Lahore General Hospital Research Articles

Immunohistochemical expression of HER2 and MUC1 in breast carcinoma and its correlation with histological grades

Background: Mucin 1 (MUC1) is overexpressed in almost 90% of CA breast cases and is usually associated with poor prognosis. On the other hand, HER2 is profoundly expressed in breast carcinoma and is also linked with increased disease recurrence, tumor invasion and poor prognosis. Thus, this study was designed to assess the expression of MUC1 and HER2 against the histological grades of breast carcinoma in our population.
 Materials and methods: It was a cross sectional analytical study conducted at Post Graduate Medical Institute/General Surgery Departments of Lahore General Hospital (LGH), Lahore. Duration of study was 12 month from 27-3-2018 to 30-3-2019. Total 60 newly diagnosed cases of CA breast were included in the study. Immunohistochemistry technique was used and MUC1 and HER2 markers were applied to check the probable association between the two markers and the histological grades of cancer.
 Results: A total of 60 cases were included in the study, out of which 96.7% (n=58) were invasive ductal carcinoma, while 3.3% (n=2) were Invasive lobular carcinoma. Among the total, 60% (n=36) were found positive for MUC1 (moderate/strong) and 40% (n=24) were found negative (negative/weak). Regarding HER2, 26.7% (n=16) were strong positive, 20% (n=12) were at the borderline/equivocal and 53.3% (n=32) were found negative for HER 2.
 Conclusion: Statistically significant association was found between MUC1 and HER2 against the histological grades of breast cancer patients (p <0.05).

Metallic Foreign Body in the Neck – a Rare Incidence

Penetrating injuries of the neck comprise upto 10% of all cases of trauma.We report the case of a 19 years old female who was admitted in Neurosurgery department of Lahore General Hospital with complaints of upper and mid back pain for 3 weeks, numbness of legs, abdomen and chest for 2 weeks and weakness of legs for 10 days. There was no preceeding history of trauma, major surgery or systemic illness. Her neurological examination suggested upper motor neuron signs in both lower limbs. She underwent a series of extensive investigations to rule out the differential diagnosis of myelitis, arteriovenous malformation and caries spine. In parallel to ongoing investigations, she received symptomatic treatment and empirical antituberculous therapy. Her MRI report showed a photon deficient area at the level of T1, which was also seen in chest Xray but was overlooked as artefact. Later on it was found to be a stray bullet which was causing the symptoms.

Evaluation of Arthroscopic Bankart Repair and Open Latarjet Technique for Treatment of Recurrent Shoulder Dislocation

Background: Arthroscopic Bankart repair and open Latarjet procedures are the most frequent surgical treatments for shoulder instability and recurrent shoulder dislocation. Objectives: Therefore, we performed research to assess the clinical outcomes and recurrence rate of instability between both Arthroscopic Bankart repair and open Latarjet techniques. Methods: A cross-sectional study was performed at Lahore General Hospital, Lahore from 2021-23, comprising 74 patients, managed surgically for the condition of recurrent shoulder dislocation. The patients were allocated into two groups viz Group A and B comprising 37 patients in each, who were managed through Arthroscopic Bankart repair and open Latarjet techniques, respectively. Post-operative complications, re-occurrence and success rate were measured in terms of SSV scores. Results: Average age of patients in Arthroscopic Bankart group was 28.34+5.31 years while in open Latarjet group; it was 29.09+6.19 years. 14 (37.83%) patients of Arthroscopic Bankart repair group revealed recurrent shoulder dislocation, while no such complaint was found in the open Latarjet technique. Twenty-seven patients of Arthroscopic Bankart group showed satisfaction with the procedure and 33 out of 37 patients (89.18%) were satisfied with open Latarjet technique. Patients in open Latarjet technique group showed successful recovery of shoulder dislocation and their SSV was 87.91%, while the patients in Arthroscopic Bankart repair group showed less SSV score of 59.76%. Conclusion: Open Latarjet group patients had a greater rate of functional satisfaction, while the arthroscopic Bankart repair group showed a trend for more recurrence. Open Latarjet operation had a higher success rate and patients had a better rate of return to previous top-level sports than Arthroscopic Bankart technique. Keywords: Latarjet; Re-occurrence; Shoulder dislocation; Sports medicine; Surgical complications.

