District Headquarter Hospital Research Articles

Sonographic Evaluation of Cholelithiasis in Diabetic Patients at District Swabi

Background: Cholelithiasis, the formation of gallstones in the gallbladder, is prevalent among individuals experiencing abdominal discomfort such as epigastric pain, nausea, and loss of appetite. The relationship between diabetes and the increased risk of developing gallstones has been noted, highlighting the importance of understanding this association for better disease management. Objective: The aim of this study was to evaluate the prevalence and characteristics of gallstones in diabetic patients in the district of Swabi using ultrasonography to enhance early diagnosis and treatment approaches. Methods: This cross-sectional study was conducted at the Department of Radiology, District Head Quarters Hospital, Swabi, Pakistan. Participants included individuals presenting with upper right quadrant pain or with a history of diabetes. Ultrasonographic examinations were performed using a Toshiba Xeiro convex probe with a frequency range of 3-5 MHz. Data was collected through clinical histories and radiographic examinations, and analyzed using SPSS version 25. Ethics approval was obtained in accordance with the Declaration of Helsinki, and all participants provided informed consent. Results: A total of 112 patients were enrolled with ages ranging from 8 to 80 years (mean ± SD = 39.37 ± 16.72 years). Females constituted 56.4% (n=62) and males 43.6% (n=48) of the study population. The majority, 88.2% (n=97), reported right hypochondriac pain. Among the patients, 60% (n=66) had multiple gallstones; of these, 36.4% (n=24) were diabetic. Conversely, 40% (n=44) had a single stone, with 38.6% (n=17) being diabetic. Conclusion: The study indicates a significant association between diabetes and the presence of multiple gallstones, underscoring the need for routine ultrasonographic screening in diabetic patients experiencing right hypochondriac pain. Early detection could lead to better management and potentially reduce complications associated with cholelithiasis.

Frequency and Clinical Outcomes of Facial Nerve Palsy at District Level Teaching Hospital, Pakistan

Background: Facial nerve palsy, characterized by the dysfunction of the seventh cranial nerve, is a common neurological disorder that significantly impacts patients' quality of life. It manifests as unilateral facial weakness or paralysis, with Bell's palsy being the most prevalent cause. This condition requires thorough clinical evaluation and appropriate management to ensure optimal recovery outcomes. Objective: The objective of this study was to determine the frequency and clinical outcomes of facial nerve palsy in patients presenting to a district-level teaching hospital in Lakki Marwat, Pakistan. Methods: A cross-sectional study was conducted from May 2023 to October 2023 at the Physiotherapy Department of District Headquarter Hospital, Lakki Marwat. Patients with a confirmed diagnosis of facial nerve palsy by a neurophysician were included, while those with congenital facial nerve palsy or upper motor neuron lesions were excluded. Ethical approval was obtained, and written informed consent was collected from all participants. Clinical assessments were performed using the House-Brackmann scale to evaluate the severity of facial nerve dysfunction. Data were collected through a semi-structured questionnaire and analyzed using SPSS version 25. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to present the data. Results: Out of 102 patients, 59 (57.9%) were male, and 43 (42.1%) were female, with a mean age of 38.2 ± 10.36 years. The majority of patients (41.1%) were in the 31-40 years age group. Right-side facial palsy was more prevalent, affecting 64 (62.7%) patients. The House-Brackmann grading revealed that 49 (48.2%) patients were in Grade IV, 24 (23.5%) in Grade V, 15 (14.7%) in Grade III, 8 (7.8%) in Grade VI, and 6 (5.8%) in Grade II. Bell’s palsy was the most common cause, accounting for 52 (51%) cases, followed by external trauma in 22 (21.6%) patients, infections in 18 (17.6%) patients, and tumors in 10 (9.8%) patients. Treatment outcomes showed complete recovery in 65 (63.7%) patients, incomplete recovery in 28 (27.5%), and no recovery in 9 (8.8%). Conclusion: Facial nerve palsy was more common in male patients, with the right side of the face being predominantly affected. Bell’s palsy was identified as the leading cause. The study highlights the importance of early diagnosis and intervention, particularly physiotherapy, in managing facial nerve palsy. Further research is recommended to explore long-term outcomes and optimize treatment strategies.

