Dow University Research Articles

Susceptibility pattern of Ceftazidime-Avibactam against multi drug resistant gram-negative rods

This study was conducted to evaluate the susceptibility pattern of ceftazidime avibactam against multi drug resistant gram negative rods. This prospective study cross sectional study conducted in Microbiology Section of Dow Diagnostic Reference and Research Laboratory, Dow University of Health Sciences, Karachi, Pakistan. Identification of isolates was done in accordance with the standard bacteriological technique, and were distinguished based on gram staining, colony morphology and biochemical tests. Antibiotic susceptibility testing (AST) was performed on Muller-Hinton agar by Kirby-Bauer Disk Diffusion method in accordance with the Clinical Laboratory Standard Institute (CLSI) guidelines. Good sensitivity of Lactose fermenters (Escherichia coli, Klebsiella pneumoniae and Enterobacter) were observed against Ceftazidime avibactam. Pseudomonas aeruginosa exhibited 42% resistance in all clinical samples. Proteus species and Serratia have shown high resistance in our study. Our observations showed the persistence of high ceftazidime avibactam activity against pathogenic and multi drug resistant strains of Enterobacterales and Non lactose fermenting bacteria.

Prevalence of Vitamin D Deficiency in Patients with Autoimmune Thyroid Disorders at Tertiary Care Hospital, Karachi

Background & Objective: Vitamin D deficiency is commonly observed in patients with autoimmune thyroid disorders, potentially influencing disease severity and management. This study aimed to ascertain the magnitude of vitamin D deficiency in those with autoimmune thyroid disorders (AITDs). Methodology: A cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan from February 2024 to June 2024. Patients who attended the outpatient department and were diagnosed with AITDs, such as autoimmune hypothyroidism and Grave's disease, based on positive anti-thyroid antibodies were included in the study. The 25-hydroxy vitamin D levels in these patients were then measured. Results: The study had 60 participants, with a mean age of 35.23 ± 9.934 years. The majority of participants had low vitamin D levels (28.3% had insufficient and 48.3% had deficient levels). Additionally, it was discovered that vitamin D status and AITDs were related, where a majority of individuals had low vitamin D levels (P-value = 0.014). Further, it was revealed that anti-TPO antibodies followed by the presence of anti-TG antibodies were more indicative of low vitamin D levels. Conclusion: The individuals with AITDs, specifically hypothyroidism had a noticeably higher prevalence of vitamin D deficiency followed by insufficiency.

Comparative Analysis of Effect of Lidocaine and Adrenaline Soaked Gauze Versus Normal Saline Soaked Gauze at Skin Graft Donor Site of Thigh: A Randomized Control Trial

Objective: To compare the hemostatic effect of Lidocaine and Adrenaline soaked gauze with normal saline soaked gauze at skin graft donor site of thigh. Study Design: Randomized control trial (Trial ID: NCT04344483). Place and Duration of Study: Plastic & Reconstructive Surgery Department, Dow University of Health Sciences Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun to Oct 2020. Methodology: A randomized controlled trial was carried out on 60 Patients under treatment in burn surgery unit. Patients were randomly assigned to 2 groups. Patients in both groups at donor sites received subcutaneous infiltration for 10 minutes, either with 2% Lidocaine and 1:100,000 Adrenaline soaked gauze or with normal saline soaked gauze. Outcomes included intraoperative bleeding, number of dressings required in first 24 hours after surgery, post-operative pain in first 24 hours, systemic analgesia requirement after surgery within 24 hours and donor-site epithelization at 14th post-operatively. Statistical Package for Social Sciences version 25 was used to analyze the data. Results: out of 60 patients, the mean age was estimated as 36.58±12.42 years and 44(73.3%) patients were males while 16(26.7%) were females. Statistically significant difference was observed in number of dressings (p=0.001), mean pain score in first 24 hours (p=0.001), intra-operative bleeding (p=0.001) and systemic analgesia requirement in 24 hours of surgery (p=0.001) between both groups. Conclusion: In comparison to normal saline soaked gauze, the Lidocaine and Adrenaline soaked gauze was effective in terms of number of dressings, pain in first 24 hours, intra-operative

Determining how the gestational changes, including low hemoglobin influence the hba1c and estimated average glucose relationship