Comparison of oxidative stress levels during the third Trimester in normal pregnancy and preeclampsia.

The placenta is a complex transiently formed organ which plays a crucial role in the development of the foetus. As the placenta is responsible for maintaining pregnancy placental defects are mainly responsible for pregnancy-related issues. Preeclampsia is a pregnancy-related disorder due to uteroplacental insufficiency resulting from deficient remodelling of spiral arteries causing ischemic reperfusion injury which is finally responsible for the generation of reactive oxygen species and oxidative stress by the placenta. So, this study was planned to determine and compare serum levels of oxidative stress markers (ischemia-modified albumin and malondialdehyde) in preeclampsia and normal pregnancy in the third trimester. Study design: Cross-sectional comparative study Settings Gynae/Obs Department and Pathology Laboratory, Lahore General Hospital, Lahore. Study population: 42 Pregnant females at 34-36 weeks of gestation were selected. Group 1 compromised 21 normal healthy pregnant females and group 2 included 21 preeclamptic patients. Sampling technique: non-probability purposive sampling. Blood samples were taken at 34-36 weeks of gestation. Serum was stored for ischemiamodified albumin and malondialdehyde. Data was analyzed using SPSS version 20. An Independent t-test was used to compare values between the groups during the third trimester. A pvalue of ≤0.05 was considered significant. Comparison of ischemia-modified albumin and malondialdehyde values between group I and group 2 showed a highly significant difference of pvalue of <0.001. Oxidative stress markers were higher in preeclamptic patients as compared to normal pregnant females during the third trimester suggesting the role of the placenta in oxidative stress.

Outcome of Urethral Stricture Managed by Different Surgical Techniques

Aim: To compare the outcome of urethral stricture managed by different surgical techniques. Place and Duration: This Study was conducted at Lahore General Hospital, Lahore in the duration from May, 2022 to October, 2022. Methods: This randomized controlled trial was conducted on 60 patients divided equally in two groups. Both groups were assessed for maximum urinary flow 6 months after surgery, cause of the stricture, site of the stricture and success rate was assessed between both variables. T-test and Chi Square test with P &lt; 0.05 as statistically significant were used to assess various outcomes between both groups. Results: The mean age in urethroplasty group was 44.43±10.618 years while in endoscopic urethrotomy group the mean age was 48.23±11.790. Urethroplasty was significantly successful in 80% patients whereas endoscopic urethrotomy was successful in 43.3% patients (P = 0.003). Conclusion: Urethroplasty is a safe and effective technique for treatment of urethral stricture. Keywords: Urethral stricture, Urethroplasty, Endoscopic urethrotomy, Efficacy

An Observational Study on Autopsies

Objective: To find out and evaluate to the number of cases, natural of cases (known, unknown) and unique reference to mode, manner and cause of death of medicolegal autopsies Study Design: Cross-sectional study. Place and Duration of Study: Department of Forensic Medicine, Lahore General Hospital, Lahore from 1st January 2021 to 31st December 2022. Methodology: Two hundred and forty six medicolegal autopsies were gathered. The perceptions kept in proforma with an accentuation on the gender of subjects, cause of death (natural, un-natural), manner of death, mode of death of known and unknown cases and month-wise variation of post-mortems. Results: One hundred and eight were natural deaths and 138 were un-natural. Gunshots represented 36% of the deaths through 18% were physical assault related deaths.158 cases were known while the 88 were obscure cases. Conclusion: In larger part of the medicolegal post-mortems male populace was involved and brought about by gunshot wounds (homicidal). August and October were the months where greater part of the cases came. Keywords: Medicolegal autopsy. Mode, Manner, Known and un-known

