Tertiary Care Center In Pakistan Research Articles

“Navigating the diagnostic challenges in Homocystinuria: Insights from a tertiary care center in Pakistan”

“Navigating the diagnostic challenges in Homocystinuria: Insights from a tertiary care center in Pakistan”

Exploring treatment outcomes in Stage II-III rectal cancer patients undergoing neoadjuvant therapy at a tertiary care center in Pakistan: a comprehensive analysis of pathological outcomes.

Rectal cancer treatment has transformed in recent years, with neoadjuvant treatment (NT) and total neoadjuvant treatment (TNT) aiming to enhance pathological responses. This pioneering study in our country delves into rectal cancer management, offering crucial insights by examining pathological outcomes in patients treated with the NT and TNT approach, shaping the evolving landscape. In this retrospective-cohort study spanning January 2017 to December 2022 at a tertiary care hospital in Pakistan, ethical approval was obtained to examine outcomes of two treatments. Patients were divided into TNT (chemoradiation and pre-surgery 5 FU-based chemotherapy) and NT (chemoradiation, surgery, and subsequent 5 FU-based chemotherapy). The primary end-point was response rates-no response, pathological complete response (pCR), near complete response (near CR), and partial response (PR). The Chi-Square Test for Independence assessed the association between treatment response and type (TNT or NT). Data analysis used STATA MP 64; significance was set at p < 0.05 for all two-tailed tests. We analyzed 77 patients, 60 underwent standard neoadjuvant chemoradiation, and 17 followed the total neoadjuvant approach. Predominantly male, most were > 65 with ECOG 0-1. The TNT group showed higher response rates (76% vs 62%, p = 0.039), with 40.38% achieving pCR. In the overall population, pCR and near-CR were similar (27.2% vs 26%), while PR were 14%. Treatment characteristics correlated significantly with chemotherapy type, concurrent chemoradiation, LVI, PNI, and T, N, M staging (p < 0.05). Median overall survival was not reached, and mean survival was 89.1months (CI: 95.0 to 83.3). Side effects varied, with notable differences in neuropathy, diarrhea, oral mucositis, and thrombocytopenia between NT and TNT groups. Our study adds to evidence favoring neoadjuvant approaches in managing rectal cancer in pakistan. Demonstrating a favorable pcr rate, ongoing research with extended follow-up is essential, given the dynamic landscape of rectal cancer treatment for improved patient outcomes.

Atropine 0.01% Eye Drops for Myopia Control in a tertiary care center of Pakistan: An interventional case series

Purpose: To evaluate the real time results of once-dailyAtropine 0.01% eye drops in controlling myopia. Study Design: Interventional case series. Place and Duration of Study: The Eye Centre, South City Hospital, Karachi from September 2020 to August 2021. Methods: One hundred(both) eyes of 50 children were included in the study using non-probability consecutive sampling technique. Baseline spherical equivalent refraction(SER) was recorded at the initiation of treatment.The endpoint was measuring the rate of progression in SER at one year after treatment. Responders weredefined as the ones with either no progression of myopia or worsening of myopia of ≤ -0.50 SER and non-responders were defined as ones with a progression rate of myopia of greater than0.50 SER. Results: The baseline means SER for 100 eyes was 3.25±1.37 D. On follow-up after 12 months of treatment with Atropine 0.01% eye drops, the mean SER was -3.74 ± 1.34 D. The rate of SER progression was significantly lower at one year follow-up (p-value&lt;0.001). The percentage of responders was84%. Conclusion: Significant reduction in myopia progression occurred after treatment with Atropine 0.01% eye drops in a greater percentage of children. This has led us to be confident in providing Atropine 0.01% eye drops along with simple spectacles as an effective treatment strategy to control myopia progression.

Determining the cost of acute stroke care for a single stay at a tertiary care centre in Pakistan.

To assess the economic burden of acute stroke, and to determine the average cost of acute stroke care for a single hospital stay in a public tertiary care hospital. The cross-sectional study was conducted at the Medical Teaching Institute, Bacha Khan Medical Complex, Swabi, Pakistan, from May 16 to September 19, 2022, and comprised patients of either gender who were hospitalised with an acute stroke for the first time. All costs incurred during the care of the patients were measured using the micro-costing methodology, and the association of the cost with other variables was evaluated. Data was analysed using SPSS 24. Of the 34 patients, 24(70.6%) were males and 10(29.4%) were females. The overall mean age was 66+/-13.00 years. The mean length of hospital stay was 4+/-3.00 days. The mean total cost was 18,156+/-9,068 Pakistani rupees, which was the equivalent of 76.89+/-38.4 United States dollars. The cost of the first day of admission was the highest, declining per day as the stay progressed, and imaging/laboratory investigations formed the highest component of the overall cost (p<0.001). The cost of acute stroke care was found to be high even in a public hospital. The length of hospital stay was the most important determinant of the overall cost.

