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

ABSTRACT
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

ABSTRACT
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

ABSTRACT
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, KARACHI.

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

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.