Mardan Medical Complex Research Articles

Association of Anemia with Postpartum Haemorrhage

Introduction: Maternal anaemia is a common condition. According to the World Health Organization, pregnancy anaemia and postpartum anaemia is very frequent across the world, and confers a number of health risks to mother and child. Maternal symptoms and signs include fatigue, paleness and cardiovascular strain, reduced mental and physical performance and increased risk for blood transfusion. Objectives: To determine the association of maternal anaemia with postpartum haemorrhage in pregnant females presenting for antenatal check-up Study Design: Case control study Setting: Department of Obstetrics and Gynaecology B Unit, Mardan Medical Complex. Duration of Study: Study was carried out over a period of six months from 01-08-2019 to 31-01-2020 Subjects and Methods: A total of 224 patients (112 in each group) were included in the study. Cases were females with PPH and controls were females without PPH. Results: Mean age of the patients was 28.0±4.3 and 28.2±5.1 in group-A and B, respectively. Mean gestational age was (38.7±1.8 vs 38.5±2.4), mean BMI was (27.0±4.2 vs 26.2±4.6) and mean Hb was (9.1±2.1 vs 9.9±1.9). Majority of the patients were between para 1-2 in both cases. Anaemia was found in 59 patients (52.7%) of cases and 36 patients (32.2%) of controls (Odds ratio 2.35; 95% CI 1.36 - 4.04). Stratification for age, gestational age, BMI and parity was also carried out. Conclusion: In conclusion, postpartum anaemia has a high prevalence. Anemia during the third trimester of pregnancy, heavy bleeding perceived by the mother during delivery, younger maternal age was associated with postpartum anemia. Keywords: Anaemia, Blood loss, Postpartum haemorrhage

Clinical Characteristics and Early Findings of Coronavirus Disease (Covid-19) at a Tertiary Care Teaching Hospital in Pakistan

Background: Severe acute respiratory syndrome-2 (SARS-CoV-2) emerged as a novel coronavirus and associated with the pandemic. In our study we observed the clinical characteristics, early findings, and its association with comorbidity. Methods: A single center retrospective study was carried out in Mardan Medical Complex (MMC), Khyber Pakhtunkhwa (KP), Pakistan from May 21st, 2020 to June 30th, 2020. Altogether three thousand, one hundred and fifteen (n=3115) COVID-19 suspected patients were included in the current study. Briefly nasopharyngeal swab, sputum and blood were collected. The viral amplification was carried out by qualitative RT-PCR using commercially available kit and routine laboratory tests of all the suspected patients were performed. Results: Using RT-PCR total 19.8% (n=613/3115) confirmed cases of COVID-19 were observed. The majority were males’ patients. The most common comorbidity was type-2 diabetes (T2DM); 24.8% followed by cardiovascular diseases; 6% and T2DM with cardiovascular disease 3.1%. Among the infected patient’s leukocytosis was observed in 43% patients and 27.9% had abnormal findings on X-rays. The RNA detection efficacy from the sputum, nasopharyngeal swab, and blood specimens were 30%, 25.3% and 9.6% respectively. In total, 18.3% patients were critical, and 14.5% patients were on ventilator and the reported mortality rate were 5.2%. Conclusion: Overall, the COVID-19 patients observed in our study was comorbid and asymptomatic or with mild symptoms like fever, cough, and shortness of breath. Higher, RNA detection efficacy was observed from sputum. Keywords: COVID-19, RT-PCR, T2DM, Clinical characteristics, comorbidity, Pakistan

