Lady Reading Hospital Research Articles

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.

Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Background: Midline laparotomy is widely recognized as the preferred technique for abdominal surgeries due to its simplicity and the effective exposure it provides. Despite its prevalence, the optimal method for closing the incision remains a topic of debate among surgeons, particularly when balancing the risk of wound dehiscence with the practicalities of surgical practice. The mechanical properties of suture materials and techniques, such as continuous versus interrupted suturing, directly influence wound integrity during the critical postoperative period. Objective: The aim of this study was to compare the effectiveness and complication rates of continuous versus interrupted suturing techniques in midline laparotomies, with a focus on the incidence of wound dehiscence. Methods: This randomized controlled trial included 180 patients undergoing emergency laparotomy, divided into two groups: continuous closure (Group A) and interrupted closure (Group B). The study was conducted at Lady Reading Hospital MTI, Peshawar, with ethical committee approval. Participants were informed, consented, and demographic data were recorded. Suture techniques were performed by an experienced surgeon, and patients were monitored for wound dehiscence up to the 15th postoperative day. Data were analyzed using SPSS version 25. Results: Group A reported a wound dehiscence rate of 14.4%, with an effectiveness rate of 85.6%. In comparison, Group B showed a significantly lower dehiscence rate of 5.6% and an effectiveness rate of 94.4%. The age-wise distribution of effectiveness indicated no statistically significant difference between the groups across various age ranges, with P-values ranging from 0.2766 to 0.6037. Gender-wise, males and females also did not show significant differences in effectiveness between the two groups. Conclusion: Interrupted suturing for midline laparotomy closures showed a lower incidence of wound dehiscence compared to continuous suturing. However, factors such as increased surgery time and cost, along with postoperative issues like stitch sinus formation, need consideration. Further large-scale studies are recommended to evaluate the long-term outcomes and provide a more comprehensive assessment of the two techniques.

Vulvodynia prevalence and associated psychosexual problems in middle-aged diabetics at a tertiary care hospital in Pakistan

Background & Objective: Vulvodynia is a significant clinical disorder in women but it remains a neglected health problem in many societies. The present study was aimed to identify the frequency of vulvodynia in the diabetic and non-diabetic population and its association with common psychosexual problems in the population of Khyber Pakhtunkhwa, Pakistan. Methods: This study is cross sectional descriptive investigation and conducted in tertiary care hospital (Lady Reading Hospital, Peshawar) in 2018-2019. A total of 75 cases categorized into diabetic and non-diabetic groups were collected under the supervision of qualified gynecologists. Groups were compared on the basis of demographics, symptom frequency, psychological and clinical data, using a pre-designed proforma. Results: The incidence of vulvodynia in women with type 1 and type 2 diabetes (n = 50) and in the non-diabetic population (n = 25) was 66.6% and 33.3%, respectively. The vulvodynia severity score based on Friedrich`s criteria in diabetes was 80% and in non-diabetes it was 40%. The cotton bud swab test severity index was 80% in diabetes and 40% in non-diabetes. The erythema rating scale score in diabetes was 81% and in non-diabetes it was 39%. Finally, psychological and psychosexual problem frequency in diabetes was 100% and in non-diabetes was 88%. Conclusions: Women with diabetes had a fourfold risk of vulvodynia up to middle age as compared to non-diabetics in Peshawar, Pakistan. Diabetics with vulvodynia possessed a nine-fold risk of experiencing psychological symptoms of depression (OR = 9.33; 95% Cl 1.0-88.6) and an even higher risk of somatic depression symptoms.

