Combined Military Hospital Research Articles

Efficacy of Fixing Chest Tube to Chest Wall from Both Sides versus Single Side Fixation with Silk One Breaded Suture

Efficacy of Fixing Chest Tube to Chest Wall from Both Sides versus Single Side Fixation with Silk One Breaded Suture

Pattern of Disease Admissions and Their Outcome of Neonates Admitted In Neonatal Intensive Care Unit of A Tertiary Care Hospital in Quetta

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p: <0.001), birth weight (p: <0.001), and duration of stay (p: 0.003) was observed for reasons for admissions. Furthermore, a significant association of reasons for admission was observed with gender (p: 0.013), route of admission (p: <0.001), and respiratory support (p: <0.001). Conclusion: The pattern of the disease admission showed that respiratory-related disorders were predominantly higher, followed by infection/sepsis-related disorders and care of prematurity. Though the mortality rate was low, however, low birth weight, prematurity, and caesarean delivery are common risk factors.

Comparison of Phenylephrine Infusion Versus Boluses for Management of Blood Pressure in Elective Caesarean Section

Comparison of Phenylephrine Infusion Versus Boluses for Management of Blood Pressure in Elective Caesarean Section

Comparison of Hyperglycemic Effects of Antenatal Administration of Dexamethasone in Gestational Diabetes: A Study of Recommended Versus Predicted Split Doses Regimens

Objective: To compare three consecutive days of hyperglycemic response following antenatal Dexamethasone regimens of 12mg or 6mg in diet-controlled gestational diabetes, administered for fetal lung maturity. Study Design: Quasi-experimental study Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2020 to Mar 2021. Methodology: Forty women who met inclusion criteria were selected and assigned to two Groups. Group-A was administered quartered 24 mg steroids 6 hours daily, and Group-B was administered halved 24mg 12 hours daily. Blood sugar levels (BSL) were recorded before and after meals, thrice a day for three consecutive days, and on proforma. Results: Among the selected patients, the mean age was 25.5±2.9 years, and the mean gestational age (duration of pregnancy) was 30.3±2.0 weeks. Out of six blood sugar levels recorded daily for three consecutive days, the episodes of hyperglycemia in the (Group-B) 12-hourly steroid dose were found to be less significant than those in the (Group-A) split 6-hourly dose. Conclusion: The recommended 12 mg, twice-a-day regimen of antenatal corticosteroids was better than the proposed 6mg, four times a day regimen as it caused fewer hyperglycemic episodes in gestational diabetics.

Comparative Efficacy of Goserelin vs. Leuprolide in Advanced Prostate Cancer in Patients Undergoing Androgen Deprivation Therapy

Comparative Efficacy of Goserelin vs. Leuprolide in Advanced Prostate Cancer in Patients Undergoing Androgen Deprivation Therapy

Frequency of Hematological Response in Patients with Chronic Myeloid Leukemia (Chronic Phase) with Imatinib After Three Months Presenting to CMH Rawalpindi

Objective: To find the frequency of haematological response in patients of chronic myeloid leukaemia (Chronic Phase) after three months of Imatinib Mesylate therapy, presenting to CMH Rawalpindi Study Design: Cross-sectional study. Place and Duration of Study: Department of Oncology Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2020. Methodology: Forty-six patients aged 18 and above within the chronic phase of CML were included. Patients underwent detailed clinical history, examination, baseline investigations, and bone marrow studies at presentation. Enrolled patients were given 400mg of Imatinib, and a complete haematological response was noted at the end of 3 months of therapy. Results: In our study, the age of patients ranged from 18 to 67 years, with a mean age of 47.2+10.6 years. 33(71.7%)were male, and 13(28.3%) were female. 42(91.3%) patients achieved complete haematological response to Imatinib at three months of therapy. Adverse drug reactions exhibited were oedema 18(39.1%), gastrointestinal disturbance 12(26.1%), anaemia 05(10.9%), and skin reactions 03(6.5%). Conclusion: This study has concluded that Imatinib Mesylate is highly effective in treating chronic phase CML at the haematological level and can be considered the drug of first choice in CML-CP.