Enhancing WHO Prescription writing guideline adherence through an educational intervention - a quality improvement study of Azad Jammu and Kashmir.

Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices. A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. We recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages. An improvement in compliance was observed during the 2nd audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). We also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the 2nd audit cycle. This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in better quality of care for patients.

Yoga Exercises as a Therapeutic Approach for Adults with Insomnia to Promote better Sleep: A Randomized Control Trial

Background: Insomnia is a prevalent sleep disorder that significantly impacts the quality of life and is associated with various health complications, including high blood pressure, heart disease, diabetes, anxiety, and depression. Traditional treatments for insomnia often involve pharmacological interventions, but there is growing interest in alternative therapies such as yoga. This study investigates the efficacy of yoga as a therapeutic approach to improving sleep quality in adults with insomnia. Objective: The objective of this study was to evaluate the effects of a structured yoga program on sleep quality and sleep latency in adults diagnosed with insomnia. Methods: The study employed a cross-sectional design conducted at multiple healthcare facilities, including the Physiotherapy Outpatient Department at Holy Family Hospital, Benazir Bhutto Hospital, and District Headquarters Hospital in Rawalpindi. The study duration was four months, involving 54 participants selected through random sampling techniques. Inclusion criteria included adults aged 18 to 65 years diagnosed with insomnia according to the International Classification of Sleep Disorders (ICSD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). Exclusion criteria included severe medical or psychiatric disorders, substance abuse, pregnancy, or recent changes in sleep medication. Participants in the intervention group engaged in a standardized yoga program consisting of gentle yoga postures, controlled breathing techniques, and mindfulness meditation, conducted twice weekly for eight weeks, with each session lasting 60 minutes. The control group received standard care for insomnia. Data collection involved subjective assessments of sleep quality using validated questionnaires and objective measures through polysomnography. Statistical analysis was performed using SPSS version 25.0, with independent sample t-tests comparing means between groups and repeated measures ANOVA for within-group analysis. Results: The yoga group showed significant improvements in subjective sleep quality and sleep latency. The mean sleep quality score improved from 2.18 ± 0.66 pre-intervention to 0.92 ± 0.37 post-intervention (p=0.0001), while the control group showed a less marked improvement from 2.37 ± 0.48 to 2.03 ± 0.18 (p=0.0012). Sleep latency in the yoga group decreased from 3.00 ± 0.00 to 1.29 ± 0.40 (p=0.0002), whereas the control group showed a reduction from 2.44 ± 0.49 to 2.11 ± 0.31 (p=0.0013). ANOVA results confirmed the statistical significance of these findings, with an F-value of 69.897 for sleep quality (p=0.0001) and 361.947 for sleep latency (p=0.0002). Conclusion: The findings indicate that a structured yoga program significantly improves sleep quality and reduces sleep latency in adults with insomnia. Yoga appears to be an effective non-pharmacological intervention for managing insomnia, offering a viable alternative to traditional treatments.

Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight.

Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers' (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW. This qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network's Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach. The HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers. The HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.

