Jinnah Postgraduate Medical Centre Research Articles

Clinical Profile and Risk Factors of Cerebral Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) is a rare but serious neurovascular disorder that can lead to life-threatening complications such as hemorrhage and cerebral edema. This condition presents with a wide array of symptoms due to the formation of blood clots in the cerebral venous sinuses, impairing the drainage of deoxygenated blood and cerebrospinal fluid from the brain. Objective: The aim of this study was to elucidate the clinical profile and risk factors associated with CVST, enhancing the understanding of its epidemiology and facilitating better diagnostic and therapeutic strategies. Methods: This prospective cross-sectional study was conducted at the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. A total of 135 participants diagnosed with CVST were enrolled through non-probability consecutive sampling. Participants underwent comprehensive physical and neurological examinations using a structured Clinical Patient Assessment Form. Diagnostic imaging included MRI, MRV, CT, and CT venography, although the principal diagnostic tools were CT and MRV. Data collection focused on demographics, clinical manifestations, and risk factors, with all information analyzed using SPSS version 25. Results: The study population predominantly consisted of females (74.8%) with the age group of 31-40 years being the most common (31.1%). Headache was the most frequently reported symptom (90.4%), followed by hemiparesis (53.3%) and seizures (40%). Significant risk factors included postpartum status (50.4%), iron deficiency anemia (25.9%), and genetic prothrombotic conditions (9.6%). Imaging studies revealed that the transverse sinus was the most affected site (74.1%). Conclusion: CVST exhibits a diverse range of clinical presentations and is associated with multiple demographic and physiological risk factors. Early diagnosis and management are crucial to prevent severe outcomes. This study highlights the importance of considering a detailed clinical and risk factor profile in patients presenting with neurological symptoms to aid in timely and accurate diagnosis of CVST.

Sensorineural hearing loss among type 2 diabetic patients and its association with peripheral neuropathy: a cross-sectional study from a lower middle-income country

IntroductionDespite potential links between diabetes and sensorineural hearing loss (SNHL), routine hearing assessments for diabetic patients are not standard practice. Our study aimed to investigate the prevalence of SNHL and...

Adequacy of Surgery of Head and Neck Cancers

Adequacy of Surgery of Head and Neck Cancers

Frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital.

Objective: To determine the frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Outpatients Obstetrics & Gynaecology, Ward 8, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: July 30, 2021 to January 29, 2022. Methods: All patients who met the inclusion criteria and visited JPMC, Karachi were enrolled in the study. After providing a thorough explanation of the procedure, risks, and benefits of the study, informed consent was obtained. The study involved conducting detailed history and examination, as well as recommending relevant laboratory investigations such as thyroid and ultrasound pelvic/TVS profiles. Results: 150 women of thyroid disorders in patients with menstrual irregularities were included with mean age was 33.72±7.62 years, mean height was 1.69±0.07 meter, mean weight was 76.60±12.70 kg, mean BMI was 26.78±4.13 kg/m2, mean parity was 2.84±2.05 and mean duration of menstrual irregularity was 0.82±0.07 days. Positive family history of thyroid disorder was found to be in 15 (10.0%). Positive history of thyroid surgery was noted in 26 (17.3%) patients. Thyroid disorder was noted in 57 (38.0%) cases. In distribution for type of thyroid disorder, subclinical hypothyroidism was noted in 37 (64.9%), 9 (15.8%) overt hypothyroidism, 11 (19.3%) subclinical hyperthyroidism while overt hyperthyroidism was noted in 0 (0.0%). In distribution of menstrual complain, amenorrhea was noted in 3 (5.3%), 3 (5.3%) oligomenorrhea, 7 (12.3%) metrorrhagia, 32 (56.1%) menorrhagia while polymenorrhea were noted in 12 (21.1%) cases. Conclusion: It is to be concluded that thyroid disorder is frequently observed in patients experiencing menstrual irregularities, as indicated by the study. However, further research is required to validate these finding.