Normal Knee Joint Spaces in Healthy Young Adults; Radiographic Measurement

Background: The weight bearing hinge joint which comprises of two condylar joint is named as knee joint. Objective: The study was carried out to find the radiographic measurements in case of normal knee joints of adults. Study design: It is a prospective study conducted at Orthopedic Department, Mardan Medical Complex and Radiology Department, Institute of Kidney Disease (IKD) Peshawar for the duration of six months from October 2021 to March 2022. Material and Methods: The study was conducted on 170 patients (patients/subjects) who visited the radiology (radiology and orthopedic) department of the hospital. The computerized data was plotted from standard radiographs and the monitoring was carried out to see the progression of degenerative conditions of knee. Statistical analysis was done by using SPSS tool and other software like Microsoft excel were also used for this purpose. The data was shown as mean and standard deviations in case of all variables. The ethical and review board committee of the hospital approved the study. Results: The data was taken from 170 patients. Patients were aware of the study and signed the consent willingly. Among these 170 patients, there were 94 females and 76 males. The average age of the patients participating in this study was 48 ± 13 (38± 13) years. In case of women the average right medial space was 0.25±0.07 (it is mm or cm??) right lateral space was 0.45±0.06, left medial was 0.19±0.08 and left lateral space was 0.44±0.0. In case of male patients, the values of right lateral space, right medial space, left lateral space and left medial space were 0.47±0.07, 0.26±0.05, and 0.47±0.06, 0.23±0.01 respectively. (in other studies normal space is 4.44 medial and 5.62 mm lateral and it is 0.45 and 0.25 mm in our study, I think it shoud be comparable) Conclusion: The study was carried out to find the radiographic measurements of normal spaces of normal knee joint in adults. The AP view was used to observe the bilateral knee joints both medial and lateral sides. The knee joint space width was variable. However, width of left and right side joint space compartments have no difference. There was no statistical variation found between both genders as well. Keywords: Bilateral knee joints, radiographic measurements, joint space compartments, condyles and articular surfaces.

Socio-Demographic Profile of Psychoactive Substance Users Attending A Tertiary Care Centre

Aim: The goal of this analysis is to determine the proportion of psychoactive substance disorder and socio-demographic profile of Psychoactive Substance Users. Study Design: A descriptive study. Place and Duration: In the Psychiatry and Behavioral Sciences department PGMI/AMC/LGH Lahore, Pakistan and Mardan Medical Complex for six months duration from October 2021 to March 2022. Methods: A total of 120 subjects with psychoactive substance use disorder (conferring to the ICD-10 criteria) were recruited after attaining their written informed consent. In the course of the study, all patients with substance use disorders were interviewed through partially structured addiction questionnaire. Data was analyzed with SPSS version 21.0 using inferential and descriptive statistics. Results: Out of the 120 subjects, 100 were men and 20 were women. The adults and adolescents were the main groups indulging in the consumption of psychoactive substances. Most of the subjects, 45%, started substance abuse at 16-20 years of age. Of the remaining 18.3%, started substance abuse at 26 years old and older, 24.2% started at the age of 21-25 years, and 12.5% started at the age of 13-15 years. It was found that 50% were in the recovery process. The relapse rate was 33.3%, 12.5% were not in contact, 2.5% died, and 1.7% were in prison. Opioid was the psychoactive substance preferred by 66.7% of the young population. The most common opioid was brown sugar; 13.3% prefer cannabis, 2.5% prefer tablets, 4.2% prefer injectable use and 0.83% prefer volatile usage of substances. Conclusion: The main consumers of psychoactive substances were the adults and adolescents and majority start using it at a younger age. Psychoactive substance abuse is a serious problem effecting young people, which is a sensitive group. So, special consideration should be paid to psychoeducation about psychoactive substances prior to adolescent. Keywords: Psychoactive substance, Sociodemographic profile.

Efficacy of Open vs. Laparoscopic Appendectomies

Background: Appendicitis is common problem treated surgically by open or laparoscopic appendectomy. Objectives: To compare short term complications of open versus laparoscopic appendectomy. Study design: Randomized control trial Setting: Department of General Surgery, Mardan Medical Complex, MTI, Mardan. Subjects: Total 110 patients of both gender aged 20 to 40 years undergoing appendectomy were enrolled. Methodology: This study was done from 12thJuly 2020 till 11th January 2021 after approval from hospital ethical committee. Total 110 patients were enrolled and divided in open appendectomy and laparoscopic appendectomy and short term complications were noted. Results: In our study total 110 patients were enrolled and divided in two groups. The mean age of patients was 32.65±4.8 years. There were 25.5% patients in younger age group and 74.5% in elder age group. In our study population there were 26.4% males and 73.6% female patients. The mean body mass index was 30.9±5.5 kg/m2. Mean duration of surgery was 1.4±0.4 hours in laparoscopic group and 1.5±0.4 hours in open appendectomy. The most common complication was wound infection in 12.7%, paralytic ileus in 10.9%, intra-abdominal abscess in 9.1% and vomiting in 6.4% patients. Complication rate was significantly increased in open appendectomy, p-value 0.032. Conclusion: Laparoscopic is safer as compared to open appendectomy.