Frequency of 17p Deletion in Chronic Lymphocytic Leukemia Patients Presenting to Combined Military Hospital Rawalpindi

Frequency of 17p Deletion in Chronic Lymphocytic Leukemia Patients Presenting to Combined Military Hospital Rawalpindi

Factors Affecting the Development of Speech in Children After Cochlear Implant

Objective: To determine the odds of different factors for developing poor speech intelligibility in pre-lingually deaf children who have undergone cochlear implantation. Study Design: Case-control study. Place and Duration of Study: Department of ENT, Combined Military Hospital, Rawalpindi Pakistan, Jan 2020 to Aug 2022. Methodology: This study was based on a sample of 60 patients: 30 cases with cochlear implants placed before two years of age, with a total time of using a cochlear implant of ≥1 year, and 30 controls. Both groups consisted of both genders aged between 3 and 12 years. All patients underwent assessment using the Speech Intelligibility Rating system and were documented for var-ious factors influencing speech development. Results: The mean age of the sample at the time of the study was 6.37±3.17 years. A total of 34(56.7%) participants were male. Factors associated with poorer speech outcomes were male gender (OR0.44[CI 95% 0.15–1.30]), no peers in the household (OR 0.53 [CI 95% 0.15–1.84]), higher maternal literacy (OR 0.42[CI 95% 0.13–1.30]). Factors associated with improved speech devel-opment included primarily oral form of communication (OR 2.14[CI 95%0.41–11.17]), less than one-year age at implantation (OR 1.29 [CI 95% 0.24–6.96]), a total duration of speech therapy less than two years (OR 1.70[CI 95% 0.32–8.74]) and the pres-ence of unilateral implants, (OR 6.33[CI 95% 1.00–40.07]). Conclusion: Earlier cochlear implantation with frequent verbal skill exercise appears essential to developing good speech in-telligibility in pre-lingually deaf children. Keywords: Children, Cochlear Implantation, Pre-Lingual Deafness, Speech intelligibility

Sharing the Experience of Two Hundred Patients in A Novel Cochlear Implant Programme At Combined Military Hospital, Rawalpindi

Objective: To share our experience of difficulties encountered while implanting different types of cochlear implants and ascertain the affordability of cochlear implant surgery among the Pakistani population to treat sensorineural hearing loss in a novel cochlear implant programme. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of ENT, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Apr 2017 to May 2021. Methodology: The study included patients who underwent cochlear implant surgeries. Patient demographics and causes of deafness, were collected. Intraoperative difficulties were encountered, and round window accessibility was also recorded. Results: Out of 200 patients, 112(56%) were males, while 88(44%) were females. 193(96.5%) patients were pre-lingual under 12 years of age, while post-lingual patients were 7(3.5%) and were adults. Cochlear implants from Med-El 186(93%), Cochlear 2(1%) and Advance Bionic 1(0.5%) were implanted through a transmastoid, facial recess approach, while Neubio 11(5.5%) was implanted through a postauricular transcanal approach. Congenital deafness with consanguinity was the leading cause of deafness, while round window variation was the most frequently encountered surgical challenge. Conclusion: In developing countries, financial restraints cause delays in surgery, leading to limited access to cochlear implant programmes. Surgical challenges are frequently encountered during surgery, and better understanding is required for easy implantation.

