Hayatabad Medical Complex Peshawar Research Articles

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 >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 & 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 & 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.
 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).
 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.
 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 & 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.

Antibiotics resistance as a major public health concern: A pharmaco-epidemiological study to evaluate prevalence and antibiotics susceptibility-resistance pattern of bacterial isolates from multiple teaching hospitals

BackgroundMulti Drugs Resistance (MDR) is among the most worrisome healthcare issues resulting from inappropriate and indiscriminate utilization of antimicrobial agents which has compromised the efficacy and reliability of antimicrobial agents (AMAs). This has not only put a huge burden on the health care system but also is a major cause of morbidity and mortality. This project was designed to evaluate the prevalence of various microbial strains among patients admitted to various teaching hospitals and to assess their susceptibility and resistance towards clinically approved antibiotics. MethodsThe study was conducted during August 2021-February 2022 to determine the prevalence of common resistant strains of bacteria and to analyze their susceptibility pattern to the commonly prescribed antibiotics using standard procedures. One hundred and thirty biological samples including urine, blood, cerebrospinal fluid (CSF), wound swabs, pus and sputum were collected from the site of infection from the patients admitted at different wards of North West General Hospital (NWGH), Peshawar, Pakistan, Khyber Teaching Hospital (KTH), Peshawar Pakistan, and Hayat Abad Medical Complex (HMC) Peshawar Pakistan. Samples were collected and cultured following standard hospital procedures. The cultured samples were subjected to identification procedures including Gram staining, morphological characterization of bacterial colonies and biochemical assessments. The identified bacteria were tested for their susceptibility using Kirby-Bauer disc diffusion method. The diameter of Inhibitory Zones (DIZ) was analyzed following Clinical and Laboratory Standards Institute (CLSI) criteria. Minimum Inhibitory Concentrations (MICs) were evaluated using agar dilution method. Antimicrobials sensitivity were presented as antibiogram following CLSI M39 standard. ResultsA total of one hundred and thirty biological samples were collected, out of which one hundred and nine samples were positive for bacterial growth and were further processed for detailed analysis. The frequency and type of bacteria isolated from various cultures indicated that Gram negative bacteria (n = 92/109) were more dominant than Gram-positive (n = 17/109) pathogens. The most prevalent bacteria isolated was Escherichia coli (29.35 %), followed by Staphylococcus aureus (15.59 %), and Klebsiella spp, (12.84 %). In addition, other pathogens including, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. showed a prevalence of 9.175 %, 8.25 %, and 5.50 % respectively. As indicated in the antbiogram, several organisms exhibited considerble decline in the sensitivies towards various antibiotics. A high percentage of resistance was observed against some antibiotics including trimethoprim, co-trimoxazole, amoxicillin/clavulanate, ciprofloxacin, piperacillin/tazobactam, cefotaxime and ceftazidime. ConclusionThe prevalence of resistant strains of pathogens is increasing day by day, while the antibiotics commonly prescribed against them are losing their efficacy, which is pushing the world to the era of pre-antibiotics. Unfortunately, the discovery of novel antibiotics is limited and researchers speculate that the is pushing towards pre-antibiotics era. Subsequently, efforts must be directed towards ensuring rational antibiotics use to prevent emergence of MDR pathogens. Our findings indicated that Gram negative bacteria including Escherichia coli was most prevalent. Other bacterial strains including S. aureus, Klebsiella spp, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. were found among the causative agents. Unfortunately, considerable decline in the sensitivities of various bacterial isolated were observed towards the tested antibiotics. Previous studies reported the high prevalence of E. coli and S. aureus in clinical samples of Pakistani hospitals including hospitals in Peshawar and thus our findings are in agreement with the previous reports. Pharmacists being experts can play their role by promoting the optimal use of antimicrobial agents and educating healthcare professionals, patients and the public.

Exploring the association between alpha hemolytic streptococcal infection and intensive treatment outcomes in acute myeloid leukemia.

