Khyber Teaching Hospital Peshawar Research Articles

Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Hospital in Peshawar

OBJECTIVES To examine demographic characteristics, diagnosis on admission, and clinical outcomes in terms of morbidity and mortality of all those obstetric patients who were shifted to the Intensive care unit. METHODOLOGY This retrospective study was conducted in Gynae Unit A, Medical and Surgical intensive care units of Khyber Teaching Hospital Peshawar from 1st January 2021 to 31st December 2022. All the obstetric patients admitted to medical or surgical intensive care units were included, i.e., pregnant women or women admitted within six weeks after delivery to medical or surgical ICUs. Data about the patient’s demographics, obstetric/medical history, diagnosis on admission, reason for shifting to Intensive care units, course and treatment, ICU course, length of stay, outcome, and maternal mortality were obtained.RESULTSThe ICU admission rate of obstetric patients in the study period was 0.7%. The age group of 26-30 years was most commonly seen in our study, where 35(40%) of our cases fell, followed by the 21-25 age group (19.5%).27(31%) of our patients were primigravidas and 60(69%) were multigravidas.21(24%) were antenatal,65(75%) were postnatal and 1(1%) was ectopic. Postpartum hemorrhage was the most common indication(24%) for which patients were referred to the intensive care unit, followed by Eclampsia in 15(17%) and placenta accreta in 13(15%). Causes of mortality for the ICU admissions were shock and ARDS in 1(7%) each, DIC in 5(33%), and Cardiac arrest in 8(53%) cases. Fifteen patients expired in the intensive care unit during the study period, making the mortality rate 17%. CONCLUSION Strengthening critical care is important for saving the high-risk obstetric population. A structured ICU with an interdisciplinary approach is necessary to reduce high-risk obstetric mortality.

Short-Term Outcomes of Posterior Fossa Decompression with or without Duraplasty for Chiari Malformation Type 1: Insights from a Tertiary Care Hospital

Objectives: To assess and compare short-term outcomes of patients who underwent posterior fossa decompression with and without duraplasty for Chiari Malformation Type 1 (CM1).Methodology: This retrospective cohort study was conducted at Khyber Teaching Hospital's Peshawar, Pakistan, in December 2023 after securing permission from the Institutional Review Board (IRB) with reference. We included patients who underwent posterior fossa decompression for Chiari Malformation Type 1 (CM1) over a one-year period from March 2022 to March 2023 at Khyber Teaching Hospital. Retrospective data of specified duration concerning CM1 Patient’s demographics, preoperative symptoms, surgical details including the use of duraplasty, and postoperative outcomes were extracted from electronic health records at Khyber Teaching Hospital, Peshawar. Data was analyzed by SPSS27. Descriptive statistics were employed to summarize demographic characteristics and baseline clinical data and frequencies were reported.Comparative analyses between posterior fossa decompression surgery with duraplasty and that without duraplasty groups were performed using t-tests for continuous variables and chi-square tests for categorical variables. Results: 52 patients were included in our study out of which 28 underwent posterior fossa decompression with duraplasty and 24 without duraplasty. 8 patients (15.4%) experienced postoperative complications. Cerebrospinal fluid leaks were observed in 3 cases (5.8%), all of which occurred in the PFD with duraplasty group. The mean length of hospital stay for patients undergoing PFD with duraplasty was 6.2 days (SD ± 1.4), while for those undergoing PFD without duraplasty, it was 5.4 days (SD ± 0.9).Conclusion: Posterior fossa decompression with duraplasty carries the risk of CSF leak so the preferred procedure for Chiari Malformation Type 1 is posterior fossa decompression without duroplasty. Those patients requiring posterior fossa decompression with duroplasty should be highly individualized.

