Jinnah Hospital Lahore Research Articles

KNOWLEDGE AND PRACTICE OF NURSES REGARDING TRACHEOSTOMY CARE

Tracheostomy is a common procedure in critical care settings for patients requiring prolonged ventilation or airway management. Nurses play a crucial role in tracheostomy care, which demands comprehensive knowledge and adherence to evidence-based practices to prevent complications. Objective: This study aimed to assess the knowledge and practices of nurses regarding tracheostomy care at Jinnah Hospital Lahore. Methods: A descriptive cross-sectional study was conducted from January 2024 to July 2024 at Jinnah Hospital Lahore. A total of [specify sample size, e.g., 150] registered nurses working in different wards and intensive care units (ICUs) were selected through simple random sampling. Data were collected using a structured questionnaire, which included sections on demographic information, knowledge, and practices. Knowledge and practice scores were categorized as good, moderate, or poor. Data analysis was performed using SPSS version 25.0, employing descriptive statistics and chi-square tests to identify associations between variables. Results: The study revealed that 60% of the nurses had moderate knowledge regarding tracheostomy care, while 25% demonstrated good knowledge, and 15% had poor knowledge. In terms of practice, 54.7% of nurses reported moderate adherence to tracheostomy care protocols, 30% had good practices, and 15.3% demonstrated poor practices. A significant association was found between formal training in tracheostomy care and higher knowledge and practice scores (p < 0.05). Conclusion: The findings indicate that most nurses possess moderate knowledge and practices concerning tracheostomy care, with notable gaps in training and adherence to standardized protocols. The study highlights the need for structured training programs and continuous professional development to enhance nurses' competency in tracheostomy care and improve patient outcomes.

Risk factors for Beta-lactam and carbapenem-resistant bacteria causing post-burn infections

Background: Burn patients are predisposed to infection because of the loss of skin barrier protection and low immunity. This study aims to evaluate the risk factors of post-burn infections due to beta-lactam and carbapenem-resistant bacteria (CR) isolated from a major burn unit.Methods: The descriptive study was conducted at Jinnah Hospital Lahore’s Burn and Reconstructive Surgery Centre (JB & RSC) and the Institute of Microbiology and Molecular Genetics (MMG), University of the Punjab, Lahore. The clinical specimens of wound swabs, including the age, gender, socio-economic status, residence, occupation, hospital stay, wards, burn degree, total burnt surface area (TBSA%), etiology of burn, and other factors were recorded. Antimicrobial susceptibility testing (AST), ESBL and CR screening (Beta- lactam and carbapenem resistant bacteria) were performed using CLSI guidelines 2017.Results: The most dominant strain was Pseudomonas spp. 26.5% (n=106), followed by 15% (n=60) Klebsiella spp., and 7.5% (n=30) Acinetobacter spp. with ESBL-producing strains. Compared to nosocomial infections, community-acquired infections were observed in 314 (78.5%) patients with more ESBL production. There was a significant relation between burnt people having an age of ≤ 29 years with ESBL (p=0.985) and carbapenemases (p=0.694) infections. None of the other factors, like low socioeconomic status and more hospital stays had a significant correlation (p > 0.05).Concluded: It has been concluded that MDR gram-negative strains play a serious role in burn infections and demand suitable methods to decrease their number. Pseudomonas spp. was the most common post-burn infection causing bacteria. Unfortunately, a high frequency of burn infections was observed in the patients at a young age.Keywords: Post burn infections; Gram negative; MDR; Beta- lactam; Carbapenem resistant