ABSTRACT Background: Gestational Diabetes Mellitus (GDM) affects up to 14% of pregnancies globally, with accurate glycemic control critical for preventing adverse outcomes. While HbA1c is a standard marker for long-term glucose control, its reliability in pregnant women with anemia is debated. This study explores the association between anemia and glycemic indicators (Glycosylated hemoglobin HbA1c, Random plasma glucose (rPG), and Estimated average glucose (eAG) in pregnant women with GDM. Additionally, it examined the correlation between average glucose levels or eAG, measured by random plasma glucose rPG, and HbA1C. Methods: A prospective case-control study was carried out over eight months at the Departments of Chemical Pathology and Obstetrics and Gynecology, Dow University of Health Sciences (DUHS). Pregnant women in their second trimester after being diagnosed for GDM through oral glucose tolerance test were classified into anemic (hemoglobin < 10.5 g/dL) and non-anemic groups. Blood samples were collected and analyzed for HbA1c, hemoglobin, and random plasma glucose levels. Data were processed using SPSS (version-26) different variables compared by using independent t-test and correlation analyses at a significance level of p < 0.05. Results: Mean values for eAG, HbA1C, and rPG were 174.22 ± 24.489 mg/dl, 8.342 ± 1.6152%, and 166.21 ± 21.478 mg/dl, respectively. Anemia was associated with significantly higher HbA1C (p < 0.001), eAG (p < 0.001), and rPG (p = 0.004). A strong positive correlation was observed between eAG and rPG (r = 0.958, p < 0.01), while eAG showed a moderate correlation with HbA1C (r = 0.501, p < 0.01). In contrast, the correlation between HbA1C and rPG was weaker (r = 0.331, p < 0.01). Conclusion: eAG proved to be a good indicator for assessing glycemic control in pregnant non-anemic women with GDM. Anemia significantly affected glycemic metrics, leading to higher HbA1C and glucose levels.

Anatomical Variation of the Olfactory Fossa According to Keros and Yenigun Classifications in Karachi, Pakistan.

The goal of our research is to assess the olfactory fossa anatomical variation through Keros and Yenigun classification by computed tomography (CT) scan of paranasal sinuses (PNS), as in order for surgeons to prevent major complications, they must be familiar with its variations in anatomy during functional endoscopic sinus surgery (FESS) related to anterior ethmoidal artery injury, as its course varies with depth and length of the olfactory fossa. At Karachi's Dow University of Health Sciences (DUHS), retrospective research was carried out. From anterior to posterior, sequential coronal and axial pictures were examined, and the existence and location of further anatomical characteristics were documented. A consultant radiologist used the picture archiving and communication system (PACS) software to do the review. The depth of the olfactory fossa and anterior-posterior length were measured. We utilized OpenEpi version 3 to compute the sample size findings. The estimated sample size was calculated as 249 by taking the prevalence of 63.5% for type 2 Keros classification, with a margin of error of 6% and a confidence level. The median length for the olfactory fossa depth (Keros) for the left and right sides were 6.2 (2.2-10.9) mm and 6.0 (2.8-10.4) mm, respectively. The median anteroposterior length of the cribriform plate (Yenigun) for the left and right sides were 11.4 (6.1-19.2) mm and 11.2 (6.0-18.0) mm, respectively. According to Keros Classification, type 2 was observed as the most prevalent category on the right side for both females and males, with 97/122 (79.5%) and 106/127 (83.5%) individuals, respectively. The chi-square test was applied for the analysis of gender and classification. Keros type 2 was observed to be the most prevalent in both males and females. Similarly, type 2 was also seen to be the most prevalent in the Yenigun classification in both genders. No statistical difference was found in both classifications (p = 0.39). In most of the literature, type 2 has been the most commonly dominated type. The reason seems due to the variation in genes and anatomy of the human PNS. Preoperative planning should take the morphological characteristics of the ethmoidal roof into account. Understanding the ethmoidal roof morphology among populations may be improved by looking at bigger patient groups and meta-analyses that compile different study findings on this topic.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Comparative Study of Inhaled Corticosteroids and Leukotriene Receptor Antagonists As Controller Options for Mildly to Moderately Persistent, Stable Asthma.