SLEEP HEALTH OF MEDICAL STUDENTS BEFORE THE ANNUAL OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)

OBJECTIVES: To determine the sleep health of medical students before the annual OSCE at Khyber Medical College Peshawar (KMC) / Khyber Teaching Hospital Peshawar (KTH). MATERIALS AND METHODS: This descriptive cross-sectional study was conducted from April 6–14, 2022, in the Department of Medicine, KTH Peshawar. All students of final-year MBBS of KMC appearing in Final OSCE were included in the study after receiving informed consent. Students were classified as day scholars and hostelites. Levels of stress alertness, sleep efficiency, duration, and timing of sleep were checked in both genders, and all were categorized according to the SATED questionnaire. RESULTS: A total of 245 students were included in this study, of which 148 were male and 97 were female. Among these students, 84 were day scholars, and 161 were hostelites. Thirty-two students were completely unsatisfied with their sleep, 45 % were satisfied sometimes, 20.2% felt drowsy during most of their daytime, and 46.5% felt drowsy during some of the day. Males had significantly better sleep health (5.35 ± 2.0) compared to females (4.4 ± 1.9)-p < .001. Males had significantly higher average satisfaction (0.99 ± 0.72, p =.027) and average duration (1.34 ± 0.69, p < .001) of sleep compared to females (0.77 ± 0.74, 0.93 ± 0.74, respectively). CONCLUSIONS: Students' sleep health was considerably worse before the annual practical examination, and this difference was somewhat higher among hostelites. KEYWORDS: Sleep health, Sleep quality, medical students

FUNCTIONAL OUTCOME OF UNCEMENTED TOTAL HIP ARTHROPLASTY IN POST-TRAUMATIC AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG PATIENTS

Objective: To determine the frequency of different outcomes of uncemented total hip replacement in young patients with avascular necrosis due to traumatic cause Materials and Methods: This study was done in Khyber Teaching Hospital Peshawar, Pakistan from March 2022 to January 2024. 96 patients of the younger age group (20-45 years) consisting of both genders with uncemented total hip arthroplasty for AVN femoral head due to traumatic cause, were studied. Age, gender, side of hip affected by AVN, and pre-operative Harris Hip Score were noted. Functional outcomes of uncemented THA were determined in terms of improvement in postoperative Harris hip score was documented at 3 months postoperatively. Results: A total of 96 patients, 80 (83.33%) men and 16 (16.67%) women underwent uncemented total hip arthroplasty. The age ranged from 20 to 45 years, with a mean of 40±7.02 years. Reasons for osteonecrosis included femoral neck fracture (50%), hip dislocation (36.46%), and acetabular fracture (13.54%). After 3 months of surgery, the Harris hip score improved and was excellent in 86.46% of patients, good in 8.33% of patients, fair in 5.2% of patients and none of the patients had poor scores. Conclusion: The cementless hip prosthesis for the treatment of post-traumatic avascular necrosis of the femoral head in active and young individuals is a very good option. The results of cementless hip arthroplasties are good and encouraging in terms of functional outcome postoperatively. Keyword: Harris Hip Score; Uncemented Total Hip Arthroplasty; Avascular Necrosis Hip

KNOWLEDGE AND PRACTICES OF LABORATORY STAFF REGARDING COVID-19 INFECTION

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

FREQUENCY OF OBESITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

OBJECTIVE: To determine the frequency of Obesity in patients with Type 2 Diabetes Mellitus in patients visiting the Outpatient department of Khyber Teaching Hospital, Peshawar MATERIALS AND METHODS. This descriptive cross-sectional study was conducted in the Department of Medicine Khyber Teaching Hospital Peshawar after approval from the hospital’s ethical committee. All type 2 diabetes mellitus patients fulfilling inclusion criteria, presented to medical OPD and ward were interviewed in detail. Relevant information like age, gender, height weight, etc. recorded using proforma. BMI was calculated using height and weight. Patients with RBS of more than 200 mg/dl and symptomatic were labeled as having diabetes (American diabetes association). Patients with a BMI of more than 25kg/m2 were labeled as having obesity (Asian Pacific criteria). Data was analyzed using SPSS version 20 and presented in tables. RESULTS. The mean and standard deviation (SDs) for age were recorded as 56­­±9 years. Mean and SDs for height were recorded as 1.5± 0.8 meters. Mean and SDs for weight were recorded as 65±12 kilogram. Mean and SDs for random blood sugar were recorded as 238±77 mg/dl. Mean and SDs for BMI were recorded as 26±5. One hundred and eighty-nine (49.2%) patients were female and 195(50.8%) were male. Two hundred and seven (53.9%) patients were recorded as obese and 177(46.1%) were recorded as non-obese. CONCLUSION. In our study, we found that the majority of type 2 diabetes mellitus patients were obese. Thus, by adopting a healthy lifestyle we can reduce and delay the onset and morbidity associated with diabetes mellitus. KEYWORDS Diabetes mellitus (DM), Body mass index (BMI), Random blood sugar (RBS), Glycated hemoglobin (HBA1C).

