Ayub Teaching Hospital Research Articles

MORPHOLOGICAL FEATURES AND CYTOPATHIC EFFECTS OF ORGANISMS IN CERVICAL SMEAR OF INFERTILE VERSUS FERTILE WOMEN: A COMPARATIVE ANALYSIS

BACKGROUND: Infertility is a challenging health problem around the world affecting 22% of women in Pakistan. Approximately 75% of women are infected with sexually transmitted diseases during their life at least once, and present with cervical epithelial cell lesions. Sexually transmitted infections are responsible for pelvic inflammatory disease which is known to be the most common cause of infertility. The rationale behind this study is to investigate whether infertile women have a higher incidence of infectious organisms in their cervical smears than the fertile controls. METHODS: One hundred and fifty subjects in total were recruited in the study sample. Cervical smears of 100 infertile women were compared with 50 fertile women in the age range of 20-40 years. Fifty fertile patients were taken as controls (Group A), 50 primary infertile (Group B) and 50 secondary infertile patients (Group C) in outpatient departments of Gynecology and Obstetrics at Ayub Teaching Hospital Abbottabad. RESULTS: A significant difference was observed among the three groups regarding the prevalence of infectious organisms in their cervical smears (p value < 0.004), with higher rate in infertile women. In addition, the secondary infertile women group showed significant rise in the rate of isolation of infectious organisms as compared to primary infertile women. CONCLUSION: It is concluded that infectious organisms are present at a remarkably higher rate in infertile women in comparison to fertile women. Women with secondary infertility have a greater possibility of colonization with infectious organisms than women with primary infertility. Thus, it is suggested that

ASSOCIATION OF SOCIODEMOGRAPHIC FACTORS AND DIETARY PREFERENCE WITH ANAEMIA AMONG MALES: A CROSS SECTIONAL STUDY

Background: Anaemia is a problem of paramount importance but research about its impact and socio-demographic characteristics in adult men is scanty. The current study aimed to determine the frequency and association of socio-demographic factors and dietary preference with anaemia in male patients. Methods: This cross-sectional study was conducted in Department of Medicine, Ayub Teaching Hospital Abbottabad. A total of 144 patients were enrolled. Patients were interviewed on basis of a questionnaire and examined for symptoms of anaemia. Admitted patients from medicine ward who were aged above 20 years were included in the study. Unconscious patients and those who were unable to communicate were excluded from the study. Data was analyzed using SPSS-22. Results: This study included a total of 144 patients. Respondents were in the age range of 22–90 years with mean age 49.66±16.474 years. A total of 90 (62.5%) patients belonged to rural areas and 54 (37.5%) belonged to urban areas, 50 (34.7%) were unemployed and 94 (65.3%) were employed. Presence of anaemia was found to be significantly associated with concomitant presence of chronic diseases (p<0.05). Conclusion: Moderate anaemia is common in our males, and is significantly associated with presence of chronic diseases. No significant association of anaemia was found with dietary preferences. Pak J Physiol 2024;20(3):56–8, DOI: https://doi.org/10.69656/pjp.v20i3.1754

The Functional Outcome of Patients Treated with Proximal Femoral Nail (Pfn) for Sub Trochanteric Femur Fracture in Ayyub Teaching Hospital, Abbottabad

Sub-trochanteric femur fractures are challenging for orthopedic surgeons to fix owing to their location and associated consequences. Different intramedullary and extra-medullary implant stabilization techniques have been explored with varying degrees of effectiveness. Objective: To assess the functional outcomes of proximal femoral nail in patients treated for sub-trochanteric femur fracture. Methods: This cross-sectional study investigated 28 patients of sub trochanteric femur fracture treated with proximal femoral nail in Orthopedic Unit of Ayub Teaching Hospital, Abbottabad from January 2021 to March 2024. Patients aged≥20 years who suffered from sub-trochanteric femur fracture and fit for surgery were included. All the patients were immobilized before surgery. Skin traction was applied and prepared for surgery. Postoperative outcome was assessed using the Harris hip score. Results: The overall mean age was 56 ± 10.8 years. Out of 28 cases, there were 18 (64.3%) male and 12 (35.7%) female. The overall mean of hospital duration was 14 ± 4.6 days. The majority of patients were 41-60 years old. Postoperative independence of ambulation was assessed in each patient after three, five, and six months. After 5 months, only two patients were unable to move around unassisted. Based on the Harris Hip Score, the incidence of exceptional, good, and fair outcomes was 6 (21.4%), 5 (17.9%), and 17 (60.7%) respectively. Conclusion: It was concluded that sub-trochanteric femur fractures can be treated with a proximal femoral implant, which offers advantages in terms of increased stability, quick disposition and minimal exposure.