Effectiveness of Aspiration Under Ultrasound Guidance in Breast Abscess in Terms of Early Resumption of Breast Feeding: A Randomized Controlled Trial

Objective: Effectiveness of aspiration under ultrasound guidance in breast abscess in terms of early resumption of breast feeding. Study Design: Randomized controlled trial Place and Duration: Mardan Medical Complex and Teaching Hospital and Jinnah International Hospital, Abbottabad, from November, 2021 to April, 2022. Methods: There were a total of 140 female participants. The patients ranged in age from 16 to 50. After obtaining the patient's written consent, demographic information including age, weight, height, and body mass index were collected. Breast abscess diagnosed on clinical examination and ultrasound breast were included. Seventy patients were assigned to Group I and treated with percutaneous aspiration, whereas the same number were assigned to Group II and underwent incision drainage. Early breast feeding was restored in both groups and compared for their respective outcomes. The entire dataset was analyzed using SPSS 20.0. Results: We observed that the percentage of patients in group I who were able to resume breast feeding was 61 (87.1%), and in group II was found in 42 (60%) patients. The level of comfort experienced by patients in group I 60 (85.7%), as compared to group II 35 (50%), was significantly greater. Conclusion: In this study, we came to the conclusion that percutaneous aspiration in breast abscess was successful and effective in comparison to incision drainage, with less problems and a high percentage of satisfaction among the women. Keywords: Incision drainage, Breast abscess, Percutaneous aspiration

Dynamic Compression Plating Versus Interlocking Nail Procedure for Fracture Shaft of Humerus; A Comparative Study

Objective: To evaluate the efficacy of dynamic compression plating against interlocking nail technique for the treatment of humeral shaft fractures. Study Design: Randomized controlled trial Place & Duration: Department of Orthopedic, Mardan Medical Complex, Mardan for the period of two years from April 2020 to October 2021. Methods: Fifty six patients (18-65 years old) of both sexes were included in the study because they had a humeral shaft fracture. The patients were randomly split into two groups. Both the dynamic compression plating group (n = 28) and the interlocking nail group (n = 28) received treatment. Radiographic examination both before and after surgery were performed. At the 12-day post-operative, complications following the operation were observed. The NEERs criteria were used to analyse the results of the functional assessments. Follow-up was taken at 6 months postoperatively. Results: Mean age of patients was 41.46±10.74 years. 42 (75%) patients were males while 25% were females. Road traffic accident was the most common cause found in 37 (66.07%) patients. Mean union time in DCP and INL group was 11.62±3.05 and 13.54±4.73 weeks. Shoulder stiffness was the commonest complication in both groups. At final follow up, in DCP group 24 (85.71%), 2 (7.14%) and 2 (7.14%) patients had excellent, good and fair outcomes, while in group B (INL) 19 (67.86%), 5 (17.86%) and 4 (14.29%) patients had excellent, good and fair outcomes. No significant difference was found in both groups regarding functional outcomes. Patients satisfaction was high in DCP group as compared to INL. Conclusion: Dynamic compression plating shows better outcomes in term of union time, complications and functional outcomes as compared to interlocking nail Technique. Keywords: Dynamic Compression Plating, Interlocking Nailing, Fracture Shaft of Humerus

Epidemiology and Susceptibility Profile of Aspergillus Species: An Experience from Tertiary Care Hospital

