Sir Ganga Ram Hospital Research Articles

Epidemiology of sleeping disorders among doctors during COVID-19 pandemic in Pakistan

Introduction: Novel coronavirus disease or COVID-19, an acute respiratory illness caused by a newly discovered SARS-CoV-2 virus emerged in December 2019. Objectives: The main objective of the study is to find the epidemiology of sleeping disorders among doctors during COVID-19 pandemic in Pakistan. Material and methods: This cross sectional study was conducted in Sir Ganga Ram Hospital Lahore during June 2021 to December 2021. A questionnaire was used to collect the data. Among the topics covered in the survey were questions regarding the quality of one's night's sleep, where one keeps infection control supplies, how one copes with stress and depression, how one learns about COVID-19 on the internet, how one views risk, and other personal information. The survey was completed over the internet. Results: The data was collected from 200 patients. Over half (55.0 percent) were married and under the age of 35. (49.1%). The majority of respondents (57.8%) spend more than two hours a day on social media. The great majority of them came from the upper echelons of the workforce. There were 38.3%, 29.8%, and 29.1%, respectively, of those who reported a worse sleep quality following the onset of COVID-19, according to their weighted proportions. Conclusion: It is concluded that COVID-19 is widely spreading in Pakistani doctors. Mental health disorders and poor sleep quality are more widespread in the medical field because of the heightened danger of exposure during pandemic illnesses. Keywords: Epidemiology, COVID-19 Disorder, Patients

Study of Applications of E-Test for the Detection of Beta Lactamase Producing Bacteria

The term antimicrobial resistance refers to the ability to resist the effects of drugs formally used to treat them and this term relates only to bacteria becoming resistant. Microorganisms which are resistant to multiple drugs are known as multidrug resistant bacteria. Methods: Most of the experimental work to study the application of E-Test for detection of lactamase producing bacteria was carried out at Pathology Laboratory of Sir Ganga Ram Hospital Lahore. While the remaining research work was done in Microbiology Laboratory of Govt. Post Graduate Islamia College Cooper Road Lahore during the study period from December 2019 to March 2020. Total 60 samples of different patients were collected from Sir Ganga Ram Hospital Lahore and most of the samples were urine (n=25), followed by Blood (n=14), Pus (n=14), and sputum (n=7). Oxidase, indole, citrate utilization, sugar fermentation (Kligler iron agar medium) and urease tests were performed for the identification bacterial strains. Results: In all of 60 samples frequency of occurrence of E. coli, Enterobacter and Klebsiella strains were 59%, 23%, 18% respectively. Most of them (n=36) were ESBLs positive and about (n=24) were ESBLs negative and their percentage were 60% and 40% respectively. Extended spectrum β-lactamase (ESBL) producing strains of Enterobacteriaceae have now become as a significant issue in hospitalized and community patients. These microorganisms are liable for many diseases, for example, urinary tract infection, septicemia, hospitalized-acquired pneumonia, intra-abdominal abscess, brain abscess and device related infections. Conclusions: The frequency of ESBL producing bacteria in most hospitals is very high especially in the hospitals where broad spectrum antibiotics are generally recommended. Among gram negative bacteria, the emergence of resistance to expanded spectrum cephalosporins has been a major concern. Many of ESBL producing bacteria showed multidrug resistance.

Hyponatremia in Patients with Acute ST Elevation Myocardial Infarction: Evaluate the Short Term Outcomes

Aim: Hyponatremia and its related short-term consequences such as death during hospitalization and heart failure in patients with acute myocardial infarction need to be studied. Study Design: Cross-sectional/observational study Place and Duration: Deptt of Cardiology, Fatima Jinnah medical university / Sir Ganga Ram Hospital Lahore. Dec 2020-Nov2021 Materials and Methods: A total of 125 patients, equally split across sexes, ranging in age from 18 to 80, were included in this research. After obtaining written agreement from patients, demographic data was collected. The sodium concentration in the blood was measured using blood samples taken from the participants. Sodium levels of less than 135 millimol/L (mmol/L) were characterized as hyponatremia. Death and heart failure were considered as outcomes. SPSS 22.0 was used to analyze the data. Results: Among 125 patients, there were 75 (60%) were male and 50 (40%) were females and had mean age 53.8±11.61 years. Frequency of hyponatremia was found among 52 (40%) patients and sodium level >135mmol/L was found among 73 (60%) patients.Among 52 hyponatremic patients, mortality was found among 27 (53.8%) and frequency of acute heart failure was found in 19 (36.5%) . Hyponatremia was shown to be associated with an increased risk of death in the hospital and acute heart failure, with a p-value of less than 0.05. Conclusion: According to the findings, hyponatremia is common in patients with acute mycocardial infarction and is related with a higher risk of death during hospitalization and an increased risk of acute heart failure. Keywords: Hyponatremia, Heart Failure, ST segment Myocardial Infarction, Mortality,

