Care Hospitals Of Peshawar Research Articles

Sociodemographic Determinants and Cardiovascular Events in Rheumatoid Arthritis: A Cross - Sectional Study from a Tertiary Care Hospital in Peshawar

OBJECTIVES To determine the relationship between sociodemographic characteristics and the occurrence of cardiovascular events in RA patients admitted to the Tertiary Care Hospital in Peshawar. METHODOLOGY A cross-sectional study was conducted from November 1, 2023, to April 30, 2024, enrolling 211 RA patients (aged 25–70 years) diagnosed according to ACR/EULAR criteria. Cardiovascular events, defined as myocardial infarction (MI) and ischemic stroke, were documented from medical records. Data on age, gender, income, and education were collected and analysed using SPSS version 25. Associations were evaluated with chi-square tests, and a p-value <0.05 was considered significant. RESULTSThe mean age of the patients was 48.07 ± 10.86 years, and the mean duration of rheumatoid arthritis (RA) was 5.71 ± 2.90 years. The male-to-female ratio was approximately 1.7:1. MI was observed in 43 patients (20.4%), and ischemic stroke in 48 patients (22.7%). There was no statistically significant association between cardiovascular events and any sociodemographic variable (p > 0.05). CONCLUSION Cardiovascular events, including MI and ischemic stroke, are common in RA patients; however, sociodemographic factors such as age, gender, income, and education were not significantly associated with their occurrence. Future research should investigate additional factors, including inflammatory biomarkers, disease activity, treatment regimens, and genetic predispositions, to gain a deeper understanding of cardiovascular risk in rheumatoid arthritis (RA).

Identifying the Patterns: Prevalence and Management of Trauma and Surgical Emergencies in a Tertiary Care Hospital in Peshawar

Identifying the Patterns: Prevalence and Management of Trauma and Surgical Emergencies in a Tertiary Care Hospital in Peshawar

COMPARATIVE ANALYSIS OF DRY EYE SYNDROME AMONG DIABETIC VERSUS NON-DIABETIC PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL, PESHAWAR. A CASE-CONTROL STUDY.

Background: Dry eye syndrome (DES) is a multifactorial ocular surface disorder that is becoming increasingly prevalent with advancing age and rising rates of diabetes mellitus worldwide. Among diabetic individuals, ocular surface abnormalities such as tear film instability and epithelial damage are frequent yet often underdiagnosed complications. The geriatric demographic, especially those with comorbidities, are at a significantly higher risk for DES due to systemic changes and impaired lacrimal gland function. Objective: To compare the prevalence of dry eye syndrome between diabetic and nondiabetic patients attending the ophthalmology outpatient department at a tertiary care hospital in Peshawar. Methods: This case-control study was conducted at the Eye OPD of Lady Reading Hospital, Peshawar, from October 5, 2020, to December 5, 2023. A total of 100 participants were selected using convenience sampling and divided equally into two groups: 50 diabetic patients (cases) and 50 nondiabetic individuals (controls), all above 40 years of age. A comprehensive anterior segment examination was performed using slit lamp biomicroscopy. Dry eye diagnosis was established through two diagnostic tools: the Schirmer test (values <10 mm considered dry; <5 mm considered severely dry) and fluorescein staining (presence of more than three stained cells indicating surface damage). Data were processed using SPSS version 25 and EPI Info 16, with significance assessed via chi-square analysis. Results: Among diabetic patients, 12 out of 50 (24%) were diagnosed with DES, compared to 26 out of 50 (52%) in the nondiabetic group. The calculated odds ratio was 7.90 at a 95% confidence interval, with a statistically significant p-value of 0.004943 (p < 0.05), indicating a notable association between diabetes and DES. Conclusion: The study indicates a significant association between diabetes mellitus and the development of dry eye syndrome, emphasizing the need for early ocular screening in diabetic patients for timely intervention.

Incidence of vaginal birth after previous cesarean section and fetal outcomes in a tertiary care hospital in Peshawar.