Frequency of Maternal Morbidities in Patients with Placenta Previa - A Prospective Single-Centered Study in Hazara Division.

OBJECTIVES The study aimed to determine the maternal morbidities in patients with placenta previa in a tertiary care hospital. Moreover, patients’ risk factors and outcomes will also be accessed as secondary outcomes. METHODOLOGY This prospective cross-sectional study was undertaken at Ayub Teaching Hospital Abbottabad from January 2022 to July 2024. Any pregnant patients carrying the ultrasound diagnosis of placenta previa in an emergency or the ward were included in the study. A non-randomized convenience technique was applied for sample collection. Patients with other placental anomalies, such as placenta accreta, were excluded from the current study. The data was analyzed in SPSS version 21, and significance was kept below 0.005.RESULTSIn the present study, 104 cases of placenta previa were recruited, among which 76(73%) patients fall in the age range between 24 and 34 years. The incidence of major placenta previa was observed in 76/104 cases. In 86% of cases, obstetric trauma was observed, and in 54 (52%) cases, purpureal sepsis was recorded. The purpureal sepsis was 10/36(28%) in patients with tamponade placement and 8/36(22%) in APH patients with a significance of 0.001. Presentation with antepartum hemorrhage was seen in 67% of cases (8/12) in the age group < 20 years. The maternal mortality was 2%. CONCLUSION The complication rate was relatively higher than reported in previous studies. The rate of morbidity can be minimized by following a multi-disciplinary approach. The cases should be managed in settings with ICU care and blood bank facilities.

Thyroid dysfunction in patients with chronic kidney disease.

Objective: To determine the frequency of thyroid dysfunction among patients with chronic kidney disease (CKD). Study Design: Cross-sectional study. Setting: Department of Medicine, Ayub Teaching Hospital's. Period: September 2019 to August 2020. Methods: The study included adult patients with CKD who were at least 18 years old, regardless of gender. Patients with acute kidney injury, pregnant and lactating females, patients with history of goiter, thyroid surgery or radioactive iodine treatment, familial diseases of thyroid disorders, history of medication for thyroid disorders, and known cases of thyroid disorders were not included. Likewise, patients who were on concurrent medications which could affect thyroid function like amiodarone, lithium, iodine, glucocorticoids and interferon were also excluded. Results: A total of 165 patients of CKD were enrolled. The mean age of the patients was 38 ± 14 years, there were 71 (43%) males and 94 (57%) females. The mean TSH, T3 and free T4 were 3.73257 ± 16.52632 mIU/L, 1.5869 ± 0.76796nmol/L, and 1.4480 ± 0.57540 ng/L respectively. Thirty-nine (23.6%) patients had thyroid dysfunction while 126 (76.4%) were euthyroid. Regarding thyroid status of the patients, twenty-two (13.3%) patients of CKD had subclinical hypothyroidism, eight (4.8%) had hypothyroidism, six (3.6%) had subclinical hyperthyroidism, three (1.8%) had hyperthyroidism 126 (76.4%) were euthyroid. Conclusion: Thyroid dysfunction is common among patients with CKD. Subclinical hypothyroidism is the most prevalent anomaly, followed by hypothyroidism. In view of the increased CVD and mortality in these patients, it is imperative to regularly screen CKD patients for thyroid dysfunction and to appropriately treat them.