Comparison of SOFA and qSOFA Scores in Predicting Infection and Mortality in HDU and ICU Patients at a Tertiary Care Center

Objective: The objective of this study is to compare the sensitivity and specificity of the SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential Organ Failure Assessment) in predicting infection and mortality in ICU (intensive care unit) and HDU (high dependency unit) patients admitted at a tertiary care center of excellence. Study Design and Setting: Prospective observational non-interventional study. Anesthesia Department of Combined Military Hospital, Rawalpindi from Jan 2023-Jun 2023. Methodology: Patients in both ICU (n=220) and HDU (n=220) setups admitted with a suspicion of sepsis were evaluated for onset of sepsis and mortality. Primary variables studied were the sensitivity and specificity for both scores for predicting infection and mortality in the ICU and HDU. Positive predictive value for both scores were calculated as secondary variable. Results: While assessing the primary variables, the sensitivity of SOFA for predicting infection in the ICU was 25.6% with a specificity of 85.3% versus a sensitivity of 76.8% and specificity of 59.0% for qSOFA. In the HDU, It showed sensitivity and specificity with PPV for SOFA being 64.7%, 95.1% and 64.7% versus 79.3%, 85.3% and 46.9% for qSOFA respectively. While assessing for mortality, SOFA values in the ICU for sensitivity, specificity and PPV were 81.8%, 93.5% and 69.2% versus 88.8%, 58.3% and 90.9% for qSOFA respectively. Conclusion: We conclude that qSOFA to be good predictor of mortality in the HDU and SOFA with good specificity for infection and mortality in the ICU

Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails.

Reduction quality is of paramount importance for an optimal outcome in unstable pertrochanteric fractures. The non-anatomical functional anteromedial buttress is proposed to prevent impending mechanical complications. We aimed to evaluate the role of anteromedial cortical support in preventing mechanical complications following fixation with the cephalomedullary nail. A prospective, single-arm interventional study was conducted in the Orthopaedics Department of a Combined Military Hospital (CMH) in Rawalpindi. The duration of the study was 24 months. Patients were recruited by the purposive sampling technique as per inclusion/exclusion criteria. Preoperatively, the reduction was categorized as per Baumgartner's and Chang's criteria. Post-operatively, weight bearing as tolerated was advised. Radiographs prior to discharge for loss of reduction were evaluated. Follow-up radiographic measurements of neck length, neck shaft angle, and their loss as per protocol were done at three and six months. A total of 202 patients were operated on from October 21 until August 23. Mortality at six months in 39 patients (19.3%) and loss to follow-up in 31 patients (15.3%) resulted in 132 patients with complete follow-up and having developed complications in 12 patients (9.09%). The mean age was 76.3 ± 7.98 years; males were 105 (79.5%), and females were 27 (20.5%). Closed reduction was 58 (43.9%), and additional manoeuvres were required in 74 (56.1%). The mean tip apex distance (TAD) was 24.56 ± 2.76, and the Calcar gap was 5.16 ± 1.27. Cleveland zone centre-centre in 54 (40.9%), inferior-centre in 65 (49.2%), and inferior-posterior (9.9%) were statistically significant for mechanical complications (p≤0.001). There was a significant association between the grading of Chang's and Baumgartner's poor groups for the development of mechanical complications (p≤0.001). The mean time to full weight bearing without support was 21 ± 1.22 weeks. The mean Hip Harris score at six months was 69.27 ± 7.68. Results suggest that anteromedial cortical support can lead to fewer potential mechanical complications at six months. A higher Chang's grade drives surgeons to engage in additional manoeuvres. Anteromedial cortical support is worth consideration for unstable pertrochanteric fractures.

