surgical emergencies found among pediatric patients on a
worldwide scale. OBJECTIVE: The aim of this study was to determine the prevalence and
identify the risk factors associated with pediatric appendicitis in children undergoing surgical
intervention at PUMHS Nawabshah. METHODOLOGY: This retrospective observational
study was conducted at the Department of Pediatric Surgery, PUMHS Nawabshah, over a
period of one year January 2024 to December 2024. Medical records of pediatric patients
diagnosed with appendicitis and who underwent appendectomy were reviewed. Data was
collected regarding patient demographics, presenting symptoms, laboratory findings, and risk
factors including age, gender, nutritional status, family history, and the presence of
comorbidities. The prevalence of appendicitis and its associated risk factors were analyzed
using descriptive statistics. RESULTS: A total of 150 pediatric patients were included in the
study, with a male-to-female ratio of 1.5:1. The prevalence of appendicitis was found to be
7.5% among pediatric patients presenting to the emergency department. The most common
presenting symptoms were abdominal pain 95%, nausea/vomiting 85%, and fever 78%.
Significant risk factors for appendicitis included age most common in children aged 6-12
years, male gender, and a family history of appendicitis. Nutritional status did not show a
significant correlation with appendicitis occurrence. Additionally, 12% of patients had a
history of recurrent abdominal pain, and 5% had a history of gastrointestinal infections.
CONCLUSION: Appendicitis remains a common surgical emergency in pediatric patients.
Early diagnosis and timely intervention are crucial for reducing morbidity. Male gender, age
between 6-12 years, and a family history of appendicitis are significant risk factors for the
condition. Further studies are recommended to evaluate the impact of nutritional status and
gastrointestinal infections on the development of appendicitis in children.

MANAGEMENT AND FETAL OUTCOMES OF SECOND STAGE FETAL COMPROMISE: A CROSS-SECTIONAL ANALYSIS AT THE GYNECOLOGY DEPARTMENT.

Tue, 31 Dec 2024 00:00:00 +0100

BACKGROUND: Second-stage fetal compromise is a critical obstetric emergency that
requires prompt intervention to prevent adverse neonatal outcomes. Prolonged second-stage
labor, fetal distress, and maternal exhaustion contribute to fetal hypoxia, leading to increased
morbidity and mortality. Effective management strategies, including operative vaginal
delivery and emergency cesarean section, play a crucial role in optimizing fetal outcomes.
OBJECTIVES: This study aims to evaluate the management approaches and fetal outcomes
in cases of second-stage fetal compromise. Specific objectives include identifying risk
factors, assessing different intervention strategies, and analyzing neonatal outcomes such as
Apgar scores, NICU admissions, and perinatal mortality. METHODS: A cross-sectional
study was conducted at the Gynecology Department, analyzing 220 cases of second-stage
fetal compromise. Data were collected from medical records, including maternal
demographics, fetal heart rate monitoring, mode of delivery, and neonatal outcomes.
Statistical analysis was performed using SPSS, applying chi-square and logistic regression
tests to determine associations between management strategies and fetal outcomes.
RESULTS: Among the 220 cases, 60% underwent emergency cesarean section, 30%
required instrumental delivery forceps/vacuum, and 10% had spontaneous vaginal delivery.
Neonatal outcomes showed that Apgar scores ≤ 7 at 5 minutes were observed in 25% of
cases, while NICU admission was required in 18%. Perinatal mortality was 4%, primarily
associated with prolonged fetal distress. Emergency cesarean section was significantly
associated with improved neonatal outcomes p < 0.05. CONCLUSION: Timely
identification and appropriate management of second-stage fetal compromise significantly
improve neonatal outcomes. Emergency cesarean section remains the most effective
intervention in severe cases. Strengthening intrapartum monitoring and decision-making can
further enhance fetal survival rates.

LETTER TO EDITOR

Asma Shabbir — Tue, 31 Dec 2024 00:00:00 +0100

Dear Editor,
I am writing to express my admiration for
the Journal of Pakistan University of
Medical and Health Sciences JPUMHS
and its commitment to publishing high
quality research in the field of medical and
health sciences.