The Outcome of Bicolumnar Acetabular Fracture Treated by Single Anterior Ilioinguinal Approach

Background: Acetabular fracture therapy, being complicated, is generally treated by non-operative methods due to a lack of surgeons’ expertise in pelvis surgery. The surgical exposure and reduction of acetabular fractures may become more direct and practical with the altered technique since it is closer to the acetabular quadrilateral plate. This study aimed to determine the efficacy of a single anterior illio-inguinal approach for the management of a Bi-columnar acetabulum fracture. Methods: Sixty patients, fulfilling the selection criteria were selected for descriptive case series from Orthopedic Surgery Department at Lahore General Hospital, from 02-12-2020 to 02-06-2021. After informed consent, surgery was performed on all patients under general anesthesia. Patients were followed-up and evaluated for efficacy in OPD after 12 weeks of surgery with a Harris hip score. All demographic and other information was recorded on a Proforma. SPSS 22 was used to assess data. Post-stratification, efficacy was compared by using chi-square, p-value ≤0.05 was considered significant. Results: Out of 60 patients, 45(75 %) were male, whereas 15(25%) were female (Mean age 52.71±10.50yrs). The Mean of duration fracture (in days) and Harris score are 11.03±5.29 and 2.83±0.45 respectively. The efficacy concerning lateral side was 60% for left side and 26.7% for right side. Efficacy was higher in less than 10 days old fractures at 55.0% while after 10 days it was 31.7%. We found that the percentage of efficacy was 86.7%. Conclusion: The current study concluded that the anterior illio-inguinal approach is highly effective (p=0.001) in the management of acetabular fractures. Keywords: Acetabulum; Pelvic; Fracture; General Surgery.

Intervene to Improve: Awareness of Testicular Self-Examination and Testicular Cancer Among Male Patients at a Tertiary Care Hospital in Lahore, Pakistan.

Background and objective Testicular canceris the commonest of all types of cancermales are affected with. Testicular cancer, when diagnosed early, has one of the best prognoses. However, in Pakistan, early detection is hindered by religious and sociocultural norms, lack of education, and awareness deficit. Testicular self-examination (TSE) can significantly facilitate early detection of the condition and decrease associated mortality rate. This study aimed to acquire the frame of mind regarding testicular cancer (TC) and testicular self-examination (TSE) among the male outdoor patients of Lahore General Hospital, Lahore. Materials and methods After ethical considerations, elaborated literature review and consequent pilot study were done to develop a bilingual questionnaire. Following patient consent, answers to a set of questions were noted down by the authors. A 90-second bilingual, motivational video was displayed and an educational pamphlet on the same topic was also handed over. Afterward, another survey was conducted to grasp the comprehension, satisfaction, and willingness to spread the message. Results About 92% of the subjects had not heard of or performed TSE and 58.3% mentioned lack of education as the reason for not knowing the method. Eighty-two percent patients had never heard of TC. Post-education, 100% patients claimed that their knowledge of the subject improved and 97% were ready to teach other male relatives. Conclusion The results indicate that the population's lack of awareness regarding testicular self-examination and testicular cancer is alarming. Most subjects did not know the age group, risk factors, presentation, and early prevention of testicular cancer.

Fine-needle aspiration cytology versus open biopsy for the diagnosis of chronic cervical lymphadenopathy

Background: For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine-needle aspiration cytology (FNAC) is considered safe, less invasive, and cost-effective. However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy. Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. Results: FNAC had a sensitivity and specificity of 92% overall. Non-Hodgkin's lymphoma, tuberculosis, Hodgkin's lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively. Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination.

