Shifa International Hospital Research Articles

PREDICTING PATIENT OUTCOMES USING ONE-HOUR ADULT EARLY WARNING SCORE (AEWS)

Early Warning Scores (EWS) are widely utilized tools to predict patient outcomes, particularly in critical care settings and emergency departments (ED). However, while Adult Early Warning Scores (AEWS) have been employed for general patient outcome prediction, the specific utility of a one-hour AEWS in the ED has not been thoroughly explored. Accurate early prediction of patient disposition could enhance clinical decision-making, resource allocation, and patient safety. Objective: This study aims to evaluate the effectiveness of one-hour Adult Early Warning Scores (AEWS) in predicting patient disposition (discharge, floor admission, or ICU admission) in the emergency department. Methods: A prospective observational study was conducted on 227 patients aged 16 years and above who presented to the ED of Shifa International Hospital, Islamabad, from January 2024 to June 2024. Vital signs, including heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature, were recorded at the one-hour mark post-admission, and the one-hour AEWS was calculated. Patient outcomes were categorized into three groups: discharge, admission to the general floor, or admission to the ICU. Logistic regression was used to determine the relationship between one-hour AEWS and patient disposition. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive power of the AEWS for determining patient outcomes. Results: There was a statistically significant correlation between the one-hour AEWS and patient disposition (p<0.001). The ROC curve analysis showed an Area Under the Curve (AUC) of 0.753, demonstrating good predictive accuracy. A cutoff AEWS value of 2.5 was identified, with patients scoring below this threshold being more likely to be discharged, while those scoring above 2.5 were more likely to require hospital admission or ICU care. The sensitivity and specificity of AEWS at this cutoff were 71% and 68%, respectively. Conclusion: The one-hour AEWS has proven to be a valuable tool in predicting patient disposition in the emergency department. Its ability to distinguish between patients who can be safely discharged and those requiring further care highlights its potential utility in improving patient triage, optimizing resource use, and enhancing clinical decision-making. Further multicenter studies are needed to validate these findings and assess the integration of AEWS into routine ED practice.

Early onset Colorectal Cancer and its association with its histological subtypes

Objective: There are different clinicopathological features between early and late onset colorectal cancer. We aimed to characterize the histological features of colorectal cancer (CRC) at different age groups in our institution. Methods: Total 232 patients with histologically proven colorectal cancer between ages 13-99 were included. This is retrospective study. Data collected from tumour registry Shifa International Hospital from January 1st 2018 to December 31st 2020. Pearson Chi square test was used for significance of categorical variables. P-values less than 0.05 were considered significant. Results: Mean age at diagnosis was 55.49+/-16.43 years. Out of total 232 patients 58.6% were male and 41.3% were females (p value= 0.16). 150 (64.9%) were aged > 50 years and 81 (35.1%) were age < or equal to 50 years (p value = 0.44). Most common histological subtype was adenocarcinoma that was found in 188 (81%) cases. One hundred fifty five (66.8%) patients had Grade-II tumor, 67(28.9%) with Grade-III and 10 (4.3%) with Grade-I tumor. Fifty eight (25%) patients presented with metastatic disease. A significantly higher percentage of patients with signet ring cell cancer presented with a high-grade tumor when compared with patients with adenocarcinoma and mucinous carcinoma (93.7% vs 21.8%, p-value- <0.001%; 93.7% vs 39.2%, p-value <0.001).A significantly higher percentage of patients with mucinous adenocarcinoma and signet ring cell carcinoma presented at age less than 50 as compared to those with adenocarcinoma (60.7%, 56.2% and 30.8% respectively; p-value <0.05). Conclusion: This study signifies that mucinous and signet ring cell type CRC present at an early age and with a higher proportion of patients with high tumour grade. Early diagnosis is key to help improve outcomes in these patients. doi: https://doi.org/10.12669/pjms.40.10.10143 How to cite this: Ibrar F, Atiq M, Shafqat F, Khan HM. Early onset Colorectal Cancer and its association with its histological subtypes. Pak J Med Sci. 2024;40(10):2395-2399. doi: https://doi.org/10.12669/pjms.40.10.10143 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diagnostic Accuracy of Beta-D-Glucan and Galactomannan as Fungal Markers in the Detection of Positive Fungal Cultures among Immunocompromised Patients

