Journal of Rawalpindi Medical College
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Analgesic Efficacy Of Preoperative Versus Postoperative Ultrasound-Guided Transverse Abdominis Plane Block For Laparoscopic Cholecystectomy
No full textObjective: In enhanced recovery procedures, the transversus abdominis plane (TAP) block is applied as one of the multimodal pain control techniques. The study evaluated whether administering an ultrasound-guided TAP block before or after laparoscopic cholecystectomy is more effective for managing postoperative pain within enhanced recovery protocols.
Methods: A prospective study was conducted at PAF Hospital Mushaf Sargodha between July 2024 and December 2024. Patients who met the criteria for laparoscopic cholecystectomy were split randomly into two groups (n=50 for each group). Patients in the preoperative group (PG) had a bilateral ultrasound-guided transversus abdominis plane block performed with 20 cc of bupivacaine 0.25% performed on them after the induction of general anaesthesia. A visual analogue scale was used to evaluate the patients’ levels of pain when they were first brought into the recovery room, as well as after four, eight, twelve, and twenty-four hours had passed. The pain score recorded in the recovery room as well as at the 4th, 8th, 12th, and 24th hours is the primary outcome.
Result: The ultrasound-guided TAP block resulted in a significantly reduced pain score in the POG group in comparison to the PG group with stable hemodynamic parameters (heart rate and mean arterial pressure). Following the operation, the POG patients reported significantly less pain when coughing at 4,8,12 and 24 hours. The POG consistently had considerably higher levels of patient satisfaction across the board. Patients in the POG had much lower rates of post-operative nausea and vomiting and required a longer time duration before rescuing analgesic demand than patients in the PG group.
Conclusion: When it comes to giving postoperative analgesia, our study suggested that postoperative TAP block is more effective than preoperative TAP block.
Keywords: analgesic, ultrasound, Laparoscopic cholecystectom
Urgency Or Emergency; Effective Management Of Hypertensive Crisis In Pregnancy
Full text linkObjective: Hypertension affects approximately 10% of pregnancies worldwide, contributing significantly to maternal morbidity and mortality. Severe hypertension in pregnancy is defined as systolic blood pressure exceeding 160 mmHg and diastolic blood pressure greater than 110 mmHg, persisting for more than 15 minutes. This condition represents an obstetric emergency that necessitates immediate and appropriate management.
Methods: A quasi-experimental study was conducted at a tertiary care centre in Rawalpindi. The study included 70 patients, divided into two groups: Group 1 (n = 35) received oral nifedipine, while Group 2 (n = 35) was treated with intravenous labetalol. Treatment was initiated with 5 mg of oral nifedipine and 20 mg of intravenous labetalol as part of a gradual dose-escalation protocol designed to reduce pharmacological risks while ensuring effective blood pressure control.
Results: The findings revealed that therapeutic blood pressure was achieved significantly faster in the nifedipine group (mean time: 22.3 ± 11.5 minutes) compared to the labetalol group (mean time: 33.5 ± 13.3 minutes, p=0.03). Additionally, fewer doses were required in the nifedipine group than in the labetalol group. The rate of treatment failure was notably higher among patients treated with intravenous labetalol.
Conclusion: Oral nifedipine proved to be as efficacious and safe as intravenous labetalol, with the added advantage of convenience in low-resource settings.
Keywords: Pregnancy-induced hypertension, nifedipine, labetalol, failed treatment, Preeclampsi
Assessing The Relationship Between Dental Practitioners’ Empathy And Emotional Intelligence In A Public Institute. A Cross-Sectional Study
Full text linkObjective: The purpose of the study is to determine the relationship between empathy and emotional intelligence among dental at a public institute in Karachi.
Method: A cross-sectional study was conducted at Karachi Medical & Dental College from January 2023 to August .
For this study, we targeted 250 active dental practitioners that including fresh dental graduates, dental consultants and postgraduate residents. Data collection tools used in this study were the HP (Health Professionals) version of the JSPE scale and Schutte’s Emotional Intelligence Scale (SEIS). SPSS 2 with Mann-Whitney U Test, Kruskal-Wallis Test, one ANOVA and Pearson correlation was applied to test the hypothesis.