Lipoma arborescence of knee joint in an adolescent male patient: a case report

&lt;p&gt;A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion&amp;rsquo;s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.&lt;/p&gt;

Effect of Honey on levels of BMP-2 in post-extraction tooth sockets in Humans

Background: In Pakistan, many people undergo tooth extractions every year due to various causes such as dental caries, periodontitis, and trauma. For a healthy alveolar bone after tooth extraction, some kind of intervention is always required. Honey can possibly help to improve bone healing after tooth extractions. Aim: To observe the effects of honey on bone healing of alveolar sockets after tooth extraction in humans. Method: It was an experimental study, conducted at Lahore general hospital over the period of 6 months. Twenty-four participants were included in the study through simple random sampling technique. After tooth extractions in both groups, honey was injected into extracted sockets of the experimental group while the control group was left as it was. Levels of BMP-2 were tested in saliva through the ELISA technique on days 1, 3, and 7 of tooth extraction. Results: In the control group, mean BMP-2 levels were 485.5± 52.63, 623.7 ±47.16 and 692.5± 11.86 while in the experimental group the mean values of BMP-2 were 494.3 ± 49.89, 703.6 ± 39.31 and 812.9 ± 34.40 at day 1, 3 and 7 respectively. The mean difference was calculated to be 8.75, 79.9, and 120.5. A significant difference (p-value &lt;0.001) was noted in levels of BMP-2 between the experimental and control group on days 3 and 7. Conclusion: Raise in levels of BMP-2 in the experimental group when compared with the control group confirmed better bone healing. Hence, honey can be used to promote bone healing in post-extraction tooth sockets. This study can be used in future to improve bone quality and minimize ridge resorption after tooth extractions. Keywords: Bone morphogenetic protein-2 (BMP-2), Honey, Extracted Tooth sockets, bone healing, ELISA.

Comparison of Efficacy and Outcome of Tubeless with Standard Percutaneous Nephrolithotomy in Patient with Renal Stones

Objective: To compare the outcome and complications of standard PCNL with tubeless PCNL in terms of analgesia requirement, incidence of infection, post-operative perinephric urinary collection and post-operative hospital stay. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Lahore General Hospital Lahore from 1st March 2018 to 30th April 2019. Methodology: Ninety six patients fulfilling the inclusion criteria were randomly categorized into 2 groups; Group A where patients will undergo standard PCNL and Group B where patients will undergo tubeless PCNL. Post-operatively, patients were assessed for the requirement for analgesia, rate of infection, post-operative urinary leakage and hospital stay. Results: The mean duration of surgery had no significant difference between the two treatment groups; tubeless group was on average 51 minutes while the standard PCNL group was 55 minutes. No significant difference was observed in reduction of hematocrit values between the groups (4.9% vs 4.2%). Transfusions were not required in either group. The average post-operative duration of hospital stay was 2 days in group 1 and group 2 was 3 days with P&lt;0.001. Conclusion: Tubeless PCNL is effective in patients with kidney stones and requires fewer analgesic drugs and shorter hospital stay, post-operative complications are almost the same in both groups with no significant difference. Key words: PCNL, Standard, Tubeless, Complications

DIAGNOSTIC ACCURACY OF B-HCG AND NITRAZINE PAPER TEST IN VAGINAL WASHINGS TAKING AMNIOTIC FLUID POOLING AS GOLD STANDARD OF DIAGNOSING PREMATURE RUPTURE OF MEMBRANES

