Ayub Teaching Hospital Research Articles

Assessment of patient satisfaction in inpatient department of Ayub Teaching Hospital Abbottabad, Pakistan.

Objective: To assess level of patient satisfaction in inpatient department of Ayub teaching hospital Abbottabad. Study Design: Cross-sectional Observational study. Setting: Different Wards of Ayub Teaching Hospital (ATH) Abbottabad. Period: July 2022 to September 2022. Material & Methods: Three hundred five sample size was calculated by WHO sample size calculator. Data was collected through a self-administered questionnaire by convenient sampling technique. Six parameters were marked on a Likert scale from 0-4 and total score were categorized into high satisfaction, mediocre satisfaction and low satisfaction. Data was analyzed on SPSS Version 23. Results: 240(78.69%) patients were highly satisfied, 38(12.46%) were mediocrely satisfied, while 27(8.85%) had low satisfaction with registration process. 252(82.62%) patients were highly satisfied, (10.49%) were mediocrely satisfied while 21(6.89%) patients had low satisfaction with the courtesy received from the staff. 158(51.80%) patients were highly satisfied, 86(28.2%) were mediocrely satisfied while 61(20%) had low satisfaction from hygiene of hospital. Similarly patient satisfaction during hospital stay, technical and professional expertise of hospital staff and affordability of medical treatment was also measured. Overall patients satisfaction with all six parameters combined was: 177(58.03%) patients were highly satisfied, 100(32.79%) were mediocrely satisfied and 28(9.18%) patients had low satisfaction. Conclusion: The results of this study confirm that patient satisfaction was high in the setup studied. However this study was conducted in one hospital to make it generalize there is a need of more studies at larger scale involving more hospitals.

Frequency of Irritable Bowel Syndrome in Patients Presenting with Abdominal Pain to Ayub Teaching Hospital

The irritable bowel syndrome (IBS) is a chronic and sometimes disabling functional bowel disorder. The Rome IV criteria, derived from a consensus process by a multinational group of experts in functional gastrointestinal disorders, constitute the current standard for diagnosing IBS. According to defecation ir in association with a change in stool frequency or form. Bloating is a common accompanying symptom. Symptoms must be chronic, occurring at least once per week, on average, in the previous 3 months, with a duration of at least 6 months. IBS is 2-4 times common in females and genetic predisposition is suggested by evidence and 33% of patients have family history of IBS. Some dietary factors and psychological issues like anxiety and stress are also associated with IBS. Objectives: The present study was conducted to determine the frequency of irritable bowel syndrome in in patients presenting with abdominal pain in gastroenterology OPD Ayub Teaching Hospital Abbottabad. Material and Methods: This Cross sectional ( descriptive) study was carried out in the Departmen t of Gastroenterology of Ayub Teaching Hospital Abbottabad from September 2018 to February 2019 .The study population was included, Presenting with abdominal pain of either gender having age between 15 to 60 years.A detailed history was taken from the patient with clinical examination was performed on each participant. IBS was diagnosed by using ROME IV criteria. Strictly exclusion criteria were followed to control the confounders Results: Mean age of the patients was 44.66±11.486 ranging from 15 to 60 years of age, mean duration of abdominal pain was 3.38±5.714 ranging from 1 to 48 months and mean duration of symptoms was 13.30±5.268 ranging from 8 to 20 days. In frequency of gender of patients there were 117(59.7%) male and 79(40.3%) female. In frequency of irritable bowel syndrome, there were 35(17.9%) had irritable bowel syndrome while 161(82.1%) had no IBS. Conclusion: The diagnosis of IBS relies on the identification of characteristic symptoms and the exclusion of other organic diseases. Management of patients with IBS is optimized by an individualized, holistic approach that embraces dietary, lifestyle, medical, and behavioral interventions. Keywords: Irritable bowel syndrome, abdominal pain

