Combined Military Hospital Research Articles

Study of Association of PPH due to Uterine Atonicity and Serum Calcium levels

Background: Uterine atonicity stands out as a primary and leading factor contributing to maternal morbidity and mortality. Postpartum hemorrhage (PPH) resulting from uterine atony poses a life-threatening risk. Oxytocic drugs, by elevating intracellular calcium, enhance uterine tonicity, with optimal calcium levels playing a crucial role in facilitating effective uterine contractions. The study aimed to explore the relationship between the concentration of calcium in the bloodstream and the occurrence of PPH associated with inadequate uterine contractions admitted during the 1st and 2nd stages of labour at a tertiary care facility such as the Combined Military Hospital in Dhaka. The study likely involved analyzing data to identify any patterns or connections between serum calcium levels and the incidence of uterine atony-related PPH. Methods: The study follows a randomizing controlled trial (RCT) design within the Department of Obstetrics and Gynecology at Combined Military Hospital, Dhaka. The study duration spans from January 2016 to January 2019, involving a total of 306 subjects. Group A includes those with serum calcium levels between 8-10.4 mg/dl without uterine atonicity, while Group B comprises individuals with serum calcium levels below 8 mg/dl experiencing uterine atonicity, either post cesarean or vaginal delivery. Atonicity features include a soft, distended uterus with a lack of muscle tone. Results: A total of 306 patients were included in the study, with 153 having serum calcium levels exceeding 8 mg/dl and another 153 having levels below 8 mg/dl. Among women with serum calcium levels below 8 mg/dl, 37 patients experienced uterine atonicity. In contrast, it was observed that among women with serum calcium levels exceeding 8 mg/dl, only one patient experienced uterine atonicity. This highlights a potential association between higher serum calcium levels and a reduced likelihood of developing uterine atony in the studied population. Conclusions: The study findings indicate a strong association between low calcium levels and reduced uterine tonicity, establishing low calcium as a significant risk factor for uterine atony. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 28-34

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49

Association between Birth Weight of the Babies and Mode of Delivery: A Cross-Sectional Study

Background: Birth weight has significant short and long-term effects on health and survival and is a useful predictor of prenatal and postnatal development. Birth weight is likely to play a key role for the infant’s survival because it is one of the strongest predictors of infant mortality risk. The aim of the study was to find out the association between birth weight and mode of delivery. Methods: This was a cross-sectional study conducted at Combined Military Hospital, Ghatail from 15 March 2019 to 30 June 2019. Secondary data were used, which were collected from hospital register during the period of 01 January 2018 to 31 December 2018. The study population was all the newborn babies delivered in CMH, Ghatail during that period and mothers of the newborn babies were respondents of the study. Results: Out of 526 respondents majority (64.83%) were in the age group of 23-32 years with mean age 25.14(range: 18-40) years. Of the newborn babies around half (48.3%) were male. The mean birth weight was 2.92 kg with minimum weight 1.2 kg and maximum 4.2 kg. The data showed that the prevalence of Low Birth Weight (LBW) 13.1%. Majority (84.6%) of the mothers didn’t have any comorbidity, few (15.4%) suffered from comorbidity. 53.8% babies were born by caesarean section (CS) and 46.2% were delivered by normal vaginal delivery. Among the low birth weight babies 65.2% were born by CS. Statistically significant association was found between birth weight of the babies and mode of delivery (p<0.05). Conclusion: Caesarean section cannot be routinely recommended, unless there are other obstetric indications. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 8-13

Level of Awareness of Breast Cancer Among Adult Female in a Tertiary Level Hospital