Frequency of Peptic Ulcer Disease in Patients with Chronic Liver Disease Presenting with Upper Gastrointestinal Bleeding

Background: Peptic ulcer disease (PUD) is a significant cause of morbidity and mortality worldwide, particularly in patients with chronic liver disease (CLD). The occurrence of upper gastrointestinal bleeding (UGIB) in CLD patients presents a serious complication, often requiring urgent medical intervention. Objective: The main objective of this study was to determine the frequency of peptic ulcer disease in patients with chronic liver disease presenting with upper gastrointestinal bleeding. Methods: This retrospective observational study was conducted at Ayub Teaching Hospital, Abbottabad, from 2021 to 2023. Data were collected from 105 patients diagnosed with chronic liver disease who presented with symptoms of upper gastrointestinal bleeding. The diagnosis of CLD was confirmed through clinical evaluation, biochemical tests, imaging studies, and/or liver biopsy. Patients included were aged 18 years and above and presented with UGIB evidenced by hematemesis, melena, or both. Exclusion criteria were individuals with bleeding disorders unrelated to CLD and those who did not undergo endoscopic evaluation. Data collection involved demographic information, clinical history, duration and etiology of CLD, comorbid conditions, and UGIB presentation. Upper gastrointestinal endoscopy was performed on all patients to identify the source of bleeding. Statistical analysis was performed using SPSS version 25, with a p-value of less than 0.05 considered statistically significant. Results: The study included 105 patients, with a mean age of 55.3±3.27 years; 65 (61.9%) were male, and 40 (38.1%) were female. The etiologies of CLD were viral hepatitis (42.9%), alcoholic liver disease (28.6%), non-alcoholic fatty liver disease (19.0%), and other causes (9.5%). Clinical presentations of UGIB included hematemesis (66.7%), melena (23.8%), and both (9.5%). Endoscopic findings revealed that 35 patients (33.3%) had peptic ulcer disease, with 20 (57.1%) having duodenal ulcers and 15 (42.9%) having gastric ulcers. Other sources of UGIB included esophageal varices (38.1%), gastric varices (14.3%), erosive gastritis (9.5%), and malignancies (4.8%). Associated risk factors for PUD included NSAID use (42.9%), smoking (28.6%), and coexisting portal hypertension (71.4%). The mean size of ulcers was 10.2 mm. Endoscopic therapy was utilized in 71.4% of cases, with pharmacological treatment primarily including proton pump inhibitors (85.7%). Complications included rebleeding within 7 days (14.3%) and the need for surgical intervention (5.7%). The mean hospital stay was 7.8 days, and in-hospital mortality was observed in 8.6% of patients. Conclusion: Peptic ulcer disease represents a substantial yet manageable complication in patients with chronic liver disease presenting with upper gastrointestinal bleeding. Prompt recognition and targeted therapeutic interventions are crucial for optimizing outcomes in this high-risk population.

Uterine Preservation versus Hysterectomy During Sacrospinous Colpopexy for Uterovaginal Prolapse

Objective: To compare the effectiveness and safety of uterine preservation versus hysterectomy during SSC for uterovaginal prolapse. Methodology: Ninety female patients diagnosed with uterovaginal prolapse were enrolled in a prospective study conducted from March 2023 to February 2024 at Department of Gynecology, Ayub Teaching Hospital Abbottabad. Patients were randomly assigned to either uterine preservation or hysterectomy groups during SSC. Pre-operative assessments included pelvic examinations, imaging studies, and urodynamic evaluations. Surgical outcomes such as operative time, blood loss, complications, and anatomical success rates were recorded. Post-operatively, patients were followed up at regular intervals to assess subjective outcomes including symptoms relief, quality of life improvements, and sexual function. Results: Both uterine preservation and hysterectomy groups showed comparable anatomical success rates and symptom relief following SSC. Operative time was longer in the uterine preservation group (p = 0.028), while hospital stay was shorter in the hysterectomy group (p = 0.041). No significant differences were observed in intraoperative blood loss (p = 0.102), infection rates (p = 0.076), or prolapse recurrence (p = 0.194). However, reoperation rates were higher in the uterine preservation group (p = 0.012), whereas patient satisfaction was notably higher among those who opted for uterine preservation (p = 0.001). Conclusion: Uterine preservation during sacrospinous colpopexy appears to be a viable option for treating uterovaginal prolapse, offering comparable outcomes to hysterectomy in terms of anatomical support, symptom relief, and patient satisfaction. This study suggests that the decision between uterine preservation and hysterectomy during SSC should be individualized based on patient preferences, anatomical considerations, and the presence of co-existing conditions.

