Khyber Teaching Hospital Peshawar Research Articles

Children with Epistaxis and Risk Factors for Bleeding Disorders: Importance of Preoperative Diagnostic

Objective: To determine the frequency of previously undetected bleeding problems in kids with severe epistaxis who required intraoperative nasal cautery after failing medicinal treatment. Study design: Retrospective study Setting: Khyber Teaching Hospital Peshawar . Subjects and methods: Children (under the age of 19) with epistaxis who have been referred to an otolaryngologist must also have no known bleeding disorders, have had surgical nasal cautery, and have failed medicinal treatment. Information gathered includes epistaxis duration/severity, past bleeding patterns, and bleeding in the family. All patients had a screening CBC, PT, and PTT. Results: 47 (19%) of the 248 participants who were referred for epistaxis matched the inclusion criteria (mean age 9.2 0.5 years;61.7 percent male). 31.9 percent (15/47) of the patients had abnormal coagulation findings, however only 2 patients continued to have them after repeat testing. 15 patients were sent to haematology, where 5 had bleeding disorders (3 had type 1 von Willebrand's disease, 1 had a condition of platelet aggregation, and 1 had minor factor VII insufficiency). 10.6% (5/47) of the group as a whole had a bleeding disorder. Previous trips to the emergency department for epistaxis were one of the clinically significant predictors of developing a bleeding disorder (p = 0.04). Younger patients who presented with epistaxis showed a tendency (p = 0.07). Conclusion: Children who have repeated epistaxis while receiving medical treatment are more likely to develop a bleeding condition. 10.6% (5/47) of the patients in this highly selected cohort were found to have a bleeding condition. Only 20% (1/5) of individuals with a bleeding issue were identified by screening coagulation testing (PT, PTT). In most individuals, the diagnosis was not made until after a thorough haematology examination. Keywords: epistaxis, bleeding disorders, children, diagnostic

Bacterial Spectrum and Antibiotic Sensitivity in open Fractures of the Extremities

Background: Open fractures account for around 3 - 4% of all fractures, and infection caused by deprivation of bone and soft tissue, as well as loss of skeletal stabilization, is a serious consequence, particularly in grade III open fractures. Objective: To determine bacterial spectrum and antibiotic sensitivity in open fractures of the extremities Methodology: The current study was descriptive cross sectional study carried out at the department of Orthopedic Surgery, Khyber Teaching Hospital Peshawar for duration of six months from July 2021 to January 2022. All the samples were sent to the hospital diagnostic lab for bacterial identification and antibiogram assay. Kirby- Bauer method was used for antibiogram assay. The data was analyzed by using IBM SPSS version 19.0. Results: A total of 210 patients were included in our study. Male patients were 168(80%) and female were 42(20%). The major cause of fracture was traffic accident observed in 168 (80%) patients. Positive culture report was observed in 196 (93.33%) patients. Staphylococcus Aureus was most frequently observed in 115(54.76%) patients. High resistance against commonly used antibiotics was observed in our study. All the isolates were completely (100%) resistant to ampicillin. All the isolates were 100% sensitive to Amikacin except MRSA. Conclusion: Our study observed positive culture of bacteria in most of the open fractures of the extremities. Gram positive bacteria were most common than gram negative. Antimicrobial resistance was observed in majority of the bacterial isolates against commonly used antibiotics. Key words: Open fractures, Antibiotic sensitivity, Bacterial Culture, Extremities

Effectiveness of Beta Blockers against Hypertrophic Cardiomyopathy

Objective: To determine the efficacy of beta adrenergic blockers against hypertrophic cardiomyopathy. Study Design: Retrospective study Place and Duration of Study: Khyber Teaching Hospital Peshawar from 1st April 2021 to 30th September 2021. Methodology: All the data was retrieved from the medical files of the patients who were registered as out/indoor patients at cardiology department. The sample size for this study was taken as 110 patients and age was between 5-76 years. Each patient complete information regarding age, gender, clinical history, comorbidity history, clinical symptoms, clinical assessment results, echo and ECG results was documented on a well-structured questionnaire. Patients were given beta blockers for two-year time and the effectiveness of various beta blockers was recorded. Results: There were 57.27% males while 42.73% were females. Patients where increased left ventricle outflow-tract such as LVOT was observed the efficiency of beta blocker was significantly reduced. A value of LVOT ≥50mmHg was presented in patients of the later ages while LVOT <50mmHg was seen in young and pediatric cases. Conclusion: Beta adrenergic blockers showed great effectiveness against hypertrophy cardiomyopathy. Keywords: Hypertrophy cardiomyopathy, Intervention, Beta blockers, Left ventricle