Objective: The primary emphasis of our research is on people with hematologic malignancies, and we want to learn more about the features of clinical and environmental Aspergillus isolates by doing so. Study Design: Prospective study Place and Duration: This study was carried out at Department of Pathology, Mardan Medical Complex from October 2021 to March 2022 Methods: There were 160 patients of both genders included in this study. Included patients were aged between 18-80 years. Patients with hematologic malignancy were included. Invasive aspergiluus isolates from all patients in which 80 were clinical and 80 were environmental. . With the help of SPSS 22.0, clinical data were analyzed and Aspergillus species-level cryptic identification, antifungal susceptibilities, and cyp51 gene sequencing were all carried out. Results: Among 160 included patients, majority of the cases 95 (59.4%) were males and 65 (40.6%) patients were females. We found that 75 (46.9%) cases had age >50 years. Most common diagnostic criteria were probable IA found in 140 (87.5%) cases. Co-morbidities were pulmonary disease, neurological disease, autoimmune disease, cardiac disease and burns. Cryptic Aspergillus species composed 37.5% of environmental and clinical isolates. Section Nigri had a significant value (70.5%) of cryptic species, mostly among A. awamori and A. tubingensis the former was prevalent in ambient samples and the latter in clinical isolates (P 0.003). Twelve (7.5%) of 80 A. fumigatus isolates were azole resistant. At 90 days, A.fumigatus was 100% responsible for all deaths by resistant to azoles. Conclusion: Comparing clinical and environmental isolates, this study reveals a large proportion of cryptic Aspergillus species, highlights the clinical consequences of azole resistance. Keywords: Hematologic Malignancy, Drug Resistance Mechanisms, Aspergillus, Environmental Microbiology, Azoles

Analysis of the Prevalence of Fractures Caused by Bicycle Accidents

Objective: The purpose of this study is to examine the epidemiological features of fractures that are received in bike accidents. Study design: Retrospective study Place and duration of study: Department of Orthopedic, Mardan Medical Complex, Mardan for the period of one year from January 2021 to January 2022. Methods: There were 210 patients of bike accidents were analysed through severity scoring system. Various bike types, fractures sustained, rate of mortality, helmet usage was analyzed. Detailed demographics of enrolled cases included age, sex, BMI and localities were recorded after taking informed written consent. Outcomes were assessed in terms of fractures sustained during accidents. We used SPSS-21.0 to analyze our data. Results: There were 54.8% males and 45.2% females. The mean age of the patients was 31.8±6.17 years. We found that 192 (91.4%) patients wear no helmet. The presentation of the injuries showed that majority of the cases 100 (47.6%) had lower limb injuries. The majority of patients with multiple injuries also suffered from upper limb, facial, spinal and chest trauma. Overall mortality rate was 22 (10.5%). Conclusion: We concluded in this study that wearing helmets can reduce the severe life threatening injuries caused by bike accidents. Keywords: bike accidents, fractures. Mortality, multiple injuries

Clinical Features and Surgical Management of Intracranial Meningioma’s in the Elderly

Objective: Given the threat related with surgical intervention of intracranial meningiomas in the older population because of maturing physiology and numerous co morbidities, an endeavor was made to distinguish mediators impacting results and to characterize a category of individuals who ought not be surgically treated because of deprived prognosis. Study Setting: The study was conducted in neurosurgery unit mardan medical complex / bacha khan medical college Name of Hospital, Pakistan. Methods: The investigation of 58 individuals over the age of 70 years was conducted to determine short- and long-term results. Additionally, we derived scores for our patients using the previously reported CRGS, SKALE, and GSS grading systems. Result: As per the SKALE reviewing framework, neurological grimness was exclusively associated with a crucial site (P=0.02). Six people (10.3 percent) capitulated to their wounds. The Karnofsky score (KPS 60 versus KPS 70; P=0.0162), the American Society scale status (ASA 1 or 2 versus ASA 3; P=0.0022), and the evaluation of meningioma’s were totally connected with mortality (P=0.012). The WHO grade (P=0.00048) and Simpson evaluation of resection (P=0.0437) were related with tumor repetition in six cases. Except for patients who died because of medical procedure or reoccurrence (15.5%), majority of subjects improved (50%) or remain unaltered (25.9%) in contrast with their karnofsky score before surgery. Conclusion: Neurological impairment following surgery was only observed in patients with a significant tumor placement (skull base, eloquent area, large vessels indulgence by the tumor). Because of the greatly increased threat of fatality, surgery should be carefully considered in individuals with a low functional state (KPS 60) or a bad bodily state (ASA 3 status). During routine visits, the majority of patients’ neurological health enhanced or remains constant in comparison to their condition before operation.