Background: Breast cancer is the leading and most prevalent form of cancer among the women in Bangladesh. The aim of the study was to assess the level of awareness of the breast cancer among adult female. Methods: A descriptive cross-sectional study was conducted among 103 adult females in Out Patient Departments (OPDs) of Combined Military Hospital (CMH), Dhaka during July to December 2013. Data were collected purposively by face-to-face interview with a semi-structured questionnaire. Results: A total of 103 adult females participated in the study with the mean (±SD) age was 36.26±12.70. Majority 39(37.9%) of the respondents were in age group 29-39. Most 82(79.6%) of the participants were married, 90(87.4%) were housewives, 31(30.1%) were HSC qualified. Maximum 31(88.35%) respondents had average knowledge on breast cancer. Education and occupational status was found significantly associated with level of knowledge of the respondents. Conclusion: The overall knowledge of the respondents was found average. As it is a major health burden in women and incidence is very high in Bangladesh concern authority should take necessary action to adopt measures to increase the awareness on breast cancer. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 14-21

Knowledge and Awareness on Swine Origin Influenza A(H1N1) Among Health Care Providers and Civil Employees in a Tertiary Level Hospital, Dhaka Bangladesh

Background: Swine Origin Influenza A(H1N1) viruses create yearly epidemics and rarely pandemics that cost millions of lives worldwide. Health care providers and civil employees at hospital can help in prevention of transmission of influenza by acquiring knowledge and awareness. Methods: A descriptive cross-sectional study was conducted at Combined Military Hospital Dhaka from July to December 2023. Total 213 participants were interviewed that comprises doctors, nurses, medical assistants and civil employees. Purposive sampling technique was used to collect data. Face to face interview was done through a pre-tested semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 25.0. Informed consent were obtained from the respondents addressing proper ethical issues. Results: In this study out of total participants 70.4% had previously heard about H1N1 influenza A. Total 38% participants said that internet was found as major source of information. Among the participants 64.3% told fever was common symptom and use of facemask at duty hour was consented by 33.8% as an important means for prevention. Maximum (66.3%) civil employees do not know about washing hand after contact as a preventive procedure leading to spread of infection. Maintaining distance as preventive measures observed by 13.6% participants. Moreover, all participants were aware of transmission through droplet infection except civil employees. In the present study, 50% doctors and 38.1% nurses had knowledge that drug Oseltamivir is very effective against swine Influenza A(H1N1). Remarkable differences were identified among doctors, nurses, medical assistants and civil employees regarding knowledge of quarantine and availability of vaccine. RT-PCR laboratory test is the confirmatory method to defect swine influenza A(H1N1) were exactly known by 9.9% participants, while 70.9% participants don't know the confirm diagnostic method. Conclusion: Knowledge and awareness regarding swine influenza A(H1N1) was low among study participants. For controlling epidemic or even pandemic, awareness by mass media is important. Remarkable gap observed regarding knowledge and awareness about swine influenza A(H1N1) among the health care providers and civil employees, needs to be addressed by proper training and motivation. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 1-7

Conspiracy belief regarding emerging viral infection among healthcare professionals

Background: In the recent past, newly appeared emerging and re-emerging viruses causing unexpected illness and epidemics among humans, wildlife and livestock causing threat to the public health. During onset of any pandemic, there was always an embrace of conspiracy theory regarding the pandemic along with several misconceptions, misperception and stigma among the general population. The study aimed to assess the state of conspiracy belief regarding emerging viral infection among the healthcare professionals working in Combined Military Hospital (CMH) Dhaka. Methods: This cross-sectional study was conducted during July and September 2022 among conveniently selected 254 healthcare professionals working in CMH Dhaka. Data were collected through face-to-face interview using a pretested semi-structured questionnaire with validated and reliable tools. Results: Among the 254 respondents, 53.9% were male with a mean age (±SD) of 30.54 (6.36) years. More than twothird (72.8%) were graduate, married (62.6%), mostly Muslim (89.4%) and non-smoker (80.3%) with an average (±SD) monthly income of 83740.16 (57456.80). Highest (45.3%) of the respondents were permanently posted and only 33.5% attended any seminar/workshop/symposium in last six months. Job pattern (β=0.199, p<0.007) and attended any seminar/workshop/symposium (β=-0.149, p<0.01) were determined as significant predictors for conspiracy belief regarding emerging viral infection through hierarchical analysis. Marital status of the respondents was also identified as significant socio-economic issues conspiracy belief in emerging viral infection. Conclusion: The adoption of conspiracy belief regarding emerging viral infection demands appropriate public health intervention as well as awareness among the general population specially health care professionals as evident from our study. JOPSOM 2023; 42(1):1-6