Comprehension of Long-Term Medications in Patient with Type 2 Diabetes Mellitus: A Kap Study

OBJECTIVES The study aimed to assess the comprehension of long-term medications in patients with Type 2 diabetes mellitus. METHODOLOGY A descriptive cross-sectional study was conducted in Khyber Teaching Hospital Peshawar, Pakistan, a region with potentially low literacy rates that could affect health outcomes. After acquiring approval from the Institutional Ethical Review Board, the study utilized an appropriately designed and validated questionnaire to collect data from 305 willing participants. The questionnaire assessed demographic information, comorbid conditions, and comprehension of long-term medications. RESULTSThe mean age of the patients was 58.52 ± 10.3 years, with a mean HbA1c of 9.15 ± 2.1%. Regarding T2DM treatment, 55.1% used oral anti-diabetic agents, 34.4% used insulin, and 10.2% used both. The complications were diabetic retinopathy (40.7%), chronic kidney disease (28.9%), diabetic foot ulcers (24.9%), cerebrovascular disease (16.7%), and cardiovascular disease (16.6%). Over 50% had T2DM for more than five years. Regarding affordability and access to healthcare, 8.2% couldn't afford medications, 44.9% occasionally missed medicines due to cost, and 74.4% had easy access to healthcare. Comorbidities included hypertension (47.5%) and dyslipidemia (12.8%). CONCLUSION Medication comprehension is crucial for T2DM patients’ health outcomes. Tailored interventions can improve glycemic control and reduce complications risk.

Visual Outcome and Complications in Combined Phaco-Vitrectomy Versus Separate Phaco followed by Vitrectomy for Macula Off Rhegmatogenous Retinal Detachment

Background: Cataract formation is common with pars plana vitrectomy (PPV). Removal of cataract by phacoemulsification can be done combinedly with PPV in the same settings or as separate procedure of phacoemulsification followed by PPV. Objectives: The objective of the study is to check the visual outcome, inflammation and complications in combined phaco-PPV procedure versus separate Phaco followed by PPV.Material and Methods: It was a quasi-experimental study carried out in Ophthalmology Department, Khyber Teaching hospital Peshawar from 1st May 2023 to 31st October 2023. A total of 60 patients were included and divided into 2 groups of 30 patients each. One group undergone combined phaco-PPV and the second group separate phaco followed by PPV. Results: The mean age of participants were 57.8 ± 8.24 years with 58.3% male and 41.7% female. On first post-operative day there was statistically significant difference between the visual acuity, inflammation and complications rate in combined phaco-PPV patients than separate procedure with a p-value of 0.01. There was no statistically significant difference in between the two groups in the final visual acuity, inflammation and complication rate 2 weeks after removal of silicone oil with visual acuity p-value 0.99, inflammation p-value 0.99, complications p-value 0.108Conclusion: There is no significance difference between combined phaco-PPV versus separate phaco followed by PPV in terms of visual acuity, inflammation and complication rate.Keywords: Phacoemulsification, Visual outcome, Vitrectomy