Prevalence of Early Seizures in Acute Stroke Patients

A stroke is defined as a sudden neurological deficit of cerebrovascular cause that persists beyond 24 hours. Stroke is associated with a whole spectrum of complications, especially post-stroke seizures. These seizures may adversely affect the outcome of stroke in terms of mortality and morbidity. This study was designed to find out the frequency of early post-stroke seizures. Objective: To determine the frequency of early-onset seizures after stroke among patients presenting to tertiary care hospitals. Methods: Two hundred and forty patients, presenting on the Medical floor of Jinnah Hospital Lahore with acute stroke and fulfilling the selection criteria, were approached after informed consent. The patients were followed for 14 days for the development of early seizures after the stroke. Results: Among 240 stroke patients, there were 123 (51.3%) male patients and 117 (48.8%) female patients. The minimum age observed was 30 years and the maximum was noted as 77 years. In 45% of patients, hemorrhagic stroke was detected and 55% of patients had ischemic stroke. From 108 cases of hemorrhagic stroke, there were 10.4% cases in which an episode of seizure occurred within 14 days of stroke. On the other hand, in 132 patients with ischemic stroke, 15.9% of patients developed seizure episodes. Conclusions: It was concluded that ischemic stroke was more common in frequency than hemorrhagic stroke in our population and the occurrence of episode early seizure within 14 days of stroke was more prevalent in ischemic stroke patients.

Prevalence of metabolic syndrome and its components among the teaching faculty of Allama Iqbal Medical College and Jinnah Hospital Lahore

BACKGROUND & OBJECTIVES: Metabolic syndrome and its components are established risk factors for type-2 diabetes mellitus and cardiovascular diseases. The Objectives of the current study were to assess the mean values of cardiometabolic risk factors and anthropometric parameters among the teaching faculty of Allama Iqbal Medical College and Jinnah Hospital Lahore (AIMC/JHL). To investigate the prevalence of metabolic syndrome and its components. METHODOLOGY: This cross-sectional study was conducted from December 2022 to July 2023 at AIMC/JHL. Faculty members (n=115), aged 30-60, were recruited by convenience sampling from basic and clinical departments. Metabolic syndrome was defined by ATP-III criteria. Means of quantitative variables were compared by student t-test. Chi-square was used to determine associations between nominal variables. RESULTS: Mean values of arterial blood pressure were significantly higher in males than females. Fasting hyperglycemia was present in 38.3% of participants. Decreased HDL, hypertriglyceridemia, hypertension, and central obesity were found in 65.2%, 24.3%, 34.8%, and 74.8% of participants, respectively. The prevalence of low HDL and central obesity was significantly higher among females; however, hypertriglyceridemia and hypertension were more prevalent among males. A significant correlation (r=0.241) was observed (p=0.009) between age and waist circumference. Pre-metabolic syndrome and metabolic syndrome were present in 38.3% and 43.5% of participants, respectively. CONCLUSION: An alarmingly high prevalence of metabolic syndrome and its components was observed among healthcare professionals who endeavor to treat similar diseases. This irony underscores the need for increased awareness and routine screening of metabolic syndrome among healthcare professionals

ALTERNATIVE THERAPIES FOR OXIDATIVE STRESS

Free radicals such as reactive oxygen species (ROS) induce oxidative stress and cause cellular damage due to lipid peroxidation. There are three important steps in lipid peroxidation, namely initiation, propagation and termination. Formation of reactive aldehydes such as MDA and 4-HNE takes place when there is a catabolism of lipid hydroperoxides. Hyperlipidemia especially LDL-cholesterol may lead to development of coronary artery disease causing morbidity or mortality due to cardiac arrhythmias. Conventional hypolipidemic drugs have unwanted effects. Herbal therapy for Hyperlipidemia is getting attention due to their less frequent side effects. In this study we have compared hypolipidemic effects of Gemfibrozil with Nigella sativa. Seventy five hyperlipidemic patients from Jinnah Hospital Lahore were enrolled for study. After getting consent all patients were divided in three groups comprising 25 patients in each group. Group 1 was on Nigella sativa, group 2 was on Gemfibrozil and third group was on placebo therapy. They were advised to take drugs for two months. After completion of study pretreatment and post treatment values of LDL cholesterol were analyzed statistically. In Nigella sativa group LDL cholesterol decreased from 191.14±3.45 to 159.40±2.98 mg/dl, means 31.7 mg/dl LDL reduction was observed when compared with placebo group. In Gemfibrozil group of patients LDL cholesterol decreased from 197.77±3.91 mg/dl to 159.62±2.20 mg/dl, means LDL reduction in mean values was 38.2 mg/dl, when compared with placebo group. These changes are highly significant with p-values of <0.001. We concluded from this study that alternative therapy by herbal medication is as effective as by allopathic medication. Key words: serum lipids, oxidative stress, lethality, toxicity.