As fungal infections pose a significant threat to immunocompromised patients, necessitating timely and accurate diagnostic approaches for effective management, non-invasive diagnostic markers are direly needed to detect the presence of fungi during the early stage of the infection. Objectives: To determine the diagnostic accuracy of Beta-D-Glucan and Galactomannan as fungal markers in the detection of positive fungal cultures among immunocompromised patients. Methods: This cross-sectional study was conducted at the Intensive Care Units of Shifa International Hospital, Islamabad, from April 2024 to July 2024. 57 immunocompromised patients of both genders with an age range of 12 to 80 years, who had positive fungal cultures were included in the study via Non-probability, consecutive sampling while patients who were taking any antifungal medications were excluded. Diagnostic accuracy, sensitivity and specificity of Beta-D-Glucan and Galactomannan were calculated by comparing these assay results against the gold standard of CSF analysis of fungal culture. Results: The Beta-D-Glucan and Galactomannan assays showed a specificity of a moderate nature for both assays, slightly higher for Beta-D-Glucan (77.78%) than Galactomannan (72.73%), with a high sensitivity of 92.31% for Beta-D-Glucan and 90.20% for Galactomannan. Overall, the diagnostic accuracy was high for both assays, with Beta-D-Glucan at 96.49% and Galactomannan at 94.74%. conclusions: It was concluded that while the Beta-D-Glucan assay is more sensitive, the Galactomannan assay appears to be more specific. Thus the combined use of both tests enhances diagnostic accuracy for detecting fungal infections in immunocompromised patients.

CLINICAL SPECTRUM OF DISEASE IN NEONATES BORN TO MOTHERS WITH COVID-19 IN A TERTIARY CARE HOSPITAL

COVID-19 infection during pregnancy presents potential risks to neonates, yet the full clinical spectrum in newborns born to COVID-19-positive mothers remains under investigation. Understanding the clinical outcomes in these neonates is essential for guiding management and care. Objective: To study the spectrum of clinical presentations in neonates born to mothers who tested positive for COVID-19. Methods: This prospective cross-sectional study was conducted at the Department of Pediatrics, Shifa International Hospital, from April 1, 2020, to April 30, 2021. All neonates born to COVID-19-positive mothers were included in the study and followed daily during their hospital stay. After obtaining parental consent, nasopharyngeal swabs were taken from the neonates for SARS-CoV-2 PCR testing at 24-48 hours of age. After discharge, follow-up calls were made between days 7-14. Data were entered into a predesigned proforma and analyzed using SPSS version 23. Results: A total of 82 neonates were enrolled. Approximately half were born at term, with a mean weight of >2500 grams. Forty-five neonates (53%) underwent SARS-CoV-2 PCR testing within 48 hours of age; all were negative. Sixty-one neonates (74%) were shifted to the mother’s care, while 25% required admission to the neonatal intensive care unit (NICU). The most common reasons for NICU admission included respiratory distress (15%), prematurity (6%), and lethargy (5%). Radiological findings included ground-glass appearance in five neonates (6%) and lung consolidation or infiltrates in two (3%). Hematological and biochemical abnormalities included leukocytosis (7%), leucopenia (3.6%), anemia (1.2%), metabolic acidosis (6%), and respiratory acidosis (3.6%). Most neonates (78.6%) received routine care and were fed breast milk. Fourteen neonates (16.7%) required respiratory support, with 13% needing mechanical ventilation. Complications included pneumonia (7%) and respiratory failure (9%). NICU stay varied, with 11 neonates (13%) staying less than 48 hours and 10 (12%) requiring a more extended stay. Four neonates (5%) died due to multiorgan complications. Conclusion: The majority of neonates born to COVID-19-positive mothers remained asymptomatic. However, symptomatic neonates were at risk of serious complications, requiring close monitoring and management, particularly in those with additional risk factors.

