Hayatabad Medical Complex Peshawar Research Articles

Frequency of Amblyopia in strabismus patients presenting to tertiary care hospital.

Objective: The rationale of study was to find the magnitude of amblyopia with reference to type of squint among the strabismus patients visiting Hayatabad Medical Complex Peshawar, Pakistan. Materials and Methods: After ethical approval, a cross sectional study was carried out in the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan, from April 2022 to October 2022, the total number of patients included being 237. Results: Amblyopia was observed in 113 out of 160 (70.6%) cases of uniocular squint, while in alternating squint it was found to be 11 out of 77 (14.2%). Amblyopia in patients with esotropia was seen in 73.2% (107 out of 146), while 59.3% (54 out of 91) exotropia had associated amblyopia. Conclusion: Strabismus amblyopia leads to developmental arrest of vision in early critical years of life. Permanent visual loss can be avoided with comprehensive screening and detailed examination of strabismic patient.

Positivity of Lumbar Puncture for Acute Bacterial Meningitis among Children Presenting with First Febrile Seizure

OBJECTIVES: To determine the frequency of lumber puncture-proven acute bacterial meningitis among children with fever and seizures of first onset.METHODOLOGY From March 2020 to March 2021, a hospital-based descriptive cross-sectional study was conducted at the paediatrics department of Hayatabad Medical Complex Peshawar. The sample size for a total of 342 people was estimated using WHO software. The study included all children who had first-onset febrile seizures through OPD and the emergency department. All children underwent lumber punctures using a stringent aseptic procedure, and the hospital laboratory received the samples to look for bacterial meningitis. On a pre-made Proforma, details including name, age, and gender were entered. The gathered data were input into the computer for additional SPSS analysis (version 23).RESULTS Most individuals were male and were lies in the 21-40 months of age group. Mean weight and length/height were evaluated, respectively. The majority had a history of 6-10 days of disease duration. Bacterial meningitis was found significantly (p<0.05) associated with age, gender and neurological deficit, while non-significantly (p>0.05) associated with the duration of diseases.CONCLUSION All children between the ages of 6 months and 60 months who presented with episodes of fever and seizures were found to have a statistically significant (p<0.05) association found among bacterial meningitis and age groups.

Frequency of Surgical Site Infection in Mesh Repair for Inguinal Hernias

OBJECTIVES To determine the frequency of surgical site infection in mesh repair for inguinal hernias. METHODOLOGY This Descriptive observational study was carried out at the Surgical B unit of Hayatabad Medical Complex Peshawar from November 2021 to October 2022. A total of 179 patients were included in the study were given a single dose of antibiotics, i.e.1, gm Ceftriaxone, one hour before inguinal hernia mesh repair.RESULTS A total of 179 patients aged between 30-60 years with a mean age of 45 years were enrolled. There were 98(54.7%) male while 81(45.3%) females. The frequency of wound infection was noted in 23 (12.8%) patients following mesh repair for inguinal hernia. Out of 23, most of the patients, 10(43.5%) had Medical redness & tenderness, 8(34.8%) patients had pus discharge from the wound side, and 5(21.7%) patients had wound site abscesses.CONCLUSION Surgical site infection after mesh repair was higher than the internationally reported incidence. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in these

Predictors of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention

OBJECTIVES To identify the specific predictors of acute stent thrombosis in patients after primary percutaneous coronary intervention.METHODOLOGY This retrospective study was carried out at the Department of Cardiology Hayatabad Medical Complex Peshawar from 1st January to 30th June 2022. All consecutive patients with an angiographically confirmed stent thrombosis were enrolled. Patients gave informed consent for the inclusion of data in this registry. Stent thrombosis was categorized according to the timing of the event as acute (occurrence within the first 24 hours after the index procedure).RESULTSA total of 400 patients were included in the study. Age ranged between 35-70 years, with a mean age of 52.5. There were 260(65%) males and 140(35%) females, with male to female ratio of 1.8:1. All patients underwent primary PCI with stent implantation. According to the elapsed time since stent implantation, 42(10.5%) patients presented with acute stent thrombosis after primary percutaneous coronary intervention. The mean time to develop acute stent thrombosis after primary PCI was ±4.5 hours (range 3-6 hours). In most STEMI patients, 340(85%) received a loading dose of clopidogrel at the time of the index PCI. In 23(54.7%) patients, acute stent thrombosis occurred within 6 hours, 10(23.8%) within 12 hours, 6(14.2%) within 18 hours and 3(7.1%) after clopidogrel loading.CONCLUSIONInadequate stent expansion or mal-opposition, diabetes mellitus, chronic kidney disease, and female gender were the strong predictors of acute stent thrombosis.