Effect of Early Mobilization and Bed Positioning on Mobility among Patients with Traumatic Brain Injury

Background: Traumatic brain injury is defined as the disturbance in the function of the brain , or indication of pathology of brain, by the application of an exterior bodily force. Early mobilization exercises are explained as physiotherapy exercises of altering degree that are clinically safe and accurate developmentally started within 2 to 3 days of admission in neurological ICU. This early mobilization exercises helps in improving TBI patients recovery. Objective: The purpose of this study is to validate and evaluate the effect of early mobilization and bed positioning on mobility among patients with traumatic brain injury. Methods: This quasi-experimental study included 28 TBI patients. This study was conducted at general hospital, Lahore, and Jinnah hospital Lahore. Early mobilization and bed positioning therapies protocol were performed for 6 weeks. There were three sessions per week. Each session was 30 minutes. Mobilization scale and Norton scale were used as evaluation parameters before and after 6 weeks. Results: The data’s regularity was assessed by the Shapiro-Wilks test. Following statistical analysis, the regimen for early mobilization and bed positioning therapy’s efficacy for all examined variables was confirmed. The scores on early mobilization and Norton scales differ significantly. Conclusion: The results suggested that early mobilization and bed positioning therapies has improved mobility in TBI patients. This therapy protocol has also improved the TBI patients’ quality of life. Keywords: Bed positioning, Mobility and Traumatic brain injury.

Factors of cancer diagnosed family and medical system for delay in diagnosis and treatment of esophageal cancer

Introduction. The esophagus cancer patients needs early diagnosis to achieve better prognosis. The delay barriers increase progression of diseases to higher stages. The aim of work was to identify and explore the barriers in diagnosis of esophagus cancer and chart the time duration in this process. Material and Methods. The study was conducted in Jinnah Hospital Lahore (JHL), a teaching care hospital of Allama Iqbal Medical College, during a period of one year from July 2019 to July 2020. There were 49.42 % female and 50.57 % male patients. Results. Mean age found to be 56 years. Mean Total delay (TD ) time was 206 days and median Total delay (TD ) time in days were 197 days with 25th and 75th (157, 246) percentiles respectively. Longest delays were found in 51–60 age group and age related (r=0.94) significantly to delays (p=0.0004). Initial symptom of weight loss shows maximum delay and symptoms are highly correlated (r=0.94) with delay (p=0.004). The low income group presents maximum delay. Mean patient delay (PD ) time in days were 142 days with 135 Median and (88, 195) 25th and 75th percentile respectively. Mean, Median, 25th and 75th percentiles for Physician delays (PhyD) times were (20, 18, 16, 23) respectively. Treatment delay (TD ) time (Mean, Median) in days were (18, 18.52) with 25th and 75th (14, 22) percentiles. The education significantly reduces the delays with correlation (r=0.91) and significance (p=0.02). Mean system delay (SD ) time were 25 days and median were 24 days with 25th and 75th (20, 31) percentiles. Conclusion. Illiteracy, financial problems, and unavailability of information related to the cancer and health care system, very limited number of health facilities remains the main causes of these delays.