Role of Ginger in management of nausea among patients receiving chemotherapy.

Cancer patients treated with chemotherapy often face variety of side effects, with nausea and vomiting being the most frequent. Ginger (Zingiber officinale), contains natural compounds that can speed up the metabolism and increase intestinal motility. It is traditionally used to treat gastrointestinal disorders. The objective of this study was to evaluate the role of ginger in management of nausea among patients receiving chemotherapy. This crossover interventional study was conducted to evaluate the role of ginger in management of nausea among patients receiving chemotherapy. Study was carried out at chemotherapy daycare of Shifa International Hospital Islamabad, with a sample size of 90 patients, using non-probability convenient sampling. Patients undergoing chemotherapy were given the dose of ginger (550 mg twice a day) for five consecutive days. On the next chemo cycle the same patients were given the placebo capsules of same color and weight for two times a day for five days. Patients and attendants were contacted for five days and being asked about post-chemotherapy nausea. Nausea and vomiting were measured by Rhodes scale. Results showed that Rhodes score of patients taking Ginger capsules was significantly lower than those taking placebo (p-value < 0.05) in all the five days. Ginger significantly managed the nausea among patients receiving chemotherapy. Its natural antiemetic properties provide a convenient and safe way to reduce the post-chemotherapy nausea and vomiting.

Routine Histopathology in Laparoscopic Sleeve Gastrectomy Over 10 Years.

Laparoscopic sleeve gastrectomy (LSG) is one of the world's most commonly performed types of bariatric surgery. Routine histopathology of the surgical specimen is undertaken at most institutions, regardless of the lack of clinical suspicion of any sinister pathology. We evaluated the histopathology reports of LSG cases done for morbid obesity at our hospital over 10 years to determine the distribution of gastric changes and the prevalence of Helicobacter pylori infection in these specimens. A retrospective study was conducted. All LSGs performed at Shifa International Hospital, Islamabad,Pakistan, from July 1, 2014, to June 30, 2024, were assessed. A total of 538 cases were included. Histopathology reports were reviewed for all these patients, and the histopathological diagnosis and the presence or absence of H. pylori infection were recorded. The mean age was 36.9 ± 11.4 years. There were 201 (37.4%) males. No abnormality was found in 105 (19.5%) cases. Gastritis was present in 433 (80.5%) cases. Intestinal metaplasia was present in eight (1.5%) cases in a background of gastritis. There were no cases of gastric atrophy or dysplasia. There was one case of submucosal lipoma (0.2%) and one case of gastrointestinal stromal tumor (GIST) (0.2%). Both cases were associated with gastritis. H. pylori infection was present in 140 (26.0%) cases. All of these were associated with gastritis. Among the gastritis cases, 319 (73.7%) had chronic gastritis, while 114 (26.3%) had both active and chronic gastritis. The severity of gastritis, as designated by the histopathologist in their report, was minimal in 24 (4.5%) cases, mild in 228 (42.4%), moderate in 176 (32.7%), and severe in five (0.9%). There was one case of granulomatous gastritis (non-caseating) (0.2%). There was no difference in the prevalence of gastritis or H. pylori infection based on age or gender. Histopathological examination of the LSG specimen revealed a very high prevalence of gastritis, with normal findings in less than a fifth of all cases. The prevalence of H. pylori infection (26.0%) is much higher in comparison to other studies. Routine histopathology of LSG specimens should continue to be performed in every case.

Association of SLCO1B1 gene variants with angiotensin-converting enzyme inhibitor-induced cough in a Pakistani hypertensive cohort.