ARTHROSCOPIC PREVALENCE OF RAMP LESION IN PATIENTS PRESENTING WITH ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR OF THE KNEE JOINTS

Objective: To measure the arthroscopic frequency of RAMP lesion in patients presenting with Anterior Cruciate Ligament tear of the knee. Methodology: This cross-sectional study was conducted at the Department of Orthopedic Surgery, Khyber Teaching Hospital Peshawar from 06 Aug, 2019 to 06 Feb, 2020. The patients were prepared for Arthroscopy under Spinal anesthesia by consultant orthopedic surgeon who had a further fellowship in arthroscopy and sports medicine, having a minimum of three years experience post-fellowship. All procedures were performed by the same surgeon. Standard two ports (anteromedial and anterolateral) arthroscopic technique was adopted and the inside of knee was thoroughly examined for any RAMP lesion in the posteromedial corner as per operational definition. The positive cases were recorded and one with no RAMP lesion was labelled as negative. Results: 19(17.1%) patients were recorded with RAMP lesions, diagnosed on knee arthroscopy undergoing Anterior Cruciate Ligament reconstruction of the knee. Conclusion: The RAMP lesion is a common meniscal injury that can occur at the time of anterior cruciate ligament rupture or as a result of knee laxity associated with anterior cruciate ligament insufficiency. The prevalence of RAMP lesions in this study was 17.1%. Patients younger than 30 years of age and male patients had a higher prevalence of RAMP lesions. Keywords: Anterior Cruciate Ligament, RAMP Lesions, Arthroscopy

Prevalence of Dental Fluorosis amongst patients attending the tertiary care hospital, Peshawar, Pakistan

Pakistan is a developing country where peoples drink any available water. In Pakistan water sources are limited and drinking water contains high level of fluoride, which causes both dental and skeletal fluorosis. Objectives: Objectives of the current study was to evaluate the incidence of dental fluorosis among patients who visits the tertiary care hospital, Peshawar and to assess the level and distribution of fluorosis. Methods: The study was carried out at Dental unit of Khyber Teaching Hospital Peshawar, from January 2021 to December 2021. All the samples were collected after the research was approved by the ethical committee. A written informed consent was taken from all the participants prior to collecting the data. Moreover, Dean’s Fluorosis Index was used to rank the extent of Dental Fluorosis. For statistical analysis SPSS, version 26 was used. Results: Among 2433 participants, females 1451/2433(59.6%) were more as compared to male (n=982/2433 (39.3%) while the dental fluorosis were more prevalent in males 414/982 (42.1%) as compared to females 568/1451 (39.1%) The fluorosis was more prevalent in age group 11-20 year 874 (89%) while only two individuals were found with dental fluorosis in age groups more than 40 years. In addition, the participants used tap water were more affected with dental fluorosis 568 (56.9%), whilst incidence of fluorosis was less in individuals drinking treated as well as other sources water 2 (1.2%). Furthermore, 620 (63%) individuals were found with local fluorosis, while 362 (37%) were found with generalize fluorosis. According to Dean’s Fluorosis Index 365 (15%) of individuals were found with very mild fluorosis while only 37 (1.5%) individuals were affected by severe type of fluorosis. Conclusion: In this study, the fluorosis incidence in Pakistan were prevalent and need continual monitoring, and sources contributing to total fluoride intake in Pakistan need further investigation. Furthermore, for fluorosis prevention education and community awareness are necessary, and prompt conciliation to relegate the effects on dental health.

