Lady Reading Hospital Peshawar Research Articles

Drug Coated Balloon vs. Drug Eluting Stent in Multiculprit Primary Percutaneous Revascularization

Background: Patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) frequently face multivessel coronary artery disease (CAD). The optimal interventional approach remains debated. Objective: To systematically review and analyze the effectiveness and safety of drug-coated balloons (DCB) versus drug-eluting stents (DES) in multiculprit primary PCI through a randomized controlled trial. Methods: This prospective, single-center, randomized controlled trial included 100 patients with STEMI and multivessel CAD at Lady Reading Hospital Peshawar from April 2023 to March 2024. Patients aged 18 years or older requiring revascularization of two or more culprit lesions were randomized into two groups: one received DCBs and the other DES. Exclusions were based on contraindications to dual antiplatelet therapy, allergies to study drugs, bleeding disorders, or life expectancy under one year. Results: Each group comprised 50 patients. The prevalence of hypertension (56% in DCB vs. 60% in DES, p=0.68) and diabetes (36% in DCB vs. 40% in DES, p=0.72) was similar. TVR rates were 10% for DCB and 8% for DES (p=0.45). MACE rates were 14% for DCB and 12% for DES (p=0.37). Conclusion: The study supports the use of DCB as an alternative to DES in specific clinical scenarios, emphasizing the need for tailored treatment decisions based on individual patient and lesion characteristics.

Blindness And Visual Impairments Causes In Patients Presenting To Tertiary Eye Care Centers Of Peshawar

Background: Blindness remains a significant issue, particularly in underdeveloped regions, with an estimated 38 million blind and 110 million visually impaired worldwide. Cataracts and glaucoma are primary causes. Many cases are preventable or treatable. Pakistan's Vision 2020 initiative targets blindness prevention, but its impact needs assessment. This study aims to determine the prevalence and causes of blindness and visual impairment among patients at tertiary eye care centers of Lady reading Hospital and Kuwait Teaching Hospital Peshawar. . Methods: The study reviewed hospital records from LRH and KTH eye care centers in February 2017. Patients with visual acuity below 3/60 were classified as blind, and below 6/18 as visually impaired. Data included age, gender, and causes of decreased visual acuity. Results: The study included 100 cases, with 55 males and 45 females. Participants averaged is 42.78 ± 20.75 years old. Blindness frequency was 10%, higher in females (13.33%) than males (7.2%). Visual impairment occurred at a rate of 39%, slightly higher in females (40%) than males (38.1%). Most cases (84.6%) were moderate visual impairment (n=33). Cataracts were the leading cause (37%), followed by uncorrected refractive errors (28%), among others. Conclusion: Despite Vision 2020 efforts, cataracts remain the leading cause of blindness in tertiary eye care hospitals. Extensive studies are required to assess the burden of avoidable blindness and understand why these causes persist.

COMPLICATIONS ASSOCIATED WITH INTERNAL ILIAC LIGATION IN THE CONTEXT OF SEVERE POST-PERIPARTUM HYSTERECTOMY BLEEDING

Severe post-peripartum hysterectomy bleeding poses a critical threat to maternal health, necessitating swift and effective interventions to ensure favorable outcomes. The main objective of the study is to find the potential complications associated with internal iliac ligation in the context of severe post-peripartum hysterectomy bleeding. This prospective observational study was conducted in the gynecology and obstetrics department of Lady Reading Hospital Peshawar from June 2022 til the required sample size is obtained. The study included women who had significant and profuse post-peripartum hysterectomy bleeding. All women with post-peripartum hysterectomy hemorrhage were identified, focusing specifically on cases where internal iliac ligation was employed as an intervention. The demographic information, including patient age, parity, medical history, and obstetric details, was collected on predesigned proforma. Data was collected from 196 patients. The mean age of the patients was 31.5±4.2 years. About 97% of patients were multiparas, and all patients presented with postpartum hemorrhage (100%). The mode of delivery was vaginal in 89% of cases. It is concluded that internal iliac ligation, while effective in controlling severe post-peripartum hysterectomy hemorrhage, presents a nuanced landscape marked by a low incidence of vascular (1.5%) and ureteric (0.5%) injuries. Consequently, we believe that procedure is worth try in the face of catastrophic uncontrolled haemorrhage, especially in low-income countries.