Frequency of Hypocalcemic Seizures in Children with Afebrile Seizure: From 2 months - 2 years in a Tertiary Care Hospital

Objective: To determine the frequency of hypocalcemic seizures in children with afebrile seizure from age 2 months - 2 years. Methodology: This Descriptive Cross-Sectional study was conducted in Pediatric Department of Ayub Teaching Hospital Abbottabad for a period of six months (15th April, 2017 to 15th October, 2017). Total 130 cases fulfilling the inclusion criteria were enrolled in the study after approval from ethical committee of hospital and informed consent from the parents of children. A detailed history and examination were done and blood samples for serum calcium level were sent to the hospital laboratory along with other routine investigation to rule out the cause. All data was analyzed using SPSS version 21. Results: Out of 130 cases 48(36.9%) children had hypocalcemia while 82(63.1%) were normocalcemic. 79 (60.8%) were males and 51 (39.2%) were females. The mean age of children was 13.03 ± 6.81 months. The average calcium level was 8.23±1.51mg/dl. Conclusion: It has been concluded that afebrile seizures occur frequently in children with hypocalcemia. Thus, we got the local evidence regarding this association and recommend to screen all new afebrile seizure cases for hypocalcemia. Key words: Hypocalcemic fits, children, afebrile seizures, hypocalcemia

Frequency of Zygomatic Complex Fracture in Patients Presenting to Ayub Teaching Hospital

Zygomatic complex fractures are a prevalent type of facial injury. It often results from road traffic accidents (RTA). It poses significant clinical challenges. Objective: To find out the frequency of zygomatic complex fractures among patients introduced at the Ayub Teaching Hospital. Methods: This cross-sectional study was carried out in the Department of Oral and Maxillofacial Surgery at Ayub Teaching Hospital, Abbottabad, Pakistan after approval from IRB (Institutional Review Board) of the Ayub Teaching Hospital Abbottabad, (IRB-F5/Dent/AMC&ATH) from September 1, 2019, to March 1, 2020. A total of 146 patients, including both genders and revealing oral and maxillofacial injury, were essential parts of the research. Before performing meticulous intra and extra-oral clinical examinations and computed tomography (CT) scans in the Department of Radiology to diagnose zygomatic complex fractures. Results: Out of the total number of 146 patients, 33.6% had ZMC fractures. The study involved patients aged 18-60 years. This is consistent with an average age of 31.993 ± 8.00 years and a mean weight of 74.664 ± 9.26 kg. Male patients represented 74.7% of cases and female comprised 25.3%. The primary causes of fractures were road traffic accidents, falls, and sports injuries. Conclusions: The research concluded that zygomatic complex fractures occurred due to road traffic accidents (RTA), which are more common in this region. Thus, the examination highlights the basic requirement for procedures to alleviate street mishaps to abridge such terrible facial injuries.

FREQUENCY OF THYROID DYSFUNCTION IN CASES OF METABOLIC SYNDROME PRESENTING AT TERTIARY CARE HOSPITAL

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Thyroid dysfunction is frequently observed in patients with metabolic syndrome, impacting their overall health outcomes. Objective: To determine the frequency of thyroid dysfunction in patients with metabolic syndrome. Methods: This cross-sectional study was conducted at the Department of Medicine, Ayub Teaching Hospital, Abbottabad, from September 2023 to March 2024. A total of 120 patients diagnosed with metabolic syndrome were included. The patients' thyroid function was assessed through clinical evaluation and laboratory tests, including serum levels of TSH, free T3, and free T4. Statistical analysis was performed using descriptive statistics to determine the frequency of thyroid dysfunction, with results expressed as percentages and means ± standard deviations. Results: The average age of the 120 patients was 44.64±9.01 years. The frequency of thyroid dysfunction among these patients was 68.4% (82/120). Subclinical hypothyroidism was present in 27.5% (33/120), hypothyroidism in 14.2% (17/120), and subclinical hyperthyroidism in 4.2% (5/120). Conclusion: The study found a high frequency of thyroid dysfunction (68.4%) in patients with metabolic syndrome, with subclinical hypothyroidism being the most prevalent form. These findings highlight the importance of regular thyroid function screening in patients with metabolic syndrome to ensure early diagnosis and management.