Assessment of Emotional Distress among Hepatitis C Patients Undergoing Antiviral Therapy at Jinnah Hospital Lahore

Hepatitis C is a significant worldwide health issue, causing mental and psychological distress in individuals, resulting in heightened stress and depression. Objective: To assess the emotional distress and assess the relationship between emotional distress and demographic variables of hepatitis c patients undergoing antiviral therapy at Jinnah Hospital Lahore. Methods: A quantitative cross sectional study design was used for this study. The study was carried out in Jinnah Hospital Lahore. Sample size of 108 patients is calculated with 95% confidence interval and 5% margin of error. Data were collected by using self-developed through convenient sampling technique. Both Male and female conscious patient, have a confirmed diagnosis of Hepatitis C and on antiviral therapy for 12 weeks were included in the study. Patients with Liver Cirrhosis and emotional trauma were excluded from study. An adopted Emotional Distress scale, consists of 14 questions was used to collect data from patients Emotional Distress Scale was used to collect data. Data were analyzed using SPSS 25.0. Chi square test applied to assess association between emotional distress and demographic variables of Hepatitis C patients. Results: The result showed that among 108, the most of the participants are the age group of 18-40 years and 58.3% are female. Emotional distress among hepatitis C patients undergoing antiviral therapy revealed varying degrees of emotional experiences and majority 45.4% of participants had severe distress. Conclusions: It was concluded that majority experienced severe emotional distress during antiviral therapy, offering valuable insights for interventions.

Assessing the Lateral Violence among Nurses at Jinnah Hospital Lahore

Background: Lateral violence, also known as horizontal hostility, significantly impacts the healthcare sector, particularly affecting nurses. This form of workplace violence includes behaviors such as bullying, verbal abuse, and psychological harassment among colleagues, leading to a hostile work environment and compromised patient care. Objective: To assess the prevalence and causes of lateral violence among nurses at Jinnah Hospital Lahore. Methods: A descriptive cross-sectional study was conducted over six months involving a convenient sample of 160 nurses at Jinnah Hospital Lahore. Data were collected using a structured questionnaire designed to assess lateral violence. Descriptive statistics were applied using SPSS version 25 to analyze the data. Results: Among the nurses surveyed, 22.5% reported often being treated with courtesy and respect by coworkers, while 51.9% rarely experienced such treatment. Misunderstandings caused by cultural differences were identified as a major cause of lateral violence by 65.0% of participants, and 56.9% cited the unwillingness of coworkers and leaders to intervene as a significant factor. Additionally, 50.0% of participants admitted to often losing patience and being less polite to coworkers. Conclusion: The study highlights the high prevalence of lateral violence among nurses at Jinnah Hospital Lahore, primarily driven by cultural misunderstandings and lack of intervention. Addressing these issues through targeted educational programs and leadership training is essential to create a more respectful and supportive work environment.

Prevalence and Knowledge of Urinary Incontinence and Awareness about Physical Therapy Treatment among Young Females of Lahore

Background: Urinary incontinence (UI), defined as involuntary urinary dribble at rest or under slight stress, is prevalent among women, particularly those who are pregnant or have had vaginal deliveries. While various treatments, including medical and physical therapy, are available for UI, awareness and knowledge about these treatments among young females remain unclear. This study aims to evaluate the prevalence of UI and the knowledge of physical therapy treatment options among young females in Lahore. Objective: To determine the prevalence and knowledge of urinary incontinence and the awareness of physical therapy treatment among young females in Lahore. Methods: This cross-sectional study included 250 young females aged 16-35 years from Jinnah Hospital Lahore, Sheikh Zayed Hospital Lahore, Ittefaq Hospital Lahore, and General Hospital Lahore. Data were collected using a self-reported quantitative questionnaire, the "International Consultation on Incontinence Questionnaire – Short Form" (ICIQ-SF), which assessed awareness about UI and knowledge of treatment options. Participants were briefed on the questions to ensure accurate responses. Data were analyzed using IBM SPSS Statistics version 25, with results presented as frequencies and percentages. Results: The study involved 250 females with an age range of 16-35 years, of whom 156 (62.4%) were single, and 94 (37.6%) were married. Obstetric data revealed that 16 (6.4%) were nulliparous, 81 (32.4%) were multiparous, 53 (21.2%) had normal labor deliveries, 49 (19.6%) had cesarean section deliveries, and 5 (2.0%) had experienced episiotomy. UI prevalence was found in 83 (34%) participants, with 63 (25%) affected moderately and 24 (10%) severely. Regarding health knowledge, 121 (48.4%) had never heard of UI, and 142 (56.8%) did not know about the presence of medical treatment. Moreover, 196 (78.4%) were unaware of the availability of physiotherapy treatment for UI. Conclusion: The prevalence of UI among young females in Lahore was significant, but the knowledge about UI and its medical treatment was relatively low. Awareness of physiotherapy treatment options was particularly lacking. These findings highlight the need for enhanced educational efforts to improve the understanding and management of UI among this population.