Asthma is a chronic inflammatory disease of the airways characterized by bronchoconstriction, airway hyperresponsiveness, and variable airflow limitation. This results in symptoms such as wheezing, difficulty breathing, chest tightness, chest pain, and coughing. The primary objective of the study is to compare the efficacy of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRA) in improving asthma control, lung function, and quality of life in patients with mild to moderate persistent asthma. This prospective comparative study was conducted at Khyber Teaching Hospital and Dow University Hospital from January 2018 to July 2021. 210 patients suffering from asthma were included in the study. Patients aged 18 years and older, diagnosed with mild to moderate persistent asthma as per Global Initiative for Asthma (GINA) guidelines, and requiring pharmacological intervention were included in the study. Participants were randomly allocated into two groups.Treatment efficacy was compared based on asthma control (Asthma Control Test (ACT) score), lung function (forced expiratory volume in one second (FEV1),peak expiratory flow rate (PEFR)), and quality of life using validated questionnaires. In this study involving 210 patients with asthma, Group A (ICS) had a mean age of 36.23 ± 7.09 years, while Group B (LTRA) had a mean age of 35.23 ± 8.01 years. Both groups exhibited similar baseline asthma control, as indicated by ACT scores of 17.2 ± 3.5 for Group A and 16.8 ± 3.2 for Group B. Significant improvements were observed in both groups at the end of the study, with ACT scores rising to 21.8 ± 2.1 (p < 0.001) for Group A and 20.5 ± 2.5 (p < 0.001) for Group B. Additionally, lung function, measured by FEV1 and PEFR, showed similar enhancements; Group A improved from a baseline FEV1 of 2.5 ± 0.8 L to 3.2 ± 0.6 L (p < 0.01), while Group B improved from 2.4 ± 0.7 L to 3.0 ± 0.5 L. The PEFR values also increased significantly from 300 ± 50 L/min to 380 ± 40 L/min (p < 0.001) for Group A and from 290 ± 45 L/min to 360 ± 30 L/min (p < 0.001) for Group B. Both treatments were well-tolerated, with adverse events being low and comparable between the groups. This study reveals that both ICSand LTRAsignificantly improve asthma control, lung function, and quality of life in patients with mild to moderate persistent asthma, with ICS showing superior efficacy. ICS led to greater improvements in ACT scores and lung function parameters, supporting its use as a more effective treatment option in this patient population.

Oral Health and Nutritional Status of Children Dwelling in Urban and Suburban Areas

Background: Literature has suggested that there is evidence regarding the impact of nutritional status on the overall oral health of children and adolescents. The study objectives were to investigate oral health and nutritional status in children in terms of dietary intake, and to determine the anthropometric measures and correlate the oral health &amp; nutritional status in urban and sub-urban children. Method: An analytical cross-sectional study was conducted from September 2022 to March 2023. Total of 267 children from Urban and sub-urban regions age 12-18 years were included using the convenience sampling technique. Urban data was collected from Dow University’s dental OPD and private schools in Karachi, while suburban data was gathered from Long Khoso village near Hyderabad. Non-clinical data as well as clinical data which included oral examinations like dental caries status, oral hygiene status, periodontal condition, fluorosis malocclusion, and anthropometric measurements were gathered. SPSS v.21 was used to analyze data. Chi-square and correlation were applied between oral health status and anthropometric measurements. P-value ≤0.05 was considered statistically significant. Results: Area of residence was found to be significantly associated with habits, milk intake, oral hygiene practices, dental caries, and oral hygiene index (p-value &lt; 0.001). A significant relationship was found between the area of residence and height (p-value 0.001). It was seen that anthropometric scores were low in suburban children. Conclusion: This study highlights a positive oral health status among all, with a high prevalence of healthy periodontal tissue and low caries severity reported in Urban as compared to suburban children.