Frequency of Congenital Cardiac Conditions in Children Born to Diabetic Moms

Introduction: The foetal cardiovascular system is teratogenically affected by maternal diabetes. Because of this, cardiovascular abnormalities are the most prevalent anomaly in children of diabetes moms. Despite improvements in the medical care provided during pregnancy to diabetic mothers, a cardiac complication in their infants is still more frequent than in infants of the general population. Objectives: to quantify the prevalence of congenital cardiac problems in offspring of diabetes moms. Materials & Methods: this-Cross-sectional-study conducted in the Departments of Paediatrics and Neonatology, Ayub Medical College and Hospital, Abbottabad . from Jan 7 2021, to Jun 6 2021. A total of 111 full-term neonates born to diabetic mothers were included. Premature babies and other congenital anomalies were excluded. After taking consent and detailed history, all the neonates included in the study were sent for (Echocardiography) at the cardiac division of Abbottabad's Ayub Teaching Hospital. In the same department, echocardiography was conducted by the same cardiologist. Neonatal congenital heart disease was treated in hospitals. Results: Mean age was 3.35 ± 1.29 days (Table I). The mean maternal age was 38.64 ± 1.37 weeks. Out of the 111 patients, 79 (71.17%) were male, and Females made up 32 (28.19%), with a male-to-female ratio of 2.5:1. The average newborn weighed 3.93 1.62 kg. In this research, I discovered that 43 (38.74%) children with a mother who has diabetes had congenital cardiac disease. Conclusion: This study has shown the prevalence of congenital cardiac abnormalities, with patent ductus arteriosus being the most prevalent abnormality among children born to diabetic moms. Keywords: congenital heart defects, diabetic mothers, patent ductus arteriosus. Births in the US, whereas just 2% of pregnancies in Faisalabad have diabetes.Teratogenic

FREQUENCY OF HEPATITIS C SEROCONVERSION IN CHRONIC KIDNEY DISEASE PATIENTS ON HEMODIALYSIS

Background: Haemodialysis increases Hepatitis-C seroconversion risk adversely affecting Chronic Kidney Disease (CKD) prognosis. This study aimed to determine the frequency of Hepatitis C seroconversion in chronic kidney disease patients on haemodialysis. Method: This cross-sectional study was conducted at Dialysis Unit of Ayub Teaching Hospital, Abbottabad from March 2016 to January 2019. A pre-designed proforma was used for data collection. A sample of 121 patients of dialysis dependent CKD was enrolled for the study through non-probability consecutive sampling. The Glomerular Filtration Rate (GFR) was re-estimated from serum creatinine to confirm the diagnosis using Modification of Diet in Renal Disease (MDRD) study equation. Patients who were Hepatitis C virus (HCV) negative at the start of dialysis, and became positive 3 months post-dialysis were considered having undergone seroconversion. Data were analysed using SPSS-16. Results: Out of 121 participants, 80 (66.1%) were male and 41 (33.8%) were female. The mean age of the patients was 51.0±6.22 years with range from 41 to 61 years. Hepatitis C seropositivity was recorded in 40 (33.06%) of the study participants during the study period. Statistically significant (p<0.05) associations were observed between HCV seropositivity and age and gender of the patients. Conclusion: Hepatitis C infection is a common complication of haemodialysis. Rigorous screening of patients for Hepatitis C and separate machines for Hepatitis C patients can lead to a decrease in the burden of this disease. Pak J Physiol 2023;19(2):32–5

Frequency of Iron Deficiency in Heart Failure Patients

Background: People suffering from heart failure frequently face iron deficiency, which has been linked to higher mortality and more frequent hospital stays. People with symptomatic systolic heart failure and iron deficiency, iron supplementation significantly decreased the risk of hospitalization for heart failure and the combined endpoint of hospitalization for heart failure and mortality, Aim: This research sought to determine the prevalence of iron insufficiency in people with chronic heart failure. Design of the study: This study is cross-sectional. Place of the study: Ayub Teaching Hospital Abbottabad from November 2019 to April 2020. Methodology: After obtaining written informed permission, the research participants who met the inclusion criteria were chosen. Patients between the ages of 40 and 70, of either gender, were included in the research group if they had a documented history of CHF for less than six months and an echocardiogram showed an LVEF of less than 45%. Results: Mean age of the patients was 55.79±9.926, ranging from 40 to 70 years and the mean BMI was 29.03±5.043 ranging from 19 to 49kg/m2, mean serum ferritin level was 226.03±160.297 ranging from 70 to 500μg/L and mean transferrin saturation was 23.15±6.449 ranging from 15 to 38%. In the frequency of heart failure, patients of heart failure were 72(48%) and 78(52%) had no HF. In the frequency of iron deficiency, patients found with a deficiency were 82(54.7%) and 68(45.3%) had no deficiency. Practical Implication: Patients with heart failure should have routine iron deficiency screenings regardless of the presence of anaemia or abnormal RCI. In order to improve risk-based selection of participants who are frequently not at risk for iron deficiency Conclusion: Men with functional classes II–III were more likely to have iron deficiency anaemia (72% prevalence). Hypertension was the most prevalent comorbidity. Keywords: Iron deficiency, Heart failure, Anemia