Chronic Granulomatous Disease; Experience of a Rare Primary Immunodeficiency from a Tertiary Care Center in Pakistan

Objective: To determine the clinical parameters, consanguinity of parents, previous family history of primary immunodeficiency (PID) and Neutrophil oxidative index (NOI) of Dihydrorhodamine (DHR) assay in chronic granulomatous disease (CGD). Study Design: Cross-sectional study. Place and Duration of Study: Immunology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from Jan 2015 to Dec 2020. Methodology: A total of 18 patients with chronic granulomatous disease were diagnosed over six years by Dihydrorhodamine assay on flow cytometry, in our institute. Results: The mean age of patients at the time of symptoms was 4.0±3.01 months, while diagnosis was made at the mean age of 42.02±46.00 months. In 6 years, 13(72%) males and 5(28%) females were diagnosed with chronic granulomatous disease by DHR assay on flow cytometry. Parents of fifteen patients (83%) had consanguineous marriages, and 8(44%) patients had positive family history of PIDs. DHR assay showed two mothers had carrier states. The commonest clinical presentation noted was recurrent respiratory tract infections in 16 (89%) patients, repeated abscesses were seen in 13 (72%) and 5(28%) patients had a history of tuberculosis. Conclusion: Chronic granulomatous disease should be suspected in patients with repeated chest infections (especially with catalase-positive organisms), abscesses, diarrhoea and death of siblings at an early age with undiagnosed PID.

Utility of pudendal nerve electrodiagnostics in cases of bladder-bowel dysfunction- A retrospective study from a tertiary care center in Pakistan

Background and Objective:&#x0D; Electrodiagnostic studies play a crucial role in identifying neurogenic and non-neurogenic causes of bladder and bowel dysfunction. Such data is scarce in Pakistan. The objective of this study was to evaluate utility of pudendal nerve assessment in bladder-bowel dysfunction.&#x0D; Methods: &#x0D; A retrospective observational study was carried out at the neurophysiology lab in Aga Khan University Hospital. Patients referred for electromyography/nerve conduction studies (EMG/NCS) for pudendal nerve assessment from June 2013 to June 2023 were included. Clinical data, EMG/NCS results, and demographic information were analyzed using SPSS.&#x0D; Results: &#x0D; Twenty patients (11 male and nine female) were included. Five patients experienced backache radiating to one or both lower extremities, along with urinary or fecal incontinence. Three patients had urinary incontinence, and additional three presented with both urinary and fecal incontinence. Three patients reported perianal numbness. Four patients had fecal incontinence, while one patient each reported painful defecation and backache along with perianal numbness. Three patients were diagnosed with pudendal neuropathy, out of which one had a coexisting lumbosacral radiculopathy as well. Five patients had isolated lumbosacral radiculopathy. Twelve patients exhibited normal EMG/NCS results.&#x0D; Conclusion: &#x0D; This study highlights the diagnostic utility of EMG/NCS in diagnosing pudendal nerve injuries. Despite its widespread use worldwide, the utilization of these tests in Pakistan is hindered by factors such as limited awareness, inadequate training, and resource constraints.

Epidemiology of a Hospital-Based Pediatric Cancer Registry - An Experience at a Major Tertiary Care Center in Pakistan

Background: Cancer is a prominent non-communicable disease, responsible for more than 8 million deaths each year worldwide. Globally, 400,000 children and daily 1000 children are diagnosed with cancer. Objective: The current study aims to analyze retrospective childhood cancer registry data from IHHN since 2016 and provide the Age Standardized Incidence Rates (ASIR) for children having different types of malignancies. Method: A retrospective study was conducted through a chart review of the childhood cancer registry, data retrieved from the Indus Paediatric Oncology Database (IPOD) software. Only patients with behavior code/3 for positive malignancy, as defined in the International Classification of Disease for Oncology, 3rd edition (ICD-O-3) were included in the dataset. Results: A total of 4631 children diagnosed with cancer were enrolled, with 2951 (63.7%) males and 1680 (36.3%) females. Overall median age and Interquartile range were 7(3.3-11) years. Leukemia was the predominant cancer in both genders, the second highest being lymphoma. Central Nervous System (CNS) tumors were the third highest cancer in males and soft tissue sarcomas in females. Hepatic tumors are the least common among genders. Conclusion: In conclusion, the childhood cancer registry at the Indus Hospital and Health Network (IHHN) reported standard quality data including patients mostly from Sindh and Baluchistan along with other provinces and neighboring countries. Moreover, at the national level, there is an essential need for the formulation of an effective childhood cancer registration system by policymakers to determine the true incidence rate and etiology of common cancers.

