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Role of Hepatic and Renal Biomarkers in Diagnosing Preeclampsia
Full text linkObjective: The study aims to gain insight into the importance of hepatic and renal biochemical parameters AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C in the domain of preeclamptic patients.
Methodology: This prospective cohort study was conducted in Central Park Medical College and Teaching Hospital Lahore from Sep 2023 to Apr 2024 on 300 subjects. Inclusion criteria were pregnant women over 18 years of age, gestational age of 20 weeks, and singleton pregnancy. Women with preexisting hypertension, kidney disease, or other diseases causing liver dysfunction were excluded. Blood and urine samples were collected to measure AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C and data was analysed using an independent t test and Chi-square test by SPSS version 26.
Results: ALT, AST, and bilirubin levels were higher (45±12 p<0.001, mean±SD 55±15 U/L, mean±SD: 1.5±0.4 mg/dL) in preeclamptic women. Creatinine, urine protein to creatinine ratio, and cystatin C (mean±SD: 1.0±0.2 mg/dl, mean±SD: 300±100 mg/g, p 1.2±0.3ng/mL) were raised in preeclamptic women as compared to the control group.
Conclusions: Serum creatinine, urine protein/creatinine ratio, and cystatin C and creatinine were found in women with preeclampsia compared to women without preeclampsia.
Keywords: Preeclampsia, urine protein to creatinine ratio, cystatin C, hepatic and renal biomarker
A Unique Case of Acute Deterioration in Visual Acuity: Vogt-Koyanagi-Harada Disease
Full text linkVogt-Koyanagi-Harada (VKH)disease is a chronic autoimmune inflammatorydisorderwithmultisystem involvement particularly involving the eye, skin, ear and brain. Our patient reported in the Ophthalmology OPD, CMH, Lahore, a 41-year-old female patient who presented with decreased visual acuityof 6/9 and 6/18 in her right and left eye respectively with intermittent tinnitus. Aslit lamp examination revealed bilateral paramacular choroiditis, more pronounced in the left eye. Fundoscopy showed the 'sunset glow fundus.' HerOCTshowedslightflattening ofthe foveal contourinthe left eye withgeneralized foveal thinning while the right eye had parafoveal thickening with a foveal lamellar hole. FFAshowed a serous detachment in herleft eye.Adiagnosis of bilateral incomplete Vogt-Koyanagi-Haradasyndrome was made as she tested negative for infectious diseases. She was started on an oral course of steroids initially but after persistent episodic exacerbations ciclosporin 75mg twice daily was started and regular 2 weekly follow-ups were advised. The mainstay of treatment for Vogt–Koyanagi–Harada disease is systemic corticosteroid therapy but the refractory cases get additional immunosuppressants like ciclosporin which was required in our patient as well.Keywords: Autoimmune, Fovea, Visual acuity
Temporal Analysis of Antimicrobial Susceptibility in Salmonella: A Three-Year Surveillance Study
Full text linkObjective: The study aimed to assess the antimicrobial susceptibility patterns of Salmonella sp. strainsover a three-year period in a tertiary care hospital.Methodology: It was a retrospective observational study. Electronic medical records were utilized fordata retrieval from 2017 to 2019. The study parameters included individuals of all age groups, andgenders diagnosed with typhoid based on positive blood cultures. Identification, speciation, andantimicrobial susceptibility testing adhered to standardized protocols, with statistical analysis conductedusing SPSS 25.0.Results: Among 769 Salmonella isolates, 709 cases were reported in 2019, making it the highestincidence over the study period. Extensively drug-resistant (XDR) strains peaked in 2019, comprisingapproximately 50% of cases, while multiple drug-resistant strains accounted for 25%. Notably, resistanceto ampicillin, ciprofloxacin, co-trimoxazole, and ceftriaxone exhibited a consistent upward trend over thethree-year span. Ciprofloxacin demonstrated the highest resistance, with only 4% sensitivity amongSalmonella isolates.Conclusion: The findings have highlighted a concerning escalation in antimicrobial resistance amongSalmonella Typhi strains in Punjab, Pakistan, particularly evident in the prevalence of extensively drugresistantstrains. Multi-drug and extensively drug-resistant strains of Salmonella are difficult to treat andmay give rise to even more drug resistance if not treated appropriately, leading to a vicious cycle of resistance.Keywords: Typhoid fever, antimicrobial resistance, Drug-resistant strains, public health, Pakista
Effects of Pediatric Endurance and Limb Strengthening Program versus Lower Limb Strength Training in Diplegic