COMPARISON OF SURGICAL SITE INFECTION BETWEEN DIABETIC AND NON-DIABETIC PATIENTS IN CLEAN SURGICAL PROCEDURES

Surgical site infections (SSIs) are a major concern in healthcare, especially for individuals with diabetes. Diabetes can impair wound healing and weaken the immune system, increasing the risk of SSIs. Studying SSIs in diabetic versus non-diabetic patients undergoing clean surgeries is vital for improving patient care. Objective: The primary objective of this study was to investigate the incidence of surgical site infections (SSIs) in individuals with diabetes compared to those without diabetes who underwent clean surgical procedures. Methods: After the ethical approval from the institutional review board, this comparative study was conducted at Combined Military Hospital Jhelum from July 2022 to December 2023. A consisted of people with diabetes (n=50), while Group B comprised patients who did not have diabetes (n=50). All patients were administered suitable antibiotics before surgery. Each patient received a singular intravenous dose of Ceftriaxone 1g, administered thirty minutes before initiating the initial incision. The patients were monitored for surgical site infections (SSI), defined as the presence of redness, fever, tenderness at the incision site, discharge from the surgical wound, or the development of an abscess within 28 days after surgery. Results: Most participants in both study groups underwent open ventral hernia repair procedures, 54% in group A and 58% in group B. Mean± S. D of the Hb1Ac levels of the participants in both groups was 8.46±1.16 and 4.14±1.01 (P=<0.0001). 58% of participants in Group A, while 22% in Group B had surgery-associated complications (p<0.0001). 30% of participants in Group A, while 10% in Group B had SSI (p<0.0001). Conclusion: Individuals with diabetes are more susceptible to experiencing higher rates of surgical site infection, especially in cases of procedures that are considered clean, in comparison to individuals without diabetes.

THE OUTCOME OF ANTIBIOTICS VS OPEN APPENDECTOMY FOR ACUTE NON-PERFORATED APPENDICITIS

Acute appendicitis is a common surgical emergency. While appendectomy has been the conventional treatment for this condition, recent advancements in antibiotic therapy have led to exploring the use of antibiotics as a non-surgical alternative for treating non-complicated acute appendicitis. Objective: The objective of the present study was to compare the outcomes of administering antibiotics and performing emergency appendicectomy in a cohort of individuals diagnosed with non-perforated acute appendicitis based on CT evaluation. Methods: After the ethical approval from the institutional review board, this randomised control trial was conducted at Combined Military Hospital Jhelum from July 2022 to December 2023. The patients were randomly assigned, using a closed envelope method, to either have open appendectomy (Group A, n=60) or receive antibiotic therapy (Group B, n=60) with intravenous ertapenem. Open appendectomy was conducted utilising the McBurney technique. The patient’s outcomes were assessed during their hospitalization period, specifically on days 0, 1, and 2, and by telephone interviews one week and two months following the intervention. Pain scores were collected at two specific time points, one week and two months after randomisation, utilising a visual analogue scale (VAS). Results: No significant differences were observed in the baseline characteristics in both groups. Mean± S.D of the pain experience of the study participants in both groups was 4.16±1.04 and 3.68±1.02 (days) (P value=0.008). Mean± S.D of the hospital stay of the study participants in both groups was 3.13±0.87 and 3.16±0.83 (days) (P value=0.843). A significant difference in the VAS score was observed (p <0.0001) in the participants of both groups at discharge and after a one-week follow-up period. Conclusion: The findings of the study indicate that a significant proportion of individuals who received antibiotic therapy for non-perforated acute appendicitis did not necessitate the surgical procedure of appendectomy within the two-month post-treatment observation period.

Neonatal Hypoglycemia How common is Hypoglycemia in Newborns Weighing Less Than 2500 gms: A Hospital Based Study

Objective:To determine the frequency of hypoglycemia in neonates weighing less than 2500 grams in first 48 hours of life presented to CMH Abbottabad.
 Study Design: Cross Sectional Study.
 
 Setting: Department of Pediatrics, Combined Military Hospital, Abbottabad.
 
 Duration of Study: This study was conducted from 1st July 2020 to 1st January 2021
 
 Subjects and Methods:
 
 A total of 110 neonates of both genders with birth weight less than 2500 grams using consecutive non-probability sampling technique were included in the study. Capillary blood was collected by heel prick after proper aseptic measure for blood glucose estimation by Glucometer at 0, 1, 2, 3, 6 and every 6 hours till 48 hours of birth. All hypoglycemic neonates were managed with intravenous administration of 10%glucose.
 Results:
 
 Gestational age range in this study was from 34 to 42 weeks with mean gestational age of 38.663±1.55 weeks, mean birth weight 1622.818±409.23 grams and mean blood glucose level was 54.763±9.55 mg/dl. Total 80% neonates were male. Hypoglycemia was observed in 27.3% neonates. No significant difference was seen comparing frequency of hypoglycemia among pre-term and term neonates (p-value 0.52), male vs female neonates (p-value 1.00) and different modes of delivery. (p-value 0.6). While frequency of hypoglycemia was significantly high in extremely low birth neonates as compared to low and very low birth weight. (p-value <0.01).
 