A Comprehensive electroencephalogram audit in a tertiary care center in Pakistan: demographic distribution, referral indications and findings

Background and Objective:&#x0D; Electroencephalography (EEG) is a widely employed non-invasive technique for recording brain electrical activity, pivotal for diagnosing various neurological conditions. The study aims to provide insight into demographic distribution, referral indications, and EEG findings in a tertiary care hospital in Pakistan.&#x0D; &#x0D; Methods:&#x0D; A retrospective cross-sectional analysis was conducted involving 2,924 patients who underwent routine EEG evaluations over a three-year period. Data was collected from the EEG records after approval from the ethical review committee. Demographic variables, referral reasons, and EEG findings were recorded and analyzed using descriptive statistics.&#x0D; &#x0D; Results:&#x0D; The study revealed a gender distribution of 41.35 % females and 58.65 % males, aligning with broader epidemiological trends. Participants were categorized into different age groups and most of the patients in our study belonged to the five to 18 years of age group. Most common indication was a suspected seizure disorder (78.32 %), followed by subclinical seizures (7.38 %) and medication adjustment (6.81 %). Notably, encephalopathy was the most common abnormal EEG finding (31 %), with temporal epilepsies being predominant within the focal seizure category.&#x0D; &#x0D; Conclusion:&#x0D; The descriptive nature of the study contributes novel insights. The study’s contribution provides valuable guidance for healthcare professionals, enhancing their comprehension of neurological conditions and refining diagnostic and treatment strategies.

Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent – An Experience From a Tertiary Care Center in Pakistan

Objectives: To estimate the prevalence of non-calcified coronary artery disease in patients with chest pain and a zero coronary artery calcium score, and to assess the prognostic significance of a zero coronary artery calcium score in these symptomatic patients.&#x0D; Methodology: All consecutive patients who underwent a CT coronary angiogram (CTCA) for evaluation of angina or angina-equivalent symptoms from 2009 to December 2020 were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. Follow-up data was collected by using the hospital's electronic patient record system and telephone communication. The endpoint, major-adverse cardiovascular events (MACE) was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization.&#x0D; Results: A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). Chest pain was the most common presenting complaint (97.4%) followed by dyspnea. At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (&gt;50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. The mean follow-up duration was 96.6 months ± 49.8 (range 21 – 194 months). All-cause Major Adverse Cardiovascular Event (MACE) was observed in 8.8% of patients. The most common MACE outcome was angina (3.96%) and all-cause mortality (3%). Only 2.7% required revascularization on follow-up with 1.2% having myocardial infarction and non-urgent revascularization. The baseline characteristics, all-cause MACE (p = 0.79), mortality (0.82), angina (p = 0.765), revascularization (p = 0.45), non-fatal MI, and non-elective revascularization (p = 0.6) did not differ significantly in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE.&#x0D; Conclusion: The incidence of soft plaque in this South Asian cohort is higher than that reported in international studies. However, in symptomatic South Asians, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.

Missed opportunities to prevent hypertension at a tertiary care centre in Pakistan.

Cardiovascular disease is the leading cause of mortality worldwide, affecting ~1.28 billion adults, and ~46% of these adults are not aware of their condition. One-third of patients do not receive appropriate care for their cardiovascular disease. To identify missed opportunities to prevent cardiovascular disease and its associated risk factors. This study was conducted among 359 adult patients aged 18-77 years leaving the outpatient department of Civil Hospital, Karachi, Pakistan, during June to September 2020. We recorded their sociodemographic information, perceived duration of clinical consultation, body weight and height, and blood pressure. We investigated if their physicians obtained sufficient medical history, performed medical examination, or counselled them on cardiovascular disease risk factors. Data were analysed using SPSS version 24.0. Almost all the participants (98%) had at least 1 risk factor for hypertension. Only 35.9% of those in the highrisk group with ≥ 3 risk factors received counselling from a physician about their hypertension, leaving a 37.6% missed opportunity rate. The frequency of missed opportunities for the prevention of cardiovascular disease, and the risk factors for hypertension were high among the study population. This was partly due to excess workload of the attending physicians; the outpatient departments were used more for the treatment of general ailments than for specialist and referral care. It is recommended to establish primary care clinics within the tertiary settings where cardiovascular risk factors can be evaluated and patients referred for appropriate care.