Knowledge and conspiracy belief of healthcare professionals on human monkeypox virus: a cross-sectional study in a tertiary hospital of Bangladesh

Background: Since early May 2022, the unprecedented outbreak of human monkey pox (HMPX) has been documented globally which demands assessment of knowledge on the emerging viral infection as well as the state of conspiracy belief among the healthcare professionals. The present study aimed to assess the knowledge about HMPX and its relation to conspiracy belief. Methods: This cross-sectional study was conducted at the Combined Military Hospital Dhaka (CMH) among purposively selected 254 healthcare professionals from July 2022 to September 2022. Data were collected through face-to-face interview using a pre-tested semi-structured questionnaire with validated and reliable tools. Results: The study comprised a total of 254 respondents, including 53.9% male, 72.8% respondents having a graduate degree and 42.9% individuals aged between 26-30 years. The study revealed very poor (61.8%) knowledge on HMPX as well as higher (50.4%) belief in conspiracy theory among the respondents. The hierarchical logistic regression revealed that male had significantly higher (B=1.12, OR 3.06, 95% CI=1.714-5.463) knowledge on HMPX virus than that of the female, age group <31 years emerged as a negative and significant predictor than that of the age group >31 years (B= -1.065, OR 0.345, 95% CI=0.172-0.690), monthly income of between 60001-90000 taka also emerged as a positive and significant predictor than that of the income of >90001 taka (B=0.763, OR 2.145, 95% CI=1.002-4.595). Conclusion: The study findings demand intervention of appropriate health educational program in the medical study curriculum. JOPSOM 2023; 42(1):29-39

Review of Ocular and Non-Ocular causes of Headache in Adult and Pediatric Patients; A multicenter study

Purpose: To determine ocular and non-ocular causes of headache in adult and pediatric patients in three tertiary care hospital of Multan, Pakistan Study Design: Cross-sectional study. Place and Duration of Study: This multi-centre study was conducted in Combined Military Hospital, Multan, Pakistan and The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from February 2023 to September 2023. Methods: The non-probability convenience sampling technique was used. The data collection and diagnosis were done by a consultant ophthalmologist. The statistical analysis of this study was conducted using SPSS version 23. Results: The study comprised of a total of 600 patients. The mean age of the adult patients was 27.16±14.39 years ranging between 16to 80 years and the mean age of pediatric patients was 10.1±2.40 years. The patients were divided into four groups based on the etiology of headache that were ocular, non-ocular, combined ocular causes and ocular and non-ocular causes combined. The most common ocular cause was myopia in 43(14.3%) adults and 47 (15.8%) pediatric patients. However, the most common non-ocular cause was migraine in 72(24.0%) adult patients and frontal sinusitis in 43 (14.3%) pediatric patients. Conclusion: Refractive errors were the most common ocular etiology of headache in ophthalmology patients predominately myopia in the adult and pediatric population. Migraine was the most common non-ocular etiology in adult population whereas frontal sinusitis was most common in the pediatric age group.

Optimal Timing to Perform Cholecystectomy in Patients with Acute Biliary Pancreatitis