MYOCARDITIS IN PEDIATRICS: A GROWING CONCERN FOR HEALTHCARE SYSTEMS IN PAKISTAN

Myocarditis, defined as an inflammation of the heart muscle, can pose significant challenges in pediatric cardiology due to its varied causes and potentially serious consequences. While there are several potential causes of myocarditis, for instance, autoimmune diseases and toxins, viral infections account for a large majority of cases in pediatric populations (Tschöpe et al., 2021). The frequency of myocarditis is still rather high due to the increased prevalence of viral diseases in children, especially during specific seasons; this puts a significant strain on hospital resources. Myocarditis in paediatric patients has consequences that go beyond the initial inflammatory insult to the heart. Patients affected with myocarditis can often exhibit acute heart failure, arrhythmias, and, in severe cases, cardiogenic shock (Ammirati et al., 2021). Moreover, long-term consequences can manifest as chronic heart failure, which necessitates continuous, ongoing monitoring and management to optimize cardiac function and quality of life (Upadhya and Kitzman, 2020). We have noticed a worrying trend in our pediatric cardiology practice at Lady Reading Hospital Peshawar, whereby approximately half of the patients who consult our outpatient and inpatient departments have left ventricular failure. A significant portion of these cases are diagnosed as viral myocarditis. We have noticed a worrying trend in our pediatric cardiology practice: about 50% of the cases that come into our outpatient and inpatient departments have left ventricular failure, and a sizable percentage of those cases are diagnosed with myocarditis. This finding not only highlights the frequency of myocarditis but also highlights the pressing need for increased awareness, prompt diagnosis, and effective management of viral myocarditis in order to reduce negative consequences in vulnerable pediatric populations. In resource-poor environments like Pakistan managing myocarditis can unique challenges. Treatment methods such as IV immunoglobulin treatment which can have proven success in some patients, are generally expensive and not readily available (Ammirati et al., 2021). This gap in access to modern treatments can further exacerbate the load on healthcare systems that are already strained by the high prevalence of myocarditis. In low and middle-income countries (LMICs) like Pakistan, proactive preventative interventions are especially important to reduce the strain on already overburdened healthcare systems. The increased frequency of myocarditis in pediatric populations can be decreased by highlighting the significance of vaccination against common viral infections linked to the illness such as adenovirus and enterovirus (Makimaa et al., 2020; Upadhya and Kitzman, 2020). In addition, raising awareness among caregivers and medical professionals about the early detection of myocarditis symptoms and the importance of promptly referring patients to specialized clinics will help to expedite intervention and enhance long-term results (Inoue et al., 2019). In summary, the growing incidence of myocarditis in pediatric patients demands a multimodal strategy that includes early detection, prevention, and complete therapeutic techniques. By addressing these issues collectively and pushing for fair access to key treatments, we can seek to lessen the impact of myocarditis on pediatric cardiac health and alleviate the load on healthcare systems, particularly in resource-limited settings.

Prevalence and Impact of Hyponatremia on Hospital Stay in Subarachnoid Hemorrhage Patients

Introduction: This research study was designed to ascertain the prevalence of hyponatremia and its impact on the duration of hospital stay in patients with subarachnoid hemorrhage (SAH) in our local population. Materials & Methods: We carried out this study at the Department of Neurology, Lady Reading Hospital Peshawar for 1 year, which started in March 2022. The total sample size was 90 and a consecutive sampling method was used for sampling the study population. Patients aged between 20 to 70 years and who had a diagnosis of SAH were involved in included in the study, while those with confounding conditions were put in the exclusion criteria. Results: Our study showed a high prevalence of hyponatremia (42%) in patients with SAH, and it was associated with a prolonged duration of hospital stays of 8.2 days (SD±3.5). There was a statistical difference in the mean hospital stay between the patients with hyponatremia and those without hyponatremia (t=3.2, p<0.002). Conclusion: Our study reported a high prevalence of hyponatremia in SAH patients and has established an association with longer hospital stays. Thus, identifying and managing patients of hyponatremia with SAH promptly should be emphasized for better results and to lessen the financial burden on families and the hospital.

PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF GRAM NEGATIVE BACILLI ISOLATED FROM URINARY TRACT INFECTIONS

The aim of the study was to find out the prevalence and antibiotic susceptibility pattern of Gram negative bacilli isolated from urinary tract infections. This cross-sectional study was conducted at the department of urology Lady reading hospital Peshawar from February 2021 to August 2023. Mid-stream urine samples were collected from individual having the symptoms of urinary tract infection and were processed and identified through various biochemical tests. Following CLSI recommendations, the isolated bacteria were screened for sensitivity to antibiotics. Kirby-Bauer disc diffusion method was used in the current study. Through MS Excel, data were analyzed. The Chi-square test was applied for calculating the p value (significant i.e. <0.05) and antibiotic resistant profiles of GNB isolated from urine samples. A total of 60000 urine samples were collected in which 65% (n=3900) patients were outdoor and 35% (n=2100) were hospitalized patients. Among them 20 % (n=1200) were culture positive. Among which 58% urine samples were from outdoor patients and 42% samples were from hospitalized patients. E.coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii were the Gram negative bacilli (GNB) isolated in our study. The most prevalent (72%) GNB was E. coli. Pseudomonas aeruginosa isolated from indoor patients’ urine samples showed high resistance. The antibiotic sensitivity pattern of K. Pneumonia was same as E.coli both in out and indoor patients. The .Acinetobacter baumannii resistance pattern was quite lower observed as 85% in Nitrofurantoin (F), 80% in Ampicillin (AMP) and 11% in Fosfomycin (FOS) respectively in urine samples of indoor as compare to outdoor patient. The most prevalent GNB observed in our study were E. coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii involved in UTIS. The choice of antibiotic for its treatment were Fosfomycin, Piperacillintazobactam, Cefoperazone-sulbactam, Amikacin and Nitrofurantoin.

A RETROSPECTIVE STUDY ON MATERNAL AND FETAL OUTCOMES ASSOCIATED WITH ASSISTED REPRODUCTIVE TECHNOLOGIES

Assisted Reproductive Technologies (ART) have revolutionized the landscape of reproductive medicine, offering hope to couples facing infertility challenges. The study's main objective is to find the maternal and fetal outcomes associated with assisted reproductive technologies. This retrospective cohort study was conducted in Lady Reading Hospital Peshawar from July 2019 to June 2023. The study includes 850 participants who underwent ART procedures between 2021 and 2022. Details of the ART procedures, such as the technique employed, the number of embryos transferred, and the utilization of preimplantation genetic testing, were meticulously documented. Maternal outcomes were a focal point, with a comprehensive assessment of pregnancy-related hypertensive disorders, gestational diabetes, mode of delivery, and any postpartum complications. Data was collected from 850 participants. The mean maternal age was 33.5 years (SD = 4.2), and the mean BMI was 25.8 (SD = 3.5). The primary causes of infertility varied, with male factor infertility being the most prevalent at 40%, followed by ovulatory dysfunction at 30% and unexplained infertility at 20%. The ART procedures in the study cohort comprised In Vitro Fertilization (IVF) at 60%, followed by Intracytoplasmic Sperm Injection (ICSI) at 25%, and other ART techniques at 15%. Regarding the number of embryos transferred, the majority received a single source (70%), with 20% receiving two starts and 10% receiving three or more. It is concluded that pregnancies conceived through Assisted Reproductive Technologies (ART) exhibit a higher prevalence of pregnancy-related hypertensive disorders and gestational diabetes compared to naturally conceived pregnancies.

IMPACT OF ANTENATAL STEROID ADMINISTRATION ON NEONATAL RESPIRATORY OUTCOMES

The administration of antenatal steroids represents a pivotal intervention in obstetric care with profound implications for neonatal respiratory outcomes. The study's main objective is to find the impact of antenatal steroid administration on neonatal respiratory outcomes. This retrospective cohort study was conducted at Lady Reading Hospital Peshawar from July 2019 to June 2023. The study included all infants born at the hospital who met the criteria for preterm birth (gestational age less than 37 weeks). Maternal demographic information was extracted, encompassing maternal age, parity, and medical history. The data collection's primary focus was antenatal steroid administration, including the type of steroid used, dosage, and timing of the gestational age at delivery. Data was collected from 550 preterm infants. The mean maternal age in the antenatal steroid group was 28.5 ± 4.2 years, and 29.1 ± 4.5 years in the no antenatal steroid group. The mean gestational age was 32.2 ± 2.1 weeks and 31.8 ± 2.3, respectively, in both groups. In the antenatal steroid group (n=300), the majority received betamethasone (90.0%) compared to dexamethasone (10.0%). The timing of administration varied, with 16.7% receiving steroids before 28 weeks, 50.0% between 28-32 weeks, and 33.3% between 32-34 weeks. The mean dosage for betamethasone was 10.5 ± 2.3 mg, while dexamethasone had a mean dosage of 8.0 ± 1.5 mg. It is concluded that antenatal steroid administration was associated with a significant reduction in RDS incidence and a lower need for mechanical ventilation among preterm infants. These findings emphasize the clinical importance of timely antenatal steroid administration in improving neonatal respiratory outcomes.