Objective: To determine the frequency of vaginal birth after one cesarean section, along with fetal outcomes. Study Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics at Hayatabad Medical Complex, Peshawar, Pakistan. Period: January 2024 to July 2024. Methods: Women aged 20-40 years, history of one previous lower segment CS, and presenting in spontaneous labor with gestational age between 32 and 41 weeks, were analyzed. All women underwent a trial of labor in the labor room, with successful vaginal births after CS (VBAC) were noted. For those women who had unsuccessful attempts, were transferred to the operating room for emergency CS. Successful VBAC cases were monitored, and key fetal, and maternal outcomes were recorded. Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 149 women, the mean age, and gestational age were 27.62±4.93 years, and 37.81±1.67 weeks, respectively. VBAC was successful in 93 (62.4%) women. The mean duration of labor in successful VBAC, and unsuccessful VBAC were 8.96±7.20 vs. 11.67±8.40 hours (p=0.039). The body mass was significantly higher among women who underwent CS (p=0.031). Low birth weight (p<0.001), Apgar score <7 at 1 minutes (p=0.014), and NICU admission were significantly more among women were unsuccessful in undergoing VBAC. In terms of maternal outcomes, infection was significantly more common among women who were unsuccessful in VBAC (p=0.025). Uterine rupture occurred I 2 (3.6%) women who were unsuccessful in VBAC (p=0.014). Hospital stay was above 3 days in 5 (5.4%) women who had VBAC (p=0.030). Conclusion: This study highlights relatively high VBAC success rate with favorable maternal and fetal outcomes. Unsuccessful VBAC was associated with prolonged labor, increased maternal complications, and poorer neonatal outcomes.

Barriers to accessing primary healthcare for minor surgical procedures and their impact on tertiary care utilisation: prospective, cross-sectional study

Introduction: Minor surgical procedures are commonly performed in surgical emergency rooms within tertiary care hospitals, yet many of these cases could be managed in primary healthcare settings. Over-reliance on tertiary facilities for minor surgical care contributes to emergency department overcrowding and increased workload for surgical teams. This study aims to assess the barriers preventing patients from accessing minor surgical care at local healthcare centres and to identify the factors leading to their preference for tertiary-level care. Methods: This prospective, observational, cross-sectional study was conducted in the surgical emergency room of Hayatabad Medical Complex, a tertiary care hospital in Peshawar, Pakistan, from 1 March 2023 to 30 March 2023. A total of 200 patients presenting with minor surgical conditions were recruited using a non-probability consecutive sampling technique. Data were collected through structured questionnaires and analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: Nearly all patients (99.5%) reported having access to a nearby healthcare facility, with Basic Health Units (46.0%) and District Headquarters Hospitals (31.5%) being the most common. However, patients sought care at the tertiary hospital due to the lack of minor operating theatres (20.0%), shortage of qualified doctors (18.0%), and resource limitations (17.5%). Difficulties in accessing tertiary care were reported by 75.0% of patients, with financial constraints (43.3%), domestic responsibilities (30.7%), and transportation issues (24.7%) being the most common barriers. Conclusion: This study highlights significant gaps in the provision of minor surgical care at the primary healthcare level, leading to increased patient reliance on tertiary hospitals. Strengthening local healthcare infrastructure and improving access to minor surgical services at community levels could reduce the burden on emergency departments and ensure more efficient resource utilisation within tertiary care facilities.

Effectiveness of Educational Session on Acute Poisoning Management of Nurses Working in Tertiary Care Hospitals: A Quasi-Experimental Study

Background: Acute poisoning is a major global health concern, particularly in developing countries, where emergency department nurses often serve as first responders. However, limited data exist regarding their preparedness, especially in the Pakistani context, revealing a significant gap in knowledge and clinical practice related to poisoning management. Objective: This study aimed to evaluate the effectiveness of a structured educational session on the knowledge and clinical practices of nurses working in public tertiary care hospitals in Peshawar, focusing on their ability to manage acute poisoning cases. Methods: A quasi-experimental pre- and post-intervention design was employed among registered nurses (n = 58) from the emergency departments of three public-sector hospitals. Participants were selected through simple random sampling based on eligibility criteria, excluding those unwilling or absent. Data were collected using a validated self-administered questionnaire assessing knowledge (15 items) and clinical practice (35 items). Following a 1-hour intervention comprising a presentation and practical demonstration, post-test data were collected after one week. Ethical approval was obtained from the Khyber Medical University Ethical Review Board, and all procedures adhered to the Declaration of Helsinki. Statistical analysis was conducted using SPSS v22, with paired t-tests, ANOVA, and correlation applied where appropriate. Results: Mean knowledge scores improved significantly from 7.08 ± 0.78 to 14.47 ± 0.75 (t = 50.83, p < 0.001), and practice scores rose from 12.81 ± 3.19 to 33.63 ± 1.56 (t = -42.60, p < 0.001). No demographic variable showed a significant association with pre-intervention scores, indicating a uniform benefit of the intervention across all groups. Conclusion: The educational session effectively enhanced nurses' knowledge and clinical practices in managing acute poisoning, underscoring the need for routine competency-based training to improve emergency response and patient outcomes in resource-limited healthcare settings.