Evaluation of Practices about Pediatrics Cardiac Catheterization among Nurses at District Head Quarter Hospital

Pediatric cardiac catheterization is a critical procedure that plays a vital role in diagnosing and treating congenital heart defects and other cardiac conditions in children. This procedure involves inserting a catheter into the heart chambers or vessels through a vein or artery. Nurses play multifaceted roles throughout the continuum of cardiac catheterization. Objective: To evaluate the practices of nurses about pediatrics cardiac catheterization. Methods: This study employed cross-sectional descriptive design at pediatric department of a District Head Quarter (DHQ) Hospital. Target population was registered nurses of age above 20 years and who had at least 6 months of practical experience with cardiac pediatric patients. Data were collected conveniently through observational checklist and analysis was done through SPSS Version 24.0. Results: Majority nurses were not encouraging bed rest to the pediatric patients nor keep affected extremity bend for 2-4 hours (80%) after catheterization. Moreover, they did not regularly check the vitals of the children and unable to monitor in every 15 minutes /hour or 30 minutes for next hour (81%). Nurses were unable to educate the pediatric parents for the removal of pressure dressing and nor assess the dressing site appropriately (92%). Conclusions: The present study findings suggested that majority nurses have poor practices before and after cardiac catheterization procedure while some have an average level of practices during the procedure. So, training programs should be arranged to enhance the practices of nurses about cardiac catheterization in pediatric population.

Characteristics of Tinnitus and its Association with Clinico-Demograhic Factors & Mental Health

Objectives: To determine the characteristics of tinnitus and its association with clinical and demographic variables including psychological health. Methodology: This cross-sectional study recruited 80 tinnitus cases from ENT outpatients of District Head Quarter Hospital Chakwal from over a period of 6 months from 1st Jan 2019 to 31st June, 2019, using convenience sampling. Sample included both genders, aged 18-75 years with tinnitus for at least three months. Tinnitus Handicap Inventory (THI) & Depression Anxiety and Stress Scale 21 (DASS-21) were used for data collection & analysis done using SPSS-version 20. Anova statistics & Pearsons correlation was determined for THI and DASS-21. Chi-square test was used to see any association with clinic-demographic variables. P<0.05 was considered significant. Results: Study revealed 30(37.5%) cases with mild, 20(25%) each with moderate and severe while least 4(5%) catastrophic tinnitus. Tinnitus severity was significant associated with gender (p=0.005), age (p=0.035), educational level (p=0.049), occupation (p=0.002), duration of tinnitus (p=0.038), site of tinnitus (P<0.001) and type of tinnitus sound (P=0.003). Duration of tinnitus was associated with anxiety (p=0.024), site of tinnitus was associated with THI (p=0.016), anxiety (p=0.021), stress (p<0.001) and depression (p=0.02) and total DASS-21 (p=0.005). A significant positive correlation was present between tinnitus handicap, Anxiety, stress, depression and DASS-21 total score (P<0.001). Conclusion: Mild tinnitus was most prevalent (37.5%) with Tinnitus severity having significant association with gender, age, educational level, occupation, duration of tinnitus, site of tinnitus, and type of tinnitus sound. Duration of tinnitus was also associated with anxiety while site of tinnitus has association with THI, anxiety, stress, depression and total DASS-21. Significant positive correlation is present between THI and Anxiety, stress, depression and DASS-21 total score.

Evaluation of the District Health Information System in District Kotli, Azad Jammu and Kashmir: A Retrospective Analysis.

It is essential to implement a high-quality electronic database for keeping important information. The District Health Information System (DHIS) is an active data-keeping system in Pakistan. This study aimed to evaluate the patients' data from the DHIS dashboard for the District Headquarters Hospital, Kotli, Azad Jammu and Kashmir (AJK). The data was requested from the hospital administration at District Headquarters Hospital, Kotli, AJK, and the data was analyzed after permission was granted. The data was given in two forms; one was a hard copy of the data for August and September and the other was a comma-separated values file for October and November, 2023. The highest frequency of patients was received in the department of emergency and trauma and the patient's median age was between 15 and 49 years. The second department was medicine with the >50 years of age. Common conditions that needed more attention were chronic obstructive pulmonary disease, acute respiratory infection, diarrhea, pneumonia, diabetes mellitus, hypertension, and ischemic heart disease. For nations with constrained healthcare systems and funds, primary health care (PHC) is the only viable approach for managing non-communicable diseases (NCDs). However, PHC systems intended for infectious diseases have not sufficiently adapted to the growing requirement of chronic care for NCD. Research using health information databases offers numerous benefits, such as the evaluation of large data sets and unexpected prevalence of disease in certain populations, such as a higher prevalence of disease in one gender or age group. Health information system-based data analysis or studies are less expensive and faster but lack scientific control over data collection.