Angiotensin-converting enzyme inhibitors (ACEIs) are prescribed for individuals with high cardiovascular (CV) risk; however, persistent cough limits the use of ACEIs in a large number of patients. The current study aimed to identify the genetic variants in the SLCO1B1 gene that might be associated with ACEI-related cough in a Pakistani hypertensive population. A prospective cohort study was conducted at a tertiary care hospital in Pakistan. A total of 74 patients who had been treated with ACEIs were recruited through a convenient sampling method. The study was approved by the Institutional Review Board & Ethics Committee of the Shifa International Hospital, Islamabad. Patients provided 2ml of blood for sequencing after signing informed consent. Partial gene sequencing of SLCO1B1 was carried out to find single nucleotide polymorphisms (SNPs) and haplotypes. It was found, through a structured questionnaire, that thirty-eight (38) patients experienced cough within 2weeks of ACEI administration and were considered as a case group (cough), and thirty-six (36) patients were considered as a control group (no cough). The incidence of cough was 51%. We found six different SNPs and 9 haplotypes in the partial gene sequences of SLCO1B1. Haplotype H4 was associated significantly with cough after adjusting for sex and smoking status. Other SNPs and haplotypes were not significantly associated with ACE-Is-induced cough. These findings emphasize the significance of SLCO1B1 genetic variants, specifically H4, as a potential predictor of ACEI-induced cough. It could be included in clinical practice as a possible risk factor for ACEI-induced cough once confirmed in larger clinical trials with bigger sample sizes. The replication of these findings in larger and more diverse populations is likely to contribute to the therapeutic use of ACEIs by predicting ACEI-induced cough.

MULTI-SYSTEM INFLAMMATORY SYNDROME IN PATIENTS ADMITTED AT NICU OF A TERTIARY CARE HOSPITAL

Multi-inflammatory syndrome in neonates (MIS-N) associated with COVID-19 is an emerging concern in neonatal intensive care units (NICUs). Understanding its clinical spectrum and outcomes is crucial for developing management strategies and improving neonatal care. Objective: To explore the clinical spectrum, associated laboratory markers, and outcomes of neonates diagnosed with MIS-N and COVID-19 admitted to the NICU. Methods: This case series was conducted at the NICU of Shifa International Hospital, Islamabad, from January 2023 to June 2023. It included 47 infants diagnosed with COVID-19 who developed MIS-N. Data collected encompassed clinical presentations, laboratory markers, treatments administered in the ICU, and clinical outcomes. Descriptive statistics were used to analyze the data, focusing on symptoms, treatment efficacy, and complications. Results: The neonates had a mean age of 20.65 ± 16.60 days and a mean gestational age of 36.40 ± 2.62 weeks. Elevated inflammatory markers were noted, with D-Dimers elevated in 46.8%, serum ferritin in 66%, and C-reactive protein (CRP) in 48.9% of patients. The most common symptoms included respiratory distress (74.5%), poor feeding (38.3%), and fever (29.8%). Significant findings included pulmonary hypertension in 27.7% of the patients, patent ductus arteriosus in 23.4%, and other cardiovascular anomalies. Complications such as sepsis (70.2%), oxygen dependency (21.3%), and renal failure (29.8%) were prevalent. The mortality rate was 12.8%. Conclusion: MIS-N presents a severe threat to neonates with COVID-19, demonstrating high rates of serious complications and a notable mortality rate. Echocardiography is essential for early detection of cardiac dysfunctions. These findings underscore the urgent need for specific guidelines for the early recognition and management of MIS-N in neonates.

Emerging Trends in Lung Cancer Presentation at a Leading Tertiary Oncology Center and the Need for Lung Cancer Screening in Pakistan.