Prevalence of Dental Fluorosis amongst patients attending the tertiary care hospital, Peshawar, Pakistan

Pakistan is a developing country where peoples drink any available water. In Pakistan water sources are limited and drinking water contains high level of fluoride, which causes both dental and skeletal fluorosis. Objectives: Objectives of the current study was to evaluate the incidence of dental fluorosis among patients who visits the tertiary care hospital, Peshawar and to assess the level and distribution of fluorosis. Methods: The study was carried out at Dental unit of Khyber Teaching Hospital Peshawar, from January 2021 to December 2021. All the samples were collected after the research was approved by the ethical committee. A written informed consent was taken from all the participants prior to collecting the data. Moreover, Dean’s Fluorosis Index was used to rank the extent of Dental Fluorosis. For statistical analysis SPSS, version 26 was used. Results: Among 2433 participants, females 1451/2433(59.6%) were more as compared to male (n=982/2433 (39.3%) while the dental fluorosis were more prevalent in males 414/982 (42.1%) as compared to females 568/1451 (39.1%) The fluorosis was more prevalent in age group 11-20 year 874 (89%) while only two individuals were found with dental fluorosis in age groups more than 40 years. In addition, the participants used tap water were more affected with dental fluorosis 568 (56.9%), whilst incidence of fluorosis was less in individuals drinking treated as well as other sources water 2 (1.2%). Furthermore, 620 (63%) individuals were found with local fluorosis, while 362 (37%) were found with generalize fluorosis. According to Dean’s Fluorosis Index 365 (15%) of individuals were found with very mild fluorosis while only 37 (1.5%) individuals were affected by severe type of fluorosis. Conclusion: In this study, the fluorosis incidence in Pakistan were prevalent and need continual monitoring, and sources contributing to total fluoride intake in Pakistan need further investigation. Furthermore, for fluorosis prevention education and community awareness are necessary, and prompt conciliation to relegate the effects on dental health.

A Cross-Sectional Study on Behavioral Manifestation in Alzheimer’s Disease Patients and their Association with Cognitive Impairment

Background and Aim: Dementia psychological and behavioral symptoms are significantly associated to Alzheimer’s disease (AD). Clinical profile and characterization of Alzheimer’s disease patients might assist in evolution, diagnosis, and better treatment of the disease. The present study aimed to evaluate the behavioral manifestation of Alzheimer’s disease patients. Methodology: This multi-centered cross-sectional study was carried out on 96 Alzheimer’s disease patients in the department of Psychiatry Lahore General Hospital and Psychiatry unit, Khyber Teaching Hospital Peshawar, Pakistan for duration of six months from 1st July 2021 to 30th December 2021. Alzheimer’s disease patients with lower and higher Behavioural and psychological symptoms of dementia (BPSD) scores (≤25 and 26-50 respectively) were enrolled. The patient’s demographic details and clinical information were gathered. Mini-Mental State Examination (MMSE) was used for the evaluation of dementia severity whereas severity varies from mild 27-21 to severe ≤10. Demographic details, AD pharmacological treatments, psychotic breaks presence, AD diagnosis, treatment of concomitant diseases, and extrapyramidal symptoms such as hypokinesia, fluctuating cognition, tremors, etc. were secondary outcomes. Results: Of the total 96 AD patients, 44 (45.8%) had higher and 52 (54.2%) had lower BPSD scores. About 62 (64.6%) were women and 34 (35.4%) were male patients. The overall mean age was 79.6±8.4 years. The majority of the patients had a BPSD score at inclusion and the incidence of psychotic out breaks was reported in 19 (19.8%) patients. The prevalence of symptoms such as depression, delusions, lack of concentration, lack of cooperation, and tremors was 41 (42.5%), 33 (34%), 52 (54.6%), 34 (35.9%), and 52 (54.6%) respectively. Psychotic symptoms such as hallucinations, delusions, and delirium were significantly prevalent in patients with high BPSD scores whereas Apathy and tearfulness-like emotional symptoms were predominated in lower BPSD patients. ADAS-non cognitive score and MMSE were adversely related (p=0.0314), signifying BPSD and cognitive impairment correlation. Appetite changes and lack of concentration were prominently associated with MMSE (p=0.035 and 0.052). Conclusion: Our study found a higher prevalence of non-cognitive symptoms in Alzheimer’s disease patients. Also, BPSD and cognitive impairment are significantly associated with AD. ADAS-non cognitive is a useful assessment tool. Keywords: Behavioral Manifestation, Alzheimer’s disease, Cognitive Impairment

