Hayatabad Medical Complex Peshawar Research Articles

THYROID DYSFUNCTION IN PATIENTS WITH TYPE 1 DIABETES AT A TERTIARY CARE HOSPITAL

Individuals with diabetes mellitus (DM) are reporting thyroid dysfunction at an alarming rate, and there's evidence that thyroid dysfunction—whether overt or subclinical—affects overall glycaemic control. 12.3% of individuals with Type 1 DM have overt hypothyroidism, while around 24.8% of patients have abnormal thyroid autoantibody levels. Objective: This study aimed to determine Thyroid dysfunction in patients with type 1 diabetes at a tertiary care hospital. Methods: The present descriptive study was carried out at Hayatabad Medical Complex Peshawar from January 2024 to June 2024 after obtaining permission from the ethical committee of the institute. A total of 110 participants were enrolled in the study. We included all T1DM patients of both genders. All participants with T1DM visiting the OPD were screened. The primary test for assessing thyroid function was TSH, which has an acceptable range from 0.5 to 5 mIU/ml. Triiodothyronine (T3) and free thyroxin (FT4) levels were also measured. On a Cobos 6000 machine (Roche), thyroid function tests (TFTs) were performed. Data was analyzed through SPSS version 22.0. Results: A total of 110 participants of both genders of different age groups were enrolled in this study. 63.63% of them were females and 36.36% were males. 18 individuals (16.36%) had subclinical hypothyroidism, 14 individuals (12.7%) were hypothyroid, and 78 of them (70.90%) were euthyroid. We did not identify any occurrences of hyperthyroidism in current research. In comparison to the rest of the population, individuals with hypothyroidism had significantly different mean Thyroid stimulating hormone, FT4 and FT3 levels (p <0.0001). The mean differences for age, the period of diabetes, randomized blood sugar (RBS), and HbA1c were not statistically significant. When the data was examined for subclinical hypothyroidism, however, there was a substantial variance for mean Thyroid stimulating hormone (p <0.0001) but not for FT4 or FT3. Likewise, there was no difference seen in age (p= 0.35) or gender (p= 0.63). Conclusion: Type 1 diabetes individuals often suffer from thyroid dysfunctions particularly hypothyroidism (12.7%) and subclinical hypothyroidism (16.36%). The analysis of thyroid-stimulating hormone levels and other hormonal markers for thyroid function is the most crucial approach.

Functional outcomes of proximal femoral nail versus dynamic hip screw in intertrochanteric fracture.

Objective: To compare the functional and radiological outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) treatments for patients with unstable intertrochanteric fractures. Study Design: Comparative study. Setting: Trauma Centre, Hayatabad Medical Complex Peshawar. Period: May 2020 to June 2022. Methods: The study comprised 150 patients aged over 40 years old and had Type 2 intertrochanteric fractures, as classified by Boyd and Griffin. Radiographs, functional assessments, and demographic information were collected and patients were followed for up to two years at regular intervals. Results: The mean age of patients was 70 years. The PFN group had significantly shorter surgery duration (57.47 minutes) compared to the DHS group (85.30 minutes), less blood loss (74 ml vs. 195 ml), and a shorter hospital stay (6.5 days vs. 11.8 days). Early weight bearing was achieved faster in the PFN group, with mean times to partial and full weight bearing of 3.12 and 8.45 weeks, respectively, compared to 5.52 and 12.32 weeks in the DHS group. Radiological union at three months was significantly better in the PFN group. Complications were fewer in the PFN group, with notable differences in screw cutout, migration, and backout rates. Pain levels were lower in the PFN group at three and six months post-operatively. Conclusion: PFN demonstrated superior outcomes in terms of reduced surgical time, blood loss, hospital stay, and faster weight-bearing capabilities compared to DHS. Radiological and functional outcomes also favoured PFN, making it a preferable option for treating unstable intertrochanteric fractures.