Background Lung cancer is a significant global health concern, with Pakistan lacking a national cancer registry. Methods A retrospective study analyzed 345 lung cancer patients at Shifa International Hospital from 2018 to 2020. Demographics, symptoms, cancer stage, site, and histological types were assessed using descriptive statistics and Pearson'schi-square test. Results Most patients were male (267, 77.4%) with a mean age of 45-75 years. Common symptoms included patients with cough (168, 49%), blood in sputum (114, 33%), and chest pain (120, 35%). Most cases presented at advanced stages (81% at stage 4). Adenocarcinoma (131, 38%) was the most common histological type, with significant differences noted between smokers and non-smokers. Conclusion Gender disparities exist in lung cancer incidence, with a higher proportion of male patients. Both smokers and non-smokers are affected, emphasizing the need for comprehensive screening. Early detection and intervention strategies are crucial, especially considering the advanced stage of presentation. Tailored approaches considering histological types are essential for effective management. This study underscores the urgency of implementing screening programs and raising awareness to mitigate the burden of lung cancer in Pakistan.

Impact of Sarcopenia on Post-Liver Transplant Hospitalization: Insights From a South Asian Cohort

BackgroundSarcopenia's impact on post-liver transplant outcomes remains a subject of debate, with limited data from South Asia on its association with post-liver transplant hospital stays. This study aims to investigate sarcopenia's influence on post-transplant hospitalization duration in South Asians. MethodsIn this retrospective study, patients with liver cirrhosis who underwent living-donor liver transplantation at Shifa International Hospital in Islamabad, Pakistan, between January 2022 and January 2023 were included. Computed Tomography (CT) images were used to assess the skeletal muscle index (SMI). The areas of the psoas, erector spinae, multifidus, quadratus lumborum, rectus abdominis, transverse abdominis, and internal/external oblique muscles were quantified at the level of L3. The data was analyzed using SPSS v. 29.0 (IBM Chicago, IL). ResultsThere was a total of 84 patients. Mean age was 47.4 ± 12.0 years. There were 62 (73.8%) males and 22 (26.2%) females. Hepatitis C was noted in 36 (42.9%) patients. 22 (26.2%) patients had hepatocellular carcinoma. Sarcopenia was identified in 58 (69.0%) patients. No significant association was observed between sarcopenia and ICU or general floor stays. Regression analysis identified pre-transplant MELD-Na score as the sole significant factor associated with both ICU and total length of stay (p-value 0.002; p-value 0.009). ConclusionIn our population, sarcopenia did not correlate with post-transplant ICU or overall hospital stay. The pre-transplant MELD-Na score emerged as the most influential predictor of length of stay. Therefore, delaying liver transplant procedures based on muscle mass estimations may not be a practical clinical approach for South Asian patients.

Precision in Practice: Assessing Concordance between Physician Visual Assessment and Quantitative Coronary Analysis for Stenosis Severity in CAD Patients at Shifa International Hospital

Background: Coronary Artery Disease (CAD) is a leading cause of mortality globally, necessitating accurate assessment of stenosis severity for optimal clinical management. Physician Visual Assessment (PVA) is commonly used in practice, but its subjective nature raises concerns about accuracy. Quantitative Coronary Analysis (QCA) offers a more objective method for evaluating stenosis severity. This study investigates the concordance between PVA and QCA in determining stenosis severity among CAD patients at Shifa International Hospital. Objective: To evaluate the level of concordance between Physician Visual Assessment (PVA) and Quantitative Coronary Analysis (QCA) in assessing the severity of coronary artery stenosis in patients with CAD. Methods: This retrospective cross-sectional study was conducted at the Cardiac Catheterization Department of Shifa International Hospital over a two-month period. A total of 105 CAD patients undergoing PCI were included. Lesions were evaluated by PVA during coronary angiography and subsequently assessed by QCA using Siemens Artis Zee software. The lesions were categorized into four severity groups: &lt;50%, 50-69%, 70-89%, and 90-99%. Concordance between PVA and QCA was analyzed using independent sample t-tests with a 95% confidence level, and results were processed using SPSS version 25. Ethical approval was obtained from the Institutional Review Board (IRB) of Shifa International Hospital. Results: The study population comprised 77% males and 23% females, with the majority aged between 51-70 years. The &lt;50% stenosis category showed significant differences between PVA and QCA, with mean stenosis values of 34.66% (SD = 6.7) for PVA and 42.22% (SD = 7.3) for QCA (p &lt; 0.001). Similarly, in the 50-69% category, the mean stenosis values were 56.83% (SD = 6.2) for PVA and 63.79% (SD = 4.5) for QCA (p &lt; 0.001). However, in the 70-89% and 90-99% categories, the mean differences were not statistically significant, with p-values of 0.36 and 0.21, respectively. Conclusion: The study revealed low concordance between PVA and QCA in the &lt;50% and 50-69% stenosis categories, suggesting that visual assessment alone may not be sufficient for accurate evaluation in these cases. QCA should be utilized alongside PVA to enhance diagnostic accuracy and improve treatment decisions, particularly for mild to moderate stenosis.