Gender Disparities in Dietary and Addiction-Associated Risk Factors of Hypertension: Insights from Karachi

Objectives: This study aimed to investigate the dietary and addictive risk factors associated with hypertension and assess their gender-specific patterns. Methodology: Conducted at the Outpatient Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, from July to December 2022, this descriptive cross-sectional study enrolled diagnosed hypertensive patients with a history of elevated blood pressure lasting more than six months, using a nonpurposive convenient sampling technique. Detailed histories of addictive and dietary risk factors were obtained, and blood pressure was measured. Dietary risk factors included excessive salt and fat intake, along with a diet rich in saturated fatty acids. Addictive risk factors assessed included tobacco and areca nut addiction. Results: Of the 960 patients included, 588 (61.2%) were male, and 372 (38.8%) were female. Males exhibited poorer hypertension control (42.0%) compared to females (33.7%). The most prevalent dietary risk factor was excessive fat intake (76.7%), followed by excessive salt intake (66.7%). Smoking was reported in 66 (11.2%) males and 4 (1.0%) females, while areca nut addiction was observed in 51 (8.5%) males and 15 (4.0%) females. Conclusion: Our findings underscored a significant association between male gender and inadequate hypertension control, coupled with a higher prevalence of dietary and addiction-related risk factors. These findings highlight the importance of targeted interventions aimed at mitigating these modifiable risk factors, particularly among males, to reduce the burden of hypertension-related morbidity and mortality.

DRUG AND ALCOHOL USE IN ORTHOPAEDIC TRAUMA PATIENTS: A PROSPECTIVE STUDY

The objective of this study is to prospectively investigate the prevalence, patterns, and correlates of drug and alcohol use among orthopaedic trauma patients. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Jinnah Postgraduate Medical Center from 01/09/23 to 29/02/24. Baseline data was collected upon admission and included demographic information (such as age and gender) and a comprehensive assessment of substance use history. Substance use was assessed using validated screening tools, including the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST), to capture patterns of alcohol and drug use, frequency, duration, and any previous treatment history for substance use disorders. In the present study, the prevalence of drug and alcohol use among the orthopedic traumatic participants was (40%). Among them, the majority (51%) were using alcohol, followed by marijuana use (25%), and then cocaine (11%). The means of hospital stay of participants in substance non-users and users (2.4±0.8 vs. 6.83±1.1; P<0.0001). Pre-injury alcohol and drug use appear to correlate with extended hospital stays among patients with traumatic orthopaedic injuries.

COMPARISON OF THE VARIABILITY OF RECOVERY PROFILE AND HEMODYNAMIC EFFECTS OF NEUROMUSCULAR BLOCKADE WITH CISATRACURIUM VERSUS ATRACURIUM

A randomized controlled trial was conducted at the Main Operation Theatre of Jinnah Postgraduate Medical Centre (JPMC) in Karachi to compare the recovery profile and hemodynamic effects of cisatracurium and atracurium among patients undergoing laparoscopic cholecystectomy. The study was conducted from 20th July 2019 to 19th January 2020 and included 68 patients aged between 20 to 50 years undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients with a history of allergy to the study drugs, neuromuscular, pulmonary, renal, or hepatic diseases, smoking, pregnancy, or breastfeeding, and those on preoperative medication such as antipsychotics, aminoglycosides, steroids, or neuroleptics were excluded. The patients were randomly divided into two groups. In Group 1, comprising 34 patients, cisatracurium (0.2 mg/kg) was administered, whereas in Group 2, also with 34 patients, atracurium (0.5 mg/kg) was given. Neuromuscular blocking agents were administered three minutes before intubation. The primary outcomes measured were the recovery profile and hemodynamic effects. In Group 1 (cisatracurium), the baseline mean arterial pressure (MAP) was recorded as 98.40 ± 8.02 mmHg, which increased to 112.20 ± 8.88 mmHg before intubation, resulting in a change of 13.56 ± 5.59 mmHg. In contrast, in Group 2 (atracurium), the baseline MAP was 94.10 ± 7.91 mmHg, which rose to 109.07 ± 8.35 mmHg before intubation, indicating a change of 16.50 ± 4.38 mmHg. The study concluded that cisatracurium is more effective in exhibiting neuromuscular blocking properties than atracurium in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Comparison Efficacy between Percutaneous Nephrostomy and Double J Stent in Management of Obstructive Uropathy