 
 Conclusion:
 
 Our study concluded that frequency of hypoglycemia was 27.3% in newborns weighing less than 2500 grams in first 48 hours of life. Extremely low birth weight (less than 1000gms) is a significant determinant for hypoglycemia.
 Keywords:
 
 First 48 hours, frequency, low birth weight, hypoglycemia, new borns
 

The Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy: A Cross-Sectional Study

OBJECTIVES This study aimed to assess the Factors Impacting Decision-Making for Breast Reconstruction in Women Following Mastectomy in Combined Military Hospital, Rawalpindi METHODOLOGY This prospective cross-sectional study was conducted at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi from January to June 2023. The sampling technique was non-probability sampling. A total of 56 female patients between the ages of 20-70 years with a histological diagnosis of carcinoma breast and undergoing mastectomy as part of their breast cancer therapy were included in the study. Patients who had metastatic cancer or connective tissue disorder were excluded from the study. After getting informed written consent, data was collected from patients. A semi-structured questionnaire was used as a study tool. Data was presented in the form of tables. RESULTSThe surgical preference of 56 patients was studied. Only 11(19.6%) patients opted for breast reconstruction. A total of 45(80.4%) patients refused to undergo BR. Several factors affecting the decision not to have BR were identified. They included fear of recurrence in 07 (15.5%) patients, long surgical procedures in 06 (13.3%), lack of concern regarding body image in 11(24.4%), financial issues in 13 (28.8%) patients, unsatisfactory results of breast reconstruction in 8 (17.7%) patients who had lack of trust in plastic surgeon regarding their post reconstruction breast shape. CONCLUSION This study laid the conceptual groundwork that factors like fear of recurrence, long surgical procedures, disregard for body image, poverty, and plastic surgeon distrust negatively influence the likelihood of having post-mastectomy breast reconstruction (PMBR). Methods: From January 2023 to June 2023, this cross-sectional study, carried out at a specialized Breast Clinic in the Combined Military Hospital Rawalpindi, sought to explore surgical preferences for breast reconstruction (BR) among breast carcinoma patients undergoing mastectomy and to identify factors influencing these decisions. 42 patients in all were enrolled, 8 of them selected breast reconstruction while 34 did not. The decision-making process was influenced by a number of issues, such as worry about recurrence, worries about time-consuming surgical procedures, and disregard for body image, financial limitations, and previous unsuccessful reconstructive results. Results: 28 patients had right-sided disease, 13 had left-sided cancer, and 1 had bilateral involvement, according to disease features. Furthermore, 25 individuals had N0 disease, while 17 had N1 disease, according to nodal staging. Six patients had sentinel lymph node biopsy (SLNB), two underwent axillary lymph node dissection (ALND), five chose upfront surgery, and three underwent neoadjuvant therapy before surgery, demonstrating the range of the surgical methods used. Conclusion: This study provides insightful information about the complex decision-making process involving breast reconstruction in individuals with breast cancer. The identified characteristics give healthcare professionals a framework on which to build strategies that guarantee patients receive educated and individualized care, thereby improving patient happiness and quality of life in general. Key words: breast, tumor, surgery, lymph node, reconstruction, aesthetic