Burns in epileptic patients: Pattern and outcome.

Objective: To determine the pattern and outcome of burns in epileptic patients. Study Design: Retrospective study. Setting: Plastic and Burn Unit, Lady Reading Hospital, Peshawar. Period: January 2021 to Decmber 2022. Material & Methods: The research was conducted at the Plastic surgery and burn unit of Lady Reading Hospital Peshawar. Digital records of 35 epileptic patients admitted in the last five years were extracted. The demographics, burn pattern, total body surface area, level of burn, surgical outcome, complications, and length of hospital stay of epileptic patients were extracted from the electronic record. IBM-SPSS version 20 was used to analyze the data. Results: Over the last five years, 35 epileptic patients have been admitted to our unit. Males made up 28.6% of our patients, while females were 71.4%. The patient's average age was 24.14 years ±16. 28 SD. The most common pattern in our patients was fire burn (62.9%), followed by scald (25.7%), and the least common pattern was 11.4%. 10 to 20% of body surface area burns were seen in 51.4% of patients, less than 10% in 20% of patients, and >20% burns in 28.6% of patients. The majority of the patients (37.1%) had a full-thickness burn, followed by mixed burns (31.4%), deep partial-thickness burns (20%), and superficial partial-thickness burns (11.4%). Twenty-eight patients stayed in the hospital for 1 to 14 days, 04 patients for 15 to 30 days, and 03 patients for 31 to 45 days. Conclusion: Epilepsy-related burns are a serious public health concern in developing nations, putting a significant burden on burn units due to the severity of the burns and the duration of hospital admissions.

Antimicrobial Susceptibility Patterns of Salmonella Typhi and Salmonella Paratyphi in Tertiary Care Hospitals

Background: Salmonella typhi and Salmonella paratyphi are significant causes of enteric fever, posing substantial public health challenges globally. Monitoring their antimicrobial susceptibility patterns is crucial for guiding treatment strategies and combating antimicrobial resistance, particularly in tertiary care hospitals where severe cases are managed. Aim: To determine the antibiogram profile of Salmonella typhi and Salmonella paratyphi isolated from blood cultures of paediatrics patients presenting in Lady Reading Hospital Peshawar. Methodology: The study examined the prevalence, clinical characteristics, and antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi infections among 530 participants aged 13 to 18 years presenting in Lady Reading Hospital Peshawar. Over the course of two years using a prospective observational cohort design. Recruitment, clinical evaluations, and laboratory validation using accepted methods were all part of the data gathering process. Testing for antibiotic susceptibility was done, and statistical analysis was done using SPSS version 28. Both informed consent and ethical approval were obtained. Results: The research included 530 instances of enteric fever, of which 318 cases (or 60%) were due to Salmonella typhi and 212 cases (or 40%) to Salmonella Paratyphi. There were 40.25% female cases and 59.75% male cases among them. The age group of 15–16 years old accounted for the largest percentage of cases (38.68%), followed by 13–14 years old (33.02%) and 17–18 years old (28.30%). Different patterns emerged from antimicrobial susceptibility tests; drugs such as ampicillin (66.04%), azithromycin (74.26%), cefixime (87.47%), ceftriaxone (92.77%), chloramphenicol (91.51%), ciprofloxacin (92.40%), and co-trimoxazole (55.03%) showed substantial susceptibility rates. Compared to Salmonella typhi, Salmonella paratyphi showed notably greater sensitivity rates for azithromycin (94.47%) and ceftriaxone (95.45%). Practical implication: This research provided the community with important advantages and practical consequences. The study helps healthcare professionals choose efficient treatment plans by identifying the antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi, particularly in tertiary care facilities. Conclusion: This study highlights the importance of continuous surveillance and species-specific treatment strategies to combat antimicrobial resistance and improve patient outcomes in enteric fever, particularly in tertiary care settings. Keywords:Antimicrobial susceptibility, Salmonella typhi, Salmonella Paratyphi, Tertiary care hospitals