Background: The prevalence of urolithiasis and associated acute kidney injury (AKI) has seen a notable increase in recent decades, particularly in developing countries such as Pakistan, which falls within the "stone forming belt" region. This rise has underscored the need for effective management strategies for obstructive uropathy, a potentially reversible condition if timely intervention is provided. However, the literature reveals a divergence in treatment approaches between different regions and among healthcare professionals, with no universally recommended treatment for relieving the obstructed system. Objective: This study aimed to evaluate and compare the efficacy of percutaneous nephrostomy (PCN) versus Double J stent (DJS) in the management of obstructive uropathy secondary to urolithiasis in patients with elevated serum creatinine levels. Methods: Conducted as a randomized controlled trial at the Jinnah Postgraduate Medical Center Karachi from January 2023 to December 2023, the study included patients aged 20 to 50 years with obstructive uropathy secondary to urolithiasis and serum creatinine above or equal to 2.0 mg/dL. Exclusion criteria encompassed obstructive uropathy due to bladder outlet obstruction, uncontrolled coagulopathy, and lack of consent. Participants were randomized into two groups for either PCN or DJS placement, with pre-operative and post-procedure serum creatinine and urea levels measured at multiple intervals. Data analysis was performed using SPSS version 25. Results: The study enrolled 30 patients in the PCN group and 30 in the DJS group. Efficacy rates for PCN and DJS were 93.3% (28 out of 30) and 76.7% (23 out of 30), respectively. Stratified analysis revealed no statistically significant differences in efficacy based on age, gender, or duration of illness, although a trend favoring PCN was observed in patients over 40 years and those treated within 5-10 days of illness onset. Conclusion: While both PCN and DJS are effective interventions for obstructive uropathy secondary to urolithiasis, PCN showed a non-significantly higher overall efficacy. These findings suggest a potential preference for PCN in certain patient subsets, though further research with larger sample sizes and multi-center trials is needed to substantiate these observations.

Frequency and Distribution of Complications in Cholesteatoma Patients: A Tertiary Care Hospital Study

Background: Cholesteatoma, a benign epithelial lesion, progresses with time, necessitating surgical intervention. The most common surgical treatments are canal wall up (CWU) and canal wall down (CWD). CWU, though preserving ear canal anatomy, has a higher risk of recurrence, prompting a need to evaluate the frequency and nature of complications arising from cholesteatoma to improve treatment outcomes. Objective: This study aims to identify the frequency and types of complications in patients diagnosed with cholesteatoma at a tertiary care hospital. Methods: Conducted as a cross-sectional analysis at the Department of ENT, Jinnah Postgraduate Medical Centre, Karachi, from August 10, 2019, to February 9, 2020, this study included 210 diagnosed patients. Through otoscopy, audiologic evaluations, and microscope examinations for selected cases, patients with signs of persistent disease underwent mastoid exploration. Surgical interventions were tailored based on disease extent and type. Statistical analysis employed descriptive statistics, stratification, and Chi-square tests for significance (P-value ≤0.05). Results: Of the participants, 57.6% were male, and 42.4% were female, with an average age of 31.30±8.75 years and a mean disease duration of 8.73±3.63 months. Extracranial complications were identified in 29% of patients, with 12.4% experiencing ossicular damage. Intracranial complications were found in 18.1% of patients, with meningitis constituting 8.6% of these cases. A total of 5.7% presented with multiple complications. No significant associations were found between the complications and variables such as gender, age, BMI, and disease duration. Conclusion: Extracranial complications, notably ossicular damage, were most common, followed by intracranial complications and multiple complications, underlining the necessity for early diagnosis and targeted treatment strategies.

Diagnostic Accuracy of MRI in Detecting Orbital Masses Keeping Histopathology as Gold Standard

Background: Orbital masses, encompassing a spectrum of benign and malignant lesions, pose significant diagnostic and therapeutic challenges. Magnetic resonance imaging (MRI) has been pivotal in the non-invasive evaluation of these lesions, owing to its superior soft tissue contrast and detailed anatomical resolution. The correlation between MRI findings and histopathological diagnosis remains crucial for accurate clinical decision-making. Objective: The study aimed to evaluate the diagnostic accuracy of MRI in identifying orbital masses, with a focus on differentiating between benign and malignant lesions, using histopathology as the gold standard. Methods: A prospective cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January to December 2023. A total of 145 patients scheduled for surgery or biopsy, presenting with clinical symptoms indicative of orbital masses, were enrolled using a non-probability sequential sampling method. MRI evaluations were performed using a 1.5 Tesla machine. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MRI in detecting orbital masses were calculated, comparing MRI findings with histopathological results. Results: Of the 145 patients, 55.2% were female, and 44.8% were male, with an age range predominantly between 18-30 years (87.6%). MRI identified 77.2% of cases as malignant and 22.8% as benign, whereas histopathology diagnosed 83.4% as malignant and 16.6% as benign. The diagnostic accuracy of MRI for benign masses showed a sensitivity of 81.82%, specificity of 96.43%, PPV of 87.10%, NPV of 94.74%, and an overall diagnostic accuracy of 93.10%. For malignant masses, MRI demonstrated a sensitivity of 90.16%, specificity of 86.90%, PPV of 83.33%, NPV of 92.41%, and a diagnostic accuracy of 88.28%. Conclusion: MRI exhibits a high diagnostic accuracy in identifying orbital masses, with excellent sensitivity and specificity. It proves to be a reliable diagnostic tool in differentiating between benign and malignant orbital lesions, supporting its integral role in the preoperative assessment and clinical management of patients with suspected orbital masses. Keywords: Orbital Masses, Magnetic Resonance Imaging, Diagnostic Accuracy, Histopathology, Benign Lesions, Malignant Lesions, MRI Sensitivity, MRI Specificity