Role of Computed Tomography in Diagnosis and Assessment of Disease Severity in Covid 19; Trends in Pakistan

Objective: To observe and compare relationship of High Resolution Computed Tomography severity score with presenting symptoms of COVID-19 positive patients in mild, moderate and severe disease and to analyze the trends of morbidity and mortality in Pakistan. Study Design: Retrospective Observational study Subjects and Methods: All OPD and admitted adult male and female patients serially presented to Fatima Memorial and Sir Ganga Ram Hospital Lahore with positive COVID PCR test or clinical symptoms were included in the study. These patients were classified in three groups; Group I: Mild disease, i.e. symptomatic patients who didn’t need hospital admission or oxygen support. Group II: Moderate disease, i.e. patients having oxygen saturation more than 90% & needing oxygen support at times, and Group III: severe disease, i.e. patients needing hospital admission or ventilator support and having oxygen saturation less than 90%. High resolution chest CT scan was the approach in all cases. CT severity score was used to assess the severity of lung parenchymal involvement by COVID-19 on all the HRCT. Data collected was entered and analysis made using SPSS v 25. Results: Total number of patients were 200(100%) with age ranging from 14-85 years and mean age was 49.5+ 5 years, out of which 135(67%) were males and 65(32%) were females with male to female ratio 2:1. HRCT scans of all patients were done with COVID PCR test positive in 146(73%) patients. Group I had 98(49%) patients, 87(43.5%) patients were included in Group II and 15(7.5%) patients in Group III. Oxygen was required in 78(39%) patients from group II and 14(7%) patients from severe disease required ventilator. Conclusion: Our research work presented the trends of CT severity scoring having positive correlation to clinical symptoms of patients. Moreover, most of the patients in our country were having mild and moderate disease and only 7% patients showed severe disease symptoms and CT scoring in our study. Out of those severe disease patients, mortality was only 1% as compared to 2.89% mortality reported in Iran. Keywords: COVID-19 infection, HRCT Chest, Severity score

Association between Depressed Mood and Morbid Obesity: Experience from a Bariatric Surgery Program

Introduction: Obesity is on the rise in Pakistan. This study aims to assess the association of depression and obesity in patients who have undergone bariatric surgery at our center.
 Aims & Objectives: To assess the association of depression and obesity in patients who have undergone bariatric surgery at our center.
 Place and duration of study: This one-year mixed descriptive study was conducted at Sir Ganga Ram Hospital, Lahore between January 2021 and January 2022
 Material & Methods: Ninety bariatric surgery patients files were screened to see whether data regarding depression screening and follow-up was complete as per DSM-V formulated depression questionnaire. Patients were then randomly selected and asked for short interviews to understand themes and experiences regarding their mood to understand the association between obesity and depression.
 Results: Statistically significant difference existed in the depression scores at each follow-up from the previous score and from baseline, showing decreased weight resulted in lower scores. Themes of (i) financial constraints and economic struggles, (ii) depression linked to eating habits, (iii) anger and irritability as a predominant symptom of low mood, and
 (iv) using religion as mental health therapy were picked during the interviews.
 Conclusion: Bariatric and metabolic surgery should be offered to patients as per guidelines for patients who require it. Depression and mental health disorders are prevalent in the obese population, and these should be screened for and appropriately dealt with in both the pre-operative and post-operative phase. Surgical candidacy decision should not be based on the presence or absence of mental health disorders.