Background: Acute biliary pancreatitis accounts for nearly 50% of acute pancreatitis cases, primarily caused by gallstones and biliary sludge. Cholecystectomy remains the definitive treatment to prevent recurrent biliary events, but the optimal timing of surgery remains debated.Objective: This study aimed to evaluate the optimal timing of cholecystectomy in patients with mild to moderate acute biliary pancreatitis, comparing early cholecystectomy during index admission to delayed cholecystectomy.Methods: A prospective cohort study was conducted over 24 months at Combined Military Hospital, Kohat, Pakistan. A total of 126 patients aged 18 years and older, diagnosed with mild to moderate acute biliary pancreatitis, were included. Patients with severe pancreatitis, ICU admissions, or requiring ERCP were excluded. Patients were divided into two groups: index admission cholecystectomy and delayed cholecystectomy. Data were analyzed using SPSS 25 with chi-square tests applied. A p-value of <0.05 was considered statistically significant.Results: Recurrent pancreatitis occurred in 0 patients in the early group versus 41 patients in the delayed group (p < 0.001). The mean hospital stay was significantly shorter in the early group (5.92 vs 12.31 days, p < 0.001).Conclusion: Early cholecystectomy significantly reduced recurrent biliary events and shortened hospital stay in patients with mild to moderate acute biliary pancreatitis without increasing complications.

EFFICACY OF EARLY-ONSET SEPSIS CALCULATOR IN THE PREDICTION OF ANTIBIOTICS USAGE AMONG NEONATES: A LOCAL SETTING STUDY

Early-onset sepsis (EOS) in neonates is a critical condition that requires timely diagnosis and appropriate management to prevent adverse outcomes. However, overuse of antibiotics in neonates can lead to complications, including antimicrobial resistance. The EOS calculator is a clinical tool designed to assess the risk of sepsis in neonates, helping to guide antibiotic use. Its efficacy in predicting antibiotic administration in high-risk neonates needs further evaluation. Objective: To evaluate the efficacy of the EOS calculator in predicting the use of antibiotics in neonates admitted to the neonatal intensive care unit (NICU) at a tertiary care hospital. Methods: This comparative cross-sectional study was conducted in the Pediatrics Department of Combined Military Hospital, Peshawar, from August 2020 to June 2022. A total of 982 neonates admitted to the NICU due to a high risk of infection were included. Upon admission, the attending clinician applied the EOS calculator to each neonate. However, the results were kept confidential, and routine management, including antibiotic administration, was carried out based on clinical signs and relevant investigations. The use of antibiotics within 72 hours of admission was compared to the recommendations of the EOS calculator. Statistical analysis used chi-square tests to assess the association between antibiotic use and the EOS calculator's recommendations. Results: Out of the 982 neonates included, 590 (60.1%) were male, and 392 (39.9%) were female, with a mean age of 1.38±4.53 days. Within 72 hours of admission, 562 (57.2%) neonates did not receive antibiotics according to local protocols. A statistically significant association was observed between the clinical use of antibiotics and the recommendations of the EOS calculator (p-value <0.001), demonstrating that the calculator could effectively predict antibiotic needs. Conclusion: The EOS calculator proved to be an effective tool in predicting the likelihood of sepsis in neonates at high risk of infection. Its use can guide clinicians in making informed decisions about antibiotic administration, reducing unnecessary antibiotic exposure while ensuring timely treatment for those who need it. Incorporating the EOS calculator into neonatal sepsis management protocols can enhance patient outcomes and help prevent the overuse of antibiotics in neonates.

Effects of moderate physical activity on diabetic adhesive capsulitis: a randomized clinical trial.

Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen's d = 1.46) was significantly improved with large effect size in group A as compared to group B. MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.

PROPORTION OF EARLY ONSET SEPSIS IN LOCAL NICU AND IDENTIFICATION OF MATERNAL RISK FACTORS

Early onset neonatal sepsis (EOS) remains a significant cause of morbidity and mortality in neonatal intensive care units (NICUs). Identifying maternal risk factors associated with EOS is crucial for early diagnosis and prevention. Objective: To evaluate the prevalence of early onset sepsis in neonates admitted to the local neonatal intensive care unit (NICU) and identify maternal risk factors associated with neonatal sepsis. Methods: A comparative cross-sectional study was conducted at the Pediatrics Department, Combined Military Hospital Peshawar, from January 2021 to May 2022. One thousand neonates admitted to the NICU due to any indication were included. A consultant paediatrician or neonatologist diagnosed neonatal sepsis based on clinical signs and laboratory findings. Maternal factors such as age, premature rupture of membranes (PROM), maternal fever, and chorioamnionitis were analyzed for their association with early onset sepsis. Data were statistically analysed using SPSS, with p-value &lt;0.001 considered significant. Results: Out of 1000 neonates, 690 (69%) were male and 310 (31%) were female. The mean maternal age was 33.38 ± 4.53 years. EOS was observed in 123 neonates (12.3%), while 877 (88.7%) neonates showed no signs of sepsis. PROM and chorioamnionitis were significantly associated with early-onset sepsis (p-value &lt;0.001). Conclusion: Early onset neonatal sepsis is a common condition in neonates admitted to the NICU. Neonates born to mothers with PROM or chorioamnionitis were at a significantly higher risk of developing EOS. These findings emphasise the importance of addressing maternal risk factors in reducing the incidence of neonatal sepsis.