Outcomes of Mechanical Resection of Endometrial Polyps and Submucosal Fibroids Through TruClear™ Hysteroscopy.

To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022. Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure. The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45). TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications. Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

To compare the frequency of ventilator-associated pneumonia among mechanically ventilated patients with four- hourly chlorhexidine mouthwash VS six-hourly chlorhexidine mouthwash.

Objective: To compare the frequency of ventilator-associated pneumonia among mechanically ventilated patients with four hourly chlorhexidine mouthwash VS six hourly chlorhexidine mouthwash. Study Design: Randomized Controlled Trial. Setting: Surgical Intensive Care Unit of the Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan. Period: January 2020 to June 2020. Methods: Eighty patients admitted to ICU and mechanically ventilated for at least 48 hrs were randomly allocated, and 40 patients were treated with chlorhexidine mouthwash four-hourly per day group1, and 40 received chlorhexidine mouthwash six-hourly group2. The primary researcher followed patients for up to 7 days. Lower respiratory tract specimens were obtained on admission, and after 48 hrs of intubation, findings were entered in proforma. Results: The average age of the patients in group 1 was 37.55±10.16 years and in group 2 was a 38.65±9.25 year. There were 38(47.5%) male and 42(52.5%) female. The frequency of VAP was not significant between groups (11.25% vs 6.25%, p=.23). It was observed that the rate of VAP was not significant between groups in all age stratification. Gender stratification was performed and observed that no difference was found between groups. The frequency of VAP in females in group 1 was 7 (35%) and 4 (18.2%) in group 2, with p-value=0.21 and Chi-square=1.53. The frequency of ventilator-associated pneumonia differed between groups for males in group 1 (35%) and 1 (5.6%) in group 2, with p-value=0.61 and Chi-square=0.25. Conclusion: Our study concludes that oral hygiene care incorporating chlorhexidine mouthwash effectively reduces the development of VAP in adults in ICU. We found no difference between the efficacy of four hourly and six-hourly chlorhexidine mouth wash in VAP frequency.

PREDICTIVE VALUE OF SHOCK INDEX, MODIFIED SHOCK INDEX, AND AGE SHOCK INDEX FOR OUTCOMES IN PATIENTS ADMITTED WITH SEPSIS TO THE INTENSIVE CARE UNIT

Sepsis is a life-threatening multi-organ dysfunction resulting in multiple organ failure. Various indices have been developed to predict outcomes in sepsis. Objective: The objective of this study is to evaluate the predictive value of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) for determining outcomes in patients admitted to ICU with sepsis. Methods: It is a retrospective observational study conducted at the intensive care unit of Shifa International Hospital Islamabad from January 2024 to June 2024. The data was collected from hospital medical records. After screening, 162 patients were included in this study. Demographic data and Clinical data such as vital signs, laboratory results, and clinical diagnosis were collected at admission in the ICU. Data was analyzed using SPSS v25.0. The p-value ≤0.05 was considered significant. Result: The result of the study has shown that 77 patients (47.53%) were male, 85 (52.47%) were female, and 82 (50.62%) had critical outcomes. For critical outcomes, an SI &gt; 0.7 had a sensitivity of 53.9% and a high specificity of 94.3% but a low positive predictive value (PPV). MSI &gt; 1.3 showed a sensitivity of 19.6% and a specificity of 98.1%, with a PPV of 1.6%. ASI &gt; 0.7 had a sensitivity of 15.9% and a specificity of 93.2%, with a PPV of 0.9%. Conclusion: The Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) are more effective at ruling out critical outcomes than predicting them.