Magnetic Resonance Imaging Validates the Clinical Accuracy of the Mcmurray's Test in Diagnosing Medial Meniscal Tears

Background: A physical examination method to find medial meniscal tears is the McMurray's test. The purpose of this research was to evaluate how effectively the McMurray's test can identify medial meniscal tears in a clinical situation that have been verified by MRI. However, arthroscopic evaluation is now replacing the traditional methods. Aim: To determine diagnostic accuracy of McMurray's test is in diagnosing Medial Meniscal knee injuries. Methods: This prospective case series study was conducted in the department of Orthopedic MTI Lady Reading Hospital Peshawar on 100 consecutive patients who received an MRI for suspected medial meniscal tears between August 2022 and July 2023. Each patient underwent the McMurray's test, and the findings were compared to those of the MRI scans. Positive and negative predictive values, as well as the sensitivity and specificity of the McMurray test, were calculated. The McMurray test was performed on all patients to check for meniscal tears, and arthroscopy was then performed on the affected knees to evaluate the accuracy of the test. Results: Overall, one hundred patients took part in the study. There were 65 males and 35 females among the patients. There was a wide range of ages represented in the group, from 18 to 75. A total of 45 out of the 100 cases were young adults. The mean age was 31.46, while the standard deviation was 9.12 years. Participants of all ages were involved in the study. Forty-seven patients (47%) were in the 18-30 age range, 25(25%) were in the 31-45 age range, 19(19%) were in the 46-60 age range, and 9(9%) were in the 61-75 age range. In 100 patients MRI and McMurray tests can diagnose medial meniscal abnormalities. According to the study, the sensitivity of McMurray's test is 62.9%, the specificity is 81.6%, the positive predictive value is 84.8%, and the negative predictive value is 57.4%. Practical Implication: McMurray's Test is a good alternative to MRI for diagnosis of medial meniscus in areas where the facility of imaging is not available. Conclusion: The McMurray's test is a good clinical method for detecting medial meniscal tears that has been verified by magnetic resonance imaging (MRI). Keywords: McMurray test, meniscal tears, Magnetic Resonance Imaging, arthroscopy, accuracy.

EVALUATING THE ROLE OF CERVICAL LENGTH MEASUREMENT IN PREDICTING PRETERM BIRTH: A SYSTEMATIC ANALYSIS

Evaluating cervical length measurement as a predictive tool for preterm birth is a critical focus in obstetrics and maternal-fetal medicine. The primary aim of this study is to find the role of cervical length measurement in predicting preterm birth. This prospective study was conducted in Lady Reading Hospital Peshawar from 2022 to 2023. Two hundred twenty pregnant females in their second trimester were recruited from the hospital's OPD. Baseline information is collected, including socio-demographic factors, clinical and medical history, and obstetric records. A transvaginal ultrasound assesses cervical length using standardised techniques. Baseline measurements serve as the initial data point for subsequent evaluations. Data were collected from 220 pregnant females. The mean age was 28.5 years (±4.2), and the gestational age was 22 weeks (18-24). The average BMI stood at 25.1 kg/m² (±3.5). Non-smokers constituted the majority, accounting for 81.8%, while smokers comprised 18.2% of the cohort. The mean cervical length at 22 weeks was 35.4 mm (±4.6), ranging from 25 mm to 45 mm. The incidence of preterm birth stood at 14% (n=31), with 27% (n=17) of individuals having a cervical length ≤25 mm experiencing preterm birth, whereas 8% (n=14) with a cervical length >25 mm faced the same. Progesterone was administered to 27.3% (n=60) of participants, while 72.7% (n=160) did not receive it. It is concluded that cervical length assessment at 22 weeks gestation presents a valuable predictor for preterm birth incidence within this cohort. The study highlighted a significant correlation between a cervical length of 25 mm or less and an increased risk of preterm delivery.