Incidence of Acute Complications Associated with Spinal Cord Injury (SCI): A Study of the Ayub Teaching Hospital, Abbottabad

Objective: To document the occurrence of acute problems as well as post-surgical improvements in individuals suffering from spinal cord injury. Materials and Methods: This study was conducted retrospectively in the Department of Neurosurgery. All patients of any age and both genders were included who were admitted with spinal injuries. The patients with cervical fractures received the anterior cervical plating plus graft placement in the cervical spine, whereas the patient with thoracolumbar fractures received the transpedicular fixation in thoracolumbar spine fractures. ASIA Impairment Scale for neurological status, GCS at admission, and acute complications developed within two weeks were noted. Results: 200 patients were included (mean age of 34.6 years). The common cause of SCI was a fall from an elevated position of 62.5%. On admission, 50% of patients’ neurological state was Asia grade A. The most common location involved in patients (70%) was a thoracolumbar junction. 20% of patients presented with neurogenic shock. Postoperatively, the GCS scores in all patients were been improved. The commonest acute complications associated with SCI were pulmonary in 60% of patients. 17% of patients developed an infection, 5% suffered from gastrointestinal issues, and 3% suffered from renal issues. Deep vein thrombosis (DVT) was observed in 9%. Conclusion: During the early phase of hospitalization, respiratory difficulties were among the most prevalent complications encountered in those suffering from traumatic SCI. These outcomes exacerbate the eventual suffering caused by the spinal cord injury; hence, recognizing the likelihood of occurrence, early detection, exact surgical treatment, and prevention are essential.

Prevalence of asymptomatic bacteriuria and its antibacterial susceptibility pattern among pregnant women

Background and Aim: The condition of asymptomatic bacteriuria in pregnancy is common, and up to 40% of women developing pyelonephritis in pregnancy may suffer low birth weight and membrane’s premature rupture. The present study intended to investigate the incidence of asymptomatic bacteriuria and its antibacterial susceptibility pattern among pregnant women. Patients and Methods: This cross-sectional study was carried out on 183 pregnant women attending Obstetrics and Gynecology Department of Ayub Teaching Hospital, Abbottabad from December 2021 to May 2022. Pregnant women with asymptomatic bacteriuria attended the ANC services and willing to provide written consent were enrolled. Standard bacteriological procedures were followed for bacterial isolates identification using biochemical tests, colony characteristics, and Gram-staining. Kirby- Bauer disk diffusion technique was used for Antimicrobial susceptibility test on Muller-Hinton agar medium and Clinical Laboratory Standard Institute guidelines was used for interpretation of zone of inhibition diameter. Midstream urine samples were collected from each study participant and standard microbiological methods to culture urine, identify the pathogen, and conduct sensitivity tests. Data analysis was done in SPSS version 27. Results: The prevalence of asymptomatic bacteriuria was 14.2% (n=26) among pregnant women.

Prevalence of Hypertension and Diabetes Mellitus in Patients Thrombolysed for STEMI

Objective: The objective of this study is to evaluate the frequency of hypertension and diabetes in patients, thrombolysed for STEMI and explore the relationship between these comorbidities and patient outcomes. By examining the frequency of these comorbidities in thrombolysed STEMI patients, healthcare providers can develop personalized treatment plans to optimize patient outcomes. Furthermore, these findings have the potential to contribute to future research focused on preventing or managing hypertension and diabetes in STEMI patients. Study Design: cross sectional study Study Setting: Cardiology Department, Ayub Teaching Hospital, Abbottabad, Pakistan. Duration of Study: Six months from August 1st, 2022 to 31st Jan, 2023. Material and Methods:. A total of 170 patients, aged between 18 and 80 years, were included in the sample for analysis. The study focused specifically on patients who were thrombolysed using Streptokinase. Results: In this study, male to female ratio was nearly 3:1. Among the 170 patients, 96 (56%) were found to have hypertension, while 42 (24%) were diagnosed with diabetes. Among the hypertensive patients, which accounted for 96 (56%) of the total population, 60 (62.5%) were male and 36 (37.5%) were female. Among these diabetic patients, 24 (57.1%) were male, while 18 (42.9%) were female. Conclusion: This study highlights the high frequency of hypertension and diabetes in ST-elevation myocardial infarction (STEMI) patients treated with thrombolytic therapy. These findings suggest the importance of screening STEMI patients for these comorbidities and providing appropriate follow-up care to optimize patient outcomes. Keywords: Prevalence, Hypertension, Diabetes, STEMI.