Clinical presentation, evaluation, and management of patients with myasthenia gravis at a tertiary care center in Pakistan

Note: The editors of PJNS are aware that this article contains old data. However, we have decided to publish this article because a) the data is still important as there is paucity of data in this regard from Pakistan, and b) the authors have written the article well and have mentioned this limitation of their manuscript.&#x0D; Background and objectives:&#x0D; Little is known about the clinical profile and outcome of myasthenia gravis in Pakistan. The objective of this study is to review the clinical characteristics of patients with myasthenia gravis in Pakistan, and the outcome of investigations and treatment.&#x0D; Methods: &#x0D; The study comprised a retrospective review of charts of patients diagnosed with myasthenia gravis at Aga Khan University Hospital in Karachi, Pakistan, over a period of 16 years from 1987 to 2003. The following features were reviewed: (i) clinical presentation, (ii) investigations especially nerve conduction studies, acetylcholine receptor antibodies, and imaging studies of the thorax, (iii) treatments administered (including thymectomy). Data analysis was done using Excel sheets.&#x0D; Results: &#x0D; Of the 83 patients, 51(61.4%) were males, whereas 32 (38.6%) were females. The age range was from 12 to 81 years, mean age of 43.7 years (SD± 18.2). In the 60 years plus group, there were three times as many males as compared to females. Limb weakness was noted in 58 (69.9%), ocular symptoms in 57(68.7%), and oropharyngeal symptoms in 54(65.1%) patients. Three (3.6%) presented in a state of myasthenic crisis. Tensilon test was performed in 34 patients and was positive in 31(91.2%), repetitive nerve conduction studies (RNS) were performed in 37 patients and was positive in 26(70.3%), acetylcholine receptor antibodies were done in 60 patients, and were positive in 55(91.7%). Thymic enlargement was seen in 28 out of 43 patients who underwent CT-Scan/MRI studies of the thorax. Besides pyridostigmine, most patients received immunosuppressive therapy with either steroids or azathioprine or both. The thymectomy was performed in 44 patients. &#x0D; Conclusion: &#x0D; The general disease pattern of MG, as noted in our series, appears to follow a similar pattern as noted worldwide. However, this retrospective and hospital-based study has its limitations, and more prospective and epidemiological studies are needed.

Outcomes of Allogeneic Stem Cell Transplant in Chronic Myeloid Leukaemia - A Single-Centre Experience from Pakistan

Objective: To determine indications and outcomes of stem cell transplant in Chronic Myeloid Leukemia in a tertiary care centre in Pakistan. &#x0D; Study Design: Retrospective longitudinal study&#x0D; Place and Duration of Study: Armed Forces Bone Marrow Transplant Center, Rawalpindi Pakistan, from Jan 2002 to Jan 2019.&#x0D; Methodology: Retrospective analysis of all the patients who had undergone transplants for chronic myeloid leukaemia at our centre from 2002 to 2019 was done. Cases enrolled included patients of both genders and any age for whom data related to disease status and follow-up post-transplant was available. Patients with incomplete records and follow-ups were excluded from the study.&#x0D; Results: Out of 73 patients, data from 53 patients was analyzed. At a median follow-up of 40 months, overall survival was 72%. Survival in patients &lt;40 years was better (78%) compared to the &gt;40 years (50%). Among the three conditioning regimens, Bu16Cy120 was the most commonly used (n=35, 66%) and had better overall survival (n=29, 83%) though statistical significance could not be established (p=0.172).&#x0D; Conclusion: In addition to the established indications of resistance or intolerance to tyrosine kinase inhibitors for bone marrow transplant in CML, the non-availability/ affordability, young age, and lack of access to novel drugs can be included in underdeveloped countries like Pakistan.