Outcomes of Endoscopic Third Ventriculostomy in Pediatric Patients With Hydrocephalus.

BackgroundEndoscopic third ventriculostomy (ETV) is used to treat patients with obstructive hydrocephalus in infants. This study evaluated the postoperative outcomes of ETV among pediatric patients.MethodologyA retrospective study was undertaken at the Mardan Medical Complex between June 2018 and June 2021. All pediatric patients who underwent the procedure of ETV in both the absence and presence of choroid plexus cauterization (CPC) at our center were included in the study. Using medical history data, a comprehensive survey questionnaire was designed. The findings and effects were evaluated either as a success or failure.ResultsA total of 90 cases were reviewed during the study. The rate of in-hospital mortality was 1.1% while the most commonly identified causes of hydrocephalus were myelomeningocele and aqueductal stenosis. A total of 39 (43.33%) patients had a successful surgery. In patients where hydrocephalus was secondary to aqueductal stenosis, the success rate was the highest, while the success rate was quite low for post-infectious hydrocephalus and intraventricular hemorrhage (p < 0.0001). The postoperative complication rate was 55.56% in our study. The rate of in-hospital mortality was 1.1%.ConclusionsWe found that the success rate of ETV was dependent upon factors such as the cause of hydrocephalus, type of hydrocephalus, and the age of the patient. Therefore, ETV is not suitable for all patients, and vigilance must be undertaken in selecting patients for the procedure. The rate of postoperative infections in our institution was alarmingly high which is a concerning matter for the institution.

Uterine Fibroids in Pregnancy

OBJECTIVES: To determine the maternal and fetal outcomes associated with uterine fibroids in pregnancy. METHODOLOGY: This study was conducted in the Gynaecology Department of Mardan Medical Complex from January 2018 to December 2019. All pregnant women of any age or parity or gestational age with sonographic evidence of uterine fibroids were included. Demographic details, gestational age, symptoms related to fibrosis, size, number and location of the fibroid, mode of delivery, antenatal, intrapartum and postnatal complication, and neonatal outcome were entered in a predesigned proforma. RESULTS: The incidence of uterine fibroids in pregnancy was 0.8%.77 patients were enrolled. The mean age was 26.5 + 3.22 years. The mode of delivery was a caesarean section in 32.4%, and vaginal delivery in 53% of patients.14% of patients miscarried. Fibroids were multiple in 58.4% and single in 41.5% of patients. Submucosal fibroids were seen in 23%, intramural in 18% and subserosal in 58% of cases. The most common maternal complication was abdominal pain (25%), followed by postpartum haemorrhage(23%) and antepartum haemorrhage(19%). Neonatal outcome was good, with 57% of babies being healthy and 9% being admitted to the Neonatal Intensive Care Unit (NICU) and discharged later. CONCLUSION: Pregnant women with fibroids should be cautiously screened during antenatal to avoid obstetric complications.

Incidental Dural Tears in Lumbar Decompressive Surgery: Incidence, Causes, Treatment, Results

Durotomy (Incidental dural tears or ID) is a very rarely occurring disorder when decompressive surgery (spinal surgery) of the patients takes place. This disorder has severe effects on patients. During different surgeries of the spinal cord, the chances of this durotomy vary greatly. Objective: The main objective of this research work is to evaluate the main reasons for the incidence of this durotomy disease. During different surgeries of the spinal cord surgeries (decompressive and compressive) within the different regions, many factors play their role in the initiation of this durotomy disease. It is the target of this work to find the initiation factors of the disease so that effective methods of treatment can also find out. Methods: It was a retrospective study with a statistical approach. This study was conducted in Neurosurgery unit, Mardan medical complex / Bacha khan medical college, Mardan for the Duration of one year August 2020 to July 2021. To proceed with this study, 30 patients were selected with posterolateral and posterior compressive and decompressive surgeries within the different regions of the spinal cord. The patients were randomly selected from December 2020 to December 2021. Results: The incidence of this durotomy disease was investigated within all groups and the probability of this disease was only 12.65%. The occurrence of this disease also depends upon the type of surgery. Patients suffering from spinal trauma, stenosis of the spinal, different tumors, and vertebral disc herniation had exaggerating role in the incidence of durotomy in patients having some spinal surgery. Conclusion: The durotomy disease should be considered a serious issue with a number of other complications. For the treatment of this disease, prevention is the best method and to know about the complications is important because all of the factors involved in the incidence of durotomy should be considered while performing any kind of surgery