Epidemiology and clinical features of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan.

Current cross-sectional study was carried out between September 2019 to January 2020 at the Department of Pathology, Mardan Medical Complex (MMC), Mardan, and District Headquarter Hospital North Waziristan, Khyber Pakhtunkhwa (KP), Pakistan. The objectives of the current study were to determine the prevalence of leishmaniasis and its associated risk factors in selected districts of KP province, Pakistan. Altogether, three hundred and seventy-four (n=374) leishmaniosis patients were included in the current study. Skin specimen from the ulcer border were collected. The slides were stained by Giemsa stain and examined for the presence of amastigote. The prevalence of leishmania infected patients in different region of KP were as follows: North Waziristan region 53.7 (n=201) District Mardan 34.7% (n=130); District Nowshera 6.7% (n=25), District Swabi 1.1% (n=4) and other Districts i.e. Dir, Malakand, Buner and Bajawarr were 3.7% (n=14). The frequency of leishmaniasis were more in male and majority of the infected patients were in the age group of <10 years. Among n=374 patients 95.7% (n= 358) had cutaneous leishmaniasis while 3% (n= 11) had mucocutaneous type of infection and 1.3% (n= 5) patients had both cutaneous and mucocutaneous infection. Upon treatment by Sodium stibogluconate (SSG) 97% (n=362) showed clinical signs of complete or partial recovery of their skin lesions. Conclusively, highest incidence of leishmania infection occurred during short study period and majority of the cases showed positive response to treatment.

Evaluation of Hemodialysis Complications among Children with Chronic Kidney Disease at District Head Quarter Hospital, Nankana Sahib

A patient with chronic kidney disease depends on hemodialysis to mechanically remove fluid, electrolytes, and waste products from the blood. Chronic kidney disease (CKD) is a universal matter of concern that affects around 15% of the population globally. Objective: To evaluate hemodialysis complications among children with chronic kidney disease. Methods: A cross-sectional descriptive study was carried out at the renal department of DHQ hospital. The duration of study was six months from April to September, 2023. The sample size was 45 children on hemodialysis with kidney disease. A purposive sampling technique was used. Data were gathered through self-administrated questionnaire. Data were analyzed through SPSS-25.0 and results were presented in the form of frequencies tables. Results: Majority of the participants suggested that initiation of hemodialysis lead to cardiovascular problems (72%), anemia (83%), and metallic taste (79%) in children. Moreover, majority of them complained about skin problem and itching as an adverse effect (78%). Other complications as indicated by participants are headache, restlessness, vertigo, nausea and vomiting (86%). Conversely, some subjects did not considered the hypertriglyceridemia (27%), gastric problems (31%), sleep problems (24%) and muscular pain (34%) as the result of initiation of hemodialysis procedure. Conclusions: Findings of present study suggested the most common complications of hemodialysis are hemodynamic instability, anemia and hypertension/hypotension, skin problems and itching. Other complications of hemodialysis as indicated by participants are headache, restlessness, vertigo, nausea, vomiting and decease concentration in children. However, most of the participants have limited understanding about additional complications of hemodialysis.

Gender as a threat for type 2 diabetes mellitus: Elevated fasting glucose, insulin, and HOMA-IR levels in females.