Family History of Diabetes: An Important Risk Factor for Developing PCOS

Background and Aim: Polycystic ovary syndrome (PCOS) is a new rising disorder of reproductive, metabolic, and endocrine disorders of young females of reproductive age suffering from insulin resistance, increased levels of androgens, and altered morphology of ovaries with multiple cysts, and oligoanovulation. The burden of disease is significantly high with a global prevalence of 5% - 10% of reproducing females. Literature has reported a positive correlation between diabetes mellitus in the family and the resultant risk of developing PCOS among the female population. This study will aim to assess the correlation between the familial history of diabetes mellitus and concurrent risk of developing PCOS in a tertiary care hospital in Lahore, Pakistan. Methodology: A cross sectional study was conducted in the Medicine and Gynecology department of Sir Ganga Ram Hospital, Lahore for duration of four months from October 2021 to January 2022. Participants were recruited following inclusion and exclusion criteria. Sample population was estimated to be 150 females. Participants were recruited by convenient sampling. After recruitment participants underwent physical, clinical, and serological assessment. Diagnosis of PCOS was made by following Rotterdam criteria. Data collection was done by 14 points questionnaire and history interview. Results: This study showed that all participants diagnosed with PCOS have a history of early menarche, increased level of heartbeats, a large volume of ovaries, and a lesser volume of uterus. Patients also showed increased peripheral follicles. Serologic outcomes of participants showed a generalized increase in TT levels and a generalized decrease in SHBG levels with 1.71 (1.04-2.23) nmol/L and 45.39 ± 24.44 nmol/L respectively. About 56.2% (n= 83) of the participants gave a history of the abnormal menstrual cycle and 70.3% (n= 104) of the population agreed to abnormal hair growth on the body. When assessing the history of diabetes mellitus prevalence among families of the participants, the results showed that 19% of the population (n= 28) gave a positive history of diagnosed diabetes mellitus of both mother and father, 21.1% of the participants (n= 31) suggested that their parents were never tested for diabetes mellitus before, whereas remaining 43.8% (n= 89) gave no familial history of diabetes mellitus. Conclusion: The study concludes that the most common characteristics of PCOS among the population of Pakistan is increased weight followed by abnormal hair growth, participants present with increased TT and decreased SHBG levels. Familial history of diabetes mellitus is considered a risk factor for developing PCOS. Keywords: Familial diabetes, Diabetes mellitus, Polycystic ovary syndrome, Risk factors of PCOS

Respiratory outcomes after 12 weeks in patients recovered from COVID-19 managed with non-invasive positive pressure ventilation

Aim: To assess the respiratory outcomes twelve weeks after the management with non-invasive positive pressure ventilation (NIPPV) in patients recovered from severe corona virus disease 2019 (COVID-19). Methodology: The cross-sectional analytical study was conducted in the Department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 124 patients visiting the hospital twelve weeks after recovery from COVID-19 were enrolled using convenience sampling. After excluding patients with a history of previous respiratory symptoms before the development of COVID-19, data from 87 patients who required oxygen >15 L/minute and NIPPV support were subjected to final analysis. Results: The proportion of middle-aged adults was 52.9%, males 64.4% and smokers 49.4%. Twelve weeks after treatment with NIPPV, O2 saturation <97.0% at rest was found in 97.7% patients, PR >100 at rest in 16.1% patients, severe dyspnea in 65.5% patients, O2 dependency >5 L/min in 2.3% patients, severe CXR abnormalities in 20.7% patients and lung fibrosis in 27.6% patients. The distribution of SpO2, PR, and dyspnea status twelve weeks after recovery from severe COVID-19 were not significantly different between NIPPV duration groups (p-value >0.05). However, the number of patients with O2 dependency, severe CXR abnormality, and lung fibrosis were significantly different between NIPPV duration groups (all p-values <0.05). Conclusion: Oxygen desaturation, severe dyspnea and severe CXR abnormalities twelve weeks after the treatment with NIPPV were common among patients recovered from COVID-19. Severe CXR abnormality, lung fibrosis, and O2 dependency were significantly associated with prolonged duration of NIPPV. Keywords: COVID-19, Dyspnea, Pulmonary fibrosis, SARS-CoV-2, NIPPV.

Comparison of Mean Pain Score with Inguinal Block under Gen. Anes. versus Subarachnoid Block in Adult Pts UIH