Results: Out of 250 targeted participants, 224 responses were received (response rate 89.6%). Mann-Whitney U Test and the Kruskal-Wallis test showed a statistically significant relation between empathy with gender and dental practitioners stratified according to qualification, with a p value of 0.044 and 0.012, respectively. Pearson correlation test showed a moderate correlation between empathy and emotional intelligence of dental practitioners an R-value of 0.0682.
Conclusion: This study found significant variation in empathy by gender, qualification, and occupation of the participant, while EI only differed between occupations. The finding in this study supports the inclusion of emotional competency training in dental education, primarily focused on providing better patient-centred and dental care for our patients.
Keywords: Empathy, emotional intelligence, dentistry, dentists, education
Comparison Of The Outcome Of Distal Radius Intra-Articular Fracture Treated With Volar Locking Plate Versus Wrist Spinning External Fixator
Full text linkObjective: To compare the functional outcome of patients with comminuted intra-articular distal radius fractures managed with volar locking plate and wrist spanning external fixator using the QuickDASH Score.
Methods: This prospective comparative study was conducted at –removed for blind review-- from December 2024 to May 2025, and a total of 46 patients were included in the study, with 23 patients in each group. Non-probability consecutive sampling was used. The QuickDASH score was calculated after the 16th post-operative week. The functional outcome score between the two groups was analysed using an independent sample t-test using SPSS 27.
Results: The mean age of patients in the VLP group was 48.00 ± 10.78 years, while in the Exfix group it was 45.43 ± 12.09 years. A higher proportion of patients were male, accounting for 73.9% of the study population, whereas females comprised 26.1%. The mean QuickDASH score in the VLP group (8.38 ± 3.43) was significantly lower than the mean score in the Exfix group (11.16 ± 3.99), indicating better functional outcomes in the VLP group. This difference was statistically significant with t(44) = -2.532 and p = 0.015.
Conclusion: Management of distal radius, comminuted intra-articular fractures with volar locking plate offers superior short-term functional outcomes, as demonstrated by lower QuickDASH scores at 16 weeks postoperatively.
Keywords: radius fracture, Intra-articular fractures, External fixator, Comminuted fracture, Anatomical reduction, Premature degenerative osteoarthriti
Impact of Polycystic Ovaries on Maternal and Fetal Complications in Pregnant Women: A Case-Control Study
Full text linkObjective: The objective of this study was to investigate the association between polycystic ovaries (PCOs) and maternal complications during pregnancy.
Methods: This prospective case-control study was conducted at Shahida Islam Medical Complex from November 2024 to June 2025. Data was collected from inpatient pregnant females. Demographic information was recorded, and patients were divided into cases and controls based on the status of PCOs, as diagnosed clinically according to the Rotterdam criteria. Before delivery, 5ml of venous blood was collected for estimation of lab parameters. Patients were followed till delivery, and maternal-fetal outcomes were recorded.
Results: A significant association between PCOS and gestational diabetes was found (ꭕ=11.35, p< 0.0001). Logistic regression analysis, using a backwards stepwise method, identified LH, FSH, Testosterone, Insulin Resistance, and Systolic BP as significant predictors of Gestational Diabetes. Notably, higher levels of LH and FSH were associated with increased risk (p < 0.0001 and p = 0.0000, respectively). The correlation matrix confirmed strong correlations between Testosterone and LH (r = 0.83), and between Insulin Resistance and Glucose levels (r = 0.83), highlighting metabolic dysfunctions in PCOS. Conclusion: These findings underscore the critical role of hormonal imbalances and insulin resistance in increasing the risk of pregnancy complications in PCOS patients, emphasising the need for early screening and intervention.
Keywords: Polycystic Ovary Syndrome, Pregnancy Complications, Gestational Diabetes Mellitus, Insulin Resistance, Pregnancy Outcome, Hypertension, Pregnancy-Induced, Maternal Health, Neonatal Outcome
Exploring Acetabular Index Pattern In Pakistani Healthy Children Aged 1-8 Years
No full textObjective: To determine the acetabular index values of healthy Pakistani children aged 1 to 8 years and to identify the prevalence of primary acetabular dysplasia, which may progress to hip dislocation or resolve to a normal hip.