Risk Factors and Outcomes of Pediatric Poisoning: A Cross-Sectional Study From a Tertiary Care Hospital in Peshawar, Pakistan

Background: Pediatric poisoning is a common and potentially life-threatening issue in lower-middle-income countries like Pakistan. It often goes unnoticed in households with young children and accounts for a substantial number of emergency department (ED) visits.Objective: This study aims to identify the risk factors and common agents of acute poisoning in children and to determine their outcomes.Materials and methods: In this cross-sectional study, the records of children under 14 years of age who presented to the pediatric ED with a history of poisoning within the preceding 48 hours were reviewed. The study period spanned from January 1, 2024, to December 31, 2024. A total of 154 patients were included. Data recorded included age, gender, poisoning agent, route, mode, and place of poisoning; whether the child was hospitalized or discharged after observation; length of stay; intensive care unit (ICU) admission; need for organ support; and hospitalization outcomes. All analyses were performed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Risk factors for adverse outcomes were assessed using the Chi-square test or Fisher’s exact test, as appropriate. A p-value below 0.05 was considered statistically significant.Results: Of the 154 patients, the majority (74.7%, n = 115) were under the age of three years, and most were hospitalized (88.3%, n = 136). All poisoning cases involved accidental ingestion, with the majority occurring at home (96.1%, n = 148). Organophosphorus compounds were the most common poisoning agents (27.9%, n = 43), followed by medications (26.6%, n = 41) and petroleum products (17.5%, n = 27). Most patients (80.9%, n = 110) remained hospitalized for up to three days, with a mean duration of stay of 2.8 ± 1.8 days. The majority of hospitalized patients survived (87.5%, n = 119). Although length of stay, ICU admission, and need for organ support were significantly associated with mortality in univariate analysis, none were significant predictors of mortality in multivariate analysis: length of stay (AOR: 1.54; 95% CI: 0.27-8.86; p = 0.631), ICU admission (AOR: 0.967; 95% CI: 0.05-18.64; p = 0.982), and organ support (AOR: 14.04; 95% CI: 0.55-358.32; p = 0.110).Conclusions: Pediatric poisoning predominantly affects children under the age of three years, with most incidents occurring at home. Organophosphates, medications, and petroleum products were the most commonly involved agents. High rates of hospitalization and mortality highlight the severity of the issue. To mitigate this problem, there is a pressing need for parental education, childproofing measures at home, and improved healthcare infrastructure to prevent poisoning incidents and enhance patient outcomes.

Association of hypomagnesemia with chronic use of proton-pump inhibitors in patients visiting a tertiary care hospital in Peshawar, Pakistan

Objective:To determine the association between hypomagnesemia and chronic use of proton pump inhibitors (PPIs) among patients visiting a tertiary care hospital.Method:This cross-sectional study was conducted in the Department of Medicine at Hayatabad Medical Complex, Peshawar, Pakistan from July 2024 to December 2024. A total of 303 patients aged 18 years and above, who had used a PPI for at least one month, were enrolled. Age, gender, body mass index, patient setting, duration and type of PPI used, and the presence of hypertension and diabetes mellitus were documented. Serum magnesium levels were measured for all participants. The data were analyzed using SPSS.Results:Hypomagnesemia was observed in 51.5% (n=156) patients. Patients with hypomagnesemia had a significantly higher mean age compared to those without (48.9±12.3 vs 38.2±11.4 years, p <0.001). On multivariate analysis, PPI use for more than six months (AOR: 58.1, 95% CI: 22.2–152.5, p<0.001), diabetes mellitus (AOR: 23.1, 95% CI: 6.4–82.6, p<0.001), and hypertension (AOR: 3.2, 95% CI: 1.4 – 7.1, p<0.001) were identified as independent predictors of hypomagnesemia. No significant differences in serum magnesium levels were found among patients using different types of PPIs (p=0.131).Conclusion:Hypomagnesemia was found in 51.5% of patients, irrespective of PPI type. Significant risk factors included advanced age, prolonged PPI use, diabetes mellitus, and hypertension. Raising awareness among healthcare professionals about PPI’s potential adverse effects and advocating for prudent prescription practices is essential.

Assessment of Serum Phosphate Levels in Chronic Kidney Disease Patients Across Different Stages of Kidney Disease.