Study on injectable DMPA (Depomedroxy Progesterone Acetate) and effect of its use as a short term contraception in immediate postpartum women

Background and Aim: Contraception in the postpartum period is a significant problem. When used correctly, injectable hormonal contraceptives are one of the most reliable methods of contraception currently available. The purpose of the present study was to assess the effect of injectable DMPA as a short term contraceptive in immediate postpartum women. Patients and Methods: This prospective observational study was conducted on 130 postpartum women in the Gynaecology Department of Ayub Teaching Hospital, Abbottabad from December 2018 to December 2019. The study group of 130 postpartum women were given injectable DMPA 150 mg intramuscularly during discharge from hospital and after three months. The mother was subjected to a complete general physical examination. The need of exclusive breast feeding was emphasized. Fasting blood samples were collected for liver function testing (LFT), lipid profile, blood sugar, haemoglobin (Hb). About 130 postpartum women who were not taking any hormonal contraceptive were considered a control group. All the patients were followed-up for six weeks, three months, and six months. Data analysis was done using SPSS version 27. Results: The overall mean age of study group was 24.6±2.9 years with an age range 20 to 34 years.

Frequency of Thyroid Dysfunction in Diabetic Patients

Thyroid hormones are involved in the control of insulin secretion, beta-cell function/multiplication, liver glucose synthesis, output and peripheral utilization. Thyroid dysfunction identification and correction help in glycemic control. Objective: To know the frequency of thyroid dysfunction in diabetic patients. Methods: This descriptive cross-sectional study was done in the Medical-C Department, Ayub Teaching Hospital Abbottabad from July 2018 to August 2019. Total 150 diabetic patients were enrolled by using non-probability consective sampling. Patients were labelled as diabetics on the basis of diabetes history, anti-diabetic medications use, high blood glucose (>200mg/dl) on presentation or on previous high blood sugar reading or a high HbA1c value. Fresh venous blood sample was sent for thyroid function tests (T3, T4 and TSH). Thyroid dysfunction in our study was defined as patient having Thyroid Stimulating Hormone (TSH) value above or below the normal range. Data of patients were collected on study pro forma and was analyzed using statistical program SPSS version-20.0 Results: There were 67 (44.66%) male and 83 (55.33%) female patients. The mean age was 51.83 ± 14.52 years. Thyroid dysfunction was detected in 37 (24.66%) study participants. Out of 67 male patients, 11 (16.41%) had thyroid dysfunction and out of 83 female patients, 26 (31.32%) had thyroid dysfunction. Subclinical hypothyroidism was present in 4 (2.7%), 5 (3.3%) had hypothyroidism, 20 (13.3%) had subclinical hyperthyroidism and 8 (5.3%) had hyperthyroidism. Conclusion: This study suggests that a significant portion of diabetic patients suffer from thyroid dysfunction.

Chitosan improves the efficacy of gentamicin against MDR and biofilm-forming URO pathogenic E. coli

Uropathogenic E. coli is the most common cause of urinary tract infections (UTIs), accounting for 80-90% of community-acquired UTIs and 30-50% of hospital-acquired UTIs. Uropathogenic E. coli that form biofilms are linked to chronic and persistent inflammation, resulting in severe and recurring UTIs. Biofilms promote antibiotic resistance and the horizontal transfer of virulence genes, promoting the formation of multidrug-resistant organisms. This study aimed to combine low-molecular-weight chitosan with aminoglycoside gentamicin to improve its efficacy against biofilm formation and MDR E. coli. Different strains of bacteria were isolated from urine samples of different patients at the Ayub Teaching Hospital, Abbottabad, out of which 16 were identified as E. coli by API (Analytical Profile Index) 20E. The antibiotic sensitivity profile was determined using the disk diffusion method, and the results showed that a total of 10 isolates were found to be multidrug-resistant MDR (N=62.5%). Biofilm formation was tested using the TCP method, a total of 7 isolates were found to be strong biofilm producers (N=44%). Gentamicin exhibited the highest inhibitory activity against 10 isolates of E.coli, with MIC-p ranges of 4 and 2 µg/ml, respectively, while 6 isolates showed resistance to gentamicin with MIC-p ranges >512 µg/ml.