ASSESSMENT OF LONG-TERM OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) FOR CHRONIC TOTAL OCCLUSIONS

A minimal surgical procedure called ‘PCI’ (percutaneous coronary intervention) is performed to treat those who have diseases of the coronary arteries. A period of more than three months of entire blockage of a coronary artery results in a ‘CTO’ (chronic total occlusions). The primary goal of the research is to determine the performance of patients who have ‘PCI’ (percutaneous coronary intervention) for chronic total occlusions (CTO). The study was conducted at Lady Reading Hospital MTI from March 2022 to December 2022. The research included 400 individuals with ‘percutaneous coronary intervention’ for ‘CTO.’ Information was gathered via follow-up appointments and records from patients. All-caused death was the study's primary objective; major adverse cardiac events (MACE), repeated revascularization’, and standard of life were its additional objectives. Survival analysis and descriptive statistical methods were used to analyze the data. This research looked at the long-term results of individuals who had ‘percutaneous coronary intervention ‘for ‘A CTO’ and revealed that 400 individuals had at least one ‘percutaneous coronary intervention ‘for a ‘CTO.’ The individual's average age was 58.9 ± 6.07 years, and 70.3% of them were men. This research concludes that with a total success rate of 87.5%, ‘percutaneous coronary intervention ‘for chronic complete occlusions may result in favorable long-lasting results.

The Impact of Age, Comorbidities, and Discharge Timing on Clinical Outcomes Following Elective Percutaneous Coronary Intervention.

Background The adoption of same-day discharge (SDD) in elective percutaneous coronary intervention (PCI) procedures offers potential benefits in terms of patient satisfaction and reduced healthcare costs. Despite these advantages, the safety and efficacy of SDD, especially among patients with diverse health profiles, are not fully understood. This study investigates the effects of patient-specific factors, including age, comorbidities, and discharge timing, on the clinical outcomes of elective PCI, focusing on the viability of SDD. Methods A prospective study was carried out at Lady Reading Hospital, Peshawar, Pakistan, involving 220 patients undergoing elective PCI from January to June 2023. This research compared the clinical outcomes of patients discharged on the same day with those who had extended hospital stays, examining the impact of age, comorbidities, and PCI success. Main outcome measures included post-procedure complications and hospital readmissions within 30 days. Results The study enrolled participants with an average age of 62 years, the majority (88%, n=194/220) of whom had comorbidities. Interestingly, 16% (n=35/220) of the participants were discharged on the same day, while the rest stayed longer in the hospital. Notably, those in the SDDgroup experienced significantly more complications and readmissions, with 95.14% (n=33/36) compared to only 16.22% (n=30/184) in their counterparts. Factors such as age, comorbidities, success ofPCI, timing of discharge, and patient satisfaction emerged as significant predictors of the observed outcomes. Conclusion This study highlights the essential role of personalized care in discharge planning following elective PCI, advocating for a cautious approach towards SDD, especially for older patients and those with multiple health issues.

FACTORS ASSOCIATED WITH DEVELOPING CHRONIC DAILY HEADACHE IN MIGRAINE PATIENTS

To examine the factors associated with developing chronic daily headache in migraine patients. Two hundred patients with migraine were selected for this descriptive study conducted from 01-Sept-2023 to 30-Nov-2023 at the Department of Medicine, Lady Reading Hospital, Medical Teaching Institution, Peshawar. Factors associated with developing chronic daily headache were assessed. SPSS 23 was employed for analyzing the data. The mean age was 38.09±12.03 years. The frequency of chronic daily headache in our study was 31 (15.5%). Female gender (p = 0.02), smoking (p = 0.0001), high caffeine intake (p = 0.0001), painkiller overuse (p = 0.0001) and obesity (p = 0.0001) were factors significantly identified for developing chronic daily headache. We conclude that the factors for developing chronic daily headache in migraine patients were female gender, smoking, high intake of pain relieving medicines, high intake of caffeinated drinks and obesity.

Assessing the Effectiveness of Leadership Styles among Nurses in Tertiary Hospitals of Peshawar