Objective: To assess the prevalence of alpha hemolytic streptococcal (AHS) infections and related risk factors in patients with newly diagnosed acute myeloid leukemia (AML) undergoing consistent treatment. Study Design: Prospective study. Setting: Jinnah Teaching Hospital and DHQ Charsadda undergoing treatment from Hayatabad Medical Complex Peshawar. Period: June 2022 to February 2023. Material & Methods: AML patients were recruited and algorithmically followed for AHS infections. Core symptoms, diagnostic workups, differential diagnoses, and relevant treatments were assessed in this manner. Results: AHS caused 22% of bacteremic infections in 22% of patients, mostly by blood transmission (87%). After treatment, 32% recurred. AHS had a 60% mortality rate (P < 0.002). Age, precise induction timing, and high-dose cytarabine significantly enhanced AHS incidence (OR 2.0, 1.8–1.9, and 3.8, respectively). AHS infections increased hospital stays (P < 0.0002) and decreased long-term survival (OR 2.8; P < 0.001) and disease-free survival (OR 2.1; P 0.008) in bone marrow transplant patients. Conclusion: The first prospective study investigating AHS frequency in consistently treated individuals revealed increased rates with intensified AML therapy. AHS bacteremia is particularly likely in adults with prior cases and high-dose cytarabine usage.

SERUM ALBUMIN: AN INDEPENDENT INDICATOR IN GUILLAIN–BARRE SYNDROME PATIENTS RECEIVING TREATMENT OF PLASMAPHERESIS

This study aimed to assess the role of serum albumin as an independent indicator in Guillain–Barre Syndrome patients receiving plasmapheresis treatment. This descriptive case series was conducted at Hayatabad Medical Complex Peshawar, Pakistan, from December 2022 to May 2023. Total 80 patients with GBS syndrome. Patients were divided into two groups equally. Group A patients had lower serum albumin, and group B had normal serum albumin. In both groups, serum albumin as an independent indicator was assessed. Chi-square and Independent T-tests were applied in both groups, keeping the P value less than 0.05. The mean age of the patients was 31.90±8.63 years. The frequency of male patients was 62.5%, while female patients were 37.5%. In group A, 27.5% of patients had good outcomes, while 75.5% had poor outcomes, while in group B, 57.5% had good outcomes, and 42.5% had outcomes. The outcome in group B was significantly better than in group A (P = 0.007). In the normal serum albumin group, the Guillain-Barre syndrome disability score was significantly lower after receiving plasmapheresis treatment than in patients with low serum albumin levels.

Outcome of diagnostic laparoscopy in young patients presenting with acute nonspecific abdominal pain.

Objective: To assess the role of diagnostic laparoscopy in young patients with Non-specific abdominal pain. Study Design: Prospective study. Setting: General Surgery Department, Hayatabad Medical Complex Peshawar. Period: January 2021 to December 2021. Material & Methods: A total of 140 young patients between the ages of 15 and 30 who had diagnostic laparoscopy for non-specific abdominal pain and met the inclusion criteria were included. Dates of admission, dates of operation, demographic and clinical information about patients were recorded. Results: 140 patients in all were enrolled. The mean age was 22.5 years, with a range of 15 to 30 years. There were 50(35.7%) females and 90(64.3%) males, of the total. Diagnoses and therapeutic treatment were feasible in 95 cases (67.8%), no pathology was found in 29 cases (20.7%), the preoperative picture was uncertain in 11 cases (7.8%), and no diagnosis was obtained following laparoscopy in 5 cases (3.6%), respectively. Conclusion: Early diagnostic laparoscopy in young patients is a safe and effective procedure. As a result, it is a useful investigative technique for acute abdominal pain that has not been properly identified.

Conservative Management of Splenic Injury in Blunt Abdominal Trauma: A Single Center Experience.