Snodgrass Hypospadias Repair At Ayub Teaching Hospital: An Audit Of Complications And Outcomes.

There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique. In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021. Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29). Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.

Frequency Of Primigravida In Patients With Eclampsia.

Pregnancy-induced hypertension (PIH) occurs in about 5% of pregnancies and is a major cause of high perinatal and maternal morbidity and mortality. In several international studies, primigravidas were associated with a significantly higher incidence of eclampsia. The local studies so far have a small sample size and mainly focus on preeclampsia in all pregnant women. limited data is available on the frequency of eclampsia in primigravidas in our population. This study aims to determine the frequency of primigravidas in patients with eclampsia after 20 weeks of gestation. This descriptive Cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from 7/10/2020 to 7/4/2021. A total of 134 patients were observed. Diagnosis of eclampsia was based upon obstetrical history, presence of fits or coma, raised blood pressure and presence of proteinuria on urine complete examination. Immediate management included stabilizing the patient and delivery by Induction of labour or Caesarean section. The guardians of the patients explained the purpose and the benefits of the study and informed written consent was taken. : Our study shows that among 134 patients, 96 (72%) patients were in the age range of 18-27 years while 38 (28%) patients were in the age range of 28-35 years. The mean age was 30 years with SD±10.94. Eighty two (61%) patients had a POG range ≤34 weeks while 52 (39%) patients had a POG range >34 weeks. Forty-eight (36%) patients had BMI <27 Kg/m2 while 86 (64%) patients had BMI >27 Kg/m2. Fifty-six (42%) patients had a positive history of hypertension while 78(58%) patients had a negative history of hypertension. Out of 134 patients, 102(76%) were primigravidas while 32 (24%) were multigravidas. Our study concludes that the frequency of primigravidas was 76% in patients with eclampsia after 20 weeks of gestation presenting at tertiary care hospital Abbottabad.

Effect of Thymectomy on Outcomes of Myasthenia Gravis Patients: A Case-Control Study at a Tertiary Care Hospital.

Background and objective Myasthenia gravis (MG) is an acquired autoimmune disease mediated by antibodies affecting the neuro-muscular junction on the postsynaptic membrane, resulting in neuromuscular transmission obstruction and, consequently, muscle weakening. It is believed that the thymus gland plays a critical role in the production of these antibodies. Screening patients for thymoma and surgical excision of the thymus gland is a crucial part of the treatment. To compare the odds of good outcomes in Myasthenia Gravis patients with or without thymectomy. Material and methods A retrospective case-control study was conducted at the Department of Medicine and Neurology, Ayub Teaching Hospital, Abbottabad, Pakistan, from October 2020 to September 2021. A purposive sampling technique was employed. Thirty-two MG patients with thymectomy and 64 MG patients without thymectomy were selected for investigation. Controls and cases were matched on the basis of sex and age (1:2). A positive EMGstudy, acetylcholine receptor antibodies, and a pyridostigmine testwere used to make the diagnosis of MG. Patients were called to the outpatient department for assessment of treatment outcomes. Primary outcome evaluation was done using the Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS) tool at the last follow-up after one year. Results A sample of 96 patients was evaluated, of which 63 (65%) were females and 33 (34%) were males. The mean age for Group 1 (cases) was 35 years ±8.9 and for Group 2 (controls) was 37± 11.1. Age and Osserman stages were shown to be the two most crucial prognostic factors in our study. However, there are several other factors in our study that are linked to a poor response, such as a greater BMI, dysphagia, thymoma, older age, and a longer duration of disease. Conclusions Our findings indicate that none of the analysed groups had significantly worse outcomes as a result of the current clinical practice of thymectomy patient selection.