COMPARISON OF DRUG-ELUTING STENTS VERSUS BARE-METAL STENTS FOR THE TREATMENT OF CORONARY ARTERY DISEASE

Coronary artery disease is a condition that affects millions of people worldwide and can lead to serious complications such as heart attack or stroke. Objectives: The study compares drug-eluting stents to bare-metal stents for treating coronary artery disease. Methods: The present study aimed to compare the efficacy and safety of drug-eluting stents (1) versus bare metal stents (BMS) for the treatment of coronary artery disease (CAD). The study was conducted at Cardiology Department Hayat Abad Medical Complex Peshawar Pakistan, from 01 January 2022 till 30 June 2022. The study included a total of 384 patients with CAD who underwent percutaneous coronary intervention (PCI) with either DES or BMS. Results: The study included a total of 384 patients with CAD who underwent PCI with either DES or BMS. The mean age of the study participants was 58.2 ± 9.4 years, and 75.8% were male. The baseline characteristics, including demographic data, clinical presentation, cardiovascular risk factors, and angiographic findings, were comparable between the two groups. Conclusion: In conclusion, our study contrasting medication-eluting stents versus exposed metal stents for the treatment of coronary supply route sickness found that drug-eluting stents were related to a lower chance of unfriendly heart occasions, including objective vessel revascularization, myocardial dead tissue, and cardiovascular demise, contrasted with uncovered metal stents.

BARRIERS TO INITIATE INSULIN THERAPY AND ITS ASSOCIATION WITH DURATION OF DIABETES MELITIS AND DEMOGRAPHIC FACTORS IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS, A CROSS SECTIONAL STUDY

Objectives: To determine different barriers to initiate insulin therapy and association of duration of diabetes mellitus and demographic factors with barriers in initiation of insulin therapy in Uncontrolled type 2 diabetic patients.Materials and Methods: We conducted a cross sectional study conducted among patients with type 2 diabetic patients presenting to endocrinology outpatient clinics in two Tertiary care hospitals of Peshawar ie. Khyber Teaching hospital and hayatabad medical complex Peshawar. The duration of study was 03 months after approval of synopsis. The sample size was 257.The study population was selected by consecutive non probability sampling technique. The data was collected by pre designed questionnaire. All the included patients were interviewed on pre designed questionnaire. Data was processed in SPSS version 22.Results: In study we found that patients face different barriers to initiate insulin therapy. In our study, side effects of insulin was the barrier for 97(37.7%) of the patient, difficulty in carrying insulin was barrier for 128(49.8%) patients , dose adjustment of insulin was barrier for 90(35%) patients, fear if insulin needle was barrier for 89 (34.6%) patients, self administration of insulin was barrier for 98(38.1%) patients , affordability of insulin was barrier accounting for 114(44%) patients , frightened about insulin therapy by someone was barrier for116 (45.1%) patients. The association between economic status of patient and the barrier that they are frightened by someone was statistically significant. Chi-square test was also run between duration of diabetes with all barriers in which one association was found nearly signifi cant i.e. the association of duration of diabetes with difficulty in carrying insulin with the p value of 0.064.Conclusion: The most common barrier in insulin therapy initiation of patients in the study was difficulty in carrying insulin. We found that there is near to signifi cant association between duration of diabetes and difficulty in carrying insulin. There is significant association between economic status of patient and frightened by someone. The lower the economic status the more frightened about Insulin use.

Correlation Between Complexity of Coronary Lesions and Delta High-sensitivity Troponin (hs-cTn) I Levels in Patients of Non-ST Elevation Myocardial Infarction

Non-ST Elevation Myocardial Infarction is a critical condition where early identification of myocardial injury is essential for risk stratification and treatment. High-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for detecting myocardial damage. Objectives: To assess the association between Syntax scores and initial significant delta hs-cTnI in patients who had been hospitalized with Non-ST Elevation Myocardial Infarction. Methods: Observational cohort study from January 2022 to December 2022 involving a total of one hundred and fifty patients admitted at Hayatabad Medical Complex Peshawar. hs-cTnI on admission and at 1, 2 hours and between (6h-12 h) post-admission daily was measured. Coronary lesion complexity was assessed with Syntax scores according to the results of coronary angiography. Statistical Analysis of data was performed using Pearson correlation to analyze the association between syntax scores delta hs-cTnI levels. Results: SYNTAX scores were correlated with Δhs-cTnI levels at all-time points, and the strongest correlation was found 6-12 hours post-admission (r=0.78). The syntax score had a mean value of 24.11 ± 14.74, and hs-cTnI levels increased over time to reflect the extent of myocardial injury. Conclusions: It was concluded that in Non-ST Elevation Myocardial Infarction patients, Syntax scores demonstrating more complex coronary lesions are related to higher delta hs-cTnI levels. This value highlights the use of hs-cTnI as a biomarker to evaluate the severity of myocardial injury and direct clinical decision-making in Non-ST Elevation Myocardial Infarction. Delta hs-cTnI measurements in diagnostic and risk stratification algorithms may lead to enhanced early identification of disease with improved outcomes.