COMPARISON OF INTRAVENOUS DIAZEPAM AND INTRAVENOUS MIDAZOLAM FOR TREATMENT OF RECURRENT FEBRILE SEIZURES

Background: Recurrent febrile seizures are seizures in children less than 5 years of age which reoccur within 24 hours. Benzodiazepines such as midazolam and diazepam are used to stop and decrease the recurrent rate of febrile seizures. The objective of study was to compare the efficacy of intravenous midazolam with intravenous diazepam for treatment of recurrent febrile seizures in paediatric patients. Methods: This observational cross-sectional study observed 60 children aged 6 to 59 months with recurrent febrile seizures who presented at paediatric clinic in Combined Military Hospital Kharian and THQ Hospital, Kharian from Sep to Nov 2023. The response time was noted for children who received intravenous midazolam 0.2 mg/Kg only and IV diazepam 0.2 mg/Kg only. The children were randomly allocated into group A (midazolam group) and Group B (diazepam group.) Study was done after taking informed consent from the parents. Both drugs were given during the fits. Results: The time interval from drug administration to cessation of febrile seizures was 2.50±0.94 minutes in the midazolam group and 2.4±1.12 minutes in the diazepam group. There was no significant difference between the two groups (p=0.567). Minor dizziness and sedation were the only main effects reported. Conclusion: Both diazepam and midazolam have same efficacy in the treatment of recurrent febrile seizures. Pak J Physiol 2024;20(1):12?4

Frequency of loss of calretinin expression in clinically susceptible cases of Hirschprung disease in rectal biopsies

Objective: To determine the frequency of loss of calretinin expression in clinically susceptible cases of Hirschprung disease in rectal biopsies. Material and Methods: This descriptive, cross-sectional study was conducted at Department of Histopathology, Combined Military Hospital, Multan for a period of 6 months (17th Oct 2021 to 16th April 2022). A total 93 suspected cases of Hirschprung disease were taken. Specimens received in 10 % buffered formalin and fulfilling inclusion criteria were included in the study. The cases diagnosed as Hirschprung disease were taken and calretinin immunohistochemical stain was applied and result recorded after evaluation by consultant histopathologist. Data was analyzed using (Statistical Software for Social Sciences (SPSS) version 19). Results: Out of 93 cases, 67 (72.0%) were male patients, whereas 26 (28.0%) were female patients. The average age of the study participants was 7.95 months, with a minimum age of 1 month and a maximum age of 12 months. Twenty-eight (30.1%) of the 93 study cases were from rural areas, while 65 (69.9%) were from metropolitan areas. Twenty-five families (26.9%) reported monthly incomes of up to Rs. 35000, while 68 families (73.1%) reported incomes of over Rs. 35,000. Of these 93 study cases, failure to pass meconium was noted in 24 (25.8%) patients, constipation was noted in 75 (80.6%) and abdominal distension was noted in 62 (66.7%) patients. Loss of calretinin expression was noted in 34 (36.6%) of our study cases. Conclusion: According to the findings of our investigation, calretinin is very helpful in identifying suspicious cases of Hirschsprung disease. When acetylcholinesterase enzyme histochemistry is not accessible, it can be a helpful, cost-effective diagnostic assistance in centers with limited resources. It is a reliable and efficient diagnostic tool for early diagnosis of the illness. Loss of Calretinin expression was significantly associated with age and residential status. Keywords: Calretinin expression, Frequency, Hirschsprung disease, Immunohistochemistry