This study aims to determine the serum phosphate level in patients diagnosed with chronic kidney disease (CKD) across different stages of the disease in a tertiary care hospital in Peshawar. This cross-sectional study was conducted in the Nephrology Department at Lady Reading Hospital, Peshawar, from August 2024 to January 2025. Over a six-month period, participants were recruited using a non-probability convenience sampling technique. The sample size of 296 was calculated using the WHO sample size calculator, with a 5% margin of error. The study included patients aged 18 years and older, of both sexes, diagnosed with any stage of CKD. Patients with acute kidney injury or significant disorders affecting phosphorus metabolism (e.g., primary hyperparathyroidism or malignancies) were excluded. A total of 296 patients with CKD from various etiologies were included in this study, consisting of 124 males (41.9%) and 172 females (58.1%). The age distribution was as follows: 20-39 years (17.6%), 40-49 years (26.7%), 50-59 years (29.4%), and ≥60 years (26.4%), with a mean age of 50.26 ± 12.14 years. Among the participants, 12.8% had CKD stage 2, 23% had stage 3, 33.4% had stage 4, and 30.7% had stage 5. Of the 296 patients, 77 (26%) were receiving hemodialysis, while 219 (74%) were on conservative management. The overall incidence of hyperphosphatemia was 56% (166 participants). Stage-wise, hyperphosphatemia was observed in 31.5% of CKD stage 2, 38.2% of stage 3, 72.7% of stage 4, and 61.5% of stage 5 patients. The study has shown a higher burden of hyperphosphatemia among CKD patients, with an overall incidence of 56%. The prevalence of hyperphosphatemia increased with advancing CKD stages, peaking at CKD stage 4 (72.7%) and continuously remaining high in stage 5 (61.5%). These results stressed the need for early detection and effective management of hyperphosphatemia, particularly in the later stages of CKD, to lessen its associated complications. Moreover, the demographic distribution, with a mean age of 50.26 ± 12.14 years and a female predominance (58.1%), reflects the need for targeted interventions tailored to this patient population.

Abstract 6637: Whole exome analysis of oral squamous cell carcinoma in local patients at tertiary care hospitals in Peshawar, Pakistan

Abstract The Precision Medicine Lab (PML) was established by the Federal Government in 2018 to pilot precision medicine in Pakistan using genomics in oral cancer. Oral squamous cell carcinoma (OSCC)—often called the “poor man's cancer”—constitutes 90% of all head and neck cancers and is the most common cancer in Pakistani males. Supported by a bio-repository of clinical samples and primary cell lines, PML employs a multi-omic approach to identify actionable biomarkers for diagnostic, prognostic, and therapeutic applications. With ethical approvals from IRBs and informed consent, treatment-naive biopsy-confirmed OSCC patients were recruited from two tertiary care hospitals in Peshawar, Pakistan. The cohort predominantly included older individuals (37.84% aged 41-60 years), late-stage cases (78.46% in stage IV), and self-reported non-alcohol consumers (96.9%). Smokeless tobacco use was reported by 44.6%, while 30.8% reported both smoked and smokeless tobacco use. Tumors were mostly located in the buccal mucosa (29.2%), alveolar region (27.7%), or vestibular region (24.6%). Blood and tumor samples were collected for whole exome sequencing, transcriptomics, and metabolomics, along with saliva for oral microbiome analysis. Combined with clinical history and histopathology, this multi-omic dataset enables machine learning experiments. For somatic mutation analysis, raw reads were aligned to the GRCh38.p14 genome, and variants were identified using GATK (v4.5). Mutational analyses with maftools (v2.18.0) in R (v4.3) referenced the COSMIC SBS Signature database (v3.2). Results revealed CASP8 (39%), TP53 (38%), FAT1 (29%), and NOTCH1 (29%) as frequently mutated genes. Pathways such as NOTCH (80.3%), RTK-RAS (64.3%), and Hippo (60.7%) were commonly affected. Deletions were observed in over 60% of samples in chromosomal regions 5q13.2, 6p21.32, 6p21.33, 11p15.5, 19q13.42, and 22q11.23, along with loss of heterozygosity at chromosome 17. The top three mutational signatures included those linked to DNA mismatch repair (SBS6). This study is the first to report the mutational landscape of an OSCC cohort from Pakistan. Our findings highlight potential targets for further investigation and emphasize the utility of a multi-omic approach. With matched primary cell lines for each patient, experimental validation of identified biomarkers is underway to assess their diagnostic, prognostic, and therapeutic relevance. Our integrated dataset offers a resource for machine learning studies to identify novel mutational signatures and actionable biomarkers for OSCC in local populations. Citation Format: Faisal Khan, Hina Zamir, Khudeja Salim, Madina Shirdel, Arsalan Riaz, Aqsa Hussain, Yusra Ilyas, Momal Agha, Zainab Jahan, Saba Saeed, Khadim Shah, Yasir Rehman, Fahim Uddin, Zahid Qayyum, Zubair Durrani, Muhammad Mushtaq Khattak, Johar Ali. Whole exome analysis of oral squamous cell carcinoma in local patients at tertiary care hospitals in Peshawar, Pakistan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6637.