Objective: The research aimed to compare serum levels of fasting plasma glucose, 2hrpp, fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and waist-to-height ratio in individuals with a diabetic background. Study Design: Cross-sectional Observational draft. Setting: District Headquarters Hospital, Gujranwala. Period: December 22, 2020, to December 22, 2022. Material &amp; Methods: Overall, 80 healthy participants, 20-50 years old, were recruited and graded into two groups based on gender. Group A comprised males, and Group B comprised females. All participants demonstrated normal glucose tolerance centered on the oral glucose tolerance test. Results: Females exhibited significantly higher mean levels of fasting plasma glucose (p=0.01), fasting plasma insulin (p=0.004), and Homeostasis Model Assessment of Insulin Resistance (p=0.007) compared to males. Homeostasis Model Assessment of Insulin Resistance and waist-to-height ratio exhibited a positive correlation (p=0.001). Conclusion: Females with a positive family history may present an amplified threat of Type 2 Diabetes Mellitus.

KNOWLEDGE, ATITUDE AND PRACTICE AMONG DOCTORS REGARDING COVID-19 TRANSMISSION IN DHQ HOSPITAL, NAROWAL

KNOWLEDGE, ATITUDE AND PRACTICE AMONG DOCTORS REGARDING COVID-19 TRANSMISSION IN DHQ HOSPITAL, NAROWAL&#x0D; Muhammad Tariq1 &#x0D; 1 District Health Officer, Narowal&#x0D; ABSTRACT&#x0D; BACKGROUND &#x0D; Corona virus disease-19 (COVID-19) has highlighted vulnerability to pandemics with significant impact on various sectors. Health care workers (HCWs) are likely to become infected as a result of inadequate knowledge, incorrect attitudes and practices. Given the severity of the epidemic and the necessity of doctors battling COVID-19 with limited resources in Pakistan, it was necessary to examine their knowledge, attitude and practices.&#x0D; OBJECTIVE: &#x0D; To determine knowledge, attitudes and practices (KAP) among doctors working in District Headquarter Hospital (DHQ) Hospital, Narowal regarding COVID-19 infection.&#x0D; METHODS:&#x0D; This descriptive cross-sectional survey was conducted in District Headquarters Hospital (DHQ) Narowal for a period of six months from 26th September 2021 to 26th February 2022. Questionnaire was divided into three components and gathered information about demographic data, knowledge of COVID-19 and their practice section that involves steps taken by the participant to prevent contracting the infection and data was analyzed.&#x0D; RESULTS: &#x0D; In this study comprising of 382 doctors as participants, 351 (91.9%) participants were in 25–35 years age range while 21 (5.5%) participants were between 35-45 years and 10 (2.6%) were &gt; 45 years of age. Out of 382 participants, 209 (54.75%) were males and 173 (45.3%) were females. 263 (68.8%) reside in rural areas while 119(31.3%) had urban dwelling. According to duration of service, 191 (50% ) respondents had service duration of 0-5 years, followed by 99 participants (25.9%) having service length of 6-10 years, while 51(13.5%) of 11-15 years, 23 (6.02%) of 16-20 years &amp; 18 (4.71%) of &gt; 20 years. 89.3% have monthly income less than 150,000/- Pakistani rupees while 10.7% receive monthly salary above 1.5 lac rupees. 100 (47.8%) male doctors and 80 (46.2%) female doctors stated that their major source of information regarding COVID-19 transmission and precautionary measures was television whereas 80 (38.3%) male doctors and 69 (39.9%) female doctors had internet as major source of information. Results showed that mean knowledge score of female doctors was higher as compared to male doctors (11.91±.718 vs.11.97±.184). 100% doctors had good knowledge and &gt;9 5% doctors possess positive attitude and have adopted safety practices to protect themselves from COVID-19 infection. Results also showed that mean attitude score of female doctors was higher as compared to male doctors.&#x0D; CONCLUSION: &#x0D; Participants indicated high level of awareness, optimistic attitude and appropriate practices observed during Covid-19 pandemic. Educated people are more likely to believe the scientific facts thus more compliance with preventive measures. Findings of this study might serve as baseline for planning campaigns at National level to create awareness among general masses which would help them in adopting preventive measures for better containment of Covid-19.&#x0D; KEY WORDS: &#x0D; COVID-19, Pandemic, Awareness, Attitude, Practices, Healthcare providers, Narowal