Predictors of limb saving in diabetic foot ulcer.

This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU). This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded. A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage. DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.

Pattern of Daiabetic Retinopathy and its Effects on Health Related Quality of Life in In-Patients at Endocrinology Unit, Hayatabad Medical Complex Peshawar

Pattern of Daiabetic Retinopathy and its Effects on Health Related Quality of Life in In-Patients at Endocrinology Unit, Hayatabad Medical Complex Peshawar

Retinal Nerve Fiber Layer Thickness in Recently Diagnosed Primary Open Angle Glaucoma

Objective: To determine the frequency and pattern of retinal nerve fiber layer thinning in recently diagnosed primary open-angle glaucoma (POAG). Methods: This Cross-sectional study was carried out at the Ophthalmology Department, Hayatabad Medical Complex Peshawar from 1st May 2021 to 31st March 2022. Patients with a history of POAG were included in the study and subjected to assessment of visual acuity, IOP (with GAT) and Global retinal nerve fiber thickness (G-RNFL) through OCT. RNFL thickness was further stratified by age and gender to explore effect modification, employing ANOVA for age group comparisons, and t-tests for RNFL thinning, with a significance level set at p &lt; 0.05. Results: A total of 136 patients with a history of POAG were recruited. The mean age of the study sample was 54.5 + 13.6 years. There were 66.9% males and 33.1% females. The mean duration of POAG was 239.2 + 106.1 days. The mean BCVA was 0.696 + 0.7 and IOP was 18.9 + 9.1 mmHg. The Retinal nerve fiber thickness (RNFL) was 65.4 + 22.2 microns and 50.7% had their right eye with worse involvement. Conclusion: Global retinal nerve fiber thickness is a significant prognostic factor for POAG.

KNOWLEDGE AND PRACTICES OF LABORATORY STAFF REGARDING COVID-19 INFECTION

Objective: To determine the level of knowledge and practices of laboratory staff regarding COVID-19 infection. Materials and methods: It was a Multicenter, Cross-sectional Descriptive, Questionnaire-based study done in the Pathology laboratory of Khyber Teaching Hospital and Hayatabad Medical Complex Peshawar. The participants were asked to fill out proformas after obtaining consent. The data was analyzed by SPSS. The normality of data was determined by the Shapiro-Wilks test. The difference in scores between demographic characteristics was determined by the Whitney U test and the Kruskal Wallis test. Kendall Tau determined the correlation between scores and demographics. b, point biserial and Spearman rho tests. A p-value of less than 0.05 was considered statistically significant. Results: The age of 89 study participants ranged from 15-58 years (mean age of 34±9.6). The male-to-female ratio was 15.6:1. Mean knowledge and practice scores were 10.19±1.66 and 10.2±2.4. Knowledge and practices were good in all participants except that 42 (45%) participants denied avoiding going to crowded places. Mean knowledge score and practice score were higher in females (as compared to males) and in married participants (as compared to unmarried ones), but lower in undergraduates. There was no correlation between scores and demographic characteristics. Conclusion: The laboratory staff had good knowledge of COVID-19 and observed good practices. This shows the commitment of healthcare workers in Pakistan towards themselves and society in the crucial situation of COVID-19 infection. The scores were not associated with gender, marital status, or education level. Keywords: Knowledge, practices, COVID-19.