Cancer on Hold, Infections on the Rise: The Unseen Pandemic Effect on Thoracic Surgery in the Developing World.

Background The COVID-19 pandemic disrupted global healthcare systems, leading to major shifts in surgical case prioritization. This study examines how thoracic surgical trends changed at a tertiary care hospital in Peshawar, Pakistan, specifically comparing oncologic and non-oncologic procedures, patient demographics, and surgical outcomes. Methods We conducted a retrospective comparative study of major thoracic surgeries performed between December 2018 and July 2021. The study period was divided into pre-pandemic (December 2018-March 2020) and pandemic (April 2020-July 2021) phases. Surgical records were reviewed to assess changes in oncologic and non-oncologic surgical indications, patient characteristics, and outcomes. Univariate analyses were conducted to compare the pre-pandemic and pandemic groups for baseline characteristics, indications, and procedures. Multivariable analyses identified the independent association of the pandemic with oncologic procedures. Data analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results A total of 246 thoracic surgeries were analyzed. Oncologic surgeries significantly declined from 36 (41.4%) pre-pandemic to 34 (21.4%) during the pandemic (p=0.001), with esophagectomy for esophageal carcinoma decreasing from 16 (18.4%) to 9 (5.7%) (p<0.002) and lobectomy for lung cancer dropping from six (6.9%) to one (0.6%) (p=0.018). Meanwhile, non-oncologic surgeries increased significantly from 51 (58.6%) to 125 (78.6%) during the pandemic (p<0.001). The most notable increases were in decortication for empyema thoracis, from 21 (24.1%) to 55 (34.6%),p=0.006, and emergency thoracotomy, from two (2.3%) to 11 (6.9%), p=0.034. Hydatid cystectomy remained stable from 11 (12.6%) to 17 (10.7%),p=0.722. While baseline patient characteristics remained similar, thoracic surgeries were performed more frequently in males and children under 10 years old (p=0.042) during the pandemic. Despite the increased volume, postoperative complications (p=0.39) and mortality rates (p=0.553) remained unchanged. Conclusion The COVID-19 pandemic significantly altered thoracic surgical trends, shifting the focus from oncologic to non-oncologic cases, particularly infectious and emergency conditions. The decline in cancer surgeries reflects disruptions in oncologic care, while the rise in empyema thoracis highlights increased infectious disease burden and late-stage presentations. These findings emphasize the need for strategies that ensure continued oncologic care while responding to emergent thoracic conditions during global health crises.

Prevalence of Post-traumatic Stress Disorder in Adult Burn Patients: A Study From Urban Tertiary Care Hospitals in Pakistan.

Introduction Post-traumatic stress disorder (PTSD) is one of the main psychological conditions that develops after a traumatic event such as a burn injury. Patients often experience flashbacks, nightmares, anxiety attacks, and endless thoughts about the traumatic burn injury, which deteriorate their quality of life. These patients are usually socially isolated, have low self-esteem, and are more likely to commit suicide.Burn patients, who are particularly vulnerable, often do not receive adequate post-burn care, and psychological disorders like PTSD are often overlooked in developing nations such as Pakistan. Hence, this study investigated the prevalence of PTSD among adult burn patients in tertiary care hospitals and examined its distribution across different age groups, genders, and socioeconomic classes to highlight its overall burden as well as differences among these groups. Materials and methods This cross-sectional study was conducted from January 2024 to July 2024, recruiting 275 adult burn patients from tertiary care hospitals in Peshawar, Pakistan, using non-probability convenience sampling. Non-cooperative, unwilling, unconscious,and severe burn injury patients were excluded from the study. Additionally, individualsunder the age of 18 years and those whose burn injuries occurred less than a month prior were omitted, as PTSD requires the traumatic event to have happened more than a month ago for diagnosis. All the burn patients were at different stages of recovery. A provisional diagnosis of PTSD was made by using the PTSD checklist for DSM-5, a 20-item checklist that assessed the symptoms of PTSD via a five-point Likert scale. The socioeconomic status was determined via a modified form of the Kuppuswamy Socioeconomic Status Scale. Results The diagnosis of PTSD was made in 52% (143 out of 275) of people who suffered burn injuries. The prevalence of PTSD in males and females was 40% (59 out of 148 males) and 66% (84 out of 127 females), respectively. Sixty-two percent of retirement-aged and 57% of middle-aged patients were mostly affected by PTSD. Similarly, PTSD was more prevalent in lower-class patients, i.e., 69% of patients with burn injuries from lower socioeconomic backgrounds were affected. Conclusion An alarmingly high prevalence of PTSD was found in burn patients. It was more prevalent in females than in males. A greater percentage of retirement-age and middle-aged adults were diagnosed with PTSD. When compared to patients from various socioeconomic backgrounds, burn patients from lower socioeconomic backgrounds were found to have a higher prevalence of PTSD.