Concordance Rate of Radiological Stage With Post-Operative Pathological Stage In Breast Cancer

Objective: To assess the concordance between the radiological and post-operative pathological stages in invasive breast carcinoma. Study Design: Cross-validation study Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan, from Jan to Jul 2020. Methodology: A total of 160 females aged 20-80 years with confirmed diagnosis of breast cancer underwent upfront modified radical mastectomy along with axillary node dissection were included in the study. Demographic and clinic pathological findings of all the patients were reported in pre-designed proforma. Stage concordance was labelled as a patient assigned to the same stage radiologically and pathologically. Results: The mean age of the 160 patients was 47.22±10.51 years. The relationship between radiological and pathological staging was weak (r=0.383) but statistically significant (p=0.001). The tumor stage on radiological and pathological assessment was similar in 60 cases (37.3%). Radiologic assessment overestimated the stage in 75 cases (46.6%) and underestimated it in 26 cases (16.1%). The overall concordance between radiological and pathological staging was 18.8% (p=0.001). Conclusion: Among patients with breast cancer, a high rate of discordance was observed between the radiological and pathological stages. The high odds of discordance are therefore important to plan treatment.

Is Diet A Contributing Factor To Infertility?

Objective: To evaluate the effect of dietary trans-unsaturated fatty acids (TFAs) on ovulatory infertility in young unmarried females.Methods: This cross-sectional study was conducted from 1 august 2023 to 31 December 2023 at the Basic Medical Science Institute (BMSI), Jinnah Postgraduate Medical Center Karachi. All healthy unmarried females aged 15-25 were included in the study. Females with a family history of infertility, having existing comorbidity, history of irregular menstruation cycle or hormonal replacement therapy, were excluded. Based on the Food frequency questionnaire score, 300 subjects were divided into 3 groups, Group A were low trans fats Consumers (Score 0-170), Group B was moderate trans fats consumers(Score 171-340) and Group C were high trans fats consumers (Score 341-500). The analysis of results was carried out on SPSS Software version 22.Results: The study’s 300 respondents, who ranged in age from 16 to 25, had a mean age of 21.8 years. Fifteen per cent of those in group “A” had abnormal HDL, 22% had bad LDL, and 23% had abnormal TGA, while 17% had abnormal cholesterol. An abnormal TGA, abnormal HDL, abnormal LDL, and abnormal 31% of the participants in group “B” exhibited abnormal cholesterol levels. A significant correlation between oxidative stress and hormonal indicators was found in three groups: “A” (13%) had aberrant LH, “20%” had abnormal FSH, “11%” had abnormal serum estrogen, “10%” had abnormal serum progesterone, and “C” (49% had abnormal LH, FSH, estrogen, and progesterone). Food frequency questionnaire (FFQ ) scores had a 25% positive correlation with cholesterol, a 40% negative correlation with HDL, a 31% positive correlation with LDL, and a 39% positive correlation with biochemical and hormonal indicators.Conclusion: Trans fats diets significantly increase the risk of ovulatory infertility and reproductive failure in young females

Dengue Cases Presenting to the Emergency Department of a Tertiary Care Hospital in Late 2021: A Cross-Sectional Study in Karachi.