COMPARISON OF DIFFERENT CLINICAL OUTCOMES AMONG ASTHMATIC AND NON-ASTHMATIC COVID-19 PATIENTS IN AN INTENSIVE CARE UNIT SETTING

Objectives: To compare the different clinical outcomes among asthmatic and non-asthmatic patients having COVID-19 in an ICU setting Materials and Methods: A cross-sectional study was conducted in the Covid ICU of Hayatabad Medical Complex Peshawar from April 2021 to September 2022. WHO validated questionnaire was used among 220 study participants who were selected in this study. A modified questionnaire was tested for validation through a pilot study. A Cronbach alpha of less than 0.80 was considered acceptable. A significant P value was considered as &lt; 0.05. SPSS version 22 was used for data analysis. Results: Out of a total of 220 participants, 10.9% (n= 24) were asthmatic while 89.1% (n= 196) were non-asthmatic. The majority of participants were non-asthmatic male 118 (60.2%, p-value 0.86). Different comorbidities were seen in different patients, most of the non-asthmatic patients, 81 (41.3%, p-value 0.57) had more than one co-morbidity. Most of the non-asthmatic patients, 178 (90.8%, p-value 0.40) had consolidation on their chest X-rays while 23 asthmatics (95.8%, p-value 0.40) had consolidation on their chest X-rays. The majority of the non-asthmatic patients, 161 (82.1%, p-value 0.23) had high D-dimer levels. Ventilator use in the hospital was found in the majority of the non-asthmatic patients (183/93.4%, p-value 0.75) while, 22 asthmatic patients (91.7%, p-value 0.75) were found to be on a ventilator. The majority of non-asthmatic patients had high levels of serum LDH, D-dimer, and Ferritin. Twenty asthmatic patients (83.3%, p-value 0.21) had severe ARDS, and 169 non-asthmatic patients (86.2%, p-value 0.21) had severe ARDS. The number of days of hospitalization was found more among the majority of the asthmatic patients (23/95.8%, p-value 0.61) and in non-asthmatic patients, 176 (89.8, p-value 0.61) were admitted to the hospital for 20 days. Conclusion: COVID-19 disease was found higher among non-asthmatic patients as compared to asthmatic patients. The presence of other significant comorbidities also increases COVID-19 infection severity. Key Words: Asthmatic, Non-Asthmatic, COVID-19, Comorbidities, Ventilator.

Prevalence and Antibiotic Susceptibility Pattern of Pseudomonas Aeruginosa from the Foot Ulcer of Diabetic Patients in Hayatabad Medical Complex Peshawar, Pakistan

Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, affecting 15% of diabetic patients and often leading to severe outcomes like amputation. These ulcers frequently become infected with bacteria such as Pseudomonas aeruginosa, which is known for its robust antibiotic resistance. Objective: To investigate the prevalence and antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from the foot ulcers of diabetic patients in Hayatabad Medical Complex, Peshawar. Methods: A total of 103 clinical samples from diabetic foot ulcers were collected and analyzed for the presence of Pseudomonas aeruginosa using culture techniques and biochemical tests. The antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method to identify effective treatments. Results: Pseudomonas aeruginosa was identified in 48 (46.60%) of the samples. High resistance was noted against amoxicillin-clavulanic acid (100%), and notable sensitivity was observed to gentamicin (79.16%) and cefoperazone-sulbactam (87.5%). The susceptibility to other tested antibiotics varied, with moderate resistance seen in agents like cefotaxime (25%) and trimethoprim-sulfamethoxazole (33.33%). Conclusion: The study highlights a significant presence of Pseudomonas aeruginosa in diabetic foot ulcers with substantial antibiotic resistance, emphasizing the need for precise susceptibility testing to guide effective treatment strategies.

Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

OBJECTIVES To determine the effectiveness of case-based discussion in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in the management of patients. METHODOLOGY A multidisciplinary descriptive study was conducted in the Department of Urology Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, and Department of General Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. A total number of 20 postgraduate residents, ten from Urology and General Surgery, participated in the study with equal male and female participants. Case-based discussion (CBD) assessments focused on medical record-keeping, clinical Decision-making, clinical judgment, management, follow-up, and reflective writing. The data was collected on structured proforma and was analyzed on SPSS-25. RESULTSThe total number of study participants was 20, and 410 Case-Based Discussion sessions were conducted. This constitutes an average of 4.8 assessments per week. Most encounters were related to medical clinical decisions and management. The case-based discussion showed significant improvement on the Likert scale of the supervisor’s rating, which extended over four quarters on all major parameters of formative assessment (p 0.001). The multimodal regression test showed significant enhancement in learning parameters on case-based discussions. R2=0.172 F ration=25.141 n=410 (p=0.001). There was no significant difference in the gender of residents as well as training specialty of residents of urology and general surgery (p &gt;0.05). CONCLUSION A case-based discussion is an effective tool for formative assessment of Urology and General Surgery postgraduate residents.