STRATIFYING EYELID MALIGNANCIES: A STUDY OF THE TUMORS PRESENTING TO A TERTIARY CARE HOSPITAL IN PAKISTAN

Background: Eyelid malignancies are relatively uncommon, but because of their propensity for local invasion and impact on ocular function due to the complexity of reconstruction, they pose a significant challenge. Objective: To evaluate the histological subtypes, clinical outcomes, and demographic trends of patients with malignant eyelid tumors in a tertiary care hospital in Peshawar, Pakistan. Methods: A descriptive cross-sectional study was conducted at the Ophthalmology Department of Hayatabad Medical Complex, Peshawar, Pakistan. Eyelid tumors were classified based on histological examination of biopsy samples. Statistical analysis was performed with SPSS Version 25.0, with statistical significance set at p &lt;0.05. Results: A total of 125 patients had malignant eyelid tumors. The majority 52% were males; ages ranging from 30 to 60 years, while females constituted 48%. Basal cell carcinoma had the highest prevalence of all the malignancies at 72% and typically involved the lower lid in about 56%, whereas surgical resection was the standard treatment in almost all cases. Malignant melanoma and sebaceous gland carcinoma showed the highest recurrence rates at 20% each, whereas basal cell carcinoma had the lowest rate at 5.6%. Conclusion: The most common type of malignant eyelid tumor in this study was basal cell carcinoma, consistent with local and global epidemiological patterns. The main course of treatment is still surgical excision, supplemented with adjuvant and reconstructive therapies according to necessity.

Patterns of Cardiomyopathy in Patients Presenting to a Tertiary Care Hospital

Background: Cardiomyopathy is a broad category of myocardial conditions that have a substantial effect on heart function. Improving patient treatment requires a knowledge of its epidemiology.Objective: The aim of this study was to determine the pattern of cardiomyopathy in patients presenting to a tertiary care hospital in Peshawar, Pakistan.Methodology: This cross-sectional study was conducted at the Department of Cardiology, Northwest General Hospital & Research Centre, Peshawar, from December 14, 2022, to June 14, 2023. There were 79 individuals with cardiomyopathy who were 16 years of age or older. Clinical and demographic information, such as age, gender, BMI, length of illness, and family history, were gathered. Cardiomyopathy patterns were classified using echocardiographic evaluations, and IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY) was employed for statistical analysis.Results: The average age of the 79 participants was 45.72 ± 2.45 years, and 40.5% (n=32) were between the ages of 51 and 60. There were 63.3% male individuals (n=50) and 36.7% female individuals (n=29). With 69.6% (n=55) and 30.4% (n=24) having a duration of symptoms ≤1 month and >1 month, respectively. 38.0% (n=30) had a family history of cardiomyopathy. With dilated, hypertrophic, and peripartum cardiomyopathy each at 15.2%, the most prevalent forms of cardiomyopathy were restrictive (20.3%, n=16), ischemic (17.7%, n=14), and arrhythmogenic right ventricular (16.5%, n=13). BMI (p = 0.000) and illness duration (p = 0.000) were substantially correlated with dilated and hypertrophic cardiomyopathies. Older age groups, especially those between the ages of 51 and 60, had a greater prevalence of cardiomyopathy (p = 0.000). Dilated cardiomyopathy (p = 0.000) and peripartum cardiomyopathy (p = 0.000) were significantly influenced by family history.Conclusion: The research highlights the variety of cardiomyopathy patterns seen in a tertiary care facility, with ischemic and restrictive forms being the most prevalent. This highlights the need for specialized diagnosis and treatment strategies.