Objectives: Dengue Fever (DF) is an arboviral disease caused by the Dengue virus (DENV). This study aims to assess the association of dengue prevalence with patients' residential areas and hematological laboratory findings (Total platelet count, immunoglobulins, and dengue antigens) during COVID-19 pandemic. Methods: A retrospective study was conducted at the Emergency department of Jinnah Postgraduate Medical Center, Karachi from October to December 2021. All the patients irrespective of their ages presenting to the ED with either of the following complaints: fever; GIT problems; vomiting; body ache; bleeding were included in our study. Results: Our study comprised 189 patients in total in which the females (n = 172) outnumbered the males (n = 17). Out of all, 84.7% of the patients were febrile having a low-grade fever on average. Korangi district had the most dengue cases, while Keamari had the fewest. There was no significant association reported between mean platelet count, mean TLC, and mean hemoglobin levels with dengue positivity. Conclusion: There is a concerning rise in DF cases in Karachi, particularly in the Korangi district. Despite the COVID-19 pandemic, DF demands urgent attention.

Comparison of the Efficacy of Tazarotene 0.045% versus Halobetasol Propionate 0.01% Lotion for the Treatment of Scalp Psoriasis at Tertiary Care Hospital, Karachi

Background: Psoriasis is a chronic, genetically determined inflammatory skin condition characterized by erythematous plaques with silvery scales, affecting about 2% of the global population. It significantly impacts patients' quality of life, encompassing physical, emotional, and psychosocial dimensions. While the use of topical corticosteroids (TCS) with tazarotene has shown benefits in plaque psoriasis treatment, limited data are available on the efficacy of combining halobetasol and tazarotene. Objective: This study aimed to compare the efficacy of Tazarotene 0.045% cream (TAZ) versus Halobetasol Propionate 0.01% lotion (HP) for the treatment of scalp psoriasis at a tertiary care hospital in Karachi, providing insight into their comparative effectiveness and informing clinical decision-making. Methods: A randomized control trial was conducted at the Dermatology Department of Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to February 2023. Ninety participants with scalp psoriasis were recruited and randomly assigned to two groups: Group A (n=45) received Tazarotene 0.045% cream, and Group B (n=45) received Halobetasol Propionate 0.01% lotion, both applied once daily for 6 weeks. The primary outcome was the change in Investigator's Global Assessment (IGA) score from baseline to week 6. Data analysis was performed using SPSS version 25, focusing on descriptive statistics and inferential analyses to evaluate treatment efficacy. Results: The study observed a significant reduction in IGA scores from baseline in both groups, with Group A (TAZ) showing a decrease from 3.89 ± 0.68 to 1.29 ± 0.62 and Group B (HP) from 3.87 ± 0.66 to 2.49 ± 0.62. The paired difference in IGA scores indicated a more pronounced improvement in the TAZ group (2.60 ± 0.75) compared to the HP group (1.37 ± 0.57), with significant differences between the groups (p<0.0001). Treatment success was observed in 82.2% of participants in the TAZ group compared to 51.1% in the HP group, with an odds ratio of 4.424 (95% CI: 1.690—11.578; p=0.002). Conclusion: Tazarotene 0.045% cream demonstrates significantly greater efficacy in treating scalp psoriasis compared to Halobetasol Propionate 0.01% lotion. The findings suggest Tazarotene as a preferable treatment option for scalp psoriasis, offering a better therapeutic outcome.

Prevalence and factors influencing anemia in women of reproductive age visiting a tertiary care hospital (Jinnah Postgraduate Medical Center) in Karachi: A cross-sectional study.

Anemia is a significant public health concern, primarily affecting young children, pregnant and postpartum women, and menstruating adolescent girls and women. This study aimed to evaluate the prevalence of anemia and associated factors in women of reproductive age visiting a tertiary care hospital in Karachi, Pakistan. The primary objective was to determine the prevalence of anemia in women of reproductive age, while the secondary objective was to investigate potential causes of anemia within this demographic group. A prospective cross-sectional approach was employed, adhering to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A questionnaire-based method was used to assess anemia, and data were collected from women aged 14 to 40 years. The study was conducted at the Jinnah Postgraduate Medical Center from January to May 2023. The study was approved by the Institutional Review Board of Jinnah Sindh Medical University (Institutional Review Board reference number JSMU/IRB/2023/699). A sample of 397 women was included, and various demographic and lifestyle factors were assessed. In this study of 397 participants, 71.5% were found to have anemia, primarily microcytic anemia (48.2%). Anemia prevalence was highest among the 14-18 years age group (80.7%) and those from lower socioeconomic backgrounds (73.6%). Factors such as frequent tea consumption, irregular mealtimes, and pica consumption were associated with higher anemia rates. Pregnant women and those with more children were at a heightened risk of anemia. The study reveals a notable prevalence of anemia among women of reproductive age with a surprising emphasis on younger individuals and lower socioeconomic groups. Dietary habits, lifestyle choices, and pregnancy status play significant roles in anemia development. Targeted interventions are essential, particularly for younger women, those from disadvantaged backgrounds, and pregnant individuals, to combat anemia effectively in this region.