Medical Disorders in Pregnancy Among Inpatients at a Tertiary Level Hospital of Peshawar (Khyber Pakhtunkhwa)

OBJECTIVES This study aimed to determine the prevalence, type, and demographic makeup of pregnancy-related medical conditions among patients receiving treatment in a tertiary care facility. METHODOLOGY The Monocentric retrospective impact study was conducted in the Department of Obstetrics and Gynaecology of MTI, Hayatabad Medical Complex Peshawar, from January to December 2022. Case records of all pregnant women (n=1811) with previous or recently developed medical conditions treated during the study period were collected from the records / medical registers, and all the information was recorded in a pre-structured proforma. All women with previous or recently developed medical conditions treated during the study were included. All pregnant women without any medical conditions were excluded. Data was analyzed using simple statistical measures, and the results were presented as frequency percentages. Prior approval from the institution’s ethical committee was obtained to conduct the study. vRESULTSAmong 6327 antenatal admissions, 1811 (28.62%) women had medical disorders. The most common medical disorder was PIH, reported in 384 (21.20%) of the females, followed by RH incompatibility and Gestational Diabetes Mellitus (GDM) seen in 235 (12.98%) and 205 (11.32%) females, respectively. Other notable medical conditions include UTI in 170 (9.39%), Chronic HTN in 134 (7.40%), iron deficiency anemia in 122 (6.74%), and pre-eclampsia in 100 (5.52%) of women. CONCLUSION Pre-existing medical conditions in pregnancy are not uncommon. Early recognition of acute illness and treatment of chronic conditions in pregnancy is of clear benefit and needs to be managed to arrest any adversaries to the mother and fetus.

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines.

To determine trend of following medical advice and safety of high-risk diabetic patients during Ramadan practicing updated IDF DAR guidelines. The cross-sectional study was conducted at Outpatient Department of Diabetes, Endocrinology and Metabolic Disorders Hayatabad Medical Complex Peshawar, Pakistan from April to June 2022, and comprised of high-risk diabetic patients (>6.0) based on updated IDF-DAR guidelines 2022 intending to fast. A questionnaire was designed to document patient risk factors score, type and duration of diabetes, HbA1c, comorbidities and complications developed during Ramadan. Data was analyzed using SPSS 20. Among all 130 participants, 78(60%) followed medical advice and did not fast and 52(40%) patients fasted against medical advice during month of Ramadan. Out of 130 participants, 89.2% were having type-2 diabetes Mellitus, 55.4% were female and mean age of participants was 52+14.6.40%. In fasting group, 57.7% were in the age range of 16 to 50 years while in non-fasting group 69.2% participants were more than 50 years old (P-value 0.031). There were 80.8% female participants in fasting group versus 38.5% in non-fasting group (P-value 0.001). Hypoglycemia occurred in 58.3% patients in fasting group and 29.3% non-fasting group. (P-value 0.021). On the other hand, 27.8% patients in fasting group and 55.2% of non-fasting group had hyperglycemia (P-value 0.025). Despite advised against fasting in these high-risk patients as per IDF DAR guidelines, almost half of patients fasted considering fasting a religious obligation. Those who fasted had significant hypoglycemia despite adjustment of medications as in guidelines. There is need of more intensive education before fasting, especially in high-risk diabetic patients.

Frequency of Osteomalacia and Vitamin D Deficiency in Elderly Patient Presenting at a Tertiary Care Hospital