Socio-Demographic and Clinical Profile of Admitted Patients for Psychiatric Illness in a Tertiary Care Military Hospital in Bangladesh

Background: Mental health problems are becoming a public health issue in all countries around the world. It’s often ignored and unnoticed by patients, their relatives and society as well. Treatments for all these disorders are as available as efficacious. The purpose of this study was to assess the socio-demographic and clinical profile of admitted patients for psychiatric illness in a tertiary care military hospital. Materials and methods: This hospital based retrospective study was performed by analyzing the medical records of admitted psychiatric patients, carried out in the Department of Psychiatry at Combined Military Hospital (CMH), Chattogram from 01 July 2022 to 31 December 2022. For this purpose, 41admitted patients in psychiatry ward of CMH Chattogram were enrolled in the study. Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per International Classification of Diseases (ICD) 10th Revision diagnostic criteria. Statistical analyses were carried out by using the Statistical Package for Social Sciences (SPSS)-version 16. The quantitative observations were indicated by frequencies and percentages. Ethical issues were maintained all through the study. Results: The results showed that more than half of (56.09%) patients were in 19-35 years of age with male preponderance (63.41%) and most of the cases reported from urban area (58.53%). The most common psychiatric morbidity among the patients were major depressive disorder (26.82%) followed by Anxiety disorder (17.07%) and Obsessive- compulsive disorders (17.07%). In this study majority of patients stayed 15-28 days (80.48%) on an average of 21.5 days. Conclusion: Neurotic cases were predominant in psychiatric admission. Results of this study may help in the planning for better mental health service integrated with primary healthcare system of our country. Findings of this study will also act as an eye-opener for psychiatrists regarding a wide range of psychiatric diagnoses as well future research in psychiatric fraternity. IAHS Medical Journal Vol 6(2), December 2023; 19-23

Comparative Profile of Pregnant Women with and Without Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) presents a growing public health concern due to its adverse effects on both mothers and infants. This study aims to identify the sociodemographic, obstetric, and lifestyle factors influencing GDM prevalence and compare the profiles of pregnant women with and without GDM. Methods: This case-control study was conducted at the Combined Military Hospital (CMH), Dhaka, Bangladesh, involving 150 cases (pregnant women with GDM) and 150 controls (pregnant women without GDM), each matched for age. Data collection instruments were pre-tested, and physical activity levels were measured using the Metabolic Equivalent of Task (MET). Differences between cases and controls were analyzed across various sociodemographic and obstetric characteristics. Result: Age distributions were similar, with mean ages of 25.41 ± 2.472 years for cases and 25.21 ± 2.63 years for controls (p=0.484). However, education and income disparities were observed, with 26.67% of cases achieving only a Secondary School Certificate (SSC) education compared to 16.00% of controls. A significant portion of cases (52.67%) fell into the 20,000-39,999-income bracket compared to 36.00% of controls (p&lt;0.01). Physical activity levels were notably lower among cases, with 94.00% of cases reporting low light activity versus only 18.67% of controls (p&lt;0.001). Pre-pregnancy Body Mass Index (BMI) was significantly higher among cases, with 30.67% overweight compared to 8.67% of controls (p&lt;0.001). Family history of diabetes mellitus and polycystic ovary syndrome (PCOS) were not significantly associated with GDM. Conclusion: Pre-pregnancy BMI, physical activity, and socioeconomic status play significant roles in determining GDM risk. Comprehensive education and structured physical activity programs, particularly for women of childbearing age, could help reduce the incidence and complications of GDM

Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study.