Quality of Hypospadias Surgery in a High Volume Hospital: Review of Short to Medium-Term Outcomes after Snodgrass Hypospadias Repair

OBJECTIVES The study aimed to review short-term and medium-term outcomes of Snodgrass repair from one-year to two-year follow-up. METHODOLOGY It’s a retrospective review of 114 patients (secondary data) with distal penile hypospadias without curvature who underwent Snodgrass repair performed by a single surgeon in the department of Urology, Lady Reading Hospital Peshawar from March 2021 to March 2022. Hypospadias objective score Evaluation (HOSE) was used for functional and cosmetic outcomes. RESULTSThe mean age at the time of presentation for surgery was 3 years. The mean documented follow-up was 13 months (2-23 months). 51% (58) of patients presented with coronal hypospadias, followed by sub-coronal, distal and glanular hypospadias. Overall complication rate was 10%. Three patients developed a total breakdown of their wounds that needed further staged procedures. Meatal stenosis was noted in three patients requiring meatal dilatation, and another two came back with non-obliterative strictures. One had gentle dilatation, and the other underwent an optical urethrotomy. The rest of the four patients developed urethrocutanoeus fistulae (UCF), ultimately getting repaired 6 months postoperatively. Good cosmetic and functional results were achieved in 93% of cases (HOSE score of 14 or above). CONCLUSION This study shows that Snodgrass repair is the best option for mainly correcting distal penile and midshaft hypospadias and has an acceptably low complication rate with better short to medium-term outcomes.

Prevalence of Depression among Mothers of Children with Cerebral Palsy (CP) Enrolled in Occupational Therapy Unit at Lady Reading Hospital Peshawar, Pakistan

Cerebral Palsy (CP) is one of the most prevalent physical disorder in developmental disabilities among children. This condition may prone the parents for development of depression and anxiety especially the mothers. Objective: To assess the prevalence of depression among mothers of children with CP in Peshawar, Pakistan. Methods: A descriptive cross sectional study was conducted prior to randomize control trials in Occupational Therapy Department of Lady Reading Hospital Peshawar. The sample was calculated through Openepi, consisted of 240 participants through consecutive sampling technique. The quantitative data were collected through Hospital Anxiety and Depression (HADS) scale from mothers whose score was greater than 3 on the general health questionnaire (GHQ-12). Results: The mean age of the participants was 31.63± 7.09 years. In a sample of 240 participants, married were 230 participants followed by 6 divorced and 4 widows. Furthermore, 58% participants have male children affected followed by 42% female children. The mean score of the participants’ depression was 12.49 ± 3.18 in a total score of 21, which was moderate to severe in the current study. Conclusions: The study concluded that mothers of CP child have moderate to severe level of depression. Furthermore, the study highlighted that majority of the participants were married and the prevalence rate of CP was higher male children as compared to female.

Mcmurray Test for Diagnosis of the Meniscal Tears

Aim: Meniscal tears are the most common injury of the knee. Tears of medial meniscus are seen more frequently as compared to lateral meniscus. Most often tears result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee. As majority of our population resides in peripheries where access to arthroscopy and imaging modalities is difficult so we need a clinical test for evaluation of medial meniscal tears. And then this technique can be opted in our practice for early diagnosis of meniscal tears in order to take proper management for reducing morbidity of these particular patient, if its diagnostic accuracy comes out to high. Objective: To determine the diagnostic accuracy of McMurray test in diagnosing medial meniscal tears, taking arthroscopy as gold standard. Materials and Methods: This Cross-sectional validation study was carried out in Orthopedic Department of Medical Teaching Institute Lady Reading Hospital Peshawar from July 2021 to June 2023.In this study a total of 149 patients were observed. McMurray test was performed by the a single and same consultant and was looked for medial meniscal tear (present/absent).After this arthroscopy was done in each patient by the consultant orthopedic surgeon who has examined the patient and presence or absence of medial meniscal tear was noted. McMurray test results were compared with arthroscopy result. Results: In this study mean age was 30 years with SD ± 11.35. Eighty five percent patients were male and 15% patients were female. Diagnostic accuracy of MacMurray Test findings taking arthroscopy as gold standard was analyzed as the sensitivity was 76.55%, specificity was 75%, Positive predictive value was 99.10%, Negative predictive value was 8.10%. So, the overall diagnostic accuracy was 76.51%. Practical Implication: As in our setups majority of population resides in peripheries where access to arthroscopy and magnetic resonance imaging is difficult so there is a need of clinical test for diagnosing medial meniscal tears. And this technique can be opted in routine practice for early diagnosis of medial meniscal tears in order to take proper management for reducing morbidity of these particular patients after determining the sensitivity and specificity of the test. Conclusion: This study concludes that the McMurray test had sensitivity 76.55%, specificity 75%, Positive predictive value 99.10%, Negative predictive value 8.10% and the diagnostic accuracy 76.51% in diagnosis of meniscal tear keeping knee arthroscopy as gold standard. Keywords: Arthroscopy, Knee, McMurray test, Meniscal tear, Magnetic resonance imaging.