Comparative Validity of the ALBI Grade and CTP Score in Predicting Overall Survival in Patients Receiving TACE Plus Sorafenib Therapy for Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) significantly impacts global health, with liver function being a critical factor in patient prognosis. The ALBI grade and Child-Turcotte Pugh (CTP) score are both used to evaluate liver function in HCC patients, but their effectiveness in predicting survival outcomes varies. Objective: This study aimed to evaluate and compare the effectiveness of the ALBI grade and CTP score in predicting overall survival (OS) in HCC patients undergoing combined therapy with sorafenib and transarterial chemoembolization (TACE). Methods: Conducted at Jinnah Hospital Lahore and Hijaz Hospital between January 2019 and June 2023, this study included 103 HCC patients with CTP scores of 5 and 6. We analyzed the predictive values of the ALBI grade and CTP score for OS using multivariate analyses and time-dependent ROC curves. Results: Multivariate analysis indicated significant differences in OS among patients categorized by both scoring systems, with hazard ratios of 2.16 (P<0.001) for the CTP score and 1.49 (P=0.035) for the ALBI grade. Time-dependent ROC analysis showed that the ALBI grade was more effective in discriminating long-term survival. It also remained a significant predictor of OS in a larger number of patient subgroups compared to the CTP score. Conclusion: The ALBI grade demonstrates superior prognostic stratification compared to the CTP score in HCC patients treated with TACE and sorafenib who have stable liver function.

Early detection of lung adenocarcinoma on CT scan

Background: Lung cancer is the most common human malignancy and the principal cause of cancer-related death worldwide. Nowadays, adenocarcinoma is the most common histologic form, making up over half of all cases Objective: To determine the early detection of lung adenocarcinoma on CT scan Methods: A cross-sectional study was conducted at Jinnah Hospital Lahore Pakistan, which was performed between September 2020 to October 2023, The name of CT scan machine which was used in our study was Toshiba 64 slice and its slice thickness was 0.5 mm. Iodine based contrast is used. The total number of patients in our study were 150. The number of Male patients were 61 and female were 89. For all patients, we did diagnostic tests CT test . BMI parameter of every patients we took. We also took detailed history from the patients about the signs and symptoms. We did both the Lung window and the Mediastinal window. Data was tabulated and analyzed by SPSS version 26. Result: In a current study total 150 patients were enrolled. The minimum age of patients were 43 years and the maximum age of the patients were 77 years. The mean age were 59.60±7.877 years. The minimum BMI of patients were 26 (Kg/m2) and the maximum BMI were 34 (Kg/m2). The mean BMI were 28.55±3.740 (Kg/m2). The minimum size of the Lung Adenocarcinoma of patients were 0.3 cm and the maximum size of Lung Adenocarcinoma of patients were 2.8 cm. The mean size of the lung adenocarcinoma were 1.413±0.627 cm. The stage of lung adenocarcinoma in the age group of 41-50 years 1A1 were 8, 1A2 were 7 and 1A3 were 2 . The total patients with age 41-50 years were 17. The stage of lung adenocarcinoma in the age group of 51-65 years 1A1 were 34, 1A2 were 47 and 1A3 were 19. The total patients with age 51-65 years were 99. The stage of lung adenocarcinoma in the age group of >66 years 1A1 were 6, 1A2 were 11 and 1A3 were 17. The total patients with age >66 years were 34. P-value of stages of lung adenocarcinoma in age group was 0.03. The stage of lung adenocarcinoma 1A1 in male patients were 17 and female were 31. The stage of lung adenocarcinoma 1A2 in male patients were 28 and female were 36. The stage of lung adenocarcinoma 1A3 in male patients were 16 and female were 22. Total male patients were 61 and females were 89.P-value of stages of lung adenocarcinoma in gender was 0.04. Conclusion: We concluded that routine CT examination could detect more lung cancer at an early stage, especially adenocarcinoma, and detect patients with less aggressive features. The main advantage of the CT scan is, its non-invasive, painless diagnostic test as compared to biopsies. The chance of spreading of cancer cell is reduced. In our study females were more as compared to males.