Auxiliary partial orthotopic liver transplantation (APOLT) for Crigler-Najjar syndrome: A retrospective analysis

BackgroundCrigler-Najjar syndrome is an ultra-rare hereditary disorder characterized by severe jaundice and risk of neurological complications. Current treatments, such as phototherapy, have limitations, and liver transplantation is often necessary. Auxiliary partial orthotopic liver transplantation (APOLT) is a potential treatment option. Still, its safety and efficacy in Pakistani patients with Crigler-Najjar syndrome Type I (CNS-I) have not been well established. MethodsThis retrospective study reviewed the outcomes of five pediatric patients with CNS-I who underwent APOLT at a tertiary care center in Pakistan. Patient demographics, surgical details, postoperative course, complications, and follow-up data were analyzed. The primary endpoint was the feasibility and safety of APOLT, while secondary endpoints included improvement in serum bilirubin levels, neurological symptoms, and survival rates. ResultsAmong five patients diagnosed with CNS-I, APOLT was performed without intraoperative complications. During the median follow-up period of 6 months, there were no cases of relaparotomy, graft rejection, biliary complications, or portal venous thrombosis. One patient developed a portal venous stricture, but his symptoms were controlled with conservative measures. Postoperative liver function tests showed a significant improvement, with an average reduction of 90% in serum bilirubin levels. There was some improvement in neurological symptoms, and the overall patient and graft survival rate was 100%. ConclusionThis study suggests that APOLT is a feasible and safe treatment option in patients with CNS-I. It improves liver function, bilirubin levels, and neurological symptoms. Further research with larger sample sizes is warranted to confirm these findings and evaluate the long-term outcomes of APOLT in this patient population.

Five-Year Experience of Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation from a Tertiary Cardiac Care Center of Pakistan: A Retrospective Chart Review

Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan. Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up. Results: We enrolled all 50 patients (34 male, 68%; mean age 55.14 ± 7.94 years) treated with PVI using CB-Adv. The mean duration of symptoms was 30.28 ± 13.48 months. PVI with CB-Adv was found to be curative in 49 patients (98%). Following the procedure, pericardial effusion was found in one patient (2%), whereas one patient (2%) had a retroperitoneal hematoma. On a six-month follow-up, only one patient (2%) had a recurrence of Ata, which was PAF. Conclusion: Our experience of PVI with CB-Adv has shown a high success rate of the procedure for rhythm control in patients who have PAF, which is resistant to antiarrhythmic drugs (AADs).

Impact of an outpatient palliative care consultation and symptom clusters in terminal patients at a tertiary care center in Pakistan

BackgroundPatients with terminal diseases may benefit physically and psychosocially from an outpatient palliative care visit. Palliative care services are limited in Pakistan. An improved understanding of the symptom clusters present in our population is needed. The first outpatient palliative care center in Karachi, Pakistan, was established at our tertiary care institution. The primary aim of this study was to evaluate the impact of a palliative care outpatient consultation on symptom burden in patients with a terminal diagnosis. The secondary aim was to analyze the symptom clusters present in our population.MethodsPatients with a terminal diagnosis referred to our outpatient palliative department between August 2020-August 2022 were enrolled. The Edmonton Symptom Assessment Scale (ESAS) questionnaire was administered at the initial visit and the first follow-up visit at one month. Change in symptom burden was assessed using a Wilcoxon signed ranks test. A principal component analysis with varimax rotation was performed on the symptoms reported at the initial visit to evaluate symptom clusters. The palliative performance scale (PPS) was used to measure the performance status of palliative care patients.ResultsAmong the 78 patients included in this study, the average age was 59 ± 16.6 years, 52.6% were males, 99% patients had an oncological diagnosis, and the median duration between two visits was 14 (Q1-Q3: (7.0, 21.0) days. The median PPS level was 60% (Q1-Q3: 50–70). Overall, ESAS scores decreased between the two visits (6.0 (2.8, 11.0), p < 0.001) with statistically significant improvement in pain (5.0 vs. 2.5, p < 0.001), loss of appetite (5.0 vs. 4.0, p = 0.004), depression (2.0 vs. 0.0, p < 0.001), and anxiety (1.5 vs. 0.0, p = 0.032). Based on symptoms at the initial visit, 3 clusters were present in our population. Cluster 1 included anxiety, depression, and wellbeing; cluster 2 included nausea, loss of appetite, tiredness, and shortness of breath; and cluster 3 included drowsiness.ConclusionAn outpatient palliative care visit significantly improved symptom burden in patients with a terminal diagnosis. Patients may benefit from further development of outpatient palliative care facilities to improve the quality of life in terminally ill patients.

Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years’ clinical experience from a tertiary care center in Pakistan

BackgroundUterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes.MethodsA single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan–Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis.ResultsOf the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40–55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival.ConclusionUterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.