Evaluation of Cardiovascular Risk Factors and Their Association With Coronary Artery Disease in Pakistani Adults.

Cardiovascular diseases (CVDs), especially coronary artery disease (CAD), are a major health burden, and their incidence is rising in countries like Pakistan. The objective of this research was to assess the prevalence and association of cardiovascular risk factors with CAD in Pakistani adults. The research was carried out from January 2023 to December 2023 at the Pakistan Institute of Medical Sciences (PIMS) Islamabad and Shifa International Hospital Islamabad, Pakistan, using a cross-sectional design. Based on predefined criteria, 320 individuals who were Pakistani nationals and over the age of 18 years old were included. Those having a history of congenital heart disease, pregnancy, significant comorbidities, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI) were excluded. Medical, lifestyle, and demographic data were collected, and clinical evaluations were carried out by qualified healthcare workers. The data was analyzed using descriptive statistics and relevant statistical tests. A p<0.05 was statistically significant. The study investigated cardiovascular risk factors and demographic traits in 320 adult Pakistanis. The majority of participants (n=181; 56.56%) were male and aged between 18 and 45. University education was predominant (n=170; 53.13%). Specifically, 147 participants (45.94%) had dyslipidemia, 74 (23.12%) had diabetes mellitus, and 112 (35.0%) had hypertension. Diabetes mellitus (OR: 9.60, 95% CI: 4.52-20.38, p<0.001), dyslipidemia (OR: 1.88, 95% CI: 1.29-2.75, p=0.001), and hypertension (OR: 2.67, 95% CI: 1.72-4.15, p<0.001) showed significant correlations with CAD. Poor socioeconomic status (OR: 3.00, 95% CI: 1.31-6.89, p=0.009) and genetic propensity (OR: 2.00, 95% CI: 1.02-3.92, p=0.040) were also significantly associated with CAD. Our study highlights diabetes as strongly linked to CAD in Pakistani adults, while socioeconomic status emerges as a significant predictor.

EFFICACY, SAFETY, AND PATIENT OUTCOMES OF EMERGENCY TREATMENT WITH IV INSULIN-DEXTROSE IN PATIENTS WITH HYPERKALEMIA

Hyperkalemia is a potentially life-threatening condition often encountered in emergency settings. Insulin-dextrose infusion is a common treatment to rapidly lower serum potassium levels, but this approach carries risks, particularly related to glucose imbalances. Objective: To evaluate the efficacy, safety, and clinical outcomes of insulin-dextrose infusion in the emergency treatment of patients with hyperkalemia. Methods: This retrospective study was conducted in the Emergency Department of Shifa International Hospital Islamabad from June 2023 to June 2024. The study included 400 patients with recorded potassium levels. Patients were categorized into non-hyperkalemic (K+ &lt;5.5 mmol/L) and hyperkalemic (K+ ≥ 5.5 mmol/L) groups. Hyperkalemic patients received an insulin-dextrose infusion consisting of an average of 10 units of Actrapid insulin and 50 milliliters of 50% dextrose. Clinical outcomes, including efficacy and safety, were compared between treated hyperkalemic patients and those with moderate-severe hyperkalemia who did not receive the treatment. Statistical analysis was performed using odds ratios (OR) and 95% confidence intervals (CI) to assess the association between treatment variables and outcomes. Results: Glucose imbalances were observed in 60% of patients treated with insulin, with 50% developing hyperglycemia and 20% experiencing hypoglycemia, including 5% with severe hypoglycemia six hours post-treatment. Factors significantly associated with hypoglycemia included multiple insulin doses (OR: 2.9, 95% CI: 2.0-3.9), chronic kidney disease (CKD) (OR: 1.3, 95% CI: 1.0-2.1), and baseline glucose levels below seven mmol/L (OR: 3.0, 95% CI: 2.2-4.2). Hypoglycemic patients had a higher risk of mortality (OR: 1.49, 95% CI: 1.11-2.11). ICU admission occurred in three patients treated with insulin, with a higher risk associated with multiple doses (OR: 1.8, 95% CI: 1.4-2.9) and insulin doses greater than ten units (OR: 5.3, 95% CI: 2.9-10). Conclusion: The use of insulin-dextrose infusion in the emergency management of hyperkalemia is associated with a significant risk of hypoglycemia, ICU admission, and prolonged hospital stay. These findings suggest the need for improved treatment protocols to enhance patient safety in emergency settings.

Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

Diagnostic accuracy of double density sign on CT scan of para-nasal sinuses for fungal sinusitis taking microbiology culture as gold standard.

To compare double-density sign on non-contrast computed tomography scan of paranasal sinuses with fungal sinusitis on histopathology. This prospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from July 1, 2021, to June 30, 2023, and comprised patients of either gender aged 20-60 years who were set to undergo functional endoscopic sinus surgery. Demographic characteristics and non-contrast computed tomography scan findings were recorded preoperatively, while microbiological and histopathology results were recorded post-operatively. The microbiological finding was taken as the gold standard. Data was analysed using SPSS 23. Of the 201 patients, 123(61.2%) were males and 78(38.8%) were females. The overall mean age was 41.62±8.52 years. The diagnostic accuracy of a double-density sign on computed tomography scan showed sensitivity 90%, specificity 90.8%, positive predictive value 84%, and negative predictive value 94.4%. A higher rate of sensitivity and specificity indicated that non-contrast computed tomography scan was an effective modality that could be used for the diagnosis of fungal sinusitis.

USE OF NUTRIENT RISK IN CRITICALLY ILL SCORE TO ASSESS NUTRITIONAL RISK IN MECHANICALLY VENTILATED PATIENTS

Ensuring proper nutritional support is crucial for critically ill patients. This nutritional deficit is closely associated with heightened susceptibility to nosocomial infections, delayed wound healing, and an escalated risk of mortality. Objective: The objective of this study is to evaluate the effectiveness of the Nutrient Risk in Critically Ill (NUTRIC) score in assessing the nutritional risk of mechanically ventilated patients. Method: It is a cross-sectional study. It is conducted at the Department of Critical Care Medicine, Shifa International Hospital, Islamabad from 1st Jan 2024 to 30 May 2024. The calculated sample size was 381 selected by non-probability consecutive sampling. The study utilized the modified Nutritional Risk in the Critically Ill (mNUTRIC) score to assess nutritional risk in mechanically ventilated (MV) patients. Data will be analyzed using SPSS 24.0. A P value of ≤ 5 will be significant Result: The study included a total of 381 participants, with a mean age of 55.7 ± 17.5 years and, a BMI was 23.7 ± 3.5. 219 (57.48%) had low nutritional risk (NUTRIC score ≤4), while 162 (42.51%) had high nutritional risk (NUTRIC score ≥5). Patients in the high nutritional risk group had a longer stay in the intensive care unit (ICU), had fewer ventilator-free days and had higher mortality rates compared to those in the low nutritional risk group (8.5 ± 4.1 days vs. 5.2 ± 3.9 days, p-value &lt; 0.01). Conclusion: The study highlights the significance of the NUTRIC score as a valuable tool for the estimation of nutritional risk among mechanically ventilated patients in the ICU setting

Outcomes of dorsal nasal augmentation using costochondral graft.

To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.