Chronic kidney disease associated with hypertension

Background: Globally, chronic kidney disease (CKD) is acknowledged as a major public health issue. Both the incidence and prevalence of chronic kidney disease (CKD) are rising with immense pace worldwide. Hypertension and diabetes mellitus is the main risk factor of chronic kidney disease. Objective: To determine chronic Kidney disease associated with hypertension Methods: A cross-sectional study was conducted at district headquarter hospital, Mianwali, Pakistan, which was performed between June 2020 and February 2022, the total number of patients in our study were 120. The number of Male patients were 49 and female were 71. In 120 consecutive patients who underwent for blood tests and Blood pressure monitoring. We also took stages of chronic kidney disease (CKD stage 1,2,3A,3B,4 and 5). We did renal function test for all patients (serum creatinine and serum urea). Data was tabulated and analyzed by SPSS. Results: In a current study total 120 patients were enrolled. The minimum age of patients were30 and the maximum age of the patients were 84. The mean age were 50.60±10.9 years. The minimum systolic blood pressure were 130 and maximum systolic blood pressure were 200. The mean systolic blood pressure were 149.55±13.5. The minimum diastolic blood pressure were 80 and the maximum diastolic blood pressure were 100. The mean diastolic blood pressure were 89.57±3.76 The frequency of male patients were 49 and its percentage were 40.8. The frequency of female patients were 71 and its percentage were 59.2. The frequency of age group 30-50 years were 61 and its percentage were 50.8. The frequency of age group 51-70 years were 52 and its percentage were 43.3. The frequency of age group &gt;70 years were 7 and its percentage were 5.8. The mean of renal functional test Serum creatinine were 7.82 mg/dl and its SD value were 3.59 mg/dl. The mean of renal functional test Serum urea were 109.90 mg/dl and its SD value were 24.30 mg/dl. · The mean glomerular filtration rate were 20.36 ml/min and its SD value were 13.2 ml/min. · The mean weight of patients were 56.61 kg and its SD value were 10.19 kg. · The P-value of stages of Chronic kidney disease (CKD) were 0.133. The P-value of hypertension were 0.074. Conclusion: Hypertension and diabetes mellitus is the main cause of Chronic kidney disease (CKD). Stage 5 Chronic kidney disease (CKD) patients were more in our study as compare to other stages of CKD. We concluded in our study that after age of 30, patients have higher risk of Chronic kidney disease (CKD).

Malnutrition and associated factors among sick children needing hospital care in District Umerkot, Pakistan

Background: In the Umerkot area of Pakistan, where malnutrition is common, a local hospital discovered that one-third of the hospitalized children were undernourished. The purpose of this research was to identify the prevalence of malnutrition and its associated among pediatric inpatients. &#x0D; Methods: A cross-sectional research was carried out on 298 children who were hospitalized to the District Headquarter Hospital in Umerkot and ranged in age from 06 months to 05 years. In order to determine malnutrition in accordance with WHO guidelines, anthropometry measures such as mid-upper arm circumference (MUAC) were taken. The clinical diagnosis, immunization history, and food intake were documented. &#x0D; Results: The prevalence of malnutrition was 34.6%, with moderate (26.5%) and severe (8.1%) cases included. In children, underweight afflicted 29.5%. Common diagnoses during admission were measles (18.8%), pneumonia (17.4%), and diarrhea (15.8%). Malnutrition was significantly correlated with inadequate food intake and an age-inappropriate vaccination rate of 8.7%, which is in agreement with previous research results. &#x0D; Conclusions: In order to address the critically high prevalence of inpatient malnutrition, pediatric care must include standards for nutritional assessment and treatment as well as capacity development. In local communities, it's also critical to do routine growth monitoring and to promote immunization, proper hygiene, and balanced diets.&#x0D; Keywords: Malnutrition; Pediatrics; Nutritional status; Mid-upper arm circumference; Pakistan