Tubo-Ovarian ectopic pregnancy: a rare twin ectopic pregnancy

The most common twin ectopic pregnancy is heterotopic (1/7000). We are reporting a rare case of twin tubo-ovarian ectopic pregnancy, which was presented in the emergency department of Ayub Teaching Hospital Abbottabad. A 30-year-old female arrived with worsening lower Abdominal pain persisting for three weeks. She also had per-vaginal bleeding with passage of clots 1week ago. Clinical examination revealed a tense abdomen with tenderness in the left iliac fossa. Per-vaginally, there was cervical motion tenderness and fullness in the posterior fornix. Beta HCG level revealed a sub-optimal rise whereas Transabdominal ultrasound showed an echogenic shadow in the left ovary. The uterus appeared normal. On exploratory laparotomy a large left ovarian mass was seen with ruptured chronic right tubal pregnancy with adhesions. On cut-section of the ovary, a small foetus was evident. ---Continue

Therapeutic Transformation through Healing Environment. Evaluation of Post Surgical Facilities Optimization in Selected Tertiary Healthcare Facilities in Post Covid-19 Kpk, Pakistan

Background: Healing environments in post-surgical wards are crucial for patient recovery. Despite their importance, there is a lack of such environments in many hospitals in Khyber Pukhtunkhwa (KPK), Pakistan, which affects patient outcomes. Objective: This study aimed to assess the presence of healing environment factors in post-surgical wards of selected tertiary care hospitals in KPK, Pakistan, and to determine patient satisfaction with these factors. Methods: The study utilized a purposive sampling technique to select 200 respondents from five tertiary care hospitals in KPK: Ayub Teaching Hospital (H1) in Abbottabad, Khyber Teaching Hospital (H2) in Peshawar, Government Lady Reading Teaching Hospital (H3) in Peshawar, Hayatabad Medical Complex (H4) in Peshawar, and Saidu Group of Teaching Hospitals (H5) in Saidu Shareef. Data were collected using structured questionnaires and observational studies conducted in November and December 2022. Observational data focused on five healing environment factors: access to nature, control and choices, positive distractions, social support, and environmental stressors. Ethical approval was obtained, and informed consent was secured from all participants. Data were analyzed using descriptive and inferential statistics to identify the presence and impact of healing environment factors. Results: The study revealed that social support was the only significantly present factor across all hospitals, largely due to cultural and religious practices rather than intentional design. Access to nature, control and choices, and positive distractions were notably lacking. Specifically, 60-70% of respondents reported the presence of social support, while only 20-30% indicated the presence of other healing environment factors. Environmental stressors were absent in two hospitals, indicating a variance in the quality of the healing environment across different settings. Conclusion: The absence of key healing environment factors in post-surgical wards highlights a significant gap in hospital design, impacting patient recovery and satisfaction. Integrating healing environment principles into hospital design can enhance patient outcomes and satisfaction. Future interventions should consider these elements to create more effective and supportive healthcare environments.

EFFICACY AND SAFETY OF NICORANDIL FOR PERIPROCEDURAL MYOCARDIAL INJURY IN PATIENTS UNDERGOING PCI

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with percutaneous coronary intervention (PCI) being a typical therapeutic approach. Objectives: In this comparative study, we aimed to investigate the efficacy and safety of nicorandil for periprocedural myocardial injury in patients undergoing PCI. Methods: This comparative study was conducted at Ayub Teaching Hospital from September 2023 to December 2023. Data from 90 patients was recruited for the research using inclusion and exclusion screening standards. Our study was performed on 90 patients treated with percutaneous coronary intervention (PCI). Patients from Group 1 were different from those in Group 2. Group A: the critical study parameters will switch between those patients who received nicorandil and Group B: non-nicorandil patients. Baseline demographic data, past medical history, and relevant laboratory values and clinical characteristics were documented for all patients. In addition, an intraoperative laboratory investigation was conducted, including cardiac biomarkers. Results: Research data were drawn from 90 patients whose gender wasn't a factor based on the research protocol. In Group A, the mean age of the patients was 62 years. Players in group A played for 4 ± 8.5 years. In team B, the players had a slightly longer experience and played for 63. Humans on Earth could do the same, and it could significantly impact future generations: ± 7. 9 years. Of 58 men and 32 women in the control group, there were two persons and persons in the experimental group, respectively. Only one stent differed between the two groups; however, the number was similar. 8 ± 0. 6 mmol/l in the tricorandil group and 1. +9 ± 0 in Case 1. Patients in the Nicorandil group displayed the lowest level of heart problem-causing protein (troponin) at the peak (5. There is a statistically significant 1.8-fold (2 ng/mL versus seven ng/mL) decline in serum lysozyme levels in the group administered rhG-CSF. The treatment group exhibited a substantial increase in haemoglobin levels (t(12) = 3. 74, p-value <0.005) with a mean difference of 0. 5 ± 2 ng/mL. 001, 95% CI: 2. 1 to 3. 5). Conclusion: It is concluded that nicorandil shows positive results for the efficacy (the ability of a drug to bring the desired effect) and safety of the drug in reducing myocardial injury and in maintaining the function of myocardial during percutaneous coronary intervention in patients.