This study aimed to assess the efficacy of nasal continuous positive airway pressure (CPAP) in term and preterm neonates with respiratory distress by evaluating successful outcomes, identifying factors contributing to treatment failure, and documenting associated complications. A comparative cross-sectional study design was employed. The research was conducted at Combined Military Hospital (CMH) Rawalpindi from November 2022 to July 2023. All consecutive neonates admitted during the specified period with respiratory distress requiring CPAP treatment and meeting inclusion criteria were enrolled. Pre- and post-CPAP respiratory distress levels, relevant biochemical markers, as well as mortality and morbidity rates were documented. Both descriptive and inferential statistical analyses were employed. The mean age of the study cohort was 53.3±85.6 minutes. The average time to initiate CPAP was 82.4 ± 94.7 minutes. Mean gestational age stood at 34.68±2.8 weeks. CPAP was successful in 97% of babies. The low birth weight below 1200grams was the main factor related to failure of CPAP. The mean Downes score decreased from 5.8±1.3 before CPAP to 3.3±1.6 after 12 hours of CPAP and further to 1.85±2 after 24 hours. Significant improvements in Downes score were noted after 24 hours of CPAP usage (p < 0.05) using paired sample T-test. This study affirms the effectiveness of CPAP in addressing neonatal respiratory distress. The utilization of CPAP emerges as a valuable intervention that not only reduces the requirement for invasive ventilation but also exhibits the potential to alleviate morbidity and mortality rates among neonatal populations.

The Cost-Effectiveness of Early Invasive Procedures for Acute Coronary Syndrome in Low-Income Regions: A Prospective Cohort Study in Pakistan.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited. Objective This study aims to evaluate the cost-effectiveness of early invasive procedures compared to standard care for ACS in low-income regions of Pakistan. Methods We conducted a prospective cohort study from January 1, 2021, to January 31, 2021, at four major hospitals in Pakistan: Army Cardiac Center Combined Military Hospital (CMH) Lahore, National Institute of Cardiovascular Diseases in Karachi, Lady Reading Hospital in Peshawar, and Mardan Medical Complex. The participants included 436 patients diagnosed with ACS aged 18 years or older and presenting within 24 hours of symptom onset. The patients were divided into two groups: the early invasive procedure group (n = 218) and the standard care group (n = 218). The primary outcome was the 30-day mortality rate. Secondary outcomes included recurrent myocardial infarctions, hospital readmissions, healthcare costs, and procedural complications. Data were analyzed using SPSS version 25.0 (IBM SPSS Statistics, Armonk, NY), employing descriptive statistics, chi-square tests, independent t-tests, and Kaplan-Meier survival analysis. Results The early invasive procedure group showed a mortality rate of 18 (8%) compared to 33 (15%) in the standard care group, demonstrating a significant reduction in mortality (p = 0.01). Additionally, the average healthcare cost was significantly lower in the early invasive group, with mean costs of Pakistani rupee (PKR) 187,200 (US dollar {USD} 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Recurrent myocardial infarctions occurred in 11 (5%) of the early invasive group versus 26 (12%) in the standard care group (p < 0.05). Hospital readmission rates were lower in the early invasive group, 22 (10%) compared to 39 (18%) in the standard care group (p < 0.05). Healthcare costs were significantly lower in the early invasive group, with mean costs of PKR 187,200 (USD 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Conclusion Early invasive procedures for ACS significantly improve survival rates, reduce complications, and lower healthcare costs in low-income regions of Pakistan. These findings suggest that such strategies should be considered in resource-limited settings to optimize patient outcomes and healthcare resource utilization.