Association of high pre-pregnancy body mass index with adverse maternal and perinatal outcomes.

Obesity is an epidemic of the 21st century with its rates doubling in both developed and developing countries. It raises concerns for both maternal and fetal well-being and needs altered care throughout pregnancy and in postnatal period. Raised BMI prior to conception is associated with adverse feto-maternal outcomes. Limited data is available about its association with adverse maternofetal outcome in this region of the world. Our objective was to find out association of high pre-pregnancy BMI with adverse maternal and perinatal outcomes. This cohort study of 390 patients was conducted in Gynae department of Lady Reading Hospital Peshawar. Study duration was from June 2021 to March 2022. Patients enrolled in third trimester of gestation (≥ 37 weeks) were divided into two groups based on BMI i.e., Group-A with BMI <25 and Group-B with BMI ≥ 25. Both groups were followed until their delivery and discharge. The mean age of 390 women was 28.2 ± 4.8 years. There was statistically significant association between raised pre pregnancy BMI and maternal risks like postpartum hemorrhage (p-0.0001), genital tract (p-0.0002) and perineal trauma (p-0.04). Neonatal risks significantly associated with high pre-pregnancy BMI were macrosomia (p-0.0001), and one minute APGAR score of < 8/10(p- 0.01). Both groups had no statistically significant difference for different modes of delivery i.e normal vaginal/ instrumental delivery and cesarean section (P-value 0.9). Maternal pre-conception BMI of ≥ 25 leads to poor maternal and perinatal outcomes.

Maternal Outcomes in Placenta Accreta Spectrum: Experience at Lady Reading Hospital Peshawar, Pakistan

Background: Placenta accrete spectrum includes placenta accreta, increta and percreta and results in failure of placental separation from uterine wall after delivery. It can cause massive hemorrhage and is one of the major cause of maternal mortality.Objectives: To determine maternal outcomes in placenta accreta spectrum (PAS) at Lady Reading hospital PeshawarMaterial and Methods: This cross-sectional study was carried in OBGYN department of Lady Reading hospital Peshawar from January 1st 2022 till 31st December2022. Patients with placenta accreta spectrum were included for study. These cases were recruited from antenatal OPD and from obstetric emergency unit. Mode of delivery in all cases was cesarean section. All included patients were followed till discharge to determine maternal and fetal outcomes. Information was gathered on pre designed proformas.Results: The mean age of sample of 35 cases was 33 +-3.5 years. Mean gestational age at delivery was 34+-1.01. Sixty eight percent cases of placenta percreta spectrum had emergency cesarean delivery. Thirty four percent cases received multidisciplinary intra operative care. Hemorrhage needing blood and blood products transfusion was the commonest intra operative complication accounting for 68.6% cases. Surgical wound infection was the commonest post operative complication occurring in 31.4% cases. Two mothers died during the study period.Conclusion: Hemorrhage is the most common complication of placenta percreta spectrum.Keywords: placenta percreta, obstetric hemorrhage, surgical wound infection

Diagnostic Potential of miRNA-15a-5p for the Early Detection of Myocardial Infarction

Myocardial infarction (MI), also known as a heart attack, is caused by reduced or complete cessation of blood flow to the part of the myocardium. MicroRNAs (miRNAs) are key regulators in various cellular mechanisms and have the potential to be used as diagnostic markers in certain diseases such as MI, atherosclerosis, heart failure coronary artery disease, hypertrophy, and fibrosis. The present study was conducted to assess the early diagnostic potential of circulatory miRNA-15a-5p. By using bioinformatics tools, it was found that BCL2, an antiapoptotic gene, is the putative target of miRNA-15a-5p. The blood was collected from the 50 MI patients recruited in Lady Reading Hospital Peshawar. qRT-PCR analysis showed significantly upregulated miRNA-15a-5p in MI patients’ blood and isoproterenol-induced MI rats’ blood and tissue samples. The decreased level of the antiapoptotic gene, BCL2, was confirmed by qRT-PCR in the circulation of both MI patients and MI rat model. The toxic potential of isoproterenol for MI induction in rats was confirmed by disrupted heart tissue histology, increased reactive oxygen species (ROS) and decreased antioxidative enzymes such as superoxide dismutase (SOD), catalase (CAT), peroxidase (POD), reduced glutathione (GSH) and ascorbate peroxidase (APX) in rat serum and tissue homogenate samples. In serum samples, liver function tests, and lipid profiling showed elevated levels in the MI rat model. Concludingly, this study provides future insights for miRNA research that will advance the development of diagnostic markers for the early detection of MI in patients.