Background: The healthcare sector increasingly recognizes the importance of leadership styles in shaping the work environment, employee satisfaction, and patient care outcomes. Leadership within nursing teams, particularly in tertiary hospitals, plays a crucial role in addressing the challenges of healthcare delivery and staff retention. The diversity in leadership styles—authoritarian, democratic, and laissez-faire—offers various approaches to managing nursing teams and influencing healthcare outcomes. Objective: This study aimed to assess the prevalence of different leadership styles among nurses working in tertiary hospitals in Peshawar and to explore their impact on nursing practice and healthcare delivery. Methods: A cross-sectional study design was employed, involving 240 nurses from Khyber Teaching Hospital and Lady Reading Hospital in Peshawar. Participants were selected using a convenience sampling technique. A structured questionnaire, comprising socio-demographic items and leadership style assessments, was utilized for data collection. Statistical analysis was conducted using SPSS version 25, focusing on frequencies, percentages, means, and standard deviations to evaluate the distribution of leadership styles. Results: The majority of participants reported a high range of authoritarian (44.2%), democratic (44.2%), and laissez-faire (46.3%) leadership styles. The prevalence of very high range was significant for authoritarian (43.3%) and democratic (40%) styles, indicating a strong inclination towards these leadership approaches among nursing staff. The study also highlighted a positive association between democratic leadership styles and job satisfaction among nurses. Conclusion: The findings underscore the diversity of leadership styles among nurses in tertiary hospitals in Peshawar, with a notable preference for authoritarian and democratic approaches. This diversity suggests the need for flexible leadership training programs tailored to the dynamic requirements of healthcare settings. Enhancing leadership skills among nurses is crucial for improving healthcare delivery and achieving better patient care outcomes.

Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study.

Objective The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology Thisdescriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.

Impact of Total Ischemic Time on Clinical Outcome in Stemi Patients Undergoing Percutaneous Coronary Intervention

Background: ST-segment elevation myocardial infarction (STEMI) represents a critical condition requiring prompt treatment to minimize myocardial damage. Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy, with the total ischemic time (TIT) being a crucial determinant of clinical outcomes. Despite the recognized importance of minimizing door-to-balloon (DTB) time, the impact of TIT on STEMI outcomes necessitates further exploration. Objective: This study aimed to evaluate the association between TIT and clinical outcomes in STEMI patients undergoing PCI, specifically focusing on all-cause mortality, re-hospitalization, and revascularization rates. Methods: A descriptive study was conducted at the cardiology ward of Lady Reading Hospital from May 2023 to October 2023. Ninety patients diagnosed with STEMI and undergoing PCI were enrolled. Patients were excluded if they had a history of cardiac surgeries or a DTB time >90 minutes. TIT was categorized into ≤120 minutes (Group A) and >120 minutes (Group B). Clinical outcomes assessed at 6 months post-PCI included all-cause mortality, cardiac mortality, re-hospitalization, and revascularization. Data were analyzed using SPSS version 25, employing Chi-Square tests for categorical variables, with a p-value ≤ 0.05 considered statistically significant. Results: Among the participants, Group A (TIT ≤ 120 mins) comprised 33 patients, while Group B (TIT > 120 mins) included 57 patients. Increased TIT was associated with higher rates of all-cause mortality (21.1% in Group B vs. 6.1% in Group A, p=0.05), re-hospitalization (22.8% vs. 6.1%, p=0.04), and revascularization (29.8% vs. 12.1%, p=0.05). Cardiac mortality was also higher in Group B (10.5%) compared to Group A (3.0%), though this difference was not statistically significant (p=0.20). Conclusion: The study highlights the significant impact of TIT on the prognosis of STEMI patients undergoing PCI. Shorter TIT is associated with markedly better clinical outcomes, emphasizing the need for healthcare systems to adopt strategies that reduce both pre-hospital and in-hospital delays.

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.

Lumbar Spinal Stenosis Due To Spodylolisthesis- Surgical Compared With Nonsurgical Treatment