Background: Premature Rupture of Membranes (PROM) is common in obstetrics and management of such patients depends on whether the rupture has occurred or not. With membranes ruptured the fetus is deprived of protection provided within the amniotic cavity. Beta-Human chorionic gonadotrophin (β-HCG) is a hormone and is present in high concentration in amniotic fluid as well as in the blood and urine of the mother and is studied as possible predictor of preterm labour and as marker of PROM.&#x0D; Objective: To compare the diagnostic accuracy of B-hCG &amp; nitrazine paper test in vaginal washings taking amniotic fluid pooling as gold standard for diagnosing premature rupture of membranes.&#x0D; Material &amp; Methods: It was a comparative cross-sectional study conducted at Unit Department, of Obstetrics &amp; Gynecology, Lahore General Hospital, Lahore. After that vaginal washings were taken for β-hCG testing. A pregnancy test kit (Accu Check) was used for detection of β-hCG in vaginal fluid washings. According to amount of µ-hCG in the washings the result has been positive as early as 40 Seconds but for labeling the result negative 5 minutes complete reaction time has been observed. On netrizine kit, the positive test is indicated by distinct colour band on both; control and test side.&#x0D; Results: Mean age of women was 27.17+4.55 years. Mean age of gestation was 36.16 + 3.30 weeks. Sensitivity &amp; specificity of Nitrazine Paper Test were 92.17% &amp; 66.67%. However the PPV &amp; NPV for Nitrazine Paper Test was 98.15% &amp; 30.77% respectively. Sensitivity &amp; specificity of β-hCG Test was 94.35% &amp; 75%. However the PPV &amp; NPV for β-hCG test was 98.64% &amp; 40.91% respectively.&#x0D; Conclusion: Results of this stud y showed that B-subunit of hCG measured by over-the-counter available pregnancy test kit is a dependable quick and easy test for detection of premature rupture of membranes. This test can be performed on the bed side of the patient without Lab involvement. This test can be promoted as an additional help for the diagnosis of doubtful and ambiguous cases of premature rupture of membranes.

Comparison of changes in retinal nerve fiber layer thickness and intraocular pressure between glaucoma and non-glaucoma patients after phacoemulsification.

To compare the changes in Retinal Nerve Fiber Layer (RNFL) thickness and Intraocular Pressure (IOP) after phacoemulsification in patients with glaucoma versus without glaucoma. This was a quasi-experimental study, done at Lahore General Hospital, from January 2021 to December 2021. Patients with senile cataract were divided into two groups. One group included 40 patients, with ≥40 years of age and diagnosed with primary open angle glaucoma compared with a second group of 40 age-matched controls without glaucoma, undergoing phacoemulsification and Intraocular Lens Implantation (IOL). Goldman Applanation Tonometer (GAT) and Spectral Domain Optical Coherence Tomography (SD-OCT) were used to record IOP and RNFL thickness, before surgery, at one week and one month after surgery. The results were compared with baseline readings and also between the two groups. A total of 80 patients were included in the study. Mean age was 60.3±7.9 years with male to female ratio of 1:1. Mean change in RNFL thickness in glaucomatous eyes group and non-glaucomatous Eyes group from pre-operative baseline was 11.33±4.30μm and 4.08±2.59μm respectively after one month (p-value<0.001). Difference of mean change in RNFL thickness from baseline was statistically significant between both groups (p< 0.001). Difference of mean change in IOP from baseline at four weeks was statistically significant in the individual groups but between both groups was statistically insignificant (p= 0.234). Phacoemulsification results in increase in RNFL thickness and decrease in IOP, which are good prognostic factors in control of glaucoma. However, a mean change of IOP of 1mmHg in glaucoma patient does not affect management of glaucoma.

Occupational Health Hazard among Health Care Workers in a Tertiary Care Hospital, Lahore

Background: Occupational health is a neglected public health issue among healthcare workers in developing countries and they may expose them to various forms of hazards. Objectives: The study aims at exploring the forms of occupational health hazards among nurses in a tertiary care hospital, Lahore Methods: Total 151 staff nurses were enrolled for cross-sectional descriptive study to explore the occupational health hazard. This study was conducted at Lahore General Hospital, Lahore for the duration of 02, 2021, to January 01, 2022. Only charge nurses working in medical and surgical units on permanent basis having experience more than six months were included. Results: The findings of this study showed that the mean age of the nurse was 25.87 ± 3.138 years (age range 21-32 year), the female nurse was 127(84.1%)while 24(15.9%) were male nurse. The participants faced occupational health hazards 51.8%, biological hazards73.5%, and physical hazards 59.2% and mechanical and psychology Hazards among Nurse 48.8% and 52.0% respectively. Conclusion: Occupational risks (biological hazards) are very common among the nurses in Lahore General Hospital, Lahore. To protect patients and medical staff, hospitals should implement preventative, infection control, and patient safety initiatives. Keywords: Occupational hazards; Health workers; Lahore General Hospital DOI: 10.7176/JHMN/104-05 Publication date: November 30 th 2022