Neuropathy following intramuscular injections: a clinical and neurophysiological study from a tertiary care centre in Pakistan.

To assess the clinical and neurophysiological profile of peripheral nerve injuries in patients following intramuscular injections. The descriptive, cross-sectional study was conducted at the Department of Neurology, Mayo Hospital, Lahore, Pakistan, from July 2019 to January 2021, and comprised adult patients of either gender with isolated peripheral nerve injuries following intramuscular injections. Nerve conduction studies were performed for each patient. Data was analysed using SPSS 26. Of the 99 patients, 59(59.6%) were males and 40(40.4%) were females. The mean age was 26.7+/-18.1 years, 34(34.3%) patients were under weight and 78(78.8%) were either illiterate or had low literacy level. Radial nerve was involved in 56(56.6%) cases, followed by sciatic in 39(39.4%) and axillary nerve 4(4.04%). Overall, 14(14.14%) injection had been administered by doctors, while the other 85(85.85%) were given by paramadics. Marked reduction in compound muscle action potential 72(72.7%) and sensory nerve action potential 82(82.8%) was noted, while re-innervation was seen in 78(78.7%). Intramuscular nerve injuries can be greatly minimised by spreading awareness regarding safe injection techniques and strict implementation of standard operating procedures in hospitals and clinics.

92P Management and treatment outcomes of malignant retroperitoneal tumors following resection: Experience of a tertiary care center in Pakistan

92P Management and treatment outcomes of malignant retroperitoneal tumors following resection: Experience of a tertiary care center in Pakistan

Risk Factors Associated with Early Onset Group B Streptococcal Disease and Newborn Outcomes in a Tertiary Care Center in Pakistan

Background: To assess the risk factors associated with early onset group B streptococcal disease and newborn outcomes in a tertiary care center in Pakistan. Methods: A prospective cohort study design was implemented in the postnatal wards and neonatal intensive care unit of Aga Khan Hospital between 15 December 2021 – 15 June 2022. The exposed group included all pregnancies with risk of GBS infection, the un-exposed group included all pregnancies with no risk factors for GBS. All births were followed for outcomes during admission and after discharge for 28 days of life. Information about the mother and baby dyad was retrieved from the medical records. A second proforma was filled out at the time of discharge (2 to 5 days of life for healthy babies and at 10 to 15 days of life for babies admitted for NICU). These were the average length of stay of healthy and ill newborns at our facility.) The final follow up was at 28 days of life which was at the clinic or telephonic. Data on morbidities such as sepsis, use of antibiotics and hospitalization breast feeding practices was captured at the day 28 follow up. Results: A total of 78 patients were included, with a mean maternal age of 30.82 ± 4.65 years and gestational age of 37.26 ± 2.1 weeks. GBS colonization was positive in high vaginal swab in 23 (29.5%) patients, in urine culture in 16 (20.2%) patients, and 1 (1.3%) patient who delivered a previous baby with GBS infection. Two patients suffered from pneumonia among them one patient also had sepsis and 77 patients were stable at 28 days. In 16 (41%) cases of GBS colonization, high vaginal swab yielded a negative result. Similarly, in 23 (59%) patients with GBS colonization, urine culture was also negative. Only one patient with GBS colonization had a history of a previous infant with GBS infection. Approximately 70% of GBS positive had PROM. Maternal Leukocytosis and tachycardia were significantly higher in patients with GBS (p&lt;0.0001). Uterine tenderness was found in 14 (35.9%) mothers with GBS colonization (p&lt;0.0001). Intrapartum fever was significantly more common in mothers with GBS colonization (p=0.011). Tachycardia was significantly higher in neonates of mothers with GBS colonization (p=0.01). Need of oxygen was significantly higher in neonates with mothers having GBS colonization (p=0.002). Conclusion: In hindsight, GBS colonization and the early onset of Group B streptococcus infection is a public health issue in Pakistan that requires attention. Recommended antenatal screening measures should be implemented, as well as the necessary steps, such as an antibiotics treatment regimen following a positive GBS colonization report, to protect newborns from this disease. Keywords: colonization, maternal risk factors, group B streptococcal, early onset group B streptococcal disease, GBS, PROM

Changing Prevalence of Emergency Obstetric Hysterectomy, Its Indications and Maternal Outcomes Over a 4-year Period at a Tertiary Care Center in Pakistan

Changing Prevalence of Emergency Obstetric Hysterectomy, Its Indications and Maternal Outcomes Over a 4-year Period at a Tertiary Care Center in Pakistan