Background: Lumbar spinal stenosis with spondylolisthesis stands for severe pain and dysfunction because of the narrowing of the spinal canal and vertebral slip. With patients being treated either surgically or by other methods, distinction between the two is necessary to resolve controversies. Objectives: To conduct a comparative analysis between surgery and non-surgery in the management of lumbar spinal stenosis with spondylolisthesis using observational and randomized control study groups. Study Design: A Observational and randomized cohort comparative study Place and duration of study : department of neurosurgery lady reading hospital Peshawar from jan-2020 to jan-2023 Methods: Based on the observational and randomized cohort study conducted in the period jan-2020 to jan-2023 in the Lady Reading Hospital, 604 patients were included in the study. Collectively, treatment embraced either surgical untethering or other mean. Specific patient outcomes such as pain relief and functional gain were measured during the follow-up which ranged up to 3 years. Results: In terms of body pain, surgical intervention provided statistically significant and more superior results in a mean of 18. 1 as compared to nonsurgical management over 3 years of follow up, similarly for physical functions the mean improvement was of 18. 3 and for Oswestry Disability Index it was 16. 7. Conclusion: The decision of preferring surgical intervention for the treatment of lumbar spinal stenosis with spondylolisthesis correspond to the maximum long term advantages of surgical over non surgical treatment principles focusing on the pain relief and functional recovery. Therefore, the present outcomes favour surgical management as the most preferred treatment approach with the adoption of individualised management plans following thorough clinical examinations of the patients. Keywords: Spinal Stenosis, Spondylolisthesis , Surgery Outcomes

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.

Outcome of Olecranon Fracture Treated with Tension Band Wiring Versus Anatomical Locking Plate Fixation

Aim: Up to 10% of all upper limb fractures involve the olecranon, and this type of fracture is the most common osseous injury of the elbow joint. These show a bimodal distribution occurring in younger patients due to high-energy trauma and in elderly cohorts with low bone quality after low-energy falls. Objective: To compare functional outcome of tension band wiring versus anatomical locking plate fixation for reduction of olecranon fracture Materials and Methods: This randomized controlled trial study was conducted in the Department of Orthopedic, Lady Reading Hospital, Medical Teaching Institute Peshawar from December 2022 to June 2023. Non-probability consecutive sampling technique was used in this study. Sample size was calculated using WHO calculator keeping 95% confidence interval 80 % power of study, 10% absolute precision, mean Mayo elbow score was 84.0±9.3 in the TBW group and 88.3±9.1 in the locking plate fixation group (4). Expected sample size is 32 patients in each group, total 72 patients. Patients of both genders have age range from 20 to 70 year with Mayo type 2A olecranon fractures, more than 2 mm of joint displacement determined on X-ray elbow, and elbow extension loss determined on physical examination presented within 7 days of the injury were included in the study while Patients with open fracture and revision surgery were excluded from the study. Results: In this study age distribution among 72 patients was analyzed as n= 20-30 Years 17(27.4%) 31-40 Years 14(22.6%) 41-50.Years 11(17.7%) 51-70 Years 20(32.3%). Mean age was 47.1 Years with SD ± 2.87. Gender wise Distribution among 72 Patients was analyzed as Male were 31(50.0%) and female were 31(50.0%). Distribution of duration of disease among 72 patients were analysed as n= 1-2 weeks were 47(75.8%) and 3-4 weeks were 15(24.2%) Practical Implication: There are no established guidelines for the treatment of olecranon fracture in our institution. Most olecranon fractures are treated according to surgeon preferences and surgical experience of the surgeon. Previous studies showed variables results with no consensus. We will provide rationale basis for universal use of standard treatment of olecranon fracture. Conclusion: Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group. Keywords: Anatomical locking plate; complications; eyelet wire; olecranon fracture; tension band wiring.

Outcome of Primary Percutaneous Coronary Intervention for STEMI due to Stent Thrombosis

Background: Stent thrombosis (ST) is a critical complication following percutaneous coronary intervention (PCI), contributing significantly to morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Advances in drug-eluting stent technology and antiplatelet therapy have mitigated, but not eliminated, the risk of ST. The management of STEMI due to ST in resource-limited settings remains a challenging endeavor, necessitating a comprehensive evaluation of treatment outcomes. Objective: To assess the mortality rates and clinical outcomes following primary PCI in patients with STEMI attributed to stent thrombosis in a resource-constrained setting, and to analyze the association of mortality with patient age and TIMI flow grade post-PCI. Methods: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar, from July to December 2023. A total of 150 patients presenting with STEMI due to ST and undergoing PCI were included. Diagnostic measures included electrocardiography, troponin levels, echocardiography, and angiography to assess left ventricular function and stent thrombosis. The procedures were performed by experienced interventional cardiologists, followed by standard post-procedure management. Data analysis was performed using SPSS version 25, focusing on mortality rates, the association of mortality with patient age, and TIMI flow grades. Results: Among the 150 patients studied, mortality was observed in 36 cases (24%). The mean age of patients who died was 48.33 years (SD = 14.267), compared to 42.47 years (SD = 12.618) for survivors, with a significant association between age and mortality (P = 0.02). Analysis of TIMI flow grade post-PCI revealed a strong correlation with mortality; patients with TIMI flow grades I and II exhibited higher mortality rates, with a highly significant P value of 0.0001. Conclusion: The study highlights a significant mortality rate among patients with STEMI due to stent thrombosis undergoing primary PCI in a resource-limited setting. Advanced age and lower TIMI flow grades post-PCI were significantly associated with increased mortality. These findings underscore the necessity for vigilant post-PCI monitoring and tailored management strategies to improve clinical outcomes in this high-risk population.