Vitamin B12 Deficiency among Cases of Helicobacter Pylori Gastritis: A Cross Sectional Study

Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium associated with various gastrointestinal diseases, including peptic ulcer disease, gastric cancer, and vitamin B12 deficiency. Recent research has highlighted a potential link between chronic H. pylori infection and significant malabsorption of vitamin B12, particularly in populations with high prevalence rates of infection. Objective: This study aims to investigate the frequency of vitamin B12 deficiency among patients with H. pylori gastritis and to explore the association between H. pylori infection and vitamin B12 levels. Methods: A cross-sectional study was conducted from September 2023 to March 2024 at the Department of Medicine, Ayub Teaching Hospital, Abbottabad. A total of 120 patients presenting with symptoms of gastritis were enrolled after obtaining ethical approval from the hospital’s review board. Exclusion criteria included patients already on vitamin B12 supplementation. Diagnostic testing for H. pylori was performed using stool antigen tests, and vitamin B12 levels were assessed through serum measurements. Data analysis was conducted using IBM SPSS Statistics version 23, with the Chi Square test applied to examine the association between H. pylori infection and vitamin B12 deficiency, setting the level of significance at p ≤ 0.05. Results: Out of the 120 patients studied, 49 (40.8%) tested positive for H. pylori. Vitamin B12 deficiency was observed in 35 (29.2%) patients. Among those infected with H. pylori, 51.0% (25 patients) also had vitamin B12 deficiency, compared to 14.1% (10 patients) among those not infected (p = 0.0001). Conclusion: The findings indicate a significant association between H. pylori infection and vitamin B12 deficiency. This study suggests that H. pylori is a potential risk factor for vitamin B12 deficiency, underscoring the need for screening and appropriate management of H. pylori in patients presenting with vitamin B12 deficiency.

Frequency of oesophageal foreign bodies ingested by children presenting to the ENT department.

Objective: To determine the frequencies of different esophageal foreign bodies ingested by children presenting to Ayub Teaching Hospital Abbottabad. Study Design: Cross-sectional study. Setting: Department of Otorhinolaryngology, Ayub Teaching Hospital Abbottabad. Period: 2nd July 2020 to 31st December 2022. Material & Methods: Following the application of inclusion and exclusion criteria, a total of 168 patients, aged between 6 months and 11 years, presenting with suspected esophageal foreign bodies, were included in the study after obtaining written consent. Socio-demographic information, clinical history, and symptoms were carefully recorded. Diagnostic procedures included neck X-rays, extended to the chest, and abdominal X-rays as necessary. Rigid esophagoscopy, performed under general anesthesia, was utilized to confirm and remove foreign bodies. Subsequently, the nature and type of the extracted foreign bodies were identified and documented using a standardized pro forma. Results: The mean age of the patients was 5.63 ± 3.097, ranging from 1 to 11 years. Regarding the gender distribution, 105 (62.5%) were male, and 63 (37.5%) were female. When considering the types of foreign bodies, 129 (76.8%) presented with coins, 12 (7.1%) with metallic objects, 7 (4.2%) with battery cells, and 9 (5.4%) with fruit seeds. Additionally, there were a few cases of chicken bones, fish bones, and safety pins, accounting for 9 (5.4%) in the category of other foreign bodies. Conclusion: This study underscores the frequent occurrence of esophageal foreign body ingestion in young children, particularly males under the age of 5, with coins identified as the predominant culprits.