Comparison of the Outcome of Treatment of 15% Trichloroacetic Acid versus Topical 0.05% Tretinoin in the Treatment of Acanthosis Nigricans at Tertiary Care Hospital, Karachi

Background: Acanthosis Nigricans (AN) is a dermatological condition characterized by hyperpigmented, velvety plaques, commonly linked with insulin resistance, obesity, and hormonal disorders. The treatment of AN primarily focuses on managing skin changes, with topical agents like trichloroacetic acid (TCA) and tretinoin being explored for their efficacy. Objective: The study aimed to compare the effectiveness of 15% trichloroacetic acid and topical 0.05% tretinoin in the treatment of Acanthosis Nigricans, focusing on improvements in hyperpigmentation and patient satisfaction. Methods: This randomized control trial was conducted at Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to June 2023. A total of 90 participants with diagnosed AN were recruited and randomly assigned into two groups: Group A (n=45) received 15% TCA peels every two weeks, and Group B (n=45) applied topical 0.05% tretinoin daily, both for a duration of 8 weeks. The efficacy was assessed using serial photographs and a grading system for improvement. Data analysis was performed using SPSS Version 25.0, with the Chi-square test employed for comparing efficacy. Results: The mean age in Group A was 35.11 ± 7.05 years and in Group B was 37.20 ± 6.37 years. Group A showed a higher success rate with 42 participants (93.3%) demonstrating improvement, compared to 35 participants (77.8%) in Group B (P-value: 0.034, Odds Ratio: 4.000). Grades of improvement indicated that 26 participants (57.8%) in Group A and 14 (31.1%) in Group B experienced good improvement (51%-75%). Adverse effects such as erythema and post-inflammatory hyperpigmentation were more common in Group A. Conclusion: The study suggests that 15% trichloroacetic acid may offer greater improvement in hyperpigmentation in Acanthosis Nigricans compared to topical 0.05% tretinoin. However, the treatment choice should consider individual patient factors, and further research is needed to confirm these findings.

The Prevalence and Outcomes of Hepatorenal Syndrome in Chronic Liver Disease Patients in a Tertiary Care Hospital

Hepatorenal syndrome (HRS) leads to a severe kidney injury leading to its eventual failure in the background of chronic liver disease. Objective: This research’s objective was to define the frequency of hepatorenal syndrome (HRS) in the background of cirrhosis and to find out the outcomes of the patients with HRS. Methods:This is a detailed prospective clinical series research. It was conducted in the Department of Medicine, Jinnah Postgraduate Medical Center (JPMC), Pakistan, from February 2020 to December 2020 after approval by the authorized review board. Jinnah Postgraduate Medical Center (JPMC). A sample size of 101 was calculated. The lab values including prothrombin time (PT), serum albumin, and chronic liver disease variations were established for confirmative diagnosis. Frequency tables were created for parameters to be determined (sex and Child-Pugh classification). The means and their SD of parameters of interest (age and weight) were calculated. Results:The demographic variables were the mean age of the patients was 62.5±10.2 and the mean bilirubin was 2.32 ± 2.3mg/dL. 68 (67.3%) of the patients had normal creatinine and 33 (32.7%) of the patients had raised serum creatinine. 2(10.5%) of the patients had a numerical score of 5-6, 13 (68.4%) of the patients had a total score of 7-9 and 4(21.1%) of the patients had 10-15 scores. Hepatorenal syndrome was detected in 11.9% of patients with cirrhosis, among whom 4 (33.3%) died. Conclusions:The hepatorenal syndrome is quite common in liver diseases and it needs to be assessed.

Prevalence of urinary tract infection with asymptomatic bacteriuria among gravid females: A Pakistani multicenter cross-sectional study.