Blindness in infants presenting with advanced and untreated ROP: a single-centre study in Pakistan

ABSTRACTPurposeTo describe the ocular features and characteristics of young children presenting with advanced, untreated retinopathy of prematurity and to determine appropriate screening guidelines for retinopathy of prematurity (ROP) in Pakistan.Material...

Diagnostic accuracy of magnetic resonance spectroscopy (MRS) for diagnosis of focal brain lesions taking histopathology as gold standard.

Objective: To determine diagnostic accuracy of MRS for diagnosis of malignant brain lesions taking histopathology as gold standard. Study Design: Cross Sectional Validation study. Setting: Department of Radiology, Lahore General Hospital, Lahore. Material &amp; Methods: A total number of 127 patients who were referred for the diagnosis of focal brain lesions were included. In all patients, MRS was done by consultant radiologist to diagnose malignancy. All patients underwent surgery in the neurosurgery department and after surgery biopsy specimen were taken for diagnosis of malignancy using histopathology findings. Results: Mean age of patients was 40.88±11.37 years. There were 88 (69.29%) males and 39 (30.71%) female patients. On MRS, malignancy was diagnosed in 99 (77.95%) patients and on histopathology malignancy was diagnosed in 102 (80.31%) patients. Regarding diagnostic accuracy, MRS was 97.00% sensitive, 94.10% specific, with PPV of 78.60% and NPV of 88.00%. Conclusion: Magnetic resonance spectroscopy (MRS) has good sensitivity and specificity in differentiating neoplasm from non-neoplastic focal brain lesions.

Frequency of Cathetrization in the Management of Overt Postpartum Urinary Retention

Urinary retention after postpartum can be defined as “inability of the patient to pass urine after six hours of postpartum. Objective: To determine the role of catheterization in patients with postpartum urinary retention. Methods: It was multicenter study. Patients from five different hospitals were included in the study. Duration of study was one and half years. Patients suffering from overt postpartum urinary retention who refused self intermittent catheterization were included in the study. Results: Total 68 patients were included in the study from five different teaching hospitals. In Social Security Teaching Hospital 13 patients, in Lady Wallingdon Hospital 32patients, in Lahore General Hospital 13, in Ali Fatima Teaching Hospital 12 and in Central Park Hospital 8 patients were reported. The age of these patients was from 18 to 29 years with a mean age of 21 years (+ 1.6). The duration of catheterization was from 3 to 18 days with mean days was 7 (+ 1.8). Conclusions: In overt type of postpartum urinary retention, early treatment results in saving patients to develop long term urinary complications.

Impact and Burden on the Quality of Life of Primary Caregivers of Schizophrenic Patients Presented in Lahore General Hospital