Comparison of Ringer’s Lactate Versus 0.9% Normal Saline Solution in the Management of Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) is a life-threatening diabetic condition characterized by metabolic and homeostatic disturbances. KDA is a common condition in people with diabetes, especially in children and adolescents Objective: To compare ringer’s lactate versus 0.9% normal saline solution in the management of diabetic ketoacidosis Methodology: The study design was randomized control trial carried out at the Medical ‘A’ ward Khyber teaching hospital (KTH) Peshawar for a period of six months after synopsis approval. Patients were divided into two groups, groups A, receive 0.9% normal saline infusion and group B receive ringers lactate infusion. 82 subjects were included in each group. SPSS software version 20 was used for analyzing data. Results: In group B subjects, the serum bicarbonates level was higher than group A subjects (p=0.091). The Anion gap and blood PH level increases non-significantly in both the groups over a period of time (p=0.061). The mean hospital stay in group A and group B was 13.11 hours and 11.5 hours respectively (p=0.0031). The fluid quantity required in group A was more than group B (p=0.0031) Conclusion: When prescribing fluid, clinicians should always be cautious since any fluid may be dangerous if dosed wrongly. The ringer’s lactate was shown to be superior to 0.9 % normal saline in terms of alleviating DKA quicker in our study. Keywords: Diabetic ketoacidosis; 0.9 % normal saline; ringer’s lactate

A Study on Clinical Characteristics and Diagnostic Stability in Acute and Transient Psychotic Disorders

Background and Aim: The acute and transient psychotic disorders (ATPDs) as an independent diagnostic entity have become a subject of nosological debate. Numerous studies considered these psychosis as schizophrenia variants or mood disorders leading to diagnostic instability. The present study aimed to investigate the clinical characteristics and diagnostic stability in acute and transient psychotic disorders. Methodology: A total of 45 acute and transient psychotic disorders diagnosed patients were investigated at Psychiatry and Behavioral Sciences LGH Lahore and Psychiatry unit, Khyber Teaching Hospital Peshawar Pakistan for six months duration from 1st June 2021 to 30th November 2021. All the patients with ages ranging from 17 to 65 years fulfilling ATPDs criteria as per ICD-10 were enrolled. The written informed consent form was taken from the patients’ relatives. Patients with drug intoxication, psychotic illness history, brain disorders, mental retardation, and those taking regular antipsychotic treatment were excluded. Patients were followed up for one month and three months and diagnosis was reevaluated after each follow-up. During the follow-up period, global functioning, clinical manifestations, and quality of life were all evaluated on a regular basis. Results: Of the total 45 ATPD diagnosed patients, male and female patients were 18 (40%) and 27 (60%) respectively. Overall mean age was 29.7±7.9 years. After one month follow-up, the prevalence of ATPD, mood disorder, and schizophrenia was 39 (86.7%), 4 (8.9%), and 2 (4.4%) respectively. After 3 months follow-up, the incidence of diagnosed ATPDs, schizophrenia, and mood disorder were 36 (80%), 5 (11.1%), and 4 (8.9%) respectively. About 36 (80%) patients retained ATPDs whereas diagnosis of psychotic disorders changed in 9 (20%) patients. Conclusion: The acute and transient psychotic disorder was diagnostically stable entity. Patient’s sizable proportion of ATPDs initial diagnosis changed to Schizophrenia-related disorders representing early manifestations. Keywords: Acute and Transient Psychotic Disorders, Schizophrenia, Diagnostic Stability

Reducing Mortality and Morbidity in Morbidly Adherent Placenta

Objectives: The goal of this study is to explore methods for minimizing mortality and morbidity in the context of a morbidly adherent placenta. Study Design: A descriptive observational case series. Place and Duration: This is two-year study was held in the Obstetrics and Gynecology department of Khyber Teaching Hospital Peshawar from January 2018 to January 2020. Methods: There are 36 females included in this study who have morbidly adherent placenta. The surgical procedure, antenatal diagnosis, quantity of blood loss, organ damage, blood transfusion, hospitalization, ICU and postnatal problems are all evaluated in these patients. SPSS version 21 was used to analyze and evaluate the data. Results: Ultrasound and colour Doppler were used to diagnose 30 patients antenatally. Six of them were revealed during surgery, nine of them had a severe hemorrhage, and five to ten units of blood were transfused. Three of the undiagnosed patients suffered a bladder injury, ten were admitted to the hospital, and two required ventilator support. In 26 patients, hysterectomy was performed, while four patients had conservative surgery. There were no cases of maternal or newborn death. Conclusion: Mortality and Morbidity may be reduced by increasing the index of suspicion, performing prenatal diagnostics, anticipating large volume blood transfusions, and performing planned hysterectomy with a fundal classical incision without disturbing the placenta. It is important to be aware of the possibility of a morbidly adherent placenta, just as it is important to be aware of other obstetric crises. Keywords: previous C-section Scar, morbidity, mortality, hysterectomy, morbidly adherent placenta