Compare the Frequency of Surgical Site Infections Following Irrigation of Appendectomy Wounds with Sterile Saline Solution Vs Imipenem Solution

Objective: The purpose of this study was to compare the frequency of surgical site infection following appendectomy wound irrigation with imipenem solution versus ordinary saline solution. Study Design: Randomized/ Prospective study Place and Duration: This prospective randomized study was conducted at Department of Surgery, Jinnah International Hospital, Abbottabad and MTI Hayatabad Medical Complex Peshawar in the period from 01 July, 2022 to 31 December, 2022. Methods: Total 106 patients of acute appendicitis who underwent for appendectomy were included. After getting informed written consent detailed demographics of enrolled cases were recorded. Patients were categorized in two groups. Fifty-three cases of group I received imipenem solution at closure of wound and group II was irrigated with saline solution in fifty three cases. Patients were followed for surgical site infection and the development of deep abscesses after surgery. Results: In all there were majority 63 (59.4%) males and 43 (40.6%) females. Patients mean age in group I was 26.7±3.43 years and had mean BMI 22.15±11.23 kg/m2 while in group II mean age was 25.16±6.39 years with mean BMI 21.14±16.44 kg/m2. Frequency of catarrhal inflammation was 47 (88.7%) in group I and 44 (83.02%) in group II followed by perforated appendix and gangrenous appendix. Frequency of SSI in group I was lower found in 4 (7.5%) as compared to group II in 8 (15.1%) cases with p value <0.005. There was no any significant difference observed in abscess formation among both groups Conclusion: In this study, we came to the conclusion that irrigation with imipenem solution can aid to lessen wound infection following appendectomy. It is simple to do and can lower medical expenses as well as patients' suffering from infections. Keywords: Wound irrigation with saline, Imipenem solution, Appendectomy wound infection

Frequency of Breast Abscess among Lactating Women Presenting to Ambulatory Care of Tertiary care Hospital

Background: The excruciating build-up of pus in breast tissue is known as a breast abscess. This condition is more common in lactating women and is caused by bacterial infection at the nipple zone, which is primarily brought on by biting the child while breastfeeding, poor sanitation, blockage of the milk ducts, and the development of lumps that may be cancerous. Mastitis to abscess development is at different levels of severity for breast abscesses. Breast abscesses can be central or perieolar in location. Acute cases are readily treatable, but surgical intervention is required for chronic cases. Aim: To determine the frequency of breast abscess among lactating women presenting to ambulatory care of tertiary care hospital of Peshawar. Study design: Cross-sectional observational study. Place and duration of study: Department of General Surgery, Hayatabad Medical Complex Peshawar from 1st March 2021 to 1st September 2021. Methodology: Three hundred and thirty four patients of ae groups 15–45 years old, lactating mothers up to 40 days after childbirth, and all women presenting with mastalgia (more than 3 on visual analogue scale) were included. Patients with an alternate infection site identified through clinical examination, those with diabetes (FBS >120mg/dl), those with other immunosuppressive conditions like HIV, and those with a history of steroid use within the previous month were excluded. Results: There were 49(14.7%) cases belong to age group of 19-30 years, while 31(9.3%) belongs to >30 years age (p 0.049). Thirty six (10.8%) of abscess was noted in those who had parity of 1-2 while 44(13.2%) had parity 3-4. The mean BMI of the study sample was 26.6+3.5kg/m2 amongst whom 29(8.7%) frequency of breast abscess was observed in 18.5-24.9 kg/m2, 36(10.8%) had BMI of 25-29.9 kg/m2 and 15(4.5%) had >30kg/m2. The mean postpartum day was 12.1±4.1 day. Fifty four (16.2%) abscess was noted in 6-12 postpartum day, while 26(7.8%) was noted in >12-19 postpartum day. Conclusion: Breast abscess was fairly common (24%) in postpartum women and significantly associated with age of the patient (>30 years). Keywords: Breast abscess, Parity, Lactating women, Post-partum, Body mass index