MORTALITY AND LENGTH OF HOSPITAL STAY IN PATIENTS WITH LIVER CIRRHOSIS BASED ON THEIR MELD SCORE

Objective: This study aimed to find the frequency of mortality and length of hospital stay in patients with liver cirrhosis based on their MELD score at admission. We also aim to study prognostication in cirrhotic patients using MELD scores at admission. Materials and Methods: A descriptive cross-sectional study was conducted in the Medical Department of Khyber Teaching Hospital Peshawar from 17/10/2019 to 17/4/2020. A total of 100 patients were observed. Investigations required for the calculation of the MELD score were done from the hospital laboratory. Admitted patients were followed for study outcome in-hospital mortality and length of hospital stay for at least 30 days. All information was noted in the predesigned proforma. RESULTS: One hundred patients were analyzed among which the mean age was 53 years with SD ± 7.11. Forty-two percent were male and 58% were female. In-hospital mortality was observed in 8(8%) while mean hospital stay was 7 days with a standard deviation ± 4.12 in patients presenting with liver cirrhosis mortality was observed in patients with a MELD score of less than 20. However, mortality was 6.89% in patients with a MELD score of 20-29 and 42.85 % in those with a MELD score of more than 30. CONCLUSION: The frequency of in-hospital mortality was 8% and the mean length of hospital stay was 7± 4.12 days in patients with liver cirrhosis. For patients with higher MELD scores, the hospital stay and mortality increased. Key Words: in-hospital mortality, mean length of hospital stay, MELD score

COMPARISON OF NEONATAL OUTCOMES IN TERM PREGNANCIES IN NORMAL VS ABNORMAL CARDIOTOCOGRAPHY- AN EXPERIENCE AT A TERTIARY CARE TEACHING HOSPITAL

OBJECTIVE: To compare the neonatal outcomes in normal vs abnormal cardiotocograhy in term pregnancy. MATERIALS AND METHODS: This was a prospective analytical study carried out in A unit of obstetrics and Gynaecology department of Khyber Teaching Hospital Peshawar from 15th April 2022 to 15th October 2022. A total 224 patients meeting inclusion criteria were included in study. In Group A (normal CTG) there were 111 patients and 113 were in Group B (abnormal CTG). Patients with known fetal congenital abnormalities, intrauterine growth restriction, and fetal mal presentations were excluded from the study. RESULTS: The mean age of sample population was 26.02+4.497. Multigravidae were more than primigravidae in both groups (86.4% vs 13.6% in Group A and 72.5% vs 27.5% in Group B). In Group B, caesarean section rate was higher (82.3%) than Group A (9%). From Group B, 26 (23%) newborns went to NICU for admission, whereas only 8 (7.2%) newborns from Group A needed NICU admission. Hypoxic ischemic encephalopathy was also observed more in newborns in Group B compared to Group A (10 vs 1). In Group A 12 babies had APGAR score <7 at 1 minute while in Group B 18 babies had APGAR score < 7 at 1 minute. In Group A 2 babies had APGAR score <7 at 5 minutes whereas in Group B 7 babies had APGAR score < 7. CONCLUSION: The caesarean section rate, NICU admission and hypoxic ischemic encephalopathy were more in Group B than in Group A and this difference was statistically significant (p-value 0.000, 0.000 and 0.006 respectively). Whereas there was no statistically significant difference in APGAR Score at 1 and 5 minutes in both groups (p-value 0.26 and 0.094 respectively) KEY WORDS: Cardiotocography, APGAR score, Caesarean section, hypoxic ischemic encephalopathy.

ASSOCIATION OF LOW BMI AND ANOVULATION WITH PRIMARY INFERTILITY IN WOMEN OF REPRODUCTIVE AGE

Infertility, defined as the inability to conceive after one year of regular unprotected intercourse, affects millions of couples worldwide, with prevalence rates varying across developed and developing nations. The main objective of the study is to find the association between low BMI and anovulation with primary infertility in women of reproductive age. This cross-sectional study was conducted in Khyber Teaching Hospital Peshawar from January 2023 to December 2023. A total of 340 female participants were added using convenient sampling methods. Data collection consisted of comprehensive clinical evaluations, including anthropometric measurements to assess BMI, hormonal assays to determine ovulatory status and detailed reproductive histories. BMI was calculated as weight in kilograms divided by height in meters squared (kg/m^2), with participants categorized into low BMI (BMI < 18.5 kg/m^2) and normal BMI (BMI ≥ 18.5 kg/m^2) groups. Data were collected from 340 female participants. The mean age was 28.5± 4.2 years for those with low BMI and 30.1± 3.8 years for those with normal BMI. Among underweight individuals, 50 were classified as infertile and 20 as fertile, totaling 70 participants. Of normal-weight individuals, 40 were infertile, and 120 were fertile, totaling 160 participants. In the overweight group, 30 were barren, and 50 were fertile, totaling 80 participants. Low BMI showed a significantly increased adjusted odds ratio (AOR) of 3.00 (95% CI: 1.80 - 5.00, p < 0.001) for infertility. Age, socioeconomic status, smoking, and alcohol consumption did not show significant associations with infertility. It is concluded that low BMI is significantly associated with an increased risk of anovulation and primary infertility in women of reproductive age, even after accounting for potential confounders.