Immunostaining Patterns of CD10 in Fibroadenomas and Phyllodes Tumours of Breast

Background: Accurate differentiation between fibroadenomas and phyllodes tumours (PTs) is challenging due to overlapping morphological features. CD10, an immunohistochemistry (IHC) marker, has shown promise in distinguishing these breast lesions. This study aimed to evaluate CD10 expression patterns in fibroepithelial lesions (FELs) of the breast. Methodology: This cross-sectional study was conducted in the Histopathology Department, at Dow University of Health Sciences over 1 year (01st Jan 2023 to 15th Dec 2023). Through the purposive sampling technique, the female patients having FELs were diagnosed by Consultant Pathologists as fibroadenomas or PT and were included in the study by employing specific histological parameters on H &amp; E slides. Immunohistochemistry with CD10 antibody was conducted on a total of 120 samples with an equal split of fibroadenomas, benign PT, borderline PT, and malignant PT (30 cases each), assessing stromal cell staining and categorizing expression as negative (&lt;10% positivity), weak (10–30% positivity), or strong (&gt;30% positivity). Data was statistically analyzed by using SPSS version 26 including reporting mean ± S.D for continuous data and utilizing the Chi-square test to assess associations, with significance set at p&lt;0.05. Results: Negative CD10 expression was observed in fibroadenomas and benign PT, while borderline and malignant PT exhibited weak and strong positive CD10 expression. The analysis revealed a highly significant association (p-value &lt; 0.001) between CD10 expression levels and the various forms of breast lesions. This strong statistical correlation indicates that CD10 could be an important biomarker for assessing the nature of breast lesions. A low p-value reinforces the reliability of the findings, suggesting that the observed differences in CD10 expression are unlikely to be due to random chance. Conclusion: The findings of the study suggest that CD10 expression could assist as a valuable marker for differentiating between FELs of the breast. Moreover, it may serve as an indicator of the aggressiveness and metastatic potential of PT.

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.

The effect of health education on quality of life (QOL) among polycystic ovary syndrome (PCOS) females at Karachi, Pakistan.

To evaluate the effect of nurses-led health education intervention on quality of life among polycystic ovary syndrome females. The quasi-experimental study was conducted from May to August 2022 at the Obstetrics and Gynaecology outpatient department of Dow University Hospital, Karachi, and comprised married females aged 18-45 years, who were diagnosed with polycystic ovary syndrome based on the Rotterdam criteria. Nurses-led health education intervention session was conducted for all the patients. Data was collected using the self-administered polycystic ovaries syndrome quality of life scale. Data was analysed using SPSS 26. Of the 50 females, 26(52%) were aged 26-35 years. There was a significance difference between baseline and postintervention scores across all domains of quality of life (p<0.05). Also, baseline body mass index of the participants was 30.4±4.711 which went down post-intervention to 29.4±4.800 (p<0.001). Nurses-led health education intervention improved the quality of life and body mass index of polycystic ovary syndrome patients.

Histopathological pattern in endometrial biopsies in reproductive age group and Post-menopausal women.

To identify and analyse the different types and frequencies of morphological pattern in endometrial biopsies along with their associated diagnoses across different age groups. The cross-sectional study was conducted at the Histopathology Section of the Dow Diagnostics Reference and Research Laboratory, Dow University Health Sciences, Karachi, from October 2022 to October 2023. Data was obtained from pre-existing medical record of samples of endometrial biopsies. Open Epi sample size calculator is used for the estimation of sample size. The patients were divided into two aged-based groups; reproductive age ≤45 years in group 1 and postmenopause age ≥46 years in group 2. The histological diagnosis was made by a consultant histopathologist. Of the 430 endometrial biopsies 222(51.6%) were in group 1 and 208(48.4%) were in group 2. In both groups, the most common finding was polyps 271(63%). Malignant changes were found in 12(5.7%) group 2 cases compared to 4(1.8%) group 1 cases. The most common endometrial lesion in both age groups was endometrial polyp. Malignant changes were seen more in postmenopausal women compared to those in the reproductive age group.

Association of pre-op TSH levels with Thyroid Carcinoma in a Tertiary Care Setup in Karachi, Pakistan

Objectives: This study aimed to explore the relationship between pre-operative TSH levels and the presence of thyroid cancer in patients with nodular thyroid disease in the Pakistani population, using data gathered from patients treated at Dr. Ruth K. M. Pfau Civil Hospital Karachi. Study Design &amp; Setting: A cross-sectional study was conducted at the Dow University of Health Sciences and Dr. Ruth K. M. Pfau Civil Hospital Karachi from January 2022 to December 2022. Methodology: Patients with thyroid swellings (presenting with either solitary nodules or with multinodular goiter), both benign as well as suspected/confirmed malignancy based on FNAC results were recruited in the study. Preoperative TSH levels, along with other clinical data, were collected. Thyroidectomy was carried out in patients fulfilling the criteria for surgery, with specimens sent for histopathology. An independent t-test was used to compare TSH levels between malignant and benign nodules. Results: A total of 82 patients were enrolled. Malignancy was confirmed in 41.5% (25 papillary carcinoma, 9 follicular carcinoma). Significantly higher mean TSH levels were observed in patients with malignant nodules (4.76 IU/mL) compared to those with benign nodules (2.48 IU/mL) (p &lt; 0.001). Conclusion: This study suggests a potential association between elevated pre-operative TSH levels and thyroid cancer in the Pakistani population. These findings warrant further investigation to explore causality and potential underlying mechanisms. The study highlights the value of TSH monitoring, particularly in resource-constrained settings.