Efficacy of Platelet-Rich Plasma Versus Steroids In Patients of Tennis Elbow

Objective: To compare the efficacy of Platelet Rich Plasma versus Steroids among patients managed for Tennis elbow at our Orthopaedic unit. Study Design: Quasi-experimental study. Place and Duration of Study: Orthopaedic Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2021 to Jul 2022. Methodology: Patients with Tennis Elbow diagnosed by a consultant orthopaedic surgeon were included in the study. They were randomly allocated treatment with platelet-rich plasma and steroid injections. The team assessed them after three months of treatment using the Disabilities of Arm, Shoulder, and Hand score. Different factors, including mode of treatment, were associated with significant improvement in these patients at the end of three months. Results: Out of 250 patients with tennis elbow included in the final analysis, 193(77.2%) were male, and 57(22.3%) were female. Patients were divided into two groups for comparison, and Group-1 had significant improvement, while Group-2 had no improvement. Out of the total, 117(46.8%) patients received platelet-rich plasma, while 133(53.2%) patients were managed with corticosteroids. The presence of comorbid illnesses and the use of platelet-rich plasma was statistically significantly found in a group with significant improvement in Disabilities of Arm, Shoulder, and Hand score (p-value&lt;0.05) as compared to a group of patients without significant improvement. Conclusion: Most patients had significant improvement in symptoms at the end of three months. In our study, patients who were managed with platelet-rich plasma and had no comorbid illness had more chances of significant improvement at the end of three months.

Diagnostic Accuracy of C-Reactive Protein in Acute Appendicitis

Objective: To determine diagnostic accuracy of C-reactive protein in acute appendicitis. Study Design: Cross-sectional study. Place and Duration of Study: Surgical unit Combined Military Hospital Gujranwala Pakistan, from Apr 2019 to Jan 2021. Methodology: One hundred and twenty patients were included in the study following the inclusion criteria after their written permission and willingness. C-reactive protein levels were sent pre-operatively to the Pathology department of Combined Military Hospital Gujranwala. Patients were operated on by two classified surgeons. After open and laparoscopic appendectomies, specimens were sent to Histopathologists at Armed Forces Institute of Pathology Rawalpindi. Results were compared to determine the diagnostic accuracy of C-reactive protein. Results: Out of 120 patients, 72(60%) were males and 48(40%) were females. The diagnostic accuracy of C-reactive protein in acute appendicitis was calculated by keeping tissue diagnosis histopathology as the gold standard, where 82(68.33%) were true positive, 7(5.84%) were false positive, 13(10.83%) were true negative, and 18(15%) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 89.13%, 67.86%, 90.11%, 65.52% and 84.17% respectively. Conclusion: The of C-reactive protein level test for the diagnosis of acute appendicitis was very sensitive but not very specific. C-reactive protein levels should be measured routinely in suspected cases of acute appendicitis, along with Total Leucocyte Count and ultrasound abdomen, as a useful marker for early diagnosis, thus reducing negative appendectomy rates.

Frequency of a Positive Cerebrospinal Fluid Study in Patients Presenting With Febrile Seizures