P16 Expression in Grading of Urothelial Carcinoma

Background: Sleep is one of the most important determinants of human health. The quality of sleep has significant effects on academic performance and is influenced by multiple factors.Objectives: To determine the association between sleep patterns / Quality and academic performance of dental undergraduates during their summative clinical examination by using an objective measure.Material and Methods: This descriptive cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, from February 1, 2023, to June 30, 2023. A sample size of 82 was calculated by the Open Epi calculator. A validated questionnaire of the Pittsburgh Sleep Quality Index (PSQI) was used in this study. The study participants were selected by convenience based consecutive sampling technique and were 3rd BDS Students appearing in annual General Medicine Examination. After data collection, these variables were analyzed by SPSS version 26 software.Results: This study comprised 43(52.4%) female and 39(47.6%) male participants, and amongst them, 34.1% of females and 20.7% of males rendered their sleep quality bad, whereas 18.3% of females and 26.8% of males responded otherwise. The findings were positively associated with bad sleep quality (47.6%). Measures of sleep quality were significantly deranged among poor sleepers compared to normal sleepers. On average, the academic performance of poor-quality sleepers was good compared to good-quality sleepers. Still, this finding is not statistically significant, as evidenced by the t-test (Mean 574 ± SD 62.156 vs. 581 ± 79.769) and p-value of 0.640.Conclusion: Poor sleep quality was common among our students. The academic performance of these students was not statistically significant in comparison to that of good quality sleepers. Keywords: Academic performance, Dental undergraduates, PSQI, Sleep quality

Sleep Pattern in Undergraduate Dental Students Undergoing Clinical Summative Assessment in a Public Sector Dental Institute of Peshawar

Background: Sleep is one of the most important determinants of human health. The quality of sleep has significant effects on academic performance and is influenced by multiple factors.Objectives: To determine the association between sleep patterns / Quality and academic performance of dental undergraduates during their summative clinical examination by using an objective measure.Material and Methods: This descriptive cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, from February 1, 2023, to June 30, 2023. A sample size of 82 was calculated by the Open Epi calculator. A validated questionnaire of the Pittsburgh Sleep Quality Index (PSQI) was used in this study. The study participants were selected by convenience based consecutive sampling technique and were 3rd BDS Students appearing in annual General Medicine Examination. After data collection, these variables were analyzed by SPSS version 26 software.Results: This study comprised 43(52.4%) female and 39(47.6%) male participants, and amongst them, 34.1% of females and 20.7% of males rendered their sleep quality bad, whereas 18.3% of females and 26.8% of males responded otherwise. The findings were positively associated with bad sleep quality (47.6%). Measures of sleep quality were significantly deranged among poor sleepers compared to normal sleepers. On average, the academic performance of poor-quality sleepers was good compared to good-quality sleepers. Still, this finding is not statistically significant, as evidenced by the t-test (Mean 574 ± SD 62.156 vs. 581 ± 79.769) and p-value of 0.640.Conclusion: Poor sleep quality was common among our students. The academic performance of these students was not statistically significant in comparison to that of good quality sleepers. Keywords: Academic performance, Dental undergraduates, PSQI, Sleep quality

Exploring Mother’s Perspectives about Routine Immunization in District Peshawar: A Cross Sectional Survey.