Objective: To determine the prevalence of urinary tract infection with asymptomatic bacteriuria among pregnant females. Study Design: Multi-center, Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Karachi, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, and Hayatabad Medical Complex, Peshawar, Pakistan. Period: January 2023 to June 2023. Material & Methods: A total of 260 pregnant females aged between 18 to 45 years and visiting outpatient department for antenatal check-up were analyzed. Enrolled females were interviewed and demographical and clinical data were noted. All women had their urine analysis done as a routine antenatal test. Urine culture analysis was also done at the same time. Asymptomatic bacteriuria was labeled when urine culture revealed the presence of more than 105 bacteria per milliliter of urine but without showing symptoms of urinary tract infections. Results: In a total of 260 pregnant females, the mean age was 28.6±5.3 years (ranging between 18-45 years). There were 125 (48.1%) females who reported during 3rd trimester of pregnancy. Residential status of 209 (80.4%) females was urban. There were 65 (25.0) females who were illiterate. Family monthly income of 198 (76.2%) females was below 30,000 Pakistani Rupees. Asymptomatic bacteriuria was revealed in 69 (26.5%) pregnant females. The most common urinary bacterial isolates were E. coli and Klebsiella found in 36 (52.2%) and 10 (14.5%) respectively. Conclusion: The prevalence of asymptomatic bacterirua among pregnant females was high (26.5%). The most common urinary isolates found among asymptomatic bacteriuria cases were E.coli.

The current spectrum of infections in cancer patients with chemotherapy related neutropenia

Background: New cancer treatments have improved patient survival but also bring side effects like weakened immunity and higher infection risk. The present study aimed to assess the pattern of blood stream infections and antimicrobial resistance in blood isolates of neutropenic patients. Material and Methods: This Cross-sectional, observational study was conducted at Department of Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan between August 2019 to August 2020. Malignant patients who underwent chemotherapy and presented with fever, neutropenia, and positive bacterial blood culture were enrolled in the study. Patients with a recent history of blood transfusion were excluded. The spectrum of bacterial infections and the antimicrobial resistance patterns of causative organisms isolated from blood were studied. The CLSI standard antimicrobial panel was used for each microorganism. Findings were presented in tabular form. Results: During the study period 95 organisms were isolated from the blood cultures. Strains of E. Coli, Klebsiella, Pseudomonas, S. Aureus, S. Pneumoniae, were found in 27 (28.4%), 18 (18.9%), 13 (13.7%), 17 (17.9%), and 2 (2.1%) patients, respectively. 44.0% of E. coli, 68.8% of Klebsiella, and 38.5% of Pseudomonas were resistant to tazobactam. 92.6% of E. coli, 88.2% of Klebsiella, 100% of Pseudomonas were resistant to Co-amoxiclav. 52.9% of Staph aureus were resistant to methicillin. 23 (92.0%) strains of E. coli, 15 (83.3%) strains of Klebsiella, 6 (46.2%) strains of Pseudomonas, and 11 (68.8%) of Staph aureus were resistant to ciprofloxacin. Conclusion: Resistance to the majority of the commonly used antimicrobial drugs was noted. Continuous antimicrobial resistance surveillance of the everchanging spectrum of causative organisms and their characterization is very important to treat the bloodstream infections (BSI) in cancer patients with chemotherapy induced neutropenia. Keywords: Neutropenia Infection, Fever, Antimicrobial resistance, Chemotherapy.

Frequency of domestic violence in pregnancy and its adverse maternal outcomes among Pakistani women

Objective: To determine the frequency of domestic violence in pregnancy and its adverse maternal outcomes among Pakistani women.Material and methods: This was a prospective descriptive longitudinal study conducted at the Department of Obstetrics &Gynecology of Jinnah Postgraduate Medical Center, Karachi from October 2021 to March 2022. The questionnaire was filled during an interview. First part included demographic profile, second part comprised of 5 items with ‘yes’ or ‘no’ options. Any positive answer meant woman was subjected to abuse. Adverse maternal outcome was also assessed.Results: Out of a total of 105 pregnant women, 43(41%) women suffered domestic violence. Verbal or emotional violence (39%) was the most common type of violence. In our study, anemia (71.4%) was the most common complication. Preterm labor (63.8%) was the second on the list. was significantly associated with domestic violence (P-value<0.05). Educational status, employment status, substance abuse, and household monthly income of spouse had a significant association (P-value<0.05) with domestic violence.Conclusion: Our study shows that high frequency of violence at the time of pregnancy is related to negative maternal outcomes.Women should be screened for violence and support services for such women should be provided in the country.