Antibiogram and Frequency of BLA-NDM-1 Gene in E.Coli Isolated from Carbapenem Resistant Cases of UTI Patients

Background: Urinary tract infections (UTI) are very common in all the population around the world. Women are the usual victims of the super bug Escherichia coli (E.coli) and usually suffer from UTI once in a lifetime. The multi-drug resistant (MDR) E.coli is very intelligent creature and turned resistant to the antibiotics through transposons, mutations and plasmids. Most of the E.coli harbors the gene bla-NDM-1 due to which they have become highly resistant to Carbapenem antibiotics. Objectives: To find the bla-NDM-1 gene in Carbapenem resistant E.coli isolated from UTI patients. To determine the frequency of Carbapenem resistant E.coli in patients attending tertiary care hospital of Peshawar. Methodology: This study was conducted in Khyber Teaching Hospital Peshawar from January 2019 to June 2019. we collected 87 urinary E.coli isolates which were resistant to Carbapenem by disc diffusion method on Mueller Hinton Agar. Polymerase chain reaction (PCR) was done to unyield the presence of bla-NDM-1 gene in these 87 cases. Results: According to this study E.coli was the most common causative agent for UTI and females suffered more than male patients. The antibiotics Tigecycline and Colistin showed 100% sensitivity against E.coli. Some of the antibiotics like Ampicillin; Meropnem etc were 100% resistant to E.coli. The gene bla-NDM-1 turned out to be positive in 26.43% of the cases. Conclusion: This study concluded that all the E.coli isolated from UTI patients having bla-NDM-1 gene exhibit resistance to Carbapenem. These isolates are very difficult to treat and limited therapeutic options are available. Keywords: Multi- drug resistant Escherichia coli, Carbapenemases, Antibiogram, Plasmids, Polymerase chain reaction, Transposons and Mutations.

Biochemical and Haematological Manifestations as Predictor for Covid-19: A Case-Control Study

Background: Corona virus causes severe pneumonia of idiopathic nature. The clinical manifestation ranges from mild to severe respiratory problems. Due presences of target receptors and the release of chemical mediators, it also affect other organs including the liver and kidney. Objective: The purpose of this study was to determine the effect of COVID-19 infection on hematological parameters, liver function and renal function. Methods: This multicenter case-control observational study was conducted at Lady reading hospital, Hayatabad medical complex and Khyber teaching hospital Peshawar. A total of 340 samples were processed including 170 COVID-19 patients and 170 control groups. Complete blood count, liver function tests and renal function tests were performed to determine the effect of COVID infection on these parameters. The data were statistically analyzed using SPSS version 22.0. Results: In complete blood count, the mean WBC count was 16632.34±7339.94 which was statistically significant with p value less than 0.05. In differential leukocyte count, the mean neutrophil values were 87.79±7.36 which was statistically significant (p=0.00). The mean value of ALT and ALP were 49.47±100.08, 114.43±64.71 respectively which were higher than the control group. Mean value of urea and creatinine were 70.58±41.89, 1.31±1.12 respectively and was statistically significant (p=0.00). Conclusion: it is concluded that COVID-19 infection affects hematological and biochemical parameters including ALT, ALP, urea and creatinine. Hence these manifestations can be used collectively as a diagnostic and prognostic biomarker. Keywords: Covid-19, liver function tests, Kidney Function Tests, blood cell count

Prevalence of Hepatitis C in Dialysis Patients in Khyber Teaching Hospital Peshawar