Reasons for Delay in Fungating Breast Cancer Presentation at a Tertiary Care Facility of Pakistan

Background and objective: Breast cancer is a treatable disease resulting in complete cure. Late presentation is not uncommon in third world countries. The factors leading to delay in reporting to the hospital must be studied. The objective of this research was to identify the factors responsible for late presentation of fungating breast cancer patients at a tertiary care hospital of Pakistan.Methods: It was a descriptive, cross-sectional study conducted at Jinnah hospital Lahore from January 2020 to December 2022. A total of 56 respondents were selected through non-probability purposive sampling technique. A pre-tested structured questionnaire was administered, data were gathered after taking informed consent and data confidentiality was ensured. The collected data were analyzed using SPSS version 23. The stage 1 and 2 carcinoma breast patients are excluded from the study. The sample size was calculated by using WHO calculator.Results: A total of 56 cases of fungating breast growths were included in the present study carried out for a period of two years. Among 56 cases the mean age of patients was 45+9 years. The study found that the reasons leading for the delay in seeking treatment were poor socioeconomic status, belief in traditional faith healers, cultural myths, reliance on alternative medicine, fear of medical procedures, resistance from family members, and lack of accessibility.Conclusion: The delayed presentation of breast cancer leading to fungating growth is a significant concern that needs to be addressed. By identifying the reasons for delayed presentation, healthcare providers and policymakers can develop targeted interventions to improve early detection and prompt treatment, eventually improving the prognosis and quality of life of breast cancer patients.Key Words: delayed presentation, fungating breast cancer, reasons, tertiary care facility.

Effect of Preoperative Administration of Dutasteride on Reducing Blood Loss in Perioperative Period of Transurethral Resection of Prostate

Background and Objective: Clinical benign prostatic hyperplasia (BPH), a condition that commonly occurs in aging men. It is characterized by the development of lower urinary tract symptoms (LUTS), which can lead to impairment of bladder function and potential renal complications. TURP is the gold standard surgical treatment of BPH. Dutasteride is a 5-reductase and is used for medical management. This study was planned to ascertain the effect of pre-treatment dutasteride in reducing blood loss in patients undergoing transurethral resection of prostate (TURP).Methods: It was a randomized clinical trial carried out at Department of Urology, Jinnah Hospital Lahore in which the total study sample was divided in two groups. One group received dutasteride and the second group was the control group. The study variables were Haemoglobin and Hematocrit values, clotting profile PT and INR, serum Ca levels and uric acid, BMI, prostate volume, residual volume of urine and hospital stay. Results were presented as mean ± SD or frequency (%). The main study outcome variable was mean blood loss (calculated by change in hemoglobin and hematocrit level).Results: 6 (10.3 %) patients needed blood transfusion in dutasteride group and 7 (12 %) in control group (p=0.14). Post-surgery change in haemoglobin and HCT levels were less in dutasteride groups as compared to the control group (ΔHb 1.94±1.27 g/dL vs. 2.16±0.73 g/dL, respectively, p=0.02; ΔHct 5.68 % ± 2.56% vs. 6.52 % ± 2.39 %, respectively, p = 0.04).Conclusion: The present research suggests that administering Dutasteride four weeks prior to the TURPprocedure results in a decrease in blood loss during the peri-operative period, ultimately leading to improved patient outcomes.Key words: Benign Prostatic Hyperplasia (BPH). Transurethral resection of Prostate (TURP), 5 Alpha Reductase Inhibitor (5-ARI)