Objective: To compare the mean pain score with inguinal block under general anesthesia versus subarachnoid block in adult patients undergoing inguinal hernioplasty. Design of the Study: Randomized controlled trial Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from January 2021 to June 2021. Materials and Methods: Sample of 200 cases was included through non probability purposive sampling. In group A, patients were given inguinal block and in group B, patients were given subarachnoid block. In Inguinal block group, a 10mL of Bupivacaine (0.5%) will be given at junction of 2/3 form umbilicus and 1/3 from anterior superior iliac spine after administration of general anesthesia with laryngeal mask airway. Patients were followed at 1, 2 and finally on 4 hours after surgery for measurement of pain. Results: The mean age of 39.63±6.50 years. Out of total 200 patients, 186 (93%) were males and 14 (7%) were females. The mean pain score at 1st hour in inguinal group was 0.76±0.87 whereas pain score in Subarachnoid block was 1.18±0.92. Similarly after 2nd hour inguinal group pain score was 0.88±0.84 and with Subarachnoid block was 1.33±1.04. At 3rd hour, with inguinal block mean pain score was 1.02±0.92 and with Subarachnoid block was 1.80±1.20. At 4th hour, with inguinal block mean pain score was 1.59±1.07 and with Subarachnoid block was 3.09±1.60. Statistically there is highly significant difference of mean pain score between both groups i.e. p-value<0.05. There was drastic increase in mean main score at 4th hour with subarachnoid block as compared to inguinal block showing that inguinal block is more effective in reducing pain after 4 hours of surgery. Conclusion: It was concluded from results of this study that inguinal block is more beneficial in controlling pain after inguinal hernia surgery as compared to subarachnoid block Keywords: Inguinal Hernia, Inguinal block, Spinal anesthesia, General anesthesia

Diagnostic Accuracy of Serum Albumin for Diagnosis of Esophageal Varices among Patients of Chronic Liver Disease taking Endoscopy as Gold Standard

Objective: To determine the diagnostic accuracy of serum albumin for the detection of esophageal varices (EV) in cases presented with chronic liver disease taking Esophagogastroduodenoscopy (EGDs) as the gold standard. Methodology: This cross-sectional study was conducted at the Department of Medicine, Sir Ganga Ram Hospital, Lahore in collaboration of Department of Gastroenterology, Services Hospital, Lahore, during a period of six months. After receiving informed consent, each patient's blood was drawn using a 5cc disposable syringe and sent to the hospital's laboratory for analysis of serum albumin levels. Esophageal varices were suspected as positive on albumin level <3.5mg. Then, patients were referred to and underwent EGD. All EGDs were done on every patient by a consultant gastroenterologist having a minimum experience of 5 years. Self-made study proforma was used for the data collection and SPSS version 26 was used for the data analysis. Results: The patient’s average age was 55.44+12.51 years. Males were found in majority 70.53%. Esophageal varices were noted positive among 41.1% of the cases out of a total 95 study subjects. The sensitivity and specificity of the serum albumin in the diagnosis of esophageal varices were found to be 80.55 percent and 83.05 percent, respectively, followed by a positive predictive value 74.35 percent, negative predictive value 87.5 percent, and the diagnostic accuracy was 82.10 percent by taking EGD as the gold standard. Conclusion: Decreased serum albumin level was observed to be the non-invasive, useful predictor and as a good first-line diagnostic tool of esophageal varices among cases having chronic liver disease in clinical practice. Keywords: Serum Albumin, Esophageal Varices, CLD, EGD

Positive Predictive Value of Upper Lip Bite Test in Predicting Difficult Intubation

Objective: To determine the positive predictive value of upper lip bite test in predicting difficult intubation by taking Cormack and Lehane classification as gold standard. Design of the Study: Cross sectional study. Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from 04/06/2021 to 03/12/2021. Materials and Methods: This study involved 313 patients of both genders, aged between 18-70 years undergoing general anesthesia on elective lists having positive upper lip bite test (Grade-III). On the basis of Cormack and Lehane Classification, the diagnosis was verified. Results of the ULBT were compared to the Cormack and Lehane grade-III and grade-IV diagnoses. Every patient's written informed permission was obtained. Results: In The mean age of the patients was 43.78±12.32 years. Majority (n=150, 47.9%) of the patients were aged between 36-52 years. There were 198 (63.3%) male and 115 (36.7%) female patients in the study group. Among the procedures, herniorrhaphy (32.9%) and cholecystectomy (26.8%) were the more frequent procedures followed by thyroidectomy (17.6%), tonsillectomy (13.1%) and mastectomy (9.6%). Majority (42.8%) of the patients belonged to ASA Class-I followed by ASA Class-II (29.7%) and ASA Class-III (27.5%). Difficult intubation was confirmed in 232 (74.1%) patients on Cormack and Lehane Classification (as per operational definition). Thus there were 232 true positive patients with 81 false positive patients. With the gold standard Cormack and Lehane Classification, the upper lip bite test yielded a positive predictive value of 74.1 percent in the prediction of difficult intubation. Conclusion: According to the gold standard of Cormack and Lehane Classification, an upper lip bite test (Grade-III) has a 74.1 percent positive predictive value for difficult intubation in patients undergoing general anaesthesia with endotracheal intubation on the elective list. Keywords: Difficult Intubation, Cormack and Lehane Classification, Upper Lip Bite Test