Introduction: The hepatitis C virus (HCV) is a Flaviviridae-related virus that causes a systemic illness that can be transmitted. HCV is a blood-borne infection that primarily affects the liver. HCV diagnosis that is accurate and timely is critical in significantly reducing the risk of morbidity and mortality. The goal of this study was to find out the Hepatitis C in chronic renal failure patients who are on hemodialysis. Method: This descriptive cross-sectional study was carried out in the Dialysis Unit of the Khyber Teaching Hospital (KTH) Peshawar's Department of Nephrology. From September to December 2017, this study took place over four months. The study included a total of 114 patients, regardless of their age or gender. Hepatitis C was detected in whole blood samples collected from 114 healthy people using an immunochromatography method. The data was analyzed using SPSS v.22. Result: The Immunochromatography technique for HCV was used to analyze 114 blood samples from recruited individuals. Male patients were 52.6% of the total, while female patients made up 47.4%. The study found that 24.56% of male patients were positive, while 28.07% of female patients were positive. Overall, the technique's sensitivity and specificity were 83.1% and 72.7%, respectively. Conclusion: It is concluded that the HCV rapid testing is still sensitive and specific for detecting hepatitis C virus, it should be used in routine clinical settings for early hepatitis C virus diagnosis when advanced diagnostic options are restricted. Keywords: HCV, Hepatitis C virus, Nephrology, Dialysis

Multi-Drug Resistance of Escherichia coli (E.coli) Isolated from Clinical Isolates in District Peshawar Kp Pakistan

Multidrug-resistant Escherichia coli have become a main public health distress in Pakistan and many countries, causing failure in treatment with the resultingenormous health burden. The current study was aimed to find the prevalence of E. coli among clinical isolates and their antibiotics susceptibility pattern using standard procedures. The Purpose of the present study to investigate the Prevalence and antibiotic susceptibility pattern of E. coli detected from clinical patients visiting Khyber teaching hospital Peshawar. In this study a total 415 sample were isolated from the patient of Khyber teaching hospital (KTH) Peshawar. The collected samples were processed for identification including Gram staining and biochemical test. Furthermore, the antibiotic susceptibility pattern of all the positive strains of E. coli was tested using selected antibiotic discs by disc diffusion method as per CLSI guidelines 2019.A total of 415 samples, 112 clinical isolates yielded the growth of E. coli using standard procedures. Out of 112 isolates, 52% were recovered from male patients while 60% were females. The positive samples were obtained from urine (58%), pus (14.3%), swab (8.9%), sputum (10.7%), and others 8.0% respectively. The highest sensitive drugs are FOS (99.1%), AK (98.2%), TZP (97.3%), MEM (93.8%), TGC (91.1%), CN (89.3%), SCF (78.6%), DO (65.2%), CT (60.7%), F (49.1%), ATM (27.7%) AMP (23.2%), CAZ (23.2%), CPM (22.3%) , CRO (19.6%) ,CTX (13.4%) and the lowest sensitive drug is CIP which is (7.1%) . The drugs which show high resistance are CIP (92.9%), CTX (86.6%), CRO (80.4%), CPM (77.7%), CAZ (76.8%), AMP (76.8%) , ATM (72.3%) , CT( 39.3%) , DO (34.8%), SCF (21.4%), CN(10.7%),TGC(8.9%), F(8.9%),MEM(6.3%) ,TZP(2.7%),AK (1.8%) ,and the lowest resistance drug is FOS (0.9%).Drug resistance monitoring and the epidemiological analysis of patient data are needed regularly and can be useful for the adequate management of antimicrobial resistance. Key words: Multidrug-resistant, Antimicrobial Resistance, Clinical Isolates, Bacteria, Peshawar

Biochemical and Haematological Manifestations as Predictor for Covid-19: A Case-Control Study