Background: Schizophrenia is a psychiatric disorder that incapacitates &amp; overpowers the way a person conceives, perceives, conjectures and executes his internal thoughts and reciprocates with the external world. It can also be defined as a persistent deficit in cognition with the negative and positive symptoms, which typically starts in young age. Schizophrenia is characterized by social and functional disabilities not only of the affected patient, but also for the society and the family. Therefore, the current research focused on the impact and burden on quality of life of the primary caregivers of schizophrenic patients. Aims &amp; Objective: To determine the quality of life, predictors of QOL and caregiver burden among primary caretakers of patients having schizophrenia. Methods: The cross-sectional research design was used in the present study and was conducted in Lahore General Hospital from January 2022 to June 2022. Using purposive sampling technique, 150 patients who attended the Psychiatry outpatient department of the hospital were recruited for this study. Results: It shows that out of total 150 people, 98 (65.3%) males and 52 (34.7%) females were present in this study. Mostly parents 101(67.4%) were primary caregivers in the present population along with spouses 13(8.7%) and 26(17.4%) were real brothers/sisters. The frequency and percentage of son/daughter 3(2.2%) and 7 (4.3%) caregivers were with other relationships. Most of the caregivers 121(80.4%) were married, and 13(8.7%) were single. It also shows that the mean age of the male patients was 43.50 (14.73) years and mean age of the female was 48.91 (16.50). Family Burden Schedule interview identifies that financial burden has highest mean and effect on physical health of others has lowest mean. In WHOQOL-BREF physical, psychological and social health subscales has highest mean than environmental one. And that significant inverse relationship of financial burden has been found with social relationships, physical health and environment of caregivers. As financial burden increases environmental conditions, physical health and social relationships of caretakers decreases. Conclusion: Caregiver burden is found to be negatively linked to QOL of the caregivers of individuals having schizophrenia. Moreover, caregiver burden is found to be a significant negative predictor of QOL of individuals taking care of people having schizophrenia. Keywords: Schizophrenia, Quality of Life, Caregivers, Patient Welfare, Burden of Life

Maternal and Fetal Outcomes in Obesity Complicated Pregnancies

Background and Aim: Obesity in reproductive age women is growing to epidemic proportions causing adverse perinatal outcomes and various pregnancy complications. Pregnant women with obesity pose risks for child and maternal health in terms of intrapartum, antenatal, postpartum and neonatal complications. The current study aim was to find the maternal and fetal outcomes in complicated pregnancies of obese women. Methodology: This cross-sectional study was conducted on 164 pregnant women in the Department of Obstetrics and Gynecology, Lahore General Hospital, from April 2021 to March 2022. Prior to study conduction, ethical approval was granted from the institution research and ethical committee. Informed consent was taken from each individual. Based on BMI index for pre-pregnancy, participants were categorized as normal weight (19-25 kg/m2), overweight (25-30 kg/m2), and obese (≥30 kg/m2). All the pregnant women with gestational age of 20 weeks who were willing to participate were enrolled. Underweight women with previous anomaly babies and miscarriage were excluded. Maternal and fetal outcomes were recorded. SPSS version 25 was used for data analysis. Results: The overall mean age of the participants was 26.4±3.61 years. Based on BMI (kg/m2), the participants were distributed as follows; 26.8% (n=44) of normal weight (19-25 kg/m2), 28.1% (n=46) of overweight (25.0 - 30 Kg/m2), and 45.1% (n=74) of obese ((≥30 kg/m2). Majority of overweight and obese women were ≥ 30 years old. Diabetes before pregnancy was strongly related to obesity (16.3%, p&lt;0.0001). Lower weight gain (10.3 ± 6.9 Kg) were seen in obese pregnant women. Comparing to the normal weight women, overweight and obese women physical exercise more often (p=0.01). Obese women were more susceptible to the risk of developing hyperglycemic disturbance (OR= 6.2; 3-10.5), hypertension (OR=6.8, 3.0-15.5), and HbA1c ≥ 6. 5 % (OR=3.5; 1.1-10.8). Longer hospitalization (4.1 ± 2.9 days) was seen in infants born to obese mother (p=0.005). The gestational age babies born from obese mother had a proportion of (14.6%) (p=0.022) with higher abdominal and thoracic circumference (30.7 ± 2.1 cm) and (32.8 ± 1.9 cm) respectively. Conclusion: Our study concluded that adverse perinatal outcomes and pregnancy complications could be caused by obesity in pregnant women. Obese women were more susceptible to increase risk of developing gestational diabetes mellitus, postpartum complications, pregnancy related hypertensive disorders, pre-eclampsia, preterm birth, cesarean section, and longer hospital stay. The importance of weight status before and during pregnancy should be identified to have adequate treatment. Keywords: Pregnancy, Maternal outcomes, Fetal outcomes, Obesity