Complications affecting outcome in COVID 19 patients admitted in high dependency unit Sir Ganga Ram Hospital, Lahore

Background: Covid 19 is a highly contagious viral infection resulting in severe acute respiratory syndrome Coronavirus (SARS-CoV-2). The objective of this study was to determine the potential complications affecting the outcome of moderate to severe COVID 19 patients admitted in HDU of Sir Ganga Ram Hospital, Lahore.Subjects and methods: It was a prospective cohort study. The study was conducted on 108 patients admitted in the COVID HDU of Sir Ganga Ram Hospital, Lahore with positive PCR for COVID-19 having moderate to severe disease. After written consent, all the demographic data and complications like ARDS, respiratory failure, cardiac injury and liver dysfunction, acute kidney injury and sepsis/DIC were obtained through specially designed proformas data was collected through specially designed proformas and data was analysed through SPSS version 22. During hospital stay, we observed the patients for the development of complications as mentioned above. All Patients were followed up till discharge and outcome were noted in terms of discharge or death.Results: Out of 108 admitted patients in COVID HDU, 68 were discharged, 26 were died and14 got left against medical advice. The mean age was 53.6 + 15.94 years with 53.7% males (n=58), the most common complication during hospital stay was sepsis (31 affected with 16 deaths, 14 survived and p-value=0.000), acute kidney injury (27 affected, 13 died, 13 survived, p-value=0.002), ARDS (seen in 19 patients with 16 deaths, 3 survived and acute cardiac injury (17 affected, 9 died, 8 survived, p-value=0.005).Conclusion: The complications like adult respiratory distress syndrome, respiratory failure, acute cardiac injury, acute kidney injury, and secondary infection had poor outcomes. This study could help clinicians to take early measures to prevent the development of complications in patients admitted in HDU.

Frequency of Uncontrolled Diabetes Mellitus in Late 3rd Trimester and Its Association with Maternal Outcome

Diabetes mellitus is a metabolic disorder characterized by elevated blood and tissue glucose levels due to absolute or relative insulin deficiency. In addition to a number of systemic complications, diabetes in pregnant women is associated with poor perinatal outcome. A recent study claimed that not merely the presence of diabetes but also poor glycemic control during pregnancy is associated with adverse maternal outcome. However, the available evidence was limited while there was no such local published material which necessitated the present study.
 OBJECTIVE: The objectives of this study were to determine the frequency of uncontrolled diabetes mellitus in late 3rd trimester among diabetic pregnant women presenting at a teaching hospital in Punjab and to compare the maternal outcome among pregnant women with controlled versus uncontrolled diabetes mellitus.
 STUDY DESIGN: It was a descriptive case series.
 SETTING: Research was conducted at Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital Lahore.
 DURATION: Duration of study was 6 months after the approval of synopsis from 01/08/2017 to 31/12/2017 (4 months) and 01/04/2018 to 31/05/2018 (2 months).
 MATERIAL AND METHODS: This study involved 217 diabetic pregnant women aged between 18-35 years presenting after 34 weeks of gestation. HbA1c levels were acquired and those with ?6% HbA1c levels were labeled to have uncontrolled diabetes. Frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage was noted and compared between women with controlled and uncontrolled diabetes. A written informed consent was obtained from every patient.
 RESULTS: The mean age of the patients was 30.1±3.9 years while the mean gestational age was 39.6±1.6 weeks. Majority (n=190, 87.6%) of the patients were aged between 26-35 years followed by 27 (12.4%) patients aged between 18-25 years. There were 75 (34.6%) primiparas and 142 (65.4%) multiparas. 36 (16.6%) patients had pre-pregnancy diabetes while 181 (83.4%) patients had gestational diabetes. 74 (34.1%) patients were taking oral hypoglycemic while 143 (65.9%) patients were on insulin. HbA1c levels ranged from 5.5% to 7.7% with a mean of 6.5±0.66%. Taking a cut-off value of ?6.0%, 146 (67.3%) patients had uncontrolled diabetes. 46 (21.2%) patients had polyhydramnios, 146 (67.3%) patients required cesarean delivery and 31 (14.3%) patients acquired post-partum hemorrhage. The frequency of polyhydramnios (27.4% vs. 8.5%; p-value=0.001), cesarean delivery (84.9% vs. 31.0%; p-value<0.001) and postpartum hemorrhage (21.2% vs. 0.0%; p-value<0.001) was significantly higher in patients with uncontrolled diabetes.
 CONCLUSION: A substantial proportion of diabetic women in late 3rd trimester had poor glycemic control and had significantly higher frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage than women with good glycemic control which advocates routine monitoring and strict glycemic control in diabetic pregnant women to improve the maternal outcome in future practice.