Road traffic accidents are the greatest cause of death worldwide. Most intra-abdominal injuries caused by blunt abdominal trauma have been treated surgically for a very long period. Over the past few decades, conservative care has gained in popularity and effectiveness as a treatment choice for blunt abdominal trauma. To determine the efficacy of conservative management in patients suffering from splenic injury in blunt abdominal trauma. The study included 62 cases of blunt abdominal trauma treated non-operatively in the general surgery department of the Hayatabad Medical Complex Peshawar between June 2021 and December 2022. Minimal hemoperitoneum was observed in 47 (75.8%) cases, moderate hemoperitoneum was noted in 11 (17.7%) cases, and 4 (6.4%) patients didn't have free fluid in the abdomen. There was no massive hemoperitoneum among the study patients. No major complications were observed during the study period. Only 7 (11.3%) cases develop minimal pleural effusion while 2 (3.2%) patients developed splenic abscess. Mortality was observed in only 1 (1.6%) case. Conservative management is a safe and efficient strategy and should be considered as a first line of treatment for all hemodynamically stable patients who suffered blunt splenic injury.

Assessment of Quality of Nurses’ Work Life in Tertiary Care Hospitals of Peshawar, Khyber Pakhtunkhwa, Pakistan

Nurses have been considered the backbone of health care delivery system, but regretfully saying that very limited attention has been paid to the development of nursing throughout the world. Objective: To assess the Quality of Nurses Work Life (QNWL) in Tertiary Care Hospitals of Peshawar Pakistan. Methods: Descriptive cross-sectional approach was applied to assess the QNWL in Lady Reading Hospital and Hayatabad Medical Complex Peshawar. Sample consisted of 240 participants via selection of multistage random sampling technique. Brook QNWL questionnaire was adopted for data collection and then validated and pre-tested it. Results: The sample data consisted of 79.20% female 20.80% male participants, out of which 46.02% were married and 53.98% un-married. The sample consisted of 94.25% Charge Nurses, 4.42% Head Nurses and 1.33% Nursing Managers in the study. The mean score of QNWL in this study was 162.24 ± 21.16. Furthermore, 3.98% nurses reported Low QNWL, 92.48% Moderate QNWL and 3.54% High QNWL in the sample. There was found an association between employment type with home life and work load subscales of QNWL whereas, home life has also an association with gender, marital status and salaries. Conclusions: It was concluded from the study findings that majority (92.48%) nurses have moderate QNWL in selected hospitals. Nurses home life and work load subscale of QNWL is affected by some demographics. Therefore, the study findings suggest recommendations in home life and work load management for policy makers in order to enhance QNWL in Tertiary Care Hospitals of Peshawar Pakistan.

Serum Vitamin D levels of children attending pediatric clinic at HMC IBP.

Objective: To assess the serum vitamin D levels of children attending pediatric clinic at HMC –IBP. Study Design: Prospective Cross Sectional study. Setting: This study was carried out in institution based private clinic of padiatrics in Hayatabad Medical Complex Peshawar. Period: April 2018 to April 2022. Material & Methods: All patients who presented to pediatric clinic with nonspecific bone and muscle pains (especially night time leg pains), mild motor delays and repeated chest infections were included in the study. Patients having clinical signs of rickets were excluded from the study. 5ml venous sample was obtained from each patient after informed verbal consent from parents. Blood test was performed in the hospital laboratory on COBAS E601 instrument employing chemiluminescent Electro Immune assay (ECLIA). Results of vitamin D levels of these patients were recorded on excel sheet and statistically analyzed using SPSS version 25. The variables were put in tables and graph and statistical relationship was assessed for quantitative variables. Definition of Vitamin D Deficiency: No international consensus on the definition of vitamin D deficiency in children exists yet. The Espaghan committee of nutrition and American Academy of pediatrics has not defined the exact definition of vitamin D deficiency. Our hospital used the level as severe to moderate deficiency <10ng/ml. mild/borderline 10-30ng/ml, 30-40ng/ml as hypovitaminosis and 40-100ng/ml as optimum level. Results: This study was conducted on 146 patients. Out of these 146 patients 78 (53.4%) were male and 68(46.6%) were females. The age range was from 1year to 15 years. The combined prevalence of deficiency and insufficiency was 52% and optimum levels were documented in 47.9% children. Severe deficiency according to definition <10ng/ml was documented in10 children (6.8%). Vitamin D levels were reported slightly lower in girls 25.88% as compared to boys 25% but severe deficiency was significantly lower in girls 4.7% as compared to boys 2.3%. p value <.o5 Older children (7-15 years) showed higher levels of vitamin D deficiency 53.4% as compared to infants (1-2 years) of 4.8%. Vitamin D deficiency was reported more in winter months (October-March) 51% than in summer (April –September47%. Conclusion: The study concluded that more than half of the patients who visited pediatric clinic with nonspecific bone and muscle pains were vitamin D deficient.