Long-term outcomes of Ventriculoperitoneal Shunt Surgery in Patients with Hydrocephalus

For the treatment of hydrocephalus, VP shunt surgery is considered the most appropriate method of treatment, but this treatment has a number of complications, it needs to be replaced after the failure of the previous shunt. Objective: To evaluate the different regulatory factors involved in the failure of Shunt surgery, the initiation points of shunt failure, and the number of shunt surgeries required after first shunt treatment. The time duration required for shunt failure was also considered to evaluate the lifelong experience with this VP shunt surgery. Methods: It is a retrospective study with a statistical approach. This study was conducted in Neurosurgery unit, Mardan medical complex / Bacha khan medical college, Mardan for the Duration of One year August 2020 to July 2021. Patients suffering from hydrocephalus undergoing shunt surgery visited the neurosurgery unit of Mardan Medical complex, Bacha Khan Medical College were included in the study. Complete information related to the etiology, imaging results, demographic distribution, surgery reports, and medical follow-ups were analyzed thoroughly. Results: About 25 patients having VP shunt surgery were selected; their average age was above 60 years. The median mean of the follow-ups was 6 and 9 respectively. Patients with having age of more than 18 years are considered adult patients and constituted of the 70 % of the total. The rate of shunt failure was estimated, it was about 46.2 %. The pediatric patients are more prone to shunt failure than the adult ones. Different factors are involved in shunt replacement but age and sex have a major role. Shunt replacement time is quite low in young patients. While in case of age, male patients have a greater number of shunt replacements within their lifespan. Conclusion: The results inferred that age has a particular role in the triggering of shunt failure, many other factors are also associated independently to increase the rate of shunt failure. There is a need for controlled studies to understand the link between risk factors and shunt failure rate.

Role of MRI in Detecting Abnormal Placentation in Patients with Strong Ultrasound Concern for Myometrial Invasion

Abnormal placentation has raised the ratio of cesarean cases. In such obstetric complication the placenta lie at the lower segment of the uterus. These abnormal attachments of placenta to uterus and invasion to adjacent organs are the main cause of placenta previa. These are not only raising delivery challenges but also raising the mortality cases. Objective: For evaluation of the diagnostic efficacy of MRI to locate placentation abnormalities with high accuracy and sensitivity. This not only helps in preoperative delivery planning but also decreases the ratio of mortality. Study Setting: It was an observational study, conducted at radiology department of Mardan Medical Complex Mardan for the duration of six months from September 2021 to February 2022. Methods: The women suspicion of placentation abnormalities were recommended with MRI. The consecutive 185 pregnant women were included in the study. The results obtained from MRI were compared with the results obtained by C-section. Cesarean section results were considered as standard. The treatment strategy was decided in accordance with the MRI findings. The treatment strategies which opt during the CS were compared with the strategy created on the basis of MRI. Results: 115 women were diagnosed with abnormal placentation. The 70 women out of 185 were diagnosed with placenta previa. The percentage false results were seen in 18 patients. The false negative results of MRI were seen in three patients. After comparison between the findings of MRI and CS the sensitivity, positive predictive values and other parameters were calculated. The sensitivity was 97%, while the positive predictive value was 84%. The other parameters such as specificity were 79% and negative predictive value was 95%. The sensitivity, accuracy, and positive predictive values of the planning strategy created for treatment on the basis of MRI findings were calculated. There was significant correlation between the findings of MRI and CS. Conclusion: For the future planning of treatment strategy for the women suspected of abnormal placentation, MRI is highly suggested diagnostic tool with better efficacy and sensitivity. This imaging modality helps in proper and accurate diagnosis of abnormal placentation. Keywords: Abnormal placentation, obstetric complications, treatment strategy, placenta previa.