Method: This cross-sectional study includes radiographic evaluation for acetabular index (AI) values in healthy children aged 1–8 years. The study includes pelvis radiographs retrieved from the data database of Ziauddin Hospital, Karachi, exposed for reasons other than hip dysplasia. Voyager Web 4.0 was used to measure the acetabular index on each radiograph. SPSS version 23 was used to conduct statistical analysis according to age, gender, and laterality.
Results: The AI values of healthy Pakistani children in the age group 1 year were 19.440 ±0.25 in boys and 19.450 ±0.28 in girls. That progressively decreased to 11.460 ±0.84 in boys and 11.190 ±0.48 in girls, at 8 years of age. The Acetabular Index (AI), when compared for age, gender, and laterality, was found statistically non-significant (t=0.53, p=0.59). Acetabular Index (AI) had an inverse relationship with age (correlation coefficient r = ¬0.96, p=0.001). For every 1-year increase in age, there was a decrease of 1.17 degrees.
Conclusion: The study revealed acetabular index values of healthy Pakistani children aged 1-8 years, within normal declared values (mean AI 220) for all age groups & gender. Contrary to the published data, AI levels were somewhat higher among boys than girls at 8 years of age. The study found no case with a high acetabular value (AI >250). However, AI levels decrease with the increase in age.
Keywords: Acetabular index, biological variation, Hip Dysplasia, Congenital hip dislocation, Healthy children, Pakista
Impact of Pediatric Tonsillectomy on Parental Quality of Life, Stress, and Work Absenteeism: A Prospective Study
Full text linkObjectives: This study aimed to compare the quality of life, stress levels, and work absenteeism of parents before and after their child underwent tonsillectomy.
Methods: In a prospective longitudinal study, 35 parents, 70% of whom were mothers, of children having tonsillectomy participated. The PARADISE criteria for recurrent tonsillitis were satisfied by every child. The PedsQL Family Impact Module was used to evaluate parental quality of life both before and one month after surgery. A 10-point Likert scale was used to measure stress levels, and information was gathered on missed workdays resulting from child illness. Effect sizes (Cohen's d) and statistical significance were computed. SPSS version 26 was used to conduct the analysis.
Results: Parental QoL levels significantly improved after surgery; the total PedsQL score rose from 50.2 to 72.9 (p < 0.001, Cohen's d = 1.62). Large effect sizes were observed in all subdomains, including cognitive, social, emotional, and physical functioning. Missed workdays dropped from 4.3 to 1.8 days (p < 0.001), and parental stress levels dramatically fell from 8.2 to 4.8 (p < 0.001, d = -2.89). Mothers gained somewhat more QoL than fathers (+24.1 vs. +21.3), according to subgroup analysis.
Conclusion: In addition to easing the children's health burden, tonsillectomy improves parental quality of life, lowers stress levels, and decreases absenteeism from work. These results highlight the wider advantages for families of prompt surgical treatment for recurrent tonsillitis in children.
Keywords: Tonsillectomy; Surgery, Oral; Quality of Life; Parent-Child Relations; Absenteeis
Level Of Depression And Quality Of Life Among Caregivers Of Cancer Patients: Hospital-Based Study
Full text linkObjective: To determine the level of depression and quality of life among caregivers of patients with cancer.
Methods: It was a descriptive cross-sectional study done at the NORI hospital in Islamabad from April 2020 to October 2020. A total of 150 study participants were selected by a purposive sampling technique. The questionnaire consists of a Sociodemographic profile of caregivers, including age, gender, marital status, occupation, relationship to patient, education, duration of caregiving, stage of the cancer of the patient, and type of cancer. To measure participants’ quality of life ‘caregiver quality of life-cancer index’ was used. The CQOLC is a self-administered scale specifically designed to evaluate cancer patient caregiver quality of life. To measure participants’ depression, the Beck depression inventory scale was used.