Knowledge and Practices of Nurses Regarding Prevention of Surgical Site Infections in Tertiary Care Hospitals Peshawar

Surgical procedures have many complications of which the leading one is post-surgical site infection (SSI), which can be prevented by following appropriate guidelines. SSI may lead to loss of body parts, septicemia and increase hospital bed occupancy. Objective: To assess nurses’ knowledge and practices regarding the prevention of surgical site infections in tertiary care hospitals in Peshawar. Methods: Descriptive cross-sectional study was conducted among 172 nurses recruited through convenient sampling. Study settings were two tertiary care hospitals in Peshawar. Data was collected through an adopted, self-administered questionnaire and were analyzed by SPSS version 26.0. Results: Findings of the study revealed that the knowledge level of the nurses was poor about the prevention of SSI, while their practice levels were also average. A significant difference was found in the knowledge level of the study participants on the basis of their gender with a p value; 0.001, qualification with a p value; 0.000. Years of experience with a p value; 0.007, and attending infection control courses with a p value; 0.03. In addition, a significant difference was found among the practices of nurses regarding the prevention of SSI on the basis of their gender with a p value; 0.012. Conclusion: The study’s findings revealed that nurses had a poor level of knowledge about SSI, while their practices were average according to arbitrary.

EFFECTS OF BELL’S PALSY ON PSYCHOSOCIAL HEALTH OF PATIENTS IN TERTIARY CARE HOSPITALS PESHAWAR

Background: Bell’s palsy is an acute unilateral facial nerve disorder resulting in partial to complete facial muscle paralysis, significantly affecting communication and social interactions. The condition is associated with viral infections, immune responses, and vascular ischemia. Its prevalence increases with age and is observed more frequently in rural populations. Recovery depends on the severity of the condition and timely intervention. Recent cases have been linked to COVID-19 and its vaccines. Physiotherapy plays a crucial role in improving functional outcomes at all stages of the disease. Objective: To evaluate the effects of Bell’s palsy on the psychosocial health of patients in tertiary care hospitals in Peshawar. Methods: A cross-sectional study was conducted in three tertiary care hospitals in Peshawar. A total of 121 patients diagnosed with Bell’s palsy were included using non-probability convenience sampling. The sample size was calculated using the OpenEpi sample size calculator. Data were collected using the House-Brackmann Grading Scale (HBGS) to assess disease severity and the Psychosocial Scale of Facial Appearance (PSFA) to evaluate psychosocial distress. Statistical analysis was performed using SPSS version 22. Descriptive statistics, including frequencies and percentages, were calculated, and the chi-square test was applied to determine associations between Bell’s palsy severity and psychosocial distress. Results: Among the 121 patients, 58.7% experienced moderate psychosocial distress, while 41.3% reported severe psychosocial issues. A statistically significant association was found between Bell’s palsy severity and psychosocial health (p&lt;0.001). Patients with severe facial paralysis had higher rates of emotional distress, social withdrawal, and self-esteem issues. The psychosocial impact was more pronounced among young, unmarried females, who expressed concerns about societal acceptance and future relationships. Conclusion: Bell’s palsy has a profound impact on psychosocial health, leading to moderate to severe psychological and social distress due to facial disfigurement, loss of facial expressions, and societal reactions. These findings highlight the need for comprehensive patient education and psychological support alongside medical treatment.

Knowledge, attitude and practice among healthcare professionals regarding the use of personal protective equipment at tertiary care hospitals in Peshawar

Background: Personal protective equipment is designed to safeguard healthcare workers and patients from potential risks during healthcare activities. The proper utilization of PPE serves as a crucial strategy for mitigating the transmission of infections within healthcare settings, thereby minimizing the risk of both healthcare-associated infections and community spread. In this study we tried to explore and assess the knowledge, attitude and practice of healthcare professionals regarding use of Personal protective equipment (PPE). Methods: A cross-sectional study was conducted at Northwest General Hospital (a private sector tertiary healthcare hospital) and Hayatabad Medical Complex (a public sector tertiary care hospital) from March to August 2023. Data was collected from 260 healthcare workers i.e. Doctors and Nurses from both institutions through a preformed questionnaire containing a total of 27 questions. Results: There was a slight positive correlation between increasing years of practice and knowledge regarding PPE (Pearson correlation = 0.017). There was a slight positive correlation between increasing years of practice and attitude (Pearson correlation = 0.035). There was a positive correlation between increasing years of practice and practice of PPE (Pearson correlation=0.147), and there was also a significant association (0.018) between increasing years of practice and practice of PPE Conclusion: Study shows that the healthcare professionals have good knowledge and attitude regarding use of PPE, but there are still gaps in practicing PPE.