Frequency of Helicobacter Pylori (H. Pylori) among Patients presenting with Duodenal Perforation

Aim: To determine the frequency of helicobacter pylori among patients presenting with duodenal perforation. Study design: Descriptive cross-sectional study. Place and duration of study: General Surgery Department Hayatabad Medical Complex Peshawar from 1st March 2021 to 30th September 2021 Methodology: One hundred and seventy five patients who had a first-time duodenal perforation, were between the ages of 20 and 60, and had a prior history of peptic ulcer disease lasting at least six months were included. Results: Thirty three (18.8%) patients had H pylori in body mass index of 18.5-24.9kg/m2, 39(22.3%) in BMI 24.9-29.9kg/m2 and 19(10.8%) in BMI 30-32.2 kg/m2. Fifty nine (33.7%) patients had H. Pylori who had peptic ulcer disease (PUC) since 7-11 years and 32(18.36%) had the condition with PUC 11-15 years. 69(39.4%) belongs to Urban areas, while 22(12.6%) belongs to rural areas. 18(10.3%) patients found to be chain smoker, while diabetes mellitus and hypertension was noted in 15(8.6%) Conclusion: Our population frequently develops duodenal perforation from H. Pylori owing to peptic ulcer disease. It is a serious problem and we advise more study to identify risk factors linked to this high H. Pylori burden and preventive measures to stop its spread and the morbidity linked to it. Key Words: Helicobacter pylori, Duodenal ulcer, Gastric ulcer, Peptic ulcer, Perforated peptic ulcer, ELISA

Spectrofluorimetric in tandem with principal component analysis for characterizing mycobacterium tuberculosis disease

In this study, fluorescence spectroscopy (FS) in tandem with the chemometric technique has effectively been used for analyzing respiratory infectious disease Mycobacterium tuberculosis. This research work is based on the fluorescence emission of bacterium grown in acid-fast bacillus (AFB) culture. Samples were collected from TB suspected patients of various areas of Khyber Pakhtunkhwa, and cultured in the Provisional TB Reference Lab, Hayatabad Medical Complex Peshawar, Pakistan. The fluorescence spectra from all these samples have been acquired using the 405 nm wavelength as excitation. The differences in the fluorescence emission spectra between TB positive, TB negative, and cultured media samples has been found at peak emission wavelengths arising at 467 nm and 490 nm. The differences between TB positive and negative samples were seen both in the intensities as well as shift in their fluorescence emission peaks. For highlighting the spectral differences, principal component analysis (PCA) is applied on the fluorescence emission data collected from the three sets of samples. PCA clearly cluster the data into three different groups based on features extracted from their fluorescence emission data. These results are novel and suggest that FS can be used as alternate confirmation tool of mycobacterium through AFB culture on a mass scale. Furthermore, this technique is fast, cost effective and user friendly that could be used effectively for the early detection of mycobacterium bacillus in the suspected individual.

How Common Peripheral Arterial Disease is in Patients Undergoing Coronary Angiography?