Objective: of this study was to investigate mothers' opinions and knowledge regarding regular immunization of their chil-dren.Methodology: Between July 2019 to January 2020, this descriptive cross-sectional study was conducted at pediatrics outpatient department, Khyber teaching Hospital Peshawar. Women aged between 19-44 years, having at least one child less than 5 years of age were asked to complete standardized questionnaire. After stratification of the collected data, regression analysis performed.Results: Mean age of participants was 27.72 ±4.07 years, 41.98% received elementary education, while 61.32% were housewives. We observed enough knowledge in 162(88.04%) patients aged 19-29 years as compared to 55 (93.22%) aged 30-44 years (p=0.002). Additionally, knowledge was noticeably greater in situations involving several children.Conclusion: Women having secondary school or higher education and several children has sufficient knowledge of im-munization.
 Key words: KAP, Immunization, Mothers, Infectious Diseases, Vaccination

A STUDY ON TRANEXAMIC ACID ROLE FOR SEROMA REDUCTION IN VENTRAL HERNIA REPAIR

This study aimed to investigate whether tranexamic acid is effective in reducing seroma formation after ventral hernia repair. The study was conducted at multiple centers, including the Department of Surgery at Khyber Teaching Hospital Peshawar and Hayatabad Medical Complex, Peshawar, from January 2023 to June 2023. The study included 70 patients of either gender, aged 18 to 50 years, undergoing ventral hernia repair. After the administration of tranexamic acid, the formation of postoperative seroma was studied. The study found that 35.7% of the patients were male, while 64.3% were female. In 53 (75.71%) patients, seroma formation subsided within six days, while in 17 (24.28%) patients, it took more than six days for seroma formation to subside (P = 0.0001).In conclusion, the study showed that tranexamic acid significantly reduced postoperative seroma formation in patients after ventral hernia repair.

FREQUENCY OF RISK FACTORS ASSOCIATED WITH DIABETIC KETOACIDOSIS IN PATIENTS PRESENTING AT KHYBER TEACHING HOSPITAL PESHAWAR

Objectives: To determine the frequency of risk factors associated with diabetic ketoacidosis in patients presenting at Khyber Teaching Hospital Peshawar. Materials and methods: Patients of either gender, aged between 18 and 60 years, with either type I or type II diabetes mellitus presenting with diabetic ketoacidosis with the duration of diabetes > 1 year were included in the study. DKA was diagnosed based on the clinical presentation of respective patients, serum Random Blood Sugar (RBS), and urinary ketones. Careful scrutinization was done for the detection of common risk factors for DKA like infections, stroke, myocardial infarction, and pancreatitis. Based on the clinical examination for Stroke and acute pancreatitis, CT imaging of the brain and CT of the abdomen with pancreatic protocol were performed. Results: Among 111 DKA patients, the mean age was 43 years with standard deviation ± 12.05. 63(57%) patients were male while 48(43%) were female. Infection was found in 54(49%) patients, stroke in 4(4%) myocardial infarctions in 3(3%), and pancreatitis was found in 7(6%) patients. Conclusion: The most common risk factor for diabetic ketoacidosis is infections in half of the participants while stroke was 4%, myocardial infarction was 3% and pancreatitis was 6%. KEYWORDS: diabetic ketoacidosis; type I diabetes; type II diabetes

THE EFFECTIVENESS OF CEFTRIAXONE AND MEROPENEM IN THE TREATMENT OF ENTERIC FEVER IN CHILDREN- EXPERIENCE IN A TERTIARY CARE HOSPITAL IN PAKISTAN

Objectives: To determine the effectiveness of ceftriaxone and Meropenem in the treatment of Enteric Fever in the Pediatric Department of Khyber Teaching Hospital Peshawar. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted at the Department of Child Health Khyber Teaching Hospital Peshawar Pakistan from June 2020 to June 2022. The sample size included 392 patients. Keeping in view 392 blood samples were taken and sent for blood culture. Both positive and negative cultures were incorporated in the study. The patients were started empirically on ceftriaxone and then in case of no response, the patients were shifted to Meropenem based on the sensitivity of the culture report. The response was defined as when the patient is afebrile for 72 hours after the treatment and the absence of complications like peritonitis, intestinal hemorrhage, and obtundation. Data was analyzed using SPSS version 21.0. RESULTS: In our study, out of 392 patients, 64% were males while 36% were females. Among blood cultures sent, 16.8% were positive and 83.2% were negative. Among the culture positive, 10.5% of patients were sensitive to Meropenem, 3.6% were sensitive to ceftriaxone and 2.8% were sensitive to other drugs. 60.7% of patients responded to Meropenem. Ceftriaxone-responsive patients were 11.7%, while 27.6% showed a response to other drugs. CONCLUSION: The efficacy of Meropenem was significantly high (in 2/3rd patients) while Ceftriaxone showed 11.73% efficacy. KEYWORDS: Enteric fever, ceftriaxone, Meropenem