Transition from physical to virtual journal club.

Objective: To determine the effectiveness of Orthopaedic virtual journal club started during COVID-19 pandemic. Study Design: Descriptive Cross sectional. Setting: Orthopaedic &amp; Traumatology Division Lady Reading Hospital Peshawar, Pakistan. Period: 6th February 2021 to 6th June 2023. Material &amp; Methods: We selected one original article which was published in Journal of Pakistan Orthopaedic Association (JPOA).The author of that article would present it in synchronous virtual journal club (VJC) on Zoom. Orthopaedic residents from all over Pakistan attended the VJC. All the residents provided feedback (on 5 point Likert scale) by answering 11 questions related to various aspects of their learning experiences which were analyzed to measure the effectiveness of VJC. Results: We conducted 12 VJC on various topics. The total number of post graduate residence who attended these VJC were 380. Final year residents were more likely to attend VJC than first year residents (p=0.02). After 12 VJC the mean resident participation was 42±1.2. We received the feedback forms of 344(90.52%) residents. The VJC was extremely convenient to vast majority (86.62%, n=298) of residents. The VJC was perceived very effective and extremely valuable by 90.11% (n=310) and 84.59% (n=291) residents respectively. Majority (90.11%, n=310) of our residents strongly agreed that VJC provided them more understanding of writing an original article. Conclusion: Our transition from physical to virtual journal club was very fruitful. Virtual Journal club was an extremely convenient, very effective and extremely valuable form of distant learning. Knowledge, attitude and skills of the residents were improved which support them in their delivery of patient care and improved patient clinical outcome. The VJC provided the residents more understanding of writing an original article.

FREQUENCY OF HEPATITIS C VIRUS IN PATIENT WITH LICHEN PLANUS PRESENTING TO TERTIARY CARE HOSPITAL IN KHYBER PAKHTUNKHWA, PAKISTAN

Lichen Planus (LP) is a chronic inflammatory condition that affects the skin, mucous membranes, or both. The present study aimed to determine the frequency of hepatitis C virus in patients with lichen planus. This cross-sectional study was conducted at the Department of Medicine, Medical Teaching Institute, Lady Reading Hospital Peshawar. The study duration was from July 2021 to December 2021. A thorough medical history and a comprehensive physical examination were obtained, including an evaluation of the affected skin and mucous membrane areas. A consultant dermatologist took Skin biopsies from the lichen planus lesions and sent them to the hospital laboratory for histopathological analysis. Hepatitis C virus infection was confirmed through PCR testing in the hospital laboratory. All collected data was documented on a specially designed form containing demographic information. The data was then analyzed using the Statistical Package for the Social Sciences (SPSS), version 23. Post-stratification chi-square tests were applied, with a significance level set at p ≤ 0.05 to determine statistical significance. In this study, we included a total of 101 patients who had lichen planus. The ages of these patients ranged from 18 to 50 years, with a mean age of 36.410 years and a standard deviation of 9.362 years. Among these patients, 23.8% were found to be infected with the Hepatitis C virus. The patients' mean Body Mass Index (BMI) was 25.78 kg/m2, with a standard deviation of 4.087 kg/m2. An interesting finding was a statistically significant association (with a p-value of 0.002) between BMI and the occurrence of Hepatitis C virus among lichen planus patients. This suggests a positive significant association between BMI and the presence of HCV in patients with lichen planus. These findings highlight the importance of considering age, gender, and BMI when assessing the risk of HCV infection in lichen planus patients. Furthermore, the relatively high prevalence of HCV among lichen planus patients in this population emphasizes the importance of regular screening for Hepatitis C in individuals with lichen planus, particularly in the fifth decade of life, and those with lower BMIs. This information may improve clinical management and patient care in lichen planus and its potential comorbidities.