Background: Cardiovascular disease is the leading cause of death in the world. The detection and treatment of risk factors for CV events is critical to improving health and longevity1. The most common among cardiovascular diseases is atherosclerotic coronary artery disease.Objective: To determine the frequency of previously undiagnosed peripheral arterial disease in patients undergoing coronary angiography.Material and Methods: This Descriptive Cross-sectional study was conducted in Cardiology Department, Hayatabad Medical Complex Peshawar from 17th June, 2020 to 16th December, 2020. The patients of 40-80 years age of both genders were included through Non probability consecutive sampling. The data was collected through a proforma specially designed for this study and was analyzed through SPSS 22. Results: A total of 171 patients were included in the study. Age wise distribution among 171 patients was analyzed as 30-40 Years 9(5.3%), 41-50 Years 51(29.8%), 51-60 Years 72(42.1%), 61-70 Years 32(18.7 %), 71-80 Years 7(4.1%). Mean age was 55.56(±9.23) years. Gender wise distribution among patients, Male were 108(63.2%) Female were 63(36.8%). Distribution of Diabetes Mellitus was 50(29.2%). Hypertension was documented in 100 (58.5%). Smoking Status 51(29.8%). Distribution of peripheral arterial disease among 171 patients was analyzed as 22(12.9%). Distribution of Types of ACS was non-ST elevation among patients was 32(18.7%), STEMI was 62(36.3%) and USA was 77 (45%). Conclusion: The study demonstrated that the frequency of asymptomatic Peripheral arterial disease (PAD) in patients with CAD was 12.9% and was strongly associated with higher incidence of cardiovascular risk factors, and multivessel disease. Keywords: Peripheral arterial disease, coronary artery disease.

Hepatocellular Damage in the Patients presenting with Dengue Fever

Background: Dengue fever is becoming endemic in Pakistan as shown by its increasing prevalence in the summer seasons for almost the last decade. Elevation of liver enzymes indicating underlying liver damage, is a common phenomenon and may be associated with other complications. Objective: To find out the frequency of hepatocellular damage in the patients presenting with dengue fever as evident by elevated liver enzymes.Material and Methods: This was a descriptive study performed in the medical unit of Hayatabad Medical Complex Peshawar Pakistan. Patients were consecutively collected from the wards, outpatients, and emergency department. The patient's collection was from the year 2022 epidemic from 10th Jul to 23rd Oct. Patients with consistent clinical features, were diagnosed on the bases of dengue NS1 test and antibodies titers. Liver enzymes, complete blood counts and ultrasound were performed to find out any evidence of liver damage and plasma leaks as evident by pleural effusion or ascites. Alanine aminotransferase (ALT) of more than 50 U/L was considered as elevated in our study. Patients with elevated liver enzymes due to expected reasons other than dengue fever as per clinical records, were excluded from the study. The patient's data was noted on a preformed Performa for further analysis. Results: We consecutively collected 500 patients for the study. The number of male patients was 59% (n=295) while female patients were 41% (n=205). The age range was 15 to 75 years (mean 45, SD 21.32). The overall frequency of elevated (ALT) was 68.2% (n=341). Stratification of patients according to the ALT level shows that only 13.68% were having an ALT level of more than 300 U/L. The frequency was 45.45% in patients without complications, 91.60% in patients with warning signs, 85.71% in severe dengue and 100% with acute liver failure. Patients with an alanine aminotransferase (ALT) of =>300U/L were having a hospital stay of 5 to 12 days (mean 8.81, SD 2.6) days verses 4 to 9 days (mean 5.8, SD 1.9) in the patients having <300U/LConclusion: Most of the patients with dengue fever have elevated alanine aminotransferase level indicative of underlying hepatocellular damage. Such patients usually recover without any serious consequences except those having elevation of 300U/l or more whose hospital stay was prolonged, and a smaller percentage was associated with acute liver failure.Keywords: dengue fever, dengue NS1, hepatocellular damage, liver enzymes, hospital stay.

Tolerance of sorafenib in patients with residual HCC post TACE

Background: Hepatocellular carcinoma (HCC) is among the most prevalent cancers and the second leading cause of cancer-related mortality globally. Objective: The aim was to investigate the sensitivity of sorafenib administration after TACE in advanced HCC patients. Methods: From June 2021 to June 2022, 36 patients from Hayatabad Medical Complex Peshawar were enrolled in this retrospective research. Based on the correct state of liver activity, sorafenib medication was started within two weeks of finishing TACE treatment. Throughout each follow-up, the liver and kidney function, adverse effects, and medicinal impact were assessed using the Modified response assessment criteria in solid tumors (mRECIST). Results: The mean overall survival (mOS) and mean time to progress (mTTP) were 11.5 months and 7.5 months, respectively. Patients with one or more localised hepatic lesions were respectively 18 months and 12 months old (2 = 4.613, P = 0.0314). No patients had a full response, three had partial responses, 11 had stable disease (SD), and 22 had progressive illness (PD), as per the mRECIST. The disease control rate (DCR) was 38.89% (14/36) and the response rate was 8.33% (3/36) for both. Hand-foot skin irritation (21 incidences, 58.3%), and diarrhoea (17 incidences, 47.22%) were the predominant adverse effects.

Frequency of Ventricular Tachycardia in First 48 Hours of ST-Elevation Myocardial Infarction

ST-elevation myocardial infarction (STEMI) has a poor long-term prognosis associated with early ventricular tachycardia (VT). Objective: To find out the frequency of ventricular tachycardia in the first 48 hours of ST-elevation myocardial infarction. Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1st October 2020 to 31st March 2021. All the patients having new onset ST-elevation Myocardial infarction as per Operational definition, both genders, aged between 40 and 75 years and who have given consent were included in the study. Non-probability consecutive sampling technique is being used for the sampling. Results: Standard deviation was ±1.357 years, while the average age was 51.56. Gender-wise distribution among patients male was 89(53.6%) and female was 77(46.4%). Distribution of duration of disease among patients 12-24 hours 80(48.2%) and more than 24 hours 86(51.8%) was 100(52.4%). Family History of coronary artery disease (CAD) 84(50.6%), diabetes mellitus 93(56.0%), hypertension 110(66.3%) and smoking status was 118(71.1%). Distribution of ventricular tachycardia was present among 103(62.0%) patients and was absent in 63(38.0%) patients. Conclusions: Ventricular tachycardia is the most common tachycardia occurring in patients in the first 48 hours who sustained myocardial infarction. It was shown that bradyarrhythmia was more common in patients with inferior wall myocardial infarction while ventricular tachycardia was found to be more in patients with anterior wall myocardial infarction.

Malnutrition levels among type-2 diabetes mellitus patients in Pakistani a multi center study

Objective: To determine the frequency of malnutrition among T2DM patients in tertiary care. Place and Duration of Study: Departments of Medicine Hayatabad medical complex peshawar Pakistan from jan 2020 to July 2021. Methodology: this Multi-center study conducted in department of medicine hmc hospital Peshawar from jan 2020 to July 2021. total of 130 T2DM patients were assessed for nutritional evaluation with the assistance of a nurse and supporting staff. With the use of a questionnaire and a Subjective Global Assessment form, the data was collected (SGA). With the aid of MS Excel and SPSS, the nutritional risk factors and malnutrition status were determined, and the data was statistically examined. Results: The results of our recent study showed that, of the 130 patients, 62 48% were at intermediate risk of malnutrition and 68/52% were at high risk. Similar to this, 48 individuals had severe malnutrition, while 80 patients were classified as having moderate malnutrition. Obese Class-I, with the greatest risk of malnutrition and the highest frequency of severe malnutrition, has been proven to have the highest incidence among the different BMI categories. 0.920 is the correlation coefficient R2.

Frequency and Clinicopathologic Characteristics of Triple-Negative Breast Cancer Among Breast Cancer Patients Presenting to Medical Oncology Department, Hayatabad Medical Complex Peshawar, Pakistan.

Breast cancer is one of the most common cancers affecting females.The outcomes of this study will aid future research and policy suggestions by giving a rapid local burden and clinicopathologic profile of triple-negative breast cancer (TNBC) patients. This cross-sectional study was carried out at the Department of Oncology, Hayatabad Medical Complex Peshawar, Pakistan, from April 21, 2022, to October 21, 2022. The sample size was 120 using a 95% confidence level, 18.7% proportion of TNBC frequency in patients with breast cancer, and 7% absolute precision. All patients who presented with newly diagnosed breast cancer and were between the ages of 30-60 yearswere included in the study. The study excluded male patients and patients with a history of surgical intervention on the breast during the previous six months. A total of 120 patients were evaluated. Age ranged between 30-60 years with a mean age of 45 years. Thirty-four (28%) patients were in the age range of 30-45 years and 86 (72%) patients were in the age range of 46-60 years. Fifty-six (47%) patients had BMI ≤27 kg/m2 while 64 (53%) had BMI >27 kg/m2. The use of oral contraceptives was noted in 25 (21%) patients. A total of 62 (52%) patients had breast cancer on the right side while 58 (48%) had it on the left side. According to the results of our study, 14% of breast cancer patients had triple-negative disease.

A Cross-Sectional Study on Association between Metabolic Syndrome and Hepatobiliary Cancers

Background and Aim: Several studies have supported the idea that a metabolic abnormality contributes to expansion of hepatocellular carcinoma (HCC). To date, metabolic factors have not been shown to be associated with hepatocellular carcinoma (HCC). Therefore, the present study aimed to assess the metabolic syndrome association with hepatocellular carcinoma. Patients and Methods: This cross-sectional study was carried out on surgically treated and radiologically confirmed 360 HCC cases in Gastroenterology Department of Central Hospital, Sargodha and Hayatabad Medical Complex Peshawar, during the period from January 2022 June 2022. Study protocol was approved by the research and ethical committee. Informed written consents were taken from each individual. Body mass index, blood pressure, medical history, and other related information were gathered from medical records. Patients were categorized into different groups based on their BMI: i) <18.5 kg/m2, ii) 18.5-23.9 kg/m2, iii) 24-29.9 kg/m2, Fiv) 30-34.9 kg/m2 and ≥ 35 kg/m2. A routine biochemical or immunological analytic method was used to determine all metabolic parameters and liver function tests. The metabolic-associated factors were associated with HCC-related different liver function’s test and stratified for BMI, free fatty acids, and Glycated Albumin (GA). Chemical analysis was used to detect antioxidant capacity (TAOC) and malondialdehyde (MDA). Data analysis was done in SPSS version 27. Results: Of the total 360 HCC patients, there were 234 (65%) male and 126 (35%) females. The overall mean age was 68.62±6.4 years. The association between hepatobiliary cancer and body mass index (BMI), smoking, ischemic heart disease, hypertension, and diabetes was found in a univariate analysis of the data. Based on BMI, patients were categorized as follows: 35 (9.7%) in (<18.5 kg/m2), 70 (19.4%) in (18.5-23.5 kg/m2), 118 (32.8%) in (24-29.9 kg/m2), 88 (24.4%) in (30-34.9 kg/m2), and 49 (13.7%) in (≥ 35 kg/m2). The incidence of smokers, non-smokers, and ex-smokers were 146 (40.6%), 60 (16.7%), and 154 (42.8%) respectively. The prevalence of different risk factors such as hypertension, diabetes, ischemic heart disease, Aspirin use, and statin use was 188 (52.2%), 124 (34.4%), 66 (18.3%), 148 (41.1%), and 142 (39.4%) respectively. The HCC group had significantly higher mean body mass index, glucose level, and lipid level than controls (P <0.05). HCC patients showed a significant association between liver function and metabolic factors. A significant association between high level of GA and increased cancer risk were found between cases and control. Conclusion: The present study concluded that hepatobiliary carcinoma may be caused by metabolic syndrome, which includes dyslipidemia, a high body mass index, and high serum glucose levels as independent risk factors. This finding supports previous research and emphasizes that the connection between hapotabiliatry cancer and increased BMI remains for liver tumors, bile duct cancer, and gallbladder cancers. Keywords: Hepatobiliary carcinoma, metabolic syndrome, Obesity, Diabetes

Different Doses of Lumbar Epidermal Methylprednisolone Injection and their effect on Pain Control and Blood Glucose Level in Diabetic patients

Background: Frequency of diabetes mellitus is high between people suffering from lumbar spinal degenerative sickness Despite the fact that injection of steroid in epidural space are recognised to rise the glycaemic Blood amount postoperatively, therefore it is inquiry that decrease dose of methylprednisolone (40mg) cannot rise blood glycaemic level as compare to higher dose of methylprednisolone (80mg) and their effect on pain management of patients. Aim: To evaluate 2 common doses (80mg & 40mg) of methylprednisolone effects which is given through Epidural lumbar route, on glycaemic Blood level and pain management of diabetes mellitus patients to determine an adequate epidural steroid dose. Methods: This was an observational prospective study was conduct at Department of Anaesthesia Hayatabad Medical Complex Peshawar in June 2022. Overall 110 Diabetes mellitus patients were participated. They acquired lumbar epidural, methylprednisolone for spinal stenosis radiculopathy or failed back surgery syndrome. Methylprednisolone dose were given to patients, either 80mg (Group A) or 40 mg (Group B) was determined clinically after the procedure type. Results: HbA1c level was noted in group A 6.21mmol/L while in group B 6.52 mmol/L (p =0.991). The increase in fasting blood glucose (FBG) were greater significantly A Group than in B Group on post procedure day (PPD)1,2&3 (PPD1: 179 mg/dL A Group Vs 146mg/dL in B Group ), (PPD2: 221 mg/dL in A Group Vs 152mg/dL in B Group ) & (PPD3: 202mg/dL in A Group Vs 175mg/dL in B Group ). Fasting blood glucose incidence was >180mg/dL were greater in A Group than in B Group on post procedure day 1&2 (PPD1: A Group=11 vs B Group=5) and (PPD2: A Group=13 Vs B Group= 4). Conclusion: Methylprednisolone increase dose 80mg rise FBG and PDG greater than a decrease dose 40mg with no effect on pain management, employment status, or clinical outcome. Thus, it is recommended that methylprednisolone 40mg will b given rather than 80mg in diabetes mellitus patients with respect to pain management and blood glycaemic level Keywords: Epidural methylprednisolone, back pain, blood glucose.

Frequency of Left Ventricular Mechanical Dyssynchrony in Chronic Heart Failure

Objective: To determine the frequency of left ventricular mechanical dyssynchrony in chronic heart failure patients. Material and Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1st September 2021 to 28th February 2022. In this descriptive cross-sectional study, 155 patients in total were examined while 27% of heart failure patients had mechanical dyssynchrony, a 95% confidence interval, and a 7% margin of error were maintained according to WHO sample size computations. Results: This study's participants had an average age of 60, with a standard deviation of ±1.26 years. 62% of the patients were male, compared to 38% of females. 35% of patients had a Broad QRS complex, whereas 65% of patients had a Narrow QRS complex. Mechanical dyssynchrony was identified in 32% of chronic heart failure patients. Conclusion: Patients in chronic heart failure with QRS > 150ms and having mechanical dyssynchrony are benefited with Cardiac Ressynchronisation Therapy (CRT) implantation which reduces morbidity and mortality, while those with a narrow QRS (<150ms) are generally non – responders. Keywords: Mechanical dyssynchrony, chronic heart failure, left ventricular ejection fraction

Prevalence and Response to Needle Stick Injuries

Aim: To study the prevalence and response to needle-stick injuries in a tertiary care hospital. Study design: Cross-sectional study Place and duration of study: Dept. of Gen. Surgery, Hayatabad Medical Complex Peshawar from 01-06-2020 to 30-06-2022. Methodology: One hundred and ninety three healthcare workers were recruited, including doctors, medical students, nurses, student nurses and paramedics. Results: There were 60(31.1%) healthcare workers reported needle stick injury. Majority of the injuries 51(85%) occurred during contact with patients who were assessed as not high-risk and 9(15%) when exposed to high-risk patients. Most of responders 49(81.7%) reported that the injury was self-inflicted and 11(18.3%) reported that it was caused by someone else. About 45(75%) injuries were caused by hollow bore needle and 15(25%) by a solid needle. Most of the needle stick injuries occurred at the bedside 50(83.4%), 8(13.4%) in the operating theatre and 2(3.4%) were at other locations. Conclusion: Needle stick injury is a significant cause of physical and psychological morbidity among healthcare personnel. Proper training and strict protocol for following the standard precaution can minimize its incidence. To improve its reporting the procedures of reporting a needle stick injury could be simplified. Keywords: Needle, injury, health care professional

Angiographic Severity of CAD in Diabetic Versus Non-Diabetic Patients Presenting with STEMI

Objective: To determine the angiographic severity of CAD in diabetic versus non-diabetic patients undergoing primary PCI for STEMI. Methodology: This cross-sectional observational study was carried out in the Cardiology unit of Hayatabad Medical Complex Peshawar from January, 2021 to August 2021. All patients undergoing primary PCI for STEMI at cardiology unit of HMC were included in the study after a thorough history, examination and informed consent. Patients were divided into two categories on the basis of diabetes status. Furthermore, patients were also classified on the basis of number of vessels with significant coronary stenosis. Continuous variables were described as means and standard deviations whereas categorical variables were described as frequencies and percentages. Chi-square test was applied to determine the significance of categorical variables. Results: A total of 68 patients with a mean age of 52±4.5 years were included in the study. Of these, 49 were males and 27 patients had diabetes. In the diabetes group, 20 patients had a history of anterior wall MI whereas 19 patients had history of anterior wall MI in the non-diabetes group. Similarly, 15 patients in the diabetes group and 11 patients in the non-diabetes group had inferior wall MI (p: 0.095). Furthermore, the number of patients who had TVCAD, DVCAD and SVCAD in the diabetic group was 15, 5 and 7 compared to 7, 15 and 19 in the non-diabetic group respectively (X2=11.039, p:<0.01). Two patients in the diabetes group had stent thrombosis whereas only 1 patient had stent thrombosis in the non-diabetes group. One patient died in the cath lab in the diabetic group whereas there was no mortality in the non-diabetic group. Conclusion: Diabetic patients presenting with STEMI is having more severe and extensive CAD during primary PCI as compared to non diabetic patients.

Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis

IntroductionAcute Appendicitis is the most common surgical emergency encountered in emergency departments. To prevent the rate of negative appendectomies, different systems i.e. Alvarado score and Appendicitis Inflammatory Response Score (AIR) scores were used, but their diagnostic accuracy in Asian population is questionable. Raja Isteri Pengiran Anak Saleha (RIPASA) score has showed promising results in the recent literature. The purpose of this study is to compare the efficacy of Alvarado, AIR and RIPASA scores in the diagnosis of acute appendicitis. MethodsAlvarado, AIR and RIPASA scores were prospectively applied to 132 included patients that were admitted with provisional diagnosis of acute appendicitis and then their surgery was performed in General Surgery Unit, Hayatabad Medical Complex Peshawar, Pakistan from 1st January 2022 to 31st July 2022. Final diagnosis was confirmed by histopathology report and scores were correlated with final report. Cut off value of score >7, >5 and >7.5 were set for Alvarado, AIR and RIPASA score, respectively according to previous literature. Statistics analysis was done for all 3 scoring systems on SPSS version 23. ResultsOf 132 patients, there were n = 79(59.8%) males and n = 53(40.2%) females. Mean age was 24 years (SD ± 11.6) with youngest patient of 9 years and oldest one was 70 years old. Negative Appendectomy rate was 8.3%(n = 11). RIPASA score was superior to AIR and Alvarado score in Sensitivity, NLR, Accuracy and Area under the Curve. AIR score performed better in specificity, NPV, PLR compared to RIPASA and Alvarado score. ConclusionRIPASA score is an overall better scoring system in diagnosing acute appendicitis in compared to Alvarado and AIR score.