ASSESSMENT OF SAFETY AND FEASIBILITY OF ROTATIONAL ATHERECTOMY (RA) VERSUS CONVENTIONAL STENTING IN PATIENTS WITH CHRONIC TOTAL OCCLUSION (CTO) LESIONS

Chronic total occlusion (CTO) sores in coronary arteries present a challenge in percutaneous coronary intervention (PCI) because of their complex anatomy and high rates of procedural failure. Objectives: In this comparative study, we aim to investigate the safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions. Methods: This comparative study was conducted at Ayub teaching hospital from September 2023 to December 2023. Data was collected from 110 patients from both genders. Patients aged > 18 years and diagnosed with chronic total occlusion (CTO) lesions in coronary arteries confirmed by coronary angiography were included in the study. Baseline demographic and clinical data, including age, gender, comorbidities, and angiographic characteristics, were collected for each participant. Additionally, procedural details such as the type of intervention, rotational atherectomy, conventional stenting, procedural time, fluoroscopy time, contrast volume, and any adverse events encountered during the procedure were recorded. Results: Data were collected from 110 patients from both genders. The mean age of participants in the Rotational Atherectomy (RA) group was 62.4 ± 7.3 years, while in the Conventional Stenting group, it was 61.8 ± 6.9 years. There were 40 males and 15 females in the RA group, compared to 38 males and 17 females in the Conventional Stenting group. The prevalence of diabetes mellitus was 42.0% in the RA group and 45.5% in the Conventional Stenting group. Left ventricular ejection fraction (LVEF) was 53.7 ± 4.2% in the RA group and 54.1 ± 4.5% in the Conventional Stenting group. The RA group showed a success rate of 81.8%, and the conventional stenting group achieved a success rate of 90.9%. However, the RA group experienced slightly higher rates of major procedural complications (9.1% vs. 5.5%) and minor procedural complications (12.7% vs. 10.9%) than the conventional stenting group. Conventional stenting group, the mean change was -1.2 ± 0.7. Additionally, the incidence of target lesion revascularisation (TLR) was observed in 8 patients (14.5%) in the RA group and 12 patients (21.8%) in the conventional stenting group. Furthermore, major adverse cardiovascular events (MACE) occurred in 9 patients (16.4%) in the RA group and 11 patients (20.0%) in the conventional stenting group. Conclusion: It is concluded that both rotational atherectomy (RA) and conventional stenting are effective and safe treatment options for patients with chronic total occlusion (CTO) lesions. Our findings suggest that both strategies yield comparable procedural success rates, complication rates, and efficacy outcomes, including myocardial infarction frequency, troponin levels, and left ventricular ejection fraction changes.

Utilization of Antenatal Care Services among Patients Presenting in Ayub Teaching Hospital

Regular use of antenatal care services during pregnancy has a positive impact on maternal and fetal health and serves as a tool to reduce maternal morbidity and mortality. Objective: To assess the utilization of antenatal care services among pregnant women at Ayub Teaching Hospital in Abbottabad, Pakistan. Methods: This descriptive study was conducted in Ayub Teaching Hospital in Abbottabad, KPK province, Pakistan. Data were collected on paper-based questionnaires and analyzed using SPSS. A total of 208 patients participated. Results: Key findings from the study indicated that the average age of participants was 28 years. The majority of women came from lower-middle-class backgrounds. The study also revealed a wide range of educational backgrounds among participants. Most women had prior pregnancy experience. The study found that a significant percentage of women initiated antenatal visits during the first trimester with drop in visits during the third trimester. Understanding the reasons for seeking care is crucial, with various medical concerns and routine check-ups cited. Barriers to utilization included lack of awareness, family issues, and geographical distance. Additionally, only 72% of women reported taking recommended supplements during pregnancy. Conclusions: The study identified that women from middle income group with previous experience of pregnancy seek antenatal care in first trimester with various pregnancy problems but visits were not consistent. Major reason for non-utilization of services was unawareness about the services.