Results: In this study, 44% of caregivers were under 50years, 70% were female, 88% were married, 44.7% were housewives, and 56% were secondary school graduates. 85 caregivers had been caring for the patient for over a year. 37.3% were the parents of the caregivers. 49.3% were patients with cancers of the reproductive system, and 81 had stage 3 cancer. Mean score of CQOLC (caregiver quality of life index cancer) is 80.625± 3.422, median 80, and range 72-87. 73 (48.7%) showed poor quality of life. Mean score of BDI (beck depression inventory) for depression is 24.4733± 4.877, median (range) 24(19-39). 132 (88%) showed moderate to severe depression. This study showed a significant association of depression with age, gender, relation with the patient, type of cancer, and stage of cancer (P<O.05). Similarly, quality of life has shown an association with age, gender, relationship with the patient, and duration of caregiving (P<0.05).
Conclusion: The results showed that caregivers’ quality of life is affected, and they had mild to moderate depression.
Key words: cancer, caregiver, depression, quality of lif
Epidemiological Characteristics Of Malaria In Kohat Division And Effect Of Current Eradication Program
Full text linkObjective: This retrospective study's purpose was to provide insight into the distribution and trend of malaria cases in the Kohat District of KPK, Pakistan, from 2017 to 2021. The analysis of the sociodemographic traits, annual trends, species distribution, and seasonal fluctuations of malaria cases was the main goal of the study.
Methodology: The DHQ Divisional Headquarter Hospital in Kohat, which is overseen by the KPK, Peshawar malaria control program, provided the laboratory logbook from which the data was taken. Every suspected case of malaria that provided blood samples for microscopy was recorded in the study's logbook. We retrieved and analyzed data on the participant's demographics, pregnant status, diagnostic month and year, and parasite species found.
Results: 10,958 cases of malaria were verified out of 17,832 blood films that were analyzed during the study period. Males (53.2%) and those over the age of five (9,036 cases) accounted for the majority of cases. P. vivax accounted for 88% of the total species, with P. falciparum (10%) and mixed infections (2%), following in order. The majority of those affected were over the age of 15, and males were more likely than females to become infected. Cases of malaria were reported all year round, with summer and fall seeing the greatest transmission.
Conclusion: This study offers important new information about the five-year malaria trend in the Kohat District. The results emphasize the necessity of focused measures to alleviate the greater incidence of malaria in boys older than 15 years. The report also emphasizes how crucial monitoring and surveillance systems are to directing evidence-based treatments and maintaining advancements in the fight against malaria. Subsequent investigations ought to concentrate on executing specific measures and assessing their efficacy, and looking into the effects of climate change on regional transmission of malaria as well
Efficacy Of Intravenous Therapy In Children With Iron Deficiency Anaemia Having Poor Response To Oral Iron Therapy
Full text linkObjective: Iron deficiency is the most common nutritional deficiency worldwide. Common causes of iron deficiency anaemia (IDA) in children are excessive consumption of cow’s milk and prolonged breastfeeding with delayed and poor weaning. The objective of this study is to assess the effectiveness of intravenous iron in children with IDA, with poor compliance to oral iron therapy. This study aims to determine the mean levels of Hb after IV iron therapy in children with iron deficiency anaemia having a poor response to oral iron therapy.
Subjects and Methods: It was a descriptive study. The study was conducted at the Department of Paediatric Medicine, Fatima Memorial Hospital, Lahore. A Total of 119 children fulfilling the selection criteria were enrolled in the study. The absolute dosage of iron was divided into 2 doses administered over two consecutive days. Each IV iron dose was diluted in 100 ml of normal saline in a micro-burette and infused over two hours. Patients were followed up at four weeks to check for haemoglobin levels. All the collected data were entered and analysed by using SPSS v25.0.
Results: A total 119 patients with Iron deficiency anemia (IDA) were enrolled in this study. There were 61(51.3%) males and 58(48.7%) females. Age range in this study was from 6 months to 12 years with a mean age of 7.5±1.5 years. Mean duration of IDA was 8.5±2.3 months. Mean Hb level at baseline was 8.16±0.911 g/dl and 10.76±1.023 g/dl after 4 weeks of treatment and the difference was statistically significant with p-value of 0.001.
Conclusion: Intravenous iron therapy is effective and safe to raise the haemoglobin levels in children with IDA who showed poor compliance to oral iron therapy.
Keywords: Anaemia, Iron-Deficiency, Pediatric, Haemoglobins, Iron, Intravenou