Background: Corona virus causes severe pneumonia of idiopathic nature. The clinical manifestation ranges from mild to severe respiratory problems. Due presences of target receptors and the release of chemical mediators, it also affect other organs including the liver and kidney. Objective: The purpose of this study was to determine the effect of COVID-19 infection on hematological parameters, liver function and renal function. Methods: This multicenter case-control observational study was conducted at Lady reading hospital, Hayatabad medical complex and Khyber teaching hospital Peshawar. A total of 340 samples were processed including 170 COVID-19 patients and 170 control groups. Complete blood count, liver function tests and renal function tests were performed to determine the effect of COVID infection on these parameters. The data were statistically analyzed using SPSS version 22.0. Results: In complete blood count, the mean WBC count was 16632.34±7339.94 which was statistically significant with p value less than 0.05. In differential leukocyte count, the mean neutrophil values were 87.79±7.36 which was statistically significant (p=0.00). The mean value of ALT and ALP were 49.47±100.08, 114.43±64.71 respectively which were higher than the control group. Mean value of urea and creatinine were 70.58±41.89, 1.31±1.12 respectively and was statistically significant (p=0.00). Conclusion: it is concluded that COVID-19 infection affects hematological and biochemical parameters including ALT, ALP, urea and creatinine. Hence these manifestations can be used collectively as a diagnostic and prognostic biomarker. Keywords: Covid-19, liver function tests, Kidney Function Tests, blood cell count

Association Between Cytological and Histological Grading of Breast Cancer and its Usefulness in Patient Treatment

Introduction: Breast cancer is the most common cancer in women throughout the globe, and the modern therapeutic available options have been widely researched currently. For a developing nation with limited resources, such as Pakistan, a quick, affordable, and least invasive technique like FNAC may give useful information. Aim: The aim of this study was; 1 Perform and evaluate cytomorphological classification of all breast cancer patients using the Robinson's three-tier grading system. 2 Histopathological evaluation and classification of all samples of MRM by using a modified BR classification system. 3 Correlation of histo-morphological and cytomorphological classification systems. Place and Duration: In the Pathology department of Khyber Teaching Hospital Peshawar for six months duration from February 2018 to July 2018. Material and methods: A prospective study was conducted in which two independent observers classified all breast cancer patients on the basis of cytology and histology of the tissue and cyto-histological correlation. Results: This study provided good individual correlation and inter-observer agreement in the cytopathological classification of breast cancer aspirates. Conclusion: Cytopathological classification may be useful for these patients and should therefore be included in routine reports. Keywords: Breast carcinoma; Cytopathology; Robinson classification system

THE EFFECTIVENESS OF CLOSED REDUCTION OF SUPRACONDYLAR FRACTURE OF THE HUMERUS WITH NEUROVASCULAR INJURY IN TERMS OF THE NEED FOR EXPLORATION IN CHILDREN

Abstract
 Objective: To determine the effectiveness of reduction of supracondylar fracture of the humerus with neurovascular injury and the role of exploration. 
 Material and Methods: This descriptive cross-sectional study was conducted at the Department of Orthopedic Khyber Teaching Hospital Peshawar from July 2020 till July 2021 and children with supracondylar (Gartland type II and III) fracture of the humerus were included irrespective of neurovascular complication. Data were analyzed using SPSS. Mean and standard deviation was used for quantitative data. Frequency and percentages were used for qualitative data. Shapiro Wilk’s test was done to find the normality of the data.
 Results: Mean age of the 65 children with Gartland type 3 closed extension type supracondylar fractures was 7 years ± 1.5 years. The female to male ratio was 1:2.2. The right side was involved in 28 (43%) left sides in 37(57%) patients. The mechanism of injury in all cases was a history of fall. At presentation 40 patients (61%) had no signs of neurovascular involvement while 25 patients (38%) had signs and symptoms of various nerve injuries, 11 of anterior interosseous nerve injury, 8 median nerve, and 6 radial nerve injuries, and no ulnar nerve injury while 6 patients had absent radial pulse with well perfused, pink hands
 Conclusion: Thus we conclude that in most of the cases there is no need for exploration of vessel and nerve in supracondylar fracture with neurovascular injury if the fracture is reduced properly.