Association of Refractive Errors with Axial Length and Anterior Chamber Depth in Different Age Groups

Purpose: To determine association of refractive errors with axial length and anterior chamber depth in different age groups. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department of Dow University Hospital (Ojha campus),Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan from October 2020 to December 2020. Methods: Eighty-three individuals of different age groups ranging from 11-80 years were included in the study.Ocular measurements including refractive error, axial length, and anterior chamber depth were determined in all participants. The association of refractive error with anterior chamber depth and axial length was tested by using two independent sample t test, Mann-Whitney U test and ANOVA. Results: Among 83 individuals, males were 42.2% (n=35) and females were 57.8% (n=48). Most common type of refractive error was astigmatism which was found in 48.2% (n=40) participants. The overall average depth of anterior chamber (mm) and average axial length (mm) were 3.11±0.39 and 23.27±0.87 respectively. Mean differences in anterior chamber depth were statistically significant among different age groups . Statistically significant differences in mean axial length were found among different refractive errors . Conclusion: These results show a significant relation of different refractive errors with axial length and anterior chamber depth and it can be helpfulin explaining the risk factors of different ocular diseases as well asit can also be helpful in clinical and diagnostic purposes in ophthalmology.

Factors Associated with Diabetic Foot Ulceration among Diabetes Mellitus Type 2 Patients at Dow University Hospital, Karachi

Factors Associated with Diabetic Foot Ulceration among Diabetes Mellitus Type 2 Patients at Dow University Hospital, Karachi

EFFECTIVENESS OF TOTAL LEUKOCYTE COUNT (TLC) AND C-REACTIVE PROTEIN (CRP) IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Acute appendicitis is a typical surgical emergency. Diagnosing it can be challenging due to variable symptoms. Total leukocyte count (TLC) and C-reactive protein (CRP) are commonly used to assess inflammation and guide treatment. This study evaluates the diagnostic accuracy of TLC and CRP in acute appendicitis to determine appropriate management. Objective: This study aimed to assess the diagnostic accuracy of TLC and CRP in predicting acute appendicitis and their role in determining the proper management approach, either conservative or surgical. Methods: This prospective observational cohort study was conducted in the Department of General Surgery at Dow University of Health Sciences (DUHS), Ojha Campus, from July 2023 to March 2024. A total of 87 adult patients with clinical signs of appendicitis and an Alvarado score of greater than 4 were enrolled. Data was analyzed using SPSS version 22. Variables included socio-demographic characteristics, clinical presentations, and levels of TLC and CRP. Both conservative and surgical management approaches were analysed, with laparoscopic appendectomy being the most common procedure. Results: Among the 87 patients, most were male. TLC and CRP levels were similar across genders, with notable variations in socio-demographic characteristics. CRP levels were more frequently elevated in patients managed conservatively compared to those managed surgically. Both TLC and CRP were elevated in 43 patients (49.4%), highlighting the value of using both markers together. Surgical intervention, primarily laparoscopic appendectomy, was the preferred treatment, with suppurative inflammation being the most common histopathological finding. Conclusion: The combination of TLC and CRP significantly improves the diagnostic accuracy for acute appendicitis. TLC correlates more strongly with the need for surgical intervention, whereas CRP did not show a significant association with management type. Both markers are useful in assessing the duration of the complaint, but they are not substitutes for clinical judgment. Further research is warranted to refine their diagnostic utility and evaluate their impact on surgical care availability in resource-limited settings.

Health related quality of life and associated factors among patients treated for ischaemic heart disease in two public sector hospitals of Karachi, Pakistan.