Background: Febrile seizures are a common neurological condition in pediatric practice, affecting 2-5% of children globally. These seizures occur in the context of fever without evidence of central nervous system infection or metabolic disturbance. While often benign, febrile seizures are associated with significant morbidity and can cause considerable distress for both patients and caregivers. The role of cerebrospinal fluid (CSF) abnormalities in the pathogenesis of febrile seizures is not well understood, but identifying these factors may help predict the risk of seizure occurrence. Objective: To determine the frequency of positive cerebrospinal fluid abnormalities in pediatric patients with febrile seizures and to assess the impact of these abnormalities on the risk of febrile seizures. Methods: This prospective cohort study was conducted from January 2022 to December 2023 at the Department of Paediatrics, Combined Military Hospital, Rawalpindi. A total of 117 pediatric patients aged 1 to 12 years with a history of febrile seizures presenting with a febrile illness were included. Patients with prior febrile seizures, metabolic/electrolyte disorders, or signs of meningeal infection were excluded. Comprehensive data collection included demographic information, clinical history, and CSF analysis for cell count, total protein, glucose, lactate, and electrolyte levels. Patients were monitored for febrile seizure occurrence during hospitalization. Data were analyzed using SPSS version 25, with continuous variables expressed as medians and interquartile ranges (IQR) and categorical variables as frequencies and percentages. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association between CSF abnormalities and febrile seizures. Results: The median age of the patients was 3.0 years (IQR: 2.0), with 57.3% (n=67) being male. Febrile seizures occurred in 22.2% (n=26) of patients during hospitalization. Elevated CSF total protein (&gt;60 mg/dL) was observed in 28.2% of patients, CSF glucose (&gt;42 mg/dL) in 12.0%, CSF lactate (&gt;2.0 mmol/L) in 13.7%, and CSF calcium (&gt;1.25 mmol/L) in 10.3%. These abnormalities were significantly associated with an increased risk of febrile seizures: CSF total protein (OR: 3.55, 95% CI: 1.42–8.86, p=0.005), CSF glucose (OR: 13.59, 95% CI: 3.79–48.71, p&lt;0.001), CSF lactate (OR: 4.61, 95% CI: 1.53–13.92, p=0.004), and CSF calcium (OR: 15.52, 95% CI: 3.81–63.36, p&lt;0.001). Conclusion: This study identified significant associations between elevated CSF total protein, glucose, lactate, and calcium levels and an increased risk of febrile seizures in pediatric patients. CSF analysis could be a valuable tool in identifying children at higher risk for febrile seizures, potentially guiding preventive strategies and clinical management.

Comparison of Intermittent Versus Continuous Phototherapy in Neonatal Hyperbilirubinaemia

Background: Neonatal jaundice is a common condition characterized by elevated bilirubin levels, which, if untreated, can lead to severe complications such as kernicterus. Phototherapy is a widely used treatment modality, with two primary approaches: continuous and intermittent phototherapy. While both methods aim to reduce bilirubin levels, there is ongoing debate about their relative efficacy and safety. Objective: This study aimed to compare the efficacy and safety of intermittent versus continuous phototherapy in the management of neonatal hyperbilirubinaemia in terms of bilirubin reduction, treatment duration, and associated complications. Methods: A quasi-experimental study was conducted at the Department of Paediatrics, Combined Military Hospital, Rawalpindi, from January 2022 to December 2023. The study included 62 full-term neonates with indirect bilirubin levels &gt;15.0 mg/dL but ≤20 mg/dL. Neonates were randomly assigned to receive either intermittent phototherapy (two hours on, two hours off) or continuous phototherapy. Serum indirect bilirubin levels were measured at 24 and 48 hours post-initiation of phototherapy. The total duration of phototherapy, volume of milk consumed, and complications such as hyperthermia and hypocalcaemia were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered statistically significant. Results: At 24 hours post-treatment, the median indirect bilirubin level was 12.70 mg/dL (IQR: 1.20) in the intermittent group versus 12.50 mg/dL (IQR: 1.90) in the continuous group (p=0.893). At 48 hours, the levels were 6.40 mg/dL (IQR: 1.10) and 6.50 mg/dL (IQR: 1.10), respectively (p=0.821). The median total duration of phototherapy was significantly shorter in the intermittent group (22.0 hours, IQR: 2.0) compared to the continuous group (45.0 hours, IQR: 3.0; p&lt;0.001). Neonates in the intermittent group consumed more milk (420.0 mL, IQR: 93.0) than those in the continuous group (397.0 mL, IQR: 57.0; p=0.014). Hyperthermia was less frequent in the intermittent group (3.2% vs. 25.8%, p=0.026), as was hypocalcaemia (16.1% vs. 45.2%, p=0.013). Conclusion: Intermittent phototherapy is as effective as continuous phototherapy in reducing bilirubin levels and offers additional benefits, including a shorter treatment duration, improved feeding, and fewer complications. Intermittent phototherapy should be considered a preferred option for managing neonatal hyperbilirubinaemia in clinical practice.