Association of low birth weight with environmental tobacco smoke (ETS) exposure among pregnant women.

Objectives: To determine the association between low birth weight babies and environmental tobacco smoke (ETS) exposure during pregnancy and the factors related to it. Study Design: Case Control study Setting: Obstetrical and Gynecological Units of a Sir Ganga Ram Hospital, Lahore. Period: March 2016 to August 2017. Material & Methods: Babies born to mothers’ aged between 20 to 35 years in all four Obstetrical and Gynecological units of a Sir Ganga Ram hospital, Lahore, were included. 150 low birth weight babies (LBW) born at term, fulfilling the exclusion and inclusion criteria were taken as cases and 150 normal weight babies born on same day were taken as controls. Mothers were interviewed on a semi structured and pretested questionnaire covering all variables using non- probability purposive sampling technique and the data was analyzed on SPSS Version 20.0. The difference of means was tested using independent t-test whereas difference of proportions was analyzed by using Pearson Chi -Square test. Odds Ratio of >2 was taken as significant. P value <0.05 was considered statistically significant. In order to adjust the effect of confounder data was stratified. Results: 110/150(73.3%) cases and 48/150(32%) controls were exposed to ETS with odds of low birth weight being 5.84 times higher among exposed mothers. Odds of having low birth weight was 3.55 times for ETS exposure at home than those not having home exposure. Ninety Six cases (64%) and 70(46.7%) controls had no knowledge about passive smoking. Only one third of all respondents had knowledge about Second Hand Smoke(SHS) while 110 exposed to ETS, only 09 had adequate knowledge about passive smoking with a significant difference in the knowledge among mothers of the cases and controls (p value 0.004, T score -2889). Conclusion: Mothers exposed to ETS had 5.84 odds of having LBW babies than unexposed, endorsing the association between the two particular when at home. Illiteracy, illiterate smoker husband and poor knowledge of mother about SHS and its hazards further escalated the situation. More researches are, therefore, required to evaluate the effects of passive smoking exposure in a low income country like Pakistan and steps should be taken to avoid it especially during pregnancy.

Comparative Study of Single- Versus Split-Dose Polyethylene Glycol Electrolyte Solution Before Undergoing Colonoscopy

Objective: To compare the outcome of consumption of a single versus split-dose polyethylene glycol electrolyte solution in patients undergoing colonoscopy in the morning. Methodology: A randomised controlled trial was conducted at the Department of Gastroenterology, Sir Ganga Ram Hospital, Lahore, from April to July 2021. A total of 274 patients undergoing colonoscopy, who fulfilled the selection criteria were included through a "non-probability, consecutive sampling technique". The patients were randomly divided into two groups. In group A, single dose of PEG was administered. Group B was administered a split dose of PEG which was to be consumed in two parts, 1st in evening before colonoscopy and the second in the morning. Efficacy was labelled if adequate cleaning of the intestines and a BBPS score of ≥6 were achieved during colonoscopy. Results:  In the single dose group, the mean age of patients was 45.15 ± 13.37 years, 68 (49.6%) patients were male, 69 (50.4%) patients were female, efficacy of the procedure was achieved in 54 (39.4%) patients, and the mean BBPS score was 4.99 ± 0.90. In the split dose group, mean age of patients was 49.85 ± 11.38 years, 56 (40.9%) patients were male, 81 (59.1%) patients were female, efficacy of the procedure was achieved in 137 (100%) patients, and the mean BBPS score was 7.61 ± 0.49. The difference in both groups was highly significant (p-value < 0.0001). Conclusion: A split dose is thus more efficacious and acceptable than a single dose of polyethylene glycol electrolyte solution given for bowel preparation.