COMPARATIVE ANALYSIS OF STAGED VERSUS INDEX PROCEDURE COMPLETE REVASCULARIZATION IN ST-ELEVATION MYOCARDIAL INFARCTION

ST-elevation myocardial infarction (STEMI) is a critical condition that necessitates quick and efficient revascularization techniques. Recently, there has been a discussion on the best method for revascularization staged versus index procedure complete revascularization. The study compares the clinical outcomes of staged versus index procedure complete revascularization in ST-elevation myocardial infarction. This study is a prospective comparative analysis conducted at Ayub Teaching Hospital, Abbottabad. The patients were divided into two groups, with 40 participants in each group. Demographic data that included Smoking history, Diabetes mellitus, Dyslipidemia, Previous MI, and (LVEF) was recorded. Intraoperative and postoperative outcomes at 72 hours and six months were recorded. The quality of life was also assessed using SF-36 16. Data was entered and analyzed using SPSS (Statistical Package for the Social Sciences) version 24. P-values of ≤0.05 will be considered statistically significant. These findings suggest that in Group A, the frequency of "No reflow" (1 case) and "Abrupt closure" (0 instances) p=0.02) compared to Group B, where "No reflow" was observed in 2 cases and "Abrupt closure" in 1 case, (and (p=0.01), the investigation into post-operative outcomes, revealed no statistically significant differences between the two groups. P values ranged from 0.31 to 0.45, indicating comparable outcomes. After six months post-surgery, Group A demonstrated significantly better outcomes across various health-related domains than Group B, as indicated by the SF-36 questionnaire. In conclusion, index complete vascularization holds a distinct advantage over staged procedures. The observed differences across various health indicators highlight the potential clinical significance of prioritizing complete revascularization during the initial intervention.

A COMPARATIVE ANALYSIS OF DIRECT STENTING VERSUS PRE-DILATION IN ST-ELEVATION MYOCARDIAL INFARCTION

A major cardiovascular emergency, ST-Elevation Myocardial Infarction (STEMI), needs prompt and efficient intervention to restore blood flow to the ischemic myocardium. The decision between direct and pre-dilation stenting, two of the many techniques used in primary percutaneous coronary intervention (PCI), has been a topic of continuous discussion. This comparative study was performed at Ayub Teaching Hospital Abbottabad after obtaining approval from the ethical review committee for six months. A total of 75 patients were included in this study and were divided into two groups. The documented procedural outcomes were the use of Gp IIb/IIIa inhibitors, procedure time, total procedure cost, and procedural problems. The rates of the left ventricular ejection fraction (LVEF) at discharge, ventricular fibrillation, all-cause death, and a composite of major adverse cardiac events at 30-day follow-up were documented. The results have shown that Group A has 2.44% cases of no re-flow and no abrupt closure or dissection occurrences. Group B's incidence rates were 5.88%, 2.94%, and 5.88%, respectively. The procedural time, Group A had an average of 33 ± 19 minutes, while Group B recorded a longer procedural time of 41 ± 17 minutes. Postoperatively, Group A showed a mean LVEF of 49.2 ± 8.8, no cases of cardiogenic shock or stroke, and a mortality rate of 2.44%. In contrast, Group B had a mean LVEF of 48.9 ± 9.2, encountered cardiogenic shock in 5.88% of cases, experienced a stroke in 2.94%, and recorded a mortality rate of 2.94%. Additionally, both groups exhibited ST-segment resolution, with rates of 80.49% in Group A and 67.64% in Group B. The analysis of patients undergoing coronary intervention for ST-elevation myocardial infarction (STEMI) suggests that direct stenting may yield more favorable results compared to pre-dilation.

POSTPARTUM DEPRESSION AND SOCIAL SUPPORT: A CROSS-CULTURAL ANALYSIS OF THE PAKISTANI POPULATION

The study investigates the prevalence of depression among pregnant women and its association with demographic, maternal, and socioeconomic characteristics. Participants were recruited for a year from healthcare facilities from Rural Health Center Kangra, District Haripur, Khyber Pakhtunkhwa, Ayesha Sakeena Medical Complex, Raiwind, Lahore, Creek General Hospital, Korangi, Karachi and Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, from September 1, 2022, to August 31, 2023. Among 374 women screened for depression, 39.03% screened positive, with a final sample of 179 pregnant women analyzed. Participants, predominantly aged 21-28, were in the second (81%) or third (19%) trimester. Maternal depression (64%) was linked to factors like inadequate income, lack of empowerment, poor wealth index, family debt, and insufficient funds for food. Socioeconomic challenges, coupled with inadequate social support and extensive household responsibilities, contribute to the complex landscape of maternal depression. Comprehensive interventions addressing economic hardships, mental health support, and social networks are crucial for improving maternal well-being during pregnancy.