Comparison of Iron-Supplementation Versus Combination of Vitamin-A & Iron-supplementation in Childhood Iron Deficiency Anaemia

Background and Objectives: childhood anemia is highly prevalent worldwide and its effective treatment is the cornerstone to improve health of these children. This study was conducted to compare the mean rise in haemoglobin (Hb) after iron-alone versus the combination of vitamin-A & iron supplementation in childhood iron-deficiency anemia.Methods: This randomized controlled trial was done at Paediatrics Medicine Department, Jinnah Hospital, Lahore from January-2019 to June-2019. A total of 60 cases, as per inclusion criteria were enrolled from the Paediatric Medicine Department of Jinnah Hospital Lahore. Group-A was supplemented with a combination of vitamin-A and iron while Group-B patients were supplemented with Iron alone. Hb was checked at baseline and after 3 months of treatment as per the designated group. All information, as per predesigned proforma, was entered and interpreted using SPSS version 23.0. An Independent sample t-test was applied and a p-value < 0.05 was considered statistically significant.Results: Sixty patients were included, keeping 30 in each group i.e. Group-A (Vitamin-A + Iron) & Group-B (Iron-alone). In both groups, most of the patients were male, i.e. 22(73.3%) and 23(76.7%) in group-A and group-B respectively. In group-A, the mean age was 1.96±1.6 years while 2.12±1.5 years in group-B. In group-A, the mean rise in Hb level after 3-months of treatment was 3.0±0.99 g/dl, on the other hand, it was 1.96±1.00 g/dl in group B, with a p-value of 0.00014.Conclusion: Vitamin-A supplementation combined with iron replacement therapy is recommended for substantial improvement among children with iron deficiency anemia.Keywords: Vitamin-A, Iron-Supplementation, Hemoglobin (Hb), Iron Deficiency Anemia (IDA).

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF COLORECTAL CANCER PATIENTS: A RETROSPECTIVE ANALYSIS AT A TERTIARY CARE HOSPITAL IN PAKISTAN

Colorectal cancer remains a significant global health concern, ranking as the fifth most frequent cancer in Pakistan. Projections indicate a rapid increase in colorectal cancer cases worldwide over the next two decades, with emerging nations expected to account for the majority of the cases. Objective: This research aimed to monitor the clinical and demographic details of patients with colorectal cancer treated. Methods: The study included all patients diagnosed with colorectal cancer and treated at the Surgical and Oncology Department of Jinnah Hospital Lahore between November 2022 to November 2023. Gender, age, co-morbid conditions, presenting symptoms, histopathology, grade of histopathology, and T/N/M staging were assessed. Results: One hundred fifteen individuals were examined, comprising 31.3% females and 64.3% males. The majority of patients (31.3%) were under 50 years old, with no significant difference in mean ages between sexes (p = 0.42). The mean age of patients was 45.46±15.2 years. Smoking history was present in 2.6%, diabetes in 11.3%, and hypertension in 1.3% of cases. Abdominal pain was the predominant presenting complaint (15.7%), followed by diarrhea (2.6%). Histopathology revealed moderately differentiated adenocarcinoma in 38.3% of cases, with grade 2 tumors being the most common (32.3%). Conclusions: The study highlights an increased risk of colorectal cancer, even in younger individuals in the Pakistani population. Encouraging screening among the youth with family history and getting the general population to look into their symptoms early on is crucial to identify patients in the early stages of the disease, thereby enhancing the chances of survival.

Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

OBJECTIVES This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form. METHODS: This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at <0.05. RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury. CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales.