YEAR-WISE TRENDS AND ANALYSIS OF MATERNAL MORTALITY IN AN OBSTETRIC UNIT OF A TERTIARY CARE HOSPITAL

Objective: to review the trends and causes of maternal mortality in a tertiary care hospital in Peshawar. Study design: A retrospective observational study. Place of study: Obstetrics and Gynecology Department Khyber Teaching Hospital MTI Peshawar. Duration of study: 5 years. From 1st January 2019 to 31st December 2023. Materials and methods: This was a retrospective observational hospital-based study. Mothers who were admitted and died due to pregnancy-related causes were included in the study. Deaths due to accidental causes were excluded from the study. All the relevant information was extracted from the hospital records, labour registers, and maternal mortality register of the ward and was recorded on a pre-designed proforma. Descriptive statistics were used to calculate frequencies and percentages for different variables. Results: Total numbers of live births during the study period were 19222 and total numbers of maternal deaths were 61. It gives the maternal mortality ratio of 317 per 100,000 live births. The majority of women (n=37-61%) were in the age groups of 31—40 years. Number of patients with great grand multiparty was 22(36%). All patients were un-booked with no proper ante-natal care received during pregnancy. Common causes of maternal mortality in descending order of frequency were eclampsia, post-partum hemorrhage, and ante-partum hemorrhage, all being preventable causes of death. Direct causes of death were seen in 50(82%) patients while 11 (18%) died due to indirect causes. Conclusions: The maternal mortality ratio of 317 per 100,000 live births is quite high. The top 3 causes in our study are all preventable. We all have to work hard to reduce the maternal mortality ratio.

EXPLORING THE SILENCE: BARRIERS TO MEDICAL ERROR REPORTING IN UROLOGY

Objective: To explore barriers to medical error reporting among urology healthcare professionals at tertiary care hospitals in Peshawar. Methodology: This qualitative study utilized a case study approach. Maximum variation purposive sampling was employed to select faculty of Urology (assistant professor and above) with at least two years of experience, resulting in five interviews using a structured interview guide. The interviews were recorded, transcribed, and analyzed through thematic inductive analysis. Data collection and analysis were done concurrently. Results: Four main themes precipitated from the data. Understanding the medical error landscape focuses on what constitutes a medical error. Reporting Roadblocks identified the barriers to reporting medical errors. Institutional Bottlenecks originate from the hurdles in the healthcare system to report medical errors. The last theme, pathways to progress, shows how to improve the process of reporting medical errors. Conclusion: The study highlights the complex systemic, organizational, and human factors contributing to the underreporting and mismanagement of medical errors in urology units. Addressing these challenges is essential for advancing patient safety and fostering a culture of accountability in healthcare.

Clinical and Radiological Outcomes of Minimally Invasive vs Conventional Surgery for Lumbar Spinal Stenosis: A Prospective Cohort Study

Objective The objective of this study is to compare the clinical and radiological outcomes of minimally invasive surgery (MIS) versus conventional surgery for patients with lumbar spinal stenosis (LSS). Methods: This prospective cohort study was conducted at a tertiary care hospital in Peshawar, Pakistan, the study enrolled 200 patients diagnosed with symptomatic LSS, confirmed by MRI. Patients were assigned to MIS (n=100) or conventional surgery (n=100) groups based on surgeon discretion and patient preference. Preoperative and postoperative evaluations included clinical assessments using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and patient satisfaction scores, alongside radiological assessments of spinal canal diameter and residual stenosis. Data analysis was performed using SPSS version 25.0, with a significance level set at p&lt;0.05. Results: The MIS group exhibited significantly lower VAS scores (6 months: 2.8±1.2 vs. 4.5±1.5, p&lt;0.01; 12 months: 2.5±1.1 vs. 4.2±1.3, p&lt;0.01) and ODI scores (6 months: 18.4±5.2 vs. 25.6±6.3, p&lt;0.01; 12 months: 17.8±4.9 vs. 24.8±6.0, p&lt;0.01) compared to the conventional surgery group. Patient satisfaction was higher in the MIS group (85% vs. 70%, p&lt;0.05). Radiological outcomes showed a greater increase in spinal canal diameter in the MIS group at 6 months (13.5±1.4 mm vs. 12.1±1.5 mm, p&lt;0.01) and 12 months (13.2±1.3 mm vs. 11.8±1.4 mm, p&lt;0.01) postoperatively. The incidence of residual stenosis was lower in the MIS group at both follow-ups (6 months: 10% vs. 25%, p&lt;0.05; 12 months: 12% vs. 28%, p&lt;0.05). Conclusion: MIS offers superior clinical and radiological outcomes compared to conventional surgery for LSS, with better pain relief, functional improvement, and patient satisfaction. The study supports MIS as a viable alternative to conventional surgery, though further research is needed to explore its long-term efficacy and safety. Keywords: lumbar spinal stenosis, minimally invasive surgery, conventional surgery, clinical outcomes, radiological outcomes, prospective cohort study.