Introduction: Vitamin D deficiency leads to the bone hypomineralization condition known as osteomalacia in peoples and is linked to other non-skeletal diseases. Objectives: To determine the frequency of osteomalacia and vitamin d deficiency in elderly patient presenting at a tertiary care hospital. Study Design: Cross sectional study Settings: Department of Diabetes and endocrinology Hayatabad medical complex Peshawar Materials &amp; Methods: Total 140 patients aged 50 years and above presenting with body pain and weakness who required medical treatment at hospital for various health concerns. Patients with known metabolic bone disorders other than osteomalacia, patients receiving vitamin D supplementation or specific treatments for bone disorders were excluded. Participants underwent a thorough clinical assessment, including medical history review, physical examination, and assessment of musculoskeletal symptoms associated with osteomalacia. Blood samples were collected to measure serum levels of 25-hydroxyvitamin D [25(OH)D], the biomarker for vitamin D status. Additional biochemical markers, such as alkaline phosphatase and parathyroid hormone levels, were also assessed to aid in the diagnosis of osteomalacia. Collected data of study variables were analyzed using statistical software (SPSS version 25). Results: Regarding gender, a total of 60 patients were male, constituting 42.85% of the population, while 80 patients were female, representing 57.14%. Musculoskeletal pain was reported in 80 individuals, representing 57.1% of the population. Proximal muscle weakness was observed in 50 patients, accounting for 35.7%. Additionally, 40 patients (28.6%) had a history of fractures. Vitamin D deficiency was identified in 68(48.57%), while osteomalacia was in 11(7.85%) patients. Practical Implication: Understanding the interplay between thyroid disorders and bone health can guide more comprehensive management strategies in this vulnerable population at tertiary care hospitals. Conclusion: In conclusion, our study reveals a relatively high prevalence of biochemical osteomalacia 7.85% among Pakistani old age patients challenging previous estimates in other populations Keywords: Association, Bone Hypomineralization, Non-skeletal Disorders, Osteomalacia, Vitamin D Deficienc

Factors Influencing Recurrence Following Transabdominal Preperitoneal Repair for Inguinal Hernias.

Inguinal hernia repair, a globally prevalent surgical procedure, has witnessed the widespread adoption of the transabdominal preperitoneal (TAPP) approach, promising reduced postoperative pain, faster recovery, andlower recurrence rates. However, hernia recurrence remains a persistent challenge, necessitating a comprehensive exploration of influencing factors specific to TAPP repair. The objective of this study is to identify and analyze key factors contributing to inguinal hernia recurrence post-TAPP repair Materials and methods: This is a retrospective cohort study involving 152 patients undergoing TAPP repair at Hayatabad Medical ComplexPeshawar, from November 2020 to October 2023. Demographic, preoperative, and postoperative data were meticulously collected. Statistical analysis employed IBMSPSSStatistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). An 8.5% recurrence rate was observed, with influencing factors including insufficient myopectineal orifice (MPO) dissection in three cases (23%), smaller mesh size in two cases (15.4%), infected mesh in two cases (15.4%), mesh dislodgement in one case (20%), and missed sac in one case (20%). Clinical examination and imaging studies diagnosed recurrences in 30.8% and 69.2% of cases, respectively. Despite the advantages of TAPP repair, hernia recurrence persists, emphasizing the need for ongoing refinement of surgical techniques. This study identifies critical influencing factors, notably insufficient MPOdissection, guiding efforts to enhance the efficacy of TAPP repair and improve patient outcomes.

Nutritional status of under-two years old children of depressive mothers presented to Hayatabad Medical Complex Peshawar.

Objective: Maternal mental health is an important factor for wellbeing of babies. The aim of present study was to determine the frequency of malnutrition among less than2-year-old children of depressed mother presented to HMC. Study Design: Cross-sectional study. Setting: Psychiatry Unit, Hayatabad Medical Complex, Peshawar. Period: July 2021 to February 2022. Material &amp; Methods: A sample size 364 mothers were selected through random sampling technique. Data was collected on a structured questionnaire and analyzed using SPSS version 24 for windows. Results: Mean age of mothers were 26±3 SD. Among 364 women, 130(35.72%) were normal, 125(34.34%) were having moderate depression and 109(29.94%) were having severe depression. Nutritional status of their children showed 88(24.18%) normal children, 152(41.75%) were moderate and 124(34.06%) were having severe malnutrition. Depression showed significant association with child nutrition. Conclusion: Depression in women is the major cause of malnutrition in first two year of child life. Effective strategies especially during postnatal period can help to alleviate the depression in women.