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.

Predictors of No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention among Patients with Acute Myocardial Infarction

Background: The no-reflow phenomenon, characterized by the failure to restore myocardial blood flow after reopening an occluded artery in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), has significant implications for patient prognosis. Understanding the predictors of no-reflow is crucial for improving clinical outcomes in this high-risk population. Objective: This study aims to identify the predictors of the no-reflow phenomenon in patients with AMI undergoing PCI and to assess their impact on the efficacy of the intervention. Methods: Conducted at Lady Reading Hospital's Cardiology Department, this descriptive study retrospectively analyzed 120 AMI patients treated with PCI from May 2023 to November 2023. Ethical approval was obtained, and the study conformed to the Declaration of Helsinki. The diagnosis of AMI was based on clinical symptoms and electrocardiographic findings. Experienced cardiologists performed PCI, and no-reflow was defined using Thrombolysis in Myocardial Infarction (TIMI) flow grades and Myocardial Blush Grade (MBG). Data were analyzed using SPSS Version 25, focusing on demographic variables, clinical presentations, and procedural details to identify predictors of no-reflow. Results: Out of 120 patients, 70.8% were male. The incidence of no-reflow was 22.5%. Significant predictors of no-reflow included systolic blood pressure < 100 mmHg (51.9% in no-reflow vs. 28.0% in normal flow, P=0.02), diabetes (59.3% vs. 34.4%, P=0.02), hypertension (77.8% vs. 31.2%, P=0.0001), and history of cardiovascular disease (11.1% vs. 2.2%, P=0.04). Conclusion: The study identified diabetes, hypertension, low systolic blood pressure, and a history of cardiovascular disease as significant predictors of the no-reflow phenomenon in AMI patients undergoing PCI. These findings highlight the importance of identifying and managing these risk factors to enhance the success of PCI and improve patient outcomes.

Evaluating the Differential Risk of Contrast-Induced Nephropathy Among Diabetic and Non-diabetic Patients Following Percutaneous Coronary Intervention.

Background Contrast-induced nephropathy (CIN) significantly complicates percutaneous coronary intervention (PCI), with a higher prevalence in diabetic patients. This study compares the incidence of CIN in diabetic and non-diabetic patients undergoing PCI. Material and methods Conducted at Lady Reading Hospital, Peshawar, PAK, from January to December 2023, this observational study involved 450 adult patients with coronary artery disease (CAD) undergoing PCI. The cohort was categorized based on diabetes status, excluding patients with chronic kidney disease and those on renal replacement therapy. Baseline characteristics documented included age, gender, blood pressure, creatinine levels, and the presence of acute coronary syndrome (ACS). CIN was defined as a ≥25% increase in serum creatinine from baseline within 48-72 hours post-PCI. Data analysis was performed using the StatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 25.0, Armonk,NY), incorporating descriptive statistics, Chi-square tests, and independent t-tests, with a significance level of p<0.05. Results The median age of the study population was 55 years. The cohort comprised 52% male (n=234) and 48% female (n=216). Notably, 33% (n=149) had ACS. Diabetic patients exhibited a significantly higher incidence of CIN post-PCI compared to non-diabetics. The highest incidence of CIN (17%, n=77) occurred in the 70+ age group. The findings highlight the criticality of renal function monitoring and procedural adjustments for diabetic patients. Conclusion Diabetic patients demonstrate an increased risk of CIN following PCI. This necessitates the development of tailored prevention strategies for this high-risk subgroup.