Predisposing factors of diabetic foot amputation among the diabetic patients in a tertiary care hospital

Background: Diabetes is one of the major health problems in the world. Along with multiple complications, one of those devastating complications, is diabetic foot and it can even lead to limb amputation. The objective of this study to recognize the risk factors for foot amputation among diabetic patients.Methods: This cross-sectional study was conducted at Sir Ganga Ram Hospital of Lahore. 268 diabetic patients were recruited through a set of inclusion and exclusion criteria. After taking informed consent from all patients, data was collected via a self-designed proforma. SPSS version 25 was used to analyze data. Chi-square was applied to identify any association.Results: From the total of 268 patients 72 (26.80%) were advised amputation, whereas, 196 (73.20%) patients were managed conservatively. The correlation between diabetic foot amputation and various factors which included gender (p=0.0001), educational status (p=0.0003), socioeconomic status (p=0.004), diet modification (p=0.002), blood sugar monitoring (p=0.001), life style (p=0.0003), therapy type (p=0.04), compliance with treatment (p=0.001), smoking (p=0.02), hypertension (p=0.004), ischemic heart disease (p=0.03), stroke (p=0.01), peripheral neuropathy (p=0.003), and peripheral arterial disease (p=0.001) was statistically significant, while, the correlation was not significant between diabetic foot amputation and duration of diabetes (p=0.07).Conclusions: In summary, the incidence of foot amputation among diabetic patients is quite high. The factors that lead to foot amputation are male gender, lower educational status, lower socioeconomic status, no diet modification, no blood sugar monitoring, sedentary life style, inappropriate therapy, poor compliance, history of smoking, hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease.

Comparison of Excellent Outcome of Laryngeal Mask Airway Insertion with Sevoflurane Versus Propofol as Induction Agent in Patients Undergoing Elective Surgeries under General Anesthesia

Objective: To compare the excellent outcome of laryngeal mask airway insertion with sevoflurane versus propofol as induction agent in patients undergoing elective surgery under general anesthesia. Study Design: Randomized control trial. Study Setting: was conducted at Department of Anesthesia, Sir Ganga Ram Hospital, Lahore from November 2020 to April 2021. Materials and Methods: Using a random number table, patients were randomised into two groups at random. Group A was given up to 2.5 mg/kg of propofol intravenously while breathing 100% oxygen through a face mask. The anaesthetic circuit in Group B was primed for 30 seconds with Sevoflurane 8% IN N2O 50% and O2 (flow rate 8 liter/minute). Results: In our study the mean age of the patients was 33.89±9.64 years. 70% patients were males and 30% patients were females. The study results showed the excellent outcome was observed in 70.50% patients and it was not observed in 29.50% patients. Conclusion: Our study results concluded that the Sevoflurane is a safe and reliable anesthetic compared with currently available Propofol agent in patients undergoing elective surgery under general anesthesia. Keywords: General Anesthesia, Sevoflurane, Propofol, Mallampati, Laryngeal Mask Airway, LMA

Compare the Effectiveness of Nulbuphine with Ropivacaine Versus Ropivacaine alone in Patients undergoing Upper Limb Surgeries

Objective: Ropinivacaine coupled with nulbuphine was used in this study to compare ropivacaine alone in the supraclavicular block. Study Design: Comparative/Randomized study Place and Duration: Anesthesia Deptt Sir Ganga Ram Hospital, Lahore. August 2020 to July 2021 Methods: There were 105 patients, with a range in age from 20 to 70 years, who underwent elective upper limb surgical procedures. A total of 108 patients were divided into two groups: group I consisted of 52 patients, while group II consisted of 53 patients. Group I received ropivacaine in combination with nulbuphine, while group II received ropivacaine in combination with normal saline (control). Comparisons and contrasts were made between the effectiveness of the two groups. The data was analyzed with the help of SPSS 22.0. Results: Using a p-value greater than 0.05, it was determined that there was no statistically significant difference between the two groups in terms of age, gender, body mass index, and American Society of Anesthesiologists (ASA) class I and II. A statistically significant difference (p=0.005) was found between the two groups in terms of sensory and motor block (see Table 1).The mean time of sensory blockage in group I was 427.13±15.62 minutes, whereas in group II it was 262.32±17.32 minutes. Mean time of motor block was also greater in group I than in group II (416.11±17.55 versus 231.19±16.71 ). There was a statistically significant difference in the duration of analgesia between groups I and II. Conclusion: Ropinivacaine 0.75 percent mixed with 10mg nulbuphine is particularly effective in supraclavicular brachial plexus block in terms of sensory and motor block, as well as analgesia duration when compared to ropivacaine alone. Keywords: Nulbuphine, Ropivacaine, Brachial Plexus Block, Duration of Analagesia, Supraclavicular