A Comparison of Sonourethrography and Retrograde Urethrography in Evaluation of Anterior Urethral Strictures

The urinary tract has restrictions in its lower parts. This problem can be detected by two different methods. Obstruction in the anterior portion of this tract can be diagnosed by some available standard methods. Objective: To assess the general problems in the male urethra specifically in the anterior portion. Methods: It is a prospective and comparative study with a statistical approach, conducted at Bakhtawar Amin Memorial and Trust Hospital, Multan and MTI Mardan Medical Complex, Mardan for the duration of one year from December 2020 to December 2021. The study was done by using ultrasound of high resolution. Then the comparison of the operative conclusions has to be done with retrograde urethrography (RGU) to find out the efficiency of RGU. For this study work, seventy-seven patients were selected. All these patients had some restrictions in the urinary pathway confirmed by retrograde urethrography. Different characteristics of the patients were studied and matched with the available standard methods. By both tests specificity, sensitivity, and overall accuracy of the protocol were also assessed. Different statistical analyses were performed to find out the results. Results: All the seventy-seven patients were having some restriction of urinary pathway, which were detected by sonourethrography and further confirmation was done by other previously verified methods. The retrograde urethrography shows almost very low sensitivity of this particular problem detection. This test was about 60 to 80% sensitive for this diagnosis. This sensitivity is specific for the length of about 1 to 5 cm. These results were compared with the results of sonourethrography. The problem termed as spongiofibrosis was also diagnosed with sensitivity about 76 to 82 %. A number of other problems were also detected by this method like calculi and further confirmation was done at the time of surgery. The probability was greater than 0.001 and difference in frequency was also not so significant. It was less than 0.5. Conclusions: Both of the methods have equal efficiency for the detection of different restrictions in urinary tract. When other parameters were assessed; it was inferred that sonourethrography is more efficient method

Comparison of Efficacy (Control of Primary Post-Partum Hemorrhage) after Vaginal Delivery between Balloon Inflation and Uterovaginal Packing

Objective: To compare the efficacy between balloon inflation and uterovaginal packing in women with primary post-partum hemorrhage. Material and methods: Between April 2021 to October 2021, total 120 patients with PPH after vaginal delivery, having age 18-40 years, both primi or multi paras either booked or un-booked were recruited for this randomized controlled trial. Place of study was Department of Obstetrics &amp; Gynecology, Mardan Medical Complex. Efficacy (control of PPH) after vaginal delivery between balloon inflation and uterovaginal packing was compared. Results: A total of 120 women with PPH were recruited. Mean age was 28.85 ± 5.83 years, in study group A and B mean age was 28.27 ± 5.96 years and 29.43 ± 5.66 years respectively. In study group A, balloon inflation methods was effective among 33 (55%) patients, while in study group B, uterovaginal packing method was successful among 51 (85%) patients for the control of PPH after vaginal delivery. Significantly (P=0.000) higher rate of efficacy was observed in study group B (uterovaginal packing group) as compared to study group A (balloon inflation group). Conclusion: Results of this study showed higher rate of efficacy (control of primary post-partum hemorrhage) in patients of PPH managed with uterovaginal packing as compared to managed with balloon inflation. Most of the patients were multiparas and booked. Keywords: PPH, balloon inflation, uterovaginal packing, vaginal delivery