Role of laparoscopic surgery in gynecology.

Objective: Technological advancements extend the range of indications for gynecological laparoscopy. We are presenting the outcome of our experiences with gynaecological laparoscopies and assessed rate, indications, complications and its benefits in a teaching hospital. Study Design: Retrospective Observational study. Setting: MTI Hayatabad Medical Complex Peshawar. Period: January 2021 to December 2021. Material & Methods: we performed laparoscopic procedure for a total of 222 patients and all were included in the study. Laparoscopic surgeries were performed under general anesthesia. Successful creation of the pneumoperitoneum was done with the help of Veress needle, mostly by closed access technique and occasionally with the open method. Secondary ports were introduced under direct vision. After completing the surgery laparoscope and secondary ports were removed under direct vision to minimize any iatrogenic insult. Results: During the study period, 908 major gynaecological operations including 222 laparoscopies were performed. This gave the rate of 24.45% laparoscopies per 100 operations. Diagnostic laparoscopies were performed in 195 (87.84%) cases and operative were in 27 (12.16%) cases. Complications were only in 5 of the cases, two being of major nature. A ureteric ligation occurred during laparoscopic hysterectomy resulting in conversion of laparoscopic surgeries into open surgery and another was during cystectomy due to excessive bleeding. Conclusion: Laparoscopic surgery propounds unique benefits including definite diagnosis, mobilization and speedy recovery, minimal complications, less cost and shorter hospital stay. In young patients, laparoscopy helps in preserving their fertility with better prognosis in contrast to open surgery.

Frequency of Iron Deficiency Anemia in Children Presenting with Pallor to Hayatabad Medical Complex Peshawar

To determine the frequency of iron deficiency anaemia (IDA) in children who present with clinical pallor.The study was conducted at a tertiary care hospital, Hayatabad Medical Complex, between August 2018 and July 2022. We utilized laboratory information and took blood samples of 5ml to check for haemoglobin and ferritin levels. The criteria for IDA diagnosis were the presence of low haemoglobin levels (<11gm/dl) and low ferritin levels (<30ng/ml). The data were analyzed using SPSS version 26. The study contained 492 children (1 to 15 years).The total number of anaemic was 467 (94.9%) and Iron Deficiency Anemia was found to be present in 28.8% of the patients. Our study concludes that the frequency of iron deficiency is high in children presenting with pallor. Initiatives like National programs incorporating short-term measures like iron supplements and long-term ones like fortifying wheat flour could decrease the burden of IDA.

Frequency and etiology of pericardial effusion among patients with dyspnea presenting at emergency department

Aim: To determine the frequency and etiology of pericardial effusion among patients with dyspnea presenting at emergency department. Material and Methods: This retrospective observational study was carried out at emergency Department Hayatabad Medical Complex Peshawar from September 2022 to March 2023 on 120 patients. Patients having age more than 18 years presenting with dyspnea. The frequency and etiology of pericardial effusion were determined. Results: Mean age observed was 45.23±7.52 years. Pericardial effusion in our study was 15%. The most leading etiology found was para-pneumonic effusion 33.3%, renal failure 27.7%, and malignancy 22.2% while other factors 16.6%. Conclusion: we conclude that the frequency of pericardial effusion among patients presenting with dyspnea was 15%, the most common etiological factors identified were para-pneumonic effusion, renal failure and malignancy.