Prevalence Of Skin Manifestations In Patients With Polycystic Ovarian Syndrome

Objective: This study aimed to determine the prevalence of cutaneous manifestations in PCOS patients. Method: This cross-sectional study was conducted in the dermatology department, Combined Military Hospital, Peshawar, from 1st January 2021 to 30th June 2021. After obtaining ethical approval from the hospital's ethical and research committee, a total of 50 patients aged 15 to 45 years were included in the study fulfilling the inclusion criteria. Written informed consent was taken from each patient. All patients underwent general physical, systemic and dermatological examination. Venous blood sampling was done after overnight fasting for hormonal assays (TSH, LH, FSH, prolactin and testosterone), glucose, and lipid levels. An ultrasound scan was done for the detection of ovarian cysts. Results: Mean age was 26.96 years ± 5.42 SD. The mean BMI was 26.04 Kg/m2 ± 5.10 SD. Mean FSH and LH levels were 6.86 IU/L ± 5.41 SD and 12.11 IU/L ± 8.75 SD respectively. Among them, 88% were married, 36% had menstrual irregularities and 72% had infertility. Hirsutism, acne, acanthosis nigricans, and androgenic alopecia were noted in 72%, 54%, 42%, and 20% of the patients respectively. Conclusion: Cutaneous manifestations can play an important role in the diagnosis of PCOS and also contribute an important portion of the symptoms experienced by patients suffering from PCOS. Keywords: PCOS, Skin manifestations, Hyperandrogenism, Hirsutism, Acne.

Significance of serum ferritin and De Ritis ratio in non-alcoholic fatty liver disease as diagnostic markers.

To ascertain the significance of serum ferritin and De Ritis ratio as diagnostic markers in patients of nonalcoholic fatty liver disease with and without type 2 diabetes mellitus. The comparative cross-sectional study was conducted from February to October 2022 at the Radiology Department of Combined Military Hospital, Rawalpindi, Pakistan, and comprised individuals aged 30-65 who were divided into 3 groups. Healthy controls formed group I, non-alcoholic fatty liver disease patients without type 2 diabetes mellitus formed group II and non-alcoholic fatty liver disease patients with type 2 diabetes mellitus were in group III. Blood 5ml was withdrawn and assessed for alkaline phosphatase, aspartate transaminase, alanine transaminase and ferritin. De Ritis ratio was calculated and subjected to intergroup comparison. Data was analysed using SPSS 22. Of the 210 subjects, 110(52.4%) were males and 100(47.6%) were females, with 70(33.3%) in each of the three groups. Group I had 38(54.3%) females and 32(45.7%) males with mean age 37.50±4.513. In group II, there were 27(38.6%) females and 43(61.4%) males with mean age 45.86±9.646, while in group III there were 35(50%) females and 35(50%) males with mean age 54.01±9.243 years. Serum ferritin levels were significantly increased in patient groups II and III compared to control group I (p<0.05). De Ritis ratio was markedly raised in groups II and III compared to group I (p<0.05). Ferritin was significantly correlated to age, weight, height, fasting blood glucose, haemoglobin, alkaline phosphatase, aspartate aminotransferase, alanine transaminase and bilirubin (p<0.05). De Ritis ratio had a significant correlation with body mass index and fasting blood glucose (p<0.05). Serum ferritin and De Ritis ratio were found to be useful diagnostic indicators for non-alcoholic fatty liver disease, highlighting their importance in improving disease screening.

Outcomes and Measures of Children with Bilateral Cochlear Implants: A Single-center Experience in Bangladesh

Children dealing with hearing impairment encounter challenges associated with speech and language delays, significantly impacting their quality of life. Recent data from the World Health Organization indicate that 466 million people worldwide experience disabling hearing loss, with 34 million being children. Cochlear implantation (CI) is a novel approach for severe to profound sensorineural hearing loss. In pediatric CI, the main objective is to enable hearing-impaired children to perceive sound promptly, facilitating speech and language development. This study investigated the outcomes of bilateral pediatric cochlear implant (CI) users in Bangladesh, applying the Speech, Spatial, and Qualities of Hearing questionnaire and the Classification of Auditory Performance-II (CAP-II). Conducted at the Combined Military Hospital in Bangladesh, the study involved 10 children with bilateral cochlear implants. The results revealed commendable scores in speech understanding, spatial hearing, and qualities of hearing, underscoring the effectiveness of cochlear implant interventions. Deeply examining the implications is the topic of discussion of these findings, emphasizing the positive impact of early implantation and the adaptability of assessment tools in diverse cultural contexts.