To determine the level of health-related quality of life among patients treated for ischaemic heart disease in two public-sector tertiary care settings. The analytical cross-sectional study was conducted from July to September 2021 at two tertiary care hospitals in Karachi after approval from the ethics review boards of the National Institute of Cardiovascular Diseases and the Dow University of Health Sciences, and comprised patients of either gender treated for ischaemic heart disease after being diagnosed within the preceding year who were coming for follow-up in the outpatient department. Data was collected using the short version of the World Health Organisation quality of life tool. Association of socio-demographic and clinical variables with health-related quality of life was explored. Data was analysed using SPSS 21. Of the 300 patients aged 25-85 years, 212(70.7%) were males and 88(29.3%) were females. The mean total quality of life score was 6.1+/-1.4, while mean general health was 52.6+/-10.5. The lowest score among quality of life subscales was for environmental 44.7+/-15.1, while the highest score was for psychological 60.1+/-10.7 domains. Quality of life was significantly associated with patients' age, education, comorbidities, marital status, monthly income, body mass index, activities of daily living and smoking status (p<0.05). ischaemic heart disease patients had average health-related quality of life in all domains, but showed low quality of life in the environmental domain.

Utility of diffusion weighted Magnetic Resonance Imagining to detect non-palpable undescended testis.

To assess the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of non-palpable undescended testis (NPUT) and to compare DW-MRI results with surgical findings. This descriptive, cross-sectional study was carried out at Dow Institute of Radiology, Dow University of Health Sciences. Karachi on a cohort of patients who underwent DW-MRI for suspected NPUT between 15th September, 2022 to 16th March, 2023. The study included 175 boys below the age of 16 years with history of clinically non-palpable testes. MRI scans were acquired using additional DWI sequence. Two radiology faculty of more than five years of experience independently evaluated the DW-MRI images for the presence or absence of testes in its normal anatomical position, abnormal location, side and size of testes. Out of the 175 patients, DW-MRI successfully detected 128 (73.1%) non-palpable undescended testes. Statistical analysis in clinically detected cases of showed sensitivity of NPTU 0.8%, specificity of 92.5%, diagnostic accuracy 94.29%, positive predictive value 97.7%, and negative predictive value 84.1% for localizing undescended testes with Diffusion Weighted DW-MRI taking surgical findings as gold standard. DWI sequences complement the conventional MRI, increasing its sensitivity and diagnostic accuracy. By facilitating early and accurate diagnosis, DW-MRI has the potential to streamline patient management, reduce unnecessary surgical exploration, and ultimately improve the long-term reproductive health and quality of life for individuals with undescended testes.

VERSATILITY OF TENSOR FASCIA LATA FLAP FOR RECONSTRUCTION OF GROIN DEFECTS.

The evolution of reconstructive surgery techniques has significantly improved the management of soft tissue defects across various anatomical regions. In 1972, McGregor et al. devised a pivotal method for generating a flap to cover hand defects. The benefits of this technique, which include a larger skin surface without the need for microsurgery and yielding an easily concealed donor site scar, quickly became a cornerstone in the field, evidencing its widespread acceptance and application. Objective was to compare outcomes such as wound infection, skin flap necrosis and hospital stay between primary closure and tensor fascia lata flap for the reconstruction of groin defects among patients presenting at tertiary care hospital, Karachi, Pakistan. It was a prospective observational study carried out at the Department of plastic surgery, Dow University of Health Sciences, Civil hospital, Karachi, Pakistan from 23rd August 2023 to 25th January 2024. Patients who had groin defects after trauma or excision of lymph node of age 20-80 years of either gender were included and divided into two groups. Group A (n=30) had patients who had primary wound closure, while Group B (n=30) had patients who underwent a tensor fascia lata flap procedure for wounds coverage. Both groups were compared in terms of wound infection, skin flap necrosis, and hospital stay following surgery after 4 weeks. Data was analyzed using SPSS version 23. The overall average age of participants in the study was 35.7±11.18 years. Of 73.3% participants were male and 26.7% were female. Group B (TFL flap reconstruction) demonstrated significantly lower rates of wound infection (p=0.001) and skin flap necrosis (p=0.001) compared to Group A (primary closure). Additionally, the average hospital stay was significantly shorter for Group B than Group A (p=0.001). TFL flap reconstruction for groin defects significantly reduces postoperative complications, including wound infection and skin flap necrosis, and shortens hospital stays compared to primary closure.