Analysis of the Effectiveness of Second Attempt Endoscopic Retrograde Cholangiopancreatography (ERCP) 24 Hours (Second Day) After Primary Failure.

Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive intervention that has established itself as the gold standard therapeutic option for various pancreaticobiliary conditions. Deep cannulation of the common bile duct (CBD) is essential in ERCP. However, cannulation is not possible in approximately 20% of the cases with the usual techniqueseven when performed by highly trained professionals or at major healthcare institutions. In case of failure on the first attempt, alternative choices include redoing the procedure (on the secondattempt) or moving on to more proficient endoscopic methods such as endoscopic ultrasound (EUS) or radiology-aided techniques (rendezvous procedures), totally percutaneous approaches, or surgical treatments. To analyze the effectiveness of the second attempt ERCP24 hours (second day) after primary failure. This analytical study was conducted to check the outcomes of second attempt ERCP in patients with prior failed cannulation, from June 20, 2023, to November 20,2023, at the Department of Gastroenterology, Lady Reading Hospital, Peshawar. Patients of either sex, aged >16 years with failed biliary cannulation, and who were otherwise clinically stable were included in the study. Patients with surgically modified anatomy, an unidentified main duodenal papilla, or a history of sphincterotomy at another setup were excluded. Outcomes were assessed in terms of gaining deep biliary access (cannulation) using a therapeutic duodenoscope and endoscopy system supported by a fluoroscope while using a wire-guided sphincterotome. Factors linked to second ERCP cannulation success or failure were analyzed using SPSS version 24. Ninety-four patients were enrolled including 61 (64.9%) males and 33 (35.10%) females. The mean age of the participants was 39.01±14.831 years. The most common indication for the intervention was CBDstones, which were present in 70 (74.5%) patients. Successful cannulation on the second attempt was achieved in 72 (76.6%) patients. Experienced endoscopists achieved a greater proportion of successful cannulation (86.8%) compared to 33.3% by endoscopists with lower experience (p-value: <0.001). Logistic regression analysis was conducted to predict the outcomes (cannulation), which revealed an odds ratio for endoscopist experience of 33.604 (95% confidence interval: 6.948-162.52). A second ERCP attempt24 hours after the primary failed attempt appears to be the best course of action for the majority of clinically stable patients.

Acetabular Fracture; its Management and Early Functional Outcome

Aim: To evaluate the functional results of open reduction and rigid internal fixation with Reconstruction plates and screws in acetabular fractures Methods: This prospective case series study was carried out on 47 consecutive patients, of either gender and age ranging from 18 to 60 years, who presented with an acetabular fracture within a month of injury at the Orthopedic and Trauma Department of the Medical Teaching Institute Lady Reading Hospital (LRH) in Peshawar, Pakistan, from January 2018 to September 2023. Excluded from the research were patients receiving traction therapy with a trochanteric pin for an open fracture. A non-probabilistic sequential sampling method was applied. Clinical grading followed D'aubigne and Postel's guidelines, with Matta's modifications. We measured range of motion, pain, and gait. Results: There were 47 patients in total, ages ranging from 20 to 60, with an average age of 37.52. there were 31 males (66.0%) and 16 females (33%). In 19(40.4%) patients, 5(10.6%) patients have physical violence and 23(48.9%) of the patients, the cause of injury was a road traffic collision. Our study shows that of the patients, 29(61.7%) were involved on the right side and 18(38.3%) on the left. In five (10.6%) of the instances, there was plate loosing. It is shown that 24(51.1%) cases, excellent outcomes were attained, in 15(31.9%) case good, 5(10.6%) cases fair, 3(6.4%) cases poor outcome were attained. Conclusion: According to Matta Grading, all acetabular fractures, including those involving osteoporotic bone, respond excellently to rather well to open reduction and internal fixation using a 3.5-millimeter reconstruction plate and screws. Keywords: Acetabulam, Fracture, Internal fixation, Open Reduction, Rigid Fixation.