Preliminary Study on Gynecological Disease in District Buner Khyber Pakhtunkhwa, Pakistan

Background: Gynecological diseases significantly impact women's health, yet there is limited comprehensive data on their prevalence and nature, particularly in developing regions. District Buner, located in Khyber Pakhtunkhwa, Pakistan, presents a unique demographic for studying these diseases due to its distinct socio-cultural and economic context. Objective: This study aims to ascertain the prevalence and variety of gynecological diseases in District Buner, offering insights into the specific health challenges faced by women in this region. Methods: Conducted from October 2019 to October 2020, this study involved a systematic examination of 480 patients in District Buner, spanning various age groups and backgrounds. Data were collected from local healthcare facilities, including the District Headquarters Hospital and Buner Medical Complex. The study focused on identifying and quantifying 30 different gynecological conditions, using both direct consultations with healthcare professionals and review of medical records. Results: The study uncovered high prevalence rates of several gynecological diseases, with Urinary Tract Infections (90%), Anemia (92%), and Leucorrhea (98%) being the most common. Other significant findings included Polycystic Ovarian Syndrome (52%), Pelvic Inflammatory Diseases (70%), and Uterine Prolapse (68%). The data revealed the complex interplay of socio-cultural and biological factors influencing women's reproductive health in the region. Conclusion: The findings highlight a critical need for targeted healthcare interventions, increased awareness, and resource allocation to address the prevalent gynecological conditions in District Buner. This study serves as a vital reference for healthcare policymakers and practitioners in developing effective strategies to improve women's health outcomes in the region.

Prevalence of Goiter Disease to the Human Population of District Buner, Khyber Pakhtunkhwa, Pakistan

Background: Goiter, an enlargement of the thyroid gland, continues to be a significant global health issue, affecting approximately ten million people worldwide. The prevalence of goiter is notably influenced by geographical and environmental factors, such as soil iodine content, especially in hilly terrains. Prior research has indicated a gender and age-related predisposition to the condition, with varied prevalence across different regions. Objective: This study aimed to ascertain the prevalence and demographic distribution of goiter in District Buner, Khyber Pakhtunkhwa, Pakistan, and to compare these findings with data from other regions to better understand the condition's epidemiological characteristics. Methods: A cross-sectional study was conducted from September 2021 to September 2022. A total of 280 patients from six tehsils within District Buner were investigated through questionnaires and medical examinations by healthcare professionals. Data collection occurred weekly across multiple healthcare facilities, including medical centers, rural health centers, and the District Headquarters Hospital in Buner. Results: Out of 280 patients, 78% were females, indicating a higher prevalence among women. The highest prevalence among males (33%) was recorded at 70 years of age, while for females, it peaked (86%) at 50 years. The majority of cases belonged to the age group of 30-60 years. Multinodular goiter was the most common type observed. The data also reflected a higher incidence of goiter in hilly regions compared to plain areas, likely due to iodine deficiency. Conclusion: The study confirmed that goiter is more prevalent among females and tends to increase with age. The high incidence in hilly areas supports the association with low soil iodine content. This research underscores the need for targeted public health strategies, including iodine supplementation and education, particularly in at-risk areas.

Characterizing cutaneous leishmaniasis in a conflict-affected region: a study from North Waziristan, Pakistan.

Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region. This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis. Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December. This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.