Frequency of ABO incompatibility as a cause of neonatal jaundice in neonatal unit of Ayub Teaching Hospital, Abbottabad

Background: Neonatal jaundice is a common problem encountered by neonatologists. After prevention of Rh-isoimmunization ABO incompatibility has become the most common cause of hemolysis. For infants delivered of 35 weeks gestation or later ABO incompatibility have been found to be the major risk factors for development of severe hyperbilirubinemia. Objective: To assess the frequency of ABO incompatibility as a cause of neonatal jaundice. Methodology: The current study was Cross-sectional descriptive study carried out at the Neonatal units of Ayub teaching hospital, Abbottabad. Study was carried out over a period of six months from 01-06-2011 to 30-11-2011. The calculated sample size based on using the WHO software was 246 patients. Investigations were done regarding mother and baby’s blood group, serum bilirubin levels (total, direct and indirect). Data was entered into computer using SPSS version 10. Results: A total of 246 neonates were included in this study. Mean age of the neonates was 4.62±4.09. Males were 157 (63.8%) and females were 89 (36.2%).

Perception of Neurosurgical Residents about Learning in Operation Theatre in Tertiary Care Hospitals

OBJECTIVES To explore Neurosurgical postgraduate residents perceptions of their learning environment in operating rooms.METHODOLOGY From March 2022 to August 2022, this cross-sectional study will be carried out in the Department of Neurosurgery Hayatabad Medical Complex, Peshawar, Lady Reading Hospital Peshawar, and Ayub Teaching Hospital Abbottabad. The STEEM survey examined how surgical theatres were perceived as educational environments. After receiving informed consent, a printed questionnaire was provided to 32 surgical residents. SPSS 24 was used to conduct descriptive and inferential data analyses. RESULTS Thirty-one (31) of the 32 surgical residents that were surveyed (or 98.3%) answered. Residents' average age was 29.27 years (2.37); 27 were male, and 05 were female. Most residents were in their third (34.4%) and fourth (21.3%) years of residency. 147.66 (18.57) was the overall mean score. Participants' age and gender did not affect the mean scores; nevertheless, responses were statistically more favorable for residents in their first or fifth year of residency. Fifty-three locals responded favorably or positively overall. CONCLUSION Overall, residents had positive opinions of their training, their supervisors, the opportunities for learning in the operating room, the environment, and the monitoring they received.

Frequency of common bile duct strictures in patients presenting with obstructive jaundice in Ayub teaching hospital

Background; Obstructive jaundice in simple terms means the outflow of bile has been obstructed anywhere from the liver to the duodenum. It is caused by obstruction, blockage and/or compression of common bile duct (CBD) and/or biliary tract that leads to incomplete excretion of bile into the intestine. Patients with obstructive jaundice usually present with Complains of abdominal pain, yellow discoloration of skin and/or eyes, pale stools, dark colored urine, nausea, vomiting and pruritus. Objective: To determine frequency of common bile duct strictures in patients presenting with obstructive jaundice in Ayub teaching hospital. Material and Method. This Cross Sectional Study was conducted in the department of Gastroenterology, ATH, Abbottabad from 15th September 2020 to 15th March 2021. A total of 135 patients of both gender presenting with jaundice and having serum bilirubin ≥1.1 mg/dl, alkaline phosphatase ≥140 IU/L along with evidence of obstruction of common bile duct were included in the study. Presence of CBD stricture was confirmed through Ultrasonography or CT abdomen. Results: Age range in this study was from 20 to 80 years with mean age of 44.651±12.90 years. Female gender was dominant with 61.5% patients. Common bile duct strictures was seen in 9.6% patients.