Outcome of Severe Anemia in Pregnancy; Experience at a Tertiary Care Hospital

Objective: The study was aimed at observing demographic diversity among pregnant women admitted to the labour room with Hemoglobin of less than 7gm/dl. It also observed perinatal and maternal outcomes and their associated complications. Study Design: Retrospective observational study. Settings: Gynae Unit I, Jinnah Hospital, Lahore Pakistan. Duration: 1st January 2022 to 30th June 2022. Methods: It is a retrospective observational study carried out in Gynae Unit I, Jinnah Hospital Lahore in between 1st January 2022 to 30th June 2022. All Patients presenting with Hemoglobin less than 7gm/dl and admitted in the Labour room were included in the study, and followed until delivery. A predesigned performa was filled for each of the 63 patients after their consent. Results: During the study period, 2130 deliveries were carried out in the labour room, out of which 63 patients had a recorded level of Hemoglobin below 7gm/dl. The prevalence of severe anemia in our study was 2.9%. Most patients (51) were in the age group 20-35 years. Majority of the patients (45) were un-booked while only 18 were booked patients. 40 patients were in the gestational age group of 34-37 weeks. 30 were gravida 2-5, 25 of parity more than 5 and only 13 primigravida’s. 29 out of 63 patients had no complications while 34 had complications. Conclusion: Severe Anemia is a preventable cause, the focus needs to be on early and proper antenatal check-up’s, early diagnosis, and timely referral from rural and less equipped medical centres to better equipped hospitals.

To Determine the Frequency of Clinical Remission Induction with Versus without Fecal Microbiota Transplant in Treatment of Active Ulcerative Colitis

Background: Ulcerative colitis is a long lasting inflammatory disease of the intestines that gets worse over time. Objective:. The goal of this study was to compare the success rates of inducing clinical remission in patients with active Ulcerative Colitis who underwent treatment with or without Fecal Microbiota Transplant. Methods: It was a Randomized Controlled Trial, which was done in Department of Gastroenterology/Medical Unit II of Jinnah Hospital Lahore .Study duration was 18months (from 01-01-2021 to 30-06-2022). The research included 90 patients who were randomly assigned to two groups. Standard Ulcerative Colitis therapy was given to both groups. Patients in group A recieved once-weekly faecal microbiota transplant for a period of six weeks. Patients in group B had weekly water enemas for same period. All patients underwent colonoscopy and Mayo score was noted before treatment, and after 6 weeks of treatment. Clinical remission was labeled if patients achieved Mayo score £2 after treatment. Results: Group A (Treatment) had a mean age of 39.31 ±13.45 and group B (Control) had a mean age of 38.59 ±12.11 (p=0.52). Duration of ulcerative colitis in group A was 8.08±2.64 weeks and in group B was 9.00±2.62 weeks (p=0.76). Pre-treatment Mayo score in groups A and B, were 8.29±1.91in and 8.73 ±1.61 respectively (p=0.15). Post-treatment in group A, the Mayo score was 3.71± 2.22, whereas in group B, it was 5.07± 1.75 (p=0.003). Remission was achieved in 24.44% (n=11) in fecal microbiota transplant group and 8.88% (n=4) in control group. (p=0.003). Conclusion: When compared to the control group, FMT significantly induces remission in patients with active UC.

Comparison of functional outcome of locking plate technique versus hybrid Ilizarov technique for complicated tibial plateau fractures

<p>This study compares the functional outcomes of two approaches, the locking plate technique and the hybrid Ilizarov technique, in managing complicated tibial plateau fractures. Enrolling 78 patients at Jinnah Hospital, the research explores a nuanced difference in results. In Group A (Hybrid Ilizarov Technique), 84.6% males and 15.4% females participated, while Group B (Locking Plate Technique) had 82.1% males and 17.9% females. The locking plate approach demonstrated superior outcomes, suggesting its efficacy in treating tibial plateau fractures. </p>
 <p>Study design: Cross sectional study.</p>
 <p>Study setting was department of Orthopedic Surgery, Jinnah Hospital Lahore</p>
 <p>Objective/purpose of the study was to evaluate the functional results of locking plate and hybrid Ilizarov procedure for tibial plateau fractures using Rasmussen's knee functional score.</p>