Impact of Short Birth Spacing on Maternal Anemia at District Head Quarters Hospital Nankana Sahib

Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Maternal anemia is one of the commonest complications of short birth spacing that further can enhance the risk of poor fetal and maternal outcome. Objective: To determine the effect of short birth spacing on maternal anemia at District Headquarters Hospital Nankana Sahib. Methods: This analytical cross-sectional study was done at Gynecology and obstetrics Department of District Headquarters Hospital Nankana sahib. A total of 135 pregnant women of 18 to 40 years’ age, 18 to 59 months of inter-pregnancy intervals were included. All the demographic and clinical data was collected according to predesigned questionnaire. Results: In this study all females were anemic, whereas there were 57(42.22%) females had mild anemia, 61(45.19%) females had moderate and 17(12.59%) females had severe anemia. There was association between severity of Hb levels with higher age group, lower socioeconomic status, previous history of vaginal + C-section and females with third trimester. Moreover, there was significantly negative correlation between Hb levels and higher gravida, p-value ≤ 0.05. Conclusions: Itis concluded from the results of our study that all mothers had different degrees of anemia. There was a statistically significant association between severity of Hb levels with higher age group, lower socioeconomic status, previous history of vaginal + C-section and females with third trimester (p &lt; 0.05). While, no significant association and a negative correlation was found between Hb levels and multigravida (r = - 0.181 &amp; p = 0.035).

Effect of left tilt of operating table during elective caesarean section on maternal haemodynamics and vasopressor requirement.

Objective: To compare the effects of left tilt of operating table on maternal hemodynamics and vasopressor requirement in contrast to supine position during caesarean section. Study Design: Comparative Analytical Study. Setting: District Head Quarter Hospital, Rawalpindi. Period: December 2021 to February 2022. Material &amp; Methods: A total of 38 participants were included by the lottery method of randomization into the two groups according to the inclusion and exclusion criteria: supine group and left tilt group. For Supine Group, spinal anesthesia was administered in the sitting position, and then supine position was maintained. For Left tilt group, spinal anesthesia was administered in the sitting position and was then maintained in the supine position until the full anesthetic effect was achieved, and the table was tilted 15 °to the left. The Systolic and the diastolic blood pressures were noted at regular intervals. Data were entered and analyzed using SPSS version 25. Results: The results showed that systolic blood pressure decreased significantly in the supine group (F= 16.65, p&lt; 0.000) compared to the left-tilted group (F= 2.1, p= 0.12). Intraoperative phenylephrine was required by four out of 20 participants in the supine group after 10 and 15 minutes, of out 2/20 participants after 20 minutes and out of 6/18 participants after 30 minutes. None of the participants in the left-tilt group required intraoperative phenylephrine. Conclusion: The left tilted position of the operating table is better than the supine position in terms of maternal hemodynamics and vasopressor requirement during Caesarean section.

Assessment of Lumbosacral Angle Variation Among Middle Adults with Chronic Low Back Pain

Purpose: To Assess Assessment of lumbosacral angle variation in middle adults with chronic low back pain.&#x0D; Methodology: A cross sectional study was conducted with sample size of 267 individuals from middle adults of Sikandar Medical complex Gujranwala, District Headquarter hospital Gujranwala, Gujranwala medical complex, Gujranwala. The population was Middle Adults (45-65) of both genders. Angle was measured by Measuring scale and Protractor using X-ray of lateral view of lumbosacral spine. Obtained data were analyzed using statistical package of social sciences (SPSS).&#x0D; Findings: The data has been obtained from 267 chronic low back pain patient in which 143 were male and 124 were female. Data was collected using lateral radiograph. The results show significant relation between chronic low back pain and lumbosacral angle with p-value ˂0.5. The result further shows that 32 male and 27 female were hypo lordotic while 89 male and 92 female were hyper lordotic.&#x0D; Conclusion: The study concluded that lumbosacral angle increases with chronic low back pain among middle adults. The study also concludes that age, gender also associated with lumbosacral angle variation.&#x0D; Recommendations: Future study needs a through physical examination. This study focuses on radiographs only but future study needs to focus on MRI and CT scan also for better understanding of pain causes. Awareness program should be conducted on causes, prevention, complication and treatment of chronic low back pain among middle adults