POSTPARTUM DEPRESSION AND ANXIETY: A COMMUNITY-BASED STUDY ON RISK FACTORS BEFORE, DURING AND AFTER PREGNANCY

Postpartum anxiety and depression are a significant public health concern as it is the leading cause of maternal morbidity. It is associated with adverse effects on the cognitive and social development of the infant. The primary aim of the study is to find postpartum depression and anxiety as a community-based study on risk factors before, during, and after pregnancy. The prospective cohort study was conducted in Khyber Teaching Hospital Peshawar from April 2023 to July 2023. A total of 320 pregnant women were recruited for this study. Participants were enrolled during their antenatal visits to healthcare facilities within the community, ensuring representation across diverse demographic and socio-economic backgrounds. Data collection for this community-based study on postpartum depression and anxiety was executed meticulously across three distinct phases: before, during, and after pregnancy. Data was collected from 320 pregnant females. The mean age of participants was 28.5±4.2 years. Most participants had at least a high school education (65%) and reported a moderate household income (55%). 18% of participants had a history of previous episodes of depression or anxiety. 35% reported experiencing significant life stressors before pregnancy, with financial concerns being the most common (62%). 24% had a family history of mental health disorders. It is concluded that this study has revealed a significant prevalence of postpartum depression (22%) and anxiety (18%) among participants. The identified risk factors, including prior mental health history and high prenatal stress, emphasize the need for early intervention and targeted support systems during the perinatal period.

FREQUENCY OF CARDIAC AUTONOMIC NEUROPATHY IN TYPE 2 DIABETES MELLITUS PATIENTS PRESENTING TO KHYBER TEACHING HOSPITAL PESHAWAR

This study aimed to determine the frequency of cardiac autonomic neuropathy in patients with type 2 diabetes. A cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, Pakistan, from June 2022 to June 2023. The study included 285 individuals aged 40-60 diagnosed with type 2 diabetes for at least 5 to 10 years. The study aimed to evaluate the frequency of cardiac autonomic neuropathy in type 2 diabetics. Chi-square was applied for statistical analysis with a significance level of p≤0.05. Of 285 type 2 diabetic patients, 199 (69.82%) were male, and 86 (30.18%) were female. 26.31% of the participants were diagnosed with cardiac autonomic neuropathy, of which 26.67% were male and 73.33% were female. This difference was statistically significant. 37.35% of the patients with cardiac autonomic neuropathy were smokers, while 62.65% were non-smokers. All the patients with CAN were either overweight or obese. This study found that prolonged diabetes is directly related to the development of cardiac autonomic neuropathy, and there was a statistically significant association between diabetes and gender, as well as smoking.

FREQUENCY OF CHRONIC KIDNEY DISEASE ASSOCIATED PRURITUS AND ITS ASSOCIATION WITH SLEEP QUALITY IN HEMODIALYSIS PATIENTS

A cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, between November 2022 and April 2023. The study aimed to evaluate the frequency of pruritus associated with chronic kidney disease (CKD) and its correlation with sleep quality in hemodialysis patients. The study cohort comprised 55 individuals diagnosed with CKD, aged between 18 and 70, and of both genders. Chi-square and Independent Samples T-tests were used for statistical analysis, and a significance level of P < 0.05 was considered statistically significant. The study found that 39 (70.9%) patients reported chronic kidney disease-associated pruritus. Among the pruritus patients, 7.7% reported no effect on their sleep, 43.6% reported occasional sleep, and 48.7% reported severe effects on sleep. The study showed a significant association between increasing age and pruritus (P = 0.0001) but no significant association between pruritus and gender (P = 0.23). The mean age of the patients was 40.8±14.12 years. The study concluded that the prevalence of pruritus in hemodialysis patients with chronic kidney disease was very high. Also, pruritus in individuals with chronic renal disease significantly correlated with sleep quality and advancing age among hemodialysis patients.