Impaired Glucose Tolerance in Patients with Polycystic Ovarian Syndrome

Background: Polycystic ovary syndrome first described by Stein and Leventhal, is a complex genetic trait of unclear etiology characterized by Oligomenorrhea or anovulation, biochemical or clinical hyperandrogenism and polycystic ovarian morphology on ultrasonography. Women with polycystic ovarian syndrome have an increased risk of developing impaired glucose tolerance and type 2 diabetes mellitus. This study aims to determine the prevalence of impaired glucose tolerance in patients with polycystic ovary syndrome. Study Design: Cross-sectional study Study Duration: This study was conducted in the Department of Endocrinology Ayub Teaching Hospital Abbottabad from 1st Nov 2021 to 30th April 2022. Materials and Methods: All patients with age range 16 to 40 years who were diagnosed with polycystic ovarian syndrome were included in the study. Age, ovarian volume, clinical signs of hyperandrogenism, menstrual abnormalities, serum testosterone, blood glucose at baseline and following 75g of oral glucose load, Body mass index etc. were recorded. Data was analyzed using SPSS-23. Results: Among 139 patients, 35(25.2%) were in the age range 16-25 years while 104(74.8%) were in the age range 26-40 years. Mean age was 28.6(SD±4.2) years. 69(49.6%) patients had BMI&gt; 30 Kg/m2, 60(43.2%) had BMI between 25-29.9 Kg/m2, while only 10(7.2%) patients had their BMI within normal range (18.5-24.9). Mean BMI was 30.7 Kg/m2 (SD±4.4). 47(33.8%) patients had ovarian volume less than 25ml while, 92(66.2%) had ovarian volume greater than 25ml. Mean ovarian volume was 25.5(SD±6.7). 106(76.3%) patients had serum testosterone less than 70ng/dl while, 33(23.7%) had serum testosterone greater than 70ng/dl. Mean serum testosterone was 48.8(SD±26.4). Hirsutism and Acne was observed in 92 (66.2%) and 91(65.5%) patients respectively. 75 (54%) women had positive family history of Diabetes, 56 (40.3%) had family history of polycystic ovary syndrome and 71 (51.1%) patients had past or current history of oral contraceptive pills. Impaired glucose tolerance was found in 52(37.4%) patients. Post stratification results were statistically significant. Conclusions: The prevalence of impaired Glucose tolerance with polycystic ovary syndrome can be as high as 37.4%. Increasing age and Body Mass Index, raise serum testosterone level and increasing ovarian volume are significant predictors for developing impaired glucose tolerance in women with polycystic ovary syndrome. Keywords: Polycystic Ovarian Syndrome, Impaired Glucose Tolerance, Predictive Factors.

Mid-Term Clinical and Echocardiographic Outcomes of Percutaneous Transvenous Mitral Commissurotomy in Patients with Rheumatic Mitral Stenosis

Introduction: Mitral stenosis is a condition characterized by the narrowing of the mitral valve, which regulates blood flow between the left atrium and left ventricle of the heart. Objectives: The main objective of the study is to find the mid-term clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis. Material and Methods: The present study was a retrospective observational study conducted at Ayub Teaching Hospital, Abbottabad. The study included a total of 70 patients who underwent percutaneous transvenous mitral commissurotomy (PTMC) between 1st January 2022 and 30th June 2022. Results: A total of 70 patients who underwent PTMC at Ayub Teaching Hospital, Abbottabad, between 1st January 2022 and 30th June 2022 were included in this retrospective observational study. The mean age of the patients was 39.2 ± 12.8 years, and 52 (74.3%) were females. The mean mitral valve area (MVA) prior to PTMC was 0.9 ± 0.2 cm^2 that increased to 1.8 ± 0.3 cm^2 after the procedure, and it was statistically significant (p&lt;0.001). The immediate success rate of PTMC was 94.3%, while the mid-term success rate was 90%. Conclusion: In conclusion, percutaneous transvenous mitral commissurotomy (PTMC) is a safe and effective treatment option for patients with rheumatic mitral stenosis. Our study showed that PTMC resulted in a significant improvement in mitral valve area, trans-mitral pressure gradient, pulmonary artery systolic pressure, and clinical symptoms of dyspnea, fatigue, and palpitations. Keywords: Mitral stenosis, PTMC, Patients, Procedures, MVA

Effect of No-Reflow During Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction on Six-Month Mortality

Background: No-reflow is a serious complication that can occur during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). No-reflow is a frequent event during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and it may affect cardiac prognosis. Objectives: The main objective of the study is to find the effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Methods: This study was conducted at Ayub Teaching Hospital Abbottabad over a period of six months (1st January 2022 to 30th June 2022). A total of 130 patients who underwent primary PCI for AMI were included. The occurrence of no-reflow during the procedure was noted, and six-month mortality was recorded. Results: Of the 130 patients included in the study, 34 (26.2%) developed no-reflow during PPCI. The mean age of the patients was 58.5 ± 9.6 years, and 73.8% were male. The most common risk factors for AMI were hypertension (52.3%), smoking (45.4%), and diabetes (36.2%). There were no significant differences in baseline clinical and angiographic characteristics between patients with and without no-reflow. Conclusions: The occurrence of no-reflow during primary PCI for AMI is associated with a higher six-month mortality rate. Further research is needed to explore strategies to prevent or mitigate the occurrence of no-reflow during primary PCI for AMI. Keywords: AMI, No-reflow, Mortality, percutaneous coronary intervention (PCI)