FREQUENCY OF RAISED BLOOD PRESSURE / RAISED MEAN ARTERIAL PRESSURE ABNORMALITIES IN PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA

ABSTRACT
 Objectives 
 To find out the frequency of impaired blood pressure and mean arterial pressure in our patients presenting with primary open angle glaucoma.
 Material and Methods
 This prospective cohort study was conducted in Khyber Teaching Hospital Peshawar from July 2020 to December 2020. All patients having primary open angle glaucoma, were included. Those having high blood pressure (BP) on admission or history of high blood pressure or using anti-hypertensive drugs, were admitted to the ophthalmology ward of Khyber Teaching Hospital. Blood Pressure/ Mean Arterial Pressure and Intra ocular pressure (IOP) phasing were done. Mean Arterial Pressure, MOPP and peak IOP were determined. Patients having secondary types of glaucoma, primary angle closure glaucoma and those patients who declined concent were excluded. Data was collected on a already prepared standard proforma and analysed by spss 23.
 Results
 A total of 375 patients were diagnosed to have Primary open angle glaucoma (POAG), out of which 200 (65%) patients had impaired blood pressure, so rest of 70 (35%) patients had Normal Tension Glaucoma (NTG). Out of 200 cases with primary open angle glaucoma, 175 patients (87.5%) had hypertension, while 25 patients (12.5%) had low blood pressure. Amongst the hypertensive patients, the mean arterial pressure (MAP) was raised in 70(35%) patients, while the Mean Occular Perfussion Pressure (MOPP) was raised in 15 patients ie 7.5% .
 Conclusion
 Sixty five percent of our patients with primary open angle glaucoma had impaired blood presure, out of which 87.5% of patients had high blood pressure and the rest had low blood pressure.
 Keywords Primary open angle glaucoma (POAG), impaired blood pressure, impaired mean arterial pressure.

THE FREQUENCY OF HYPOKALEMIA IN PATIENTS WITH NASOGASTRIC FEEDING IN NON-HOSPITAL SETTINGS

INTRODUCTION:
 Feeding in elderly patients with dysphagia or with an inadequate oral intake is usually considered vital, regardless of the consequences. In clinical practice, this is often achieved by insertion of a nasogastric (NG) tube early in the course of treatment. This study provided us local data about hypokalemia in patients discharged home on Nasogastric tube feeding.
 OBJECTIVES:
 To determine the frequency of hypokalemia in patients on nasogastric feeding with homemade blends and juices in non-hospitalized settings.
 SUBJECTS AND METHOD:
 The cross-sectional study was carried out in General medicine department of Khyber Teaching Hospital Peshawar from Jan 1, 2016, to Jun 30, 2016. There were total 176 Patients in our study. We enrolled Patients who had Oropharyngeal or esophageal dysphagia and were sent home on nasogastric tube feeding with homemade blends and juices. They were followed up after 2 weeks in Outpatient department and their blood samples were collected for checking their serum potassium levels. Samples were tested using K-lite 5 series electrolyte analyzer at Khyber teaching hospital laboratory for the presence of hypokalemia.
 RESULTS:
 There were 98 males and 78 females in study population. The mean age was 58.15 years ± 13.35 SD. The mean value of Potassium was 4.07 mmol/L ± 0.8 SD. We found hypokalemia in 31 (17.6 %) of the patients sent on nasogastric feeding at home in our study sample.
 
 CONCLUSION:
 Hypokalemia among patients with esophageal and oro-pharyngeal dysphagia who are on nasogastric tube feeding with homemade juices and liquefied blends for two weeks or more in non-clinical setting is a relatively common finding irrespective of age, gender or underlying disease. It is essential to recognize as it can be life-threatening.

Assess the Results of Covid-19 in Patients with Liver Disease Cirrhosis

Objective: The purpose of this research is to see how coronavirus affects people with cirrhosis, a type of chronic liver disease. Study Design: Retrospective/observational Place and Duration: Conducted at Khyber Teaching Hospital Peshawar, during from April 2021 to Oct 2021. Methodology: This study included 100 covid-19 individuals of both genders with or without chronic liver disease. There were two groups of patients. Group I (50 patients with cirrhosis) and Group II (without cirrhosis 50 patients). The mortality outcomes of the two groups were compared. SPSS 25.0 was used to analyze all of the data. Results: There were 31 (62%) males and 19 (38%) were females with mean age 43.31±=7.61 years in group I while in group II 32 (64%) and 18 (36%) patients were males and females with mean age 46.01±5.23 years. Patients with cirrhosis died at a higher rate than those without it, with a p-value of 0.0001 (34 percent vs. 10%). Conclusion: Patients with cirrhosis who also had coronavirus illness had a higher incidence of poor outcomes. Keywords: Mortality, Corvid-19, Chronic Liver Disease