Limberg Flap Versus Open Procedure in Treatment of Chronic Pilonidal Sinus

Objective: The main purpose of the study is to compare the outcomes of Limberg flap and open procedure to treat the chronic pilonidal sinus. Pilonidal sinus is a disorder of the sacrococcygeal region mostly found in younger folk. Its treatment consists of several methods but in this study, we will go through Limberg flap and open procedure to compare the outcomes of both methods. Study design: Comparative study. Material & Methods: This study was conducted from January 2020 to December 2022. 84 patients included 59 males and 25 females having age between 18 to 40 years were part of the study. All the selected patients were diagnosed with chronic pilonidal sinus and recommended for surgery at sugery Unit1 sir ganga ram hospital Lahore, Pakistan. A total of 84 patients were divided into two groups, group1 consists of 42 patients treated for the Limberg flap technique. Group 2 also contains 42 patients treated for an open procedure. The patients who were suffering from the chronic pilonidal sinus were part of the study while patients who had acute inflammation of the sinus, history of previous treatment of pilonidal sinus were omitted from the study. Results: Out of 84 patients 42 were part of group 1 and the remaining 42 were in group 2. In group1, the mean ±SD age of patients was 26 ± 2.00, 30 (71.4%) males and 12 (28.5%) females. While in group2 the mean ±SD age was 25 ± 3.00, 29 (69%) were males and 13 (30.9%) females were part of this group. The measured p-value for both groups was <0.05. General characteristics of patients show that high percentage of males was affected from pilonidal sinus disease. In group1 patients who had a 2 days stay at the hospital, recurrence was reported in 10 (23.8%) patients with P-value >0.05, irregular scar formation was observed in 16 (38%) patients, the pain was reported in 18 (42.8%) patients, and wound healing after 2 weeks was noted in 20 (47%) patients. In group 2, patients had 6 days stay at the hospital, recurrence was reported in 13 (30.9%) patients with value >0.05, irregular scar formation was observed in 26 (61%) patients, the pain was reported in 34 (80%) patients and wound healing after 2 weeks was noted in 12 (28.57%) patients. p-value was measured <0.05 for all the parameters. Conclusion: Eventually, we concluded significant results of the Limberg flap than the open procedure. A high percentage of complications were measured in patients treated with the open procedure in comparison to the Limberg flap. Keywords: Chronic pilonidal sinus, Limberg flap, open procedure.

Determination of Dietary Knowledge among Patients Suffering from Chronic Renal Failure

Chronic renal diseases are usually mentioned as decreased functioning of kidneys. The main symptoms includes in this disease are kidney damage, greater loss of albumin in urine and a reduced glomerular filtration rate (GFR). The present study was aimed to determine the dietary knowledge about the patients that suffered in chronic renal failure along with various other impediments. A transverse study was performed for 4 months in Sir Ganga Ram Hospital and dataof one hundred patients with chronic kidney failure and impediments were selected. A non-probability sampling method was used to conduct this study. Out of the total 100 patients, 36% of patients knew the renal diet. While, only 28% of patients knew about potassium, 16% about phosphorous and 20% about salt restrictions. Similarly, 57% knew about red meat and 56% knew about pulses restriction. The symptoms of studied disease was more prevalent in males as compared to females which showed gender as major factor for the renal failure. The majority of sufferers were unaware of the renal diet and electrolyte restriction in diet. Moreover, patients were also using excessive fluid against the advice of doctors. It was concluded there is need to conduct such studies to aware the necessity of appropriate dietary in control of chronic renal failure.

Treatment of Pilonidal Sinus: Comparison of primary closure by Karydakis Technique and Wide Local Excision

Treatment of pilonidal sinus is controversial. Outcome of wide excision and asymmetric closure of pilonidal sinus by Karydakis technique in uninfected pilonidal sinus was compared in this prospective randomized study, comprising of 40 patients, conducted in the Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan. Hospital stay and healing time was shorter, 6.75±3.11 versus 9.75±4.16 days, and days 10.75±5.40 versus 47.30±14.11 days respectively (p-value