Correlation of Serum Sodium Level with Severity of Hepatic Encephalopathy

Objective: To determine correlation of serum sodium levels with severity of hepatic encephalopathy (HE). Study Design: A Cross-sectional study. Place and Duration of the Study: Department of Medicine, Mardan Medical Complex, Mardan from 1st October 2020 to 30th April 2021. Methodology: A total of 170 patients of both genders with liver cirrhosis presenting with HE aged 35-65 years were included. Under aseptic conditions, blood was taken dispatched to institutional laboratory for serum sodium levels. Severity of hyponatremia was compared with study variables along with grades of HE. Post stratification chi square test was applied and p&lt;0.05 was considered statistically significant. Results: Out of a total of 170 patients, 140 (82.4%) we male. Overall, mean age was 55.0±3.87 years while 130 (76.5%) patients were aged between 51 to 65 years. Grading of HE revealed most of the patients, 73 (42.9%) to be having grade-III. Grading of hyponatremia revealed that 101(59.4%) patients had mild hyponatremia, 50 (29.4%) moderate hyponatremia while 19 (11.2%) had profound hyponatremia. Age distribution was found to have significant association with severity of hyponatremia (p&lt;0.0001). Significant correlation between grades of HE and severity of hyponatremia was noted as 15 (78.9%) out of 19 profound hyponatremia cases belonged to HE grade-III whereas all 50 patients of moderate hyponatremia belong to HE grade III and IV (p&lt;0.0001). Conclusion: Hyponatremia was observed to be a very common abnormality among patients of liver cirrhosis presenting with hepatic encephalopathy. Significant correlation of hyponatremia was found with respect to HE grades as severity of hyponatremia increased with severity of HE grades. Higher age groups had significant association with higher degree of hyponatremia. Keywords: Hepatic encephalopathy, hyponatremia, liver cirrhosis, serum sodium.

Surgical Management of Glioblastoma Multiforme

Background: Although glioblastoma (GB) is kept up to date, rate of progress is nearly unavoidable. Earlier researches put forward the endurance advantages with removal of GB; but comparatively a small number of literatures have assessed the role of operative intervention in glioblastoma management.&#x0D; Objective: The aim of this research is to assess the results of surgical resections in patients with glioblastoma.&#x0D; Methods: Study conducted in Bacha Khan Medical College, Mardan Medical Complex Records were retrospectively identified and reviewed for all individuals that went through gliolastoma biopsy or its removal between Oct 2017 and Dec 2020 to identify 50 progressive GB patients. The Kaplan-Meier method produced median survival and 95 percent CI. The Cox Proportional Risks model was used for the multivarian analysis, which conducted for age, Karnofsky score, extent of resection, and tumor site and tumor multifocality of survival after the advancement of disease.&#x0D; Results: Patients with progressing illness received first recorded resection. The median survival after progression was 12.8 and 7.0 months for patients who had not received resections at this time. In multivariable analyses, KPS 0.70 (HR 0.438), and surgical intervention were linked with better survival after advancement of glioblastoma.&#x0D; Recommendations: In the circumstance of present maximum non-operative treatment, operative intervention for advancing glioblastoma is effective in controlling the symptoms but however, the survival of the patients is limited. Further research is required to determine if any, the role of surgical intervention may prolong post-progressive endurance in progressive GB individuals.

Clinical Features and Surgical Management of Intracranial Meningiomas in the Elderly

Objective: Given the threat related with surgical intervention of intracranial meningiomas in the older populace because of maturing physiology and numerous co morbidities, an endeavor was made to distinguish mediators impacting results and to characterize a category of individuals who ought not be surgically treated because of deprived prognosis. Study Setting: Mardan Medical Complex, KPK , PAKISTAN Material and Methods: The investigation of 58 individuals over the age of 70 years was conducted to determine short- and long-term results. Additionally, we derived scores for our patients using the previously reported CRGS, SKALE, and GSS grading systems. Result: The SKALE review technique indicated that only one important site was associated to neurological depression (P=0.02). Six people (10.3% of the total) quit due to their injuries. KPS 60 vs. KPS 70; P=0.0162); the American Society scale status (ASA 1 or 2 vs. ASA 3; P=0.0022); and the examination of meningiomas all had a link with death. Six occurrences of tumor recurrence were observed to be linked with the WHO grade (P = 0.00048) and the Simpson assessment of resection (P = 0.0437). In comparison to their Karnofsky score before surgery, the majority of patients either improved (50%) or did not change at all (24.9%). The 15.5% of patients who died as a result of the surgery or a recurrence are an exception to this rule. Conclusion: Neurological impairment following surgery was only observed in patients with a significant tumour placement (skull base, eloquent area, large vessels indulgence by the tumor). Because of the greatly increased threat of fatality, surgery should be carefully considered in individuals with a low functional state (KPS 60) or a bad bodily state (ASA 3 status). During routine visits, the majority of patients’ neurological health enhanced or remains constant in comparison to their condition before operation.