Frequency of Contrast Induced Nephropathy in STEMI Patients Undergoing Primry PCI in Patients at Hayatabad Medical Complex Peshawar

Objectives: To determine the frequency of contrast induced nephropathy in STEMI patients undergoing primary PCI in patients at Hayatabad Medical Complex Peshawar.&#x0D; Methodology: 178 patients presenting with acute coronary syndrome were enrolled. Confirmation of ACS was based on typical chest pain, ECG findings and imaging findings including angiography. Patients was labelled having contrast induced nephropathy if their serum creatinine ≥25% from the baseline value within the 72- hour period is reported after percutaneous coronary intervention (PCI).&#x0D; Results: Age of the patients ranged from 40 to 80 years. Mean age of the patients was 52.80 ± 5.298 years. Male to female ratio was 2.4: 1. Contrast Induced nephropathy was recorded in 30 patients (16.8%). The association of contrast induced nephropathy with age, gender, diabetes mellitus and smoking status was statistically significant.&#x0D; Conclusion: CIN after primary PCI is strongly and positively associated with female gender, hypertension, diabetes mellitus and smoking.

COMPARISON OF SODIUM ABNORMALITIES ASSOCIATED WITH HYPOTONIC VERSUS ISOTONIC MAINTENANCE INFUSIONS IN HOSPITALIZED CHILDREN

OBJECTIVE: To compare Sodium abnormalities associated with Maintenance Infusions, Hypotonic versus isotonic in hospitalized children: A Randomized Controlled Trial MATERIAL AND METHODS: This study was a randomized control trial conducted in the Department of Pediatrics A Hayat Abad Medical Complex Peshawar from 28 October 2020 to 28 April 2021. All the admitted patients aged 1 year to 12 years requiring maintenance infusion and were nothing by mouth (NBM) for at least 48 hours and serum sodium between 135-145 mmol/l were included in the study. Patients with renal disease and on drugs affecting sodium level were excluded from the study. Two hundred and four patients who fulfilled the inclusion criteria, were randomly classified into two groups A and B 102 each. Group A was given Isotonic fluids (0.9% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L) and Group B was given hypotonic fluids (0.45% Sodium Chloride and 5% Dextrose water with Potassium 20 mmol/L). The baseline tests and targeted tests, such as CBC, Blood sugar, urea, creatinine, electrolytes (sodium, potassium, and chloride), osmolality, and arterial blood gases, were performed. Data was analyzed using SPSS version 21.0. The post-stratification chi-square test was utilized to examine potential effect modifiers, and results were presented in tables. RESULTS: For a total of 204, there were 43 (42.3%) female patients and 59 (57.8%) male patients in Group A. Eighty (78.4%) male patients and twenty-two (21.6%) female patients were documented in Group B. In Group A, 61 (59.8%) patients had ages of 1-6 years while 41 patients (40.2%) were 7-12 years old. Eighteen patients in this group developed hyponatremia after receiving isotonic fluids. Fifty-two (51.0%) patients in Group B were 1-6-year-old and 50 (49.0%) patients were 7-12 years old. while 49 patients in this group developed, hyponatremia receiving hypotonic fluids. Patients given isotonic fluids didn’t develop any complications (Hypernatremia and hyperchloremic metabolic acidosis). CONCLUSION: On the basis of the results of this study, Isotonic intravenous maintenance fluids are a safe option in the pediatric population. KEYWORDS: Children, Intravenous fluids, Hypotonic, Isotonic Maintenance Infusions

A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.

Objective: This study aims to compare the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in hypertensive patients. Study Design: Prospective Observational. Setting: Hayatabad Medical Complex Peshawar. Period: December 2022 to May 2023. Material &amp; Methods: Approach was employed to investigate the metabolic impact of these antihypertensive medications. Involving a cohort of 660 hypertensive individuals. Data collection spanned over 12-week duration, with fasting glucose and lipid profiles assessed at baseline and 4, 8, and 12 weeks. Participants were categorized into hydrochlorothiazide and captopril groups, receiving standardized dosages of 25 mg/day and 50 mg/day, respectively. Fasting blood samples were analyzed for glucose and lipid parameters. Statistical analyses included paired t-tests and subgroup comparisons. Results: Both groups exhibited reductions in fasting glucose and lipid levels; however, these changes were not statistically significant within the 12-week timeframe. Comparison with national and international studies underscores population-specific variations in antihypertensive effects on metabolism. Conclusion: This study provides insights into the metabolic effects of hydrochlorothiazide and captopril among hypertensive patients. While immediate changes were not significant, the study contributes to the body of knowledge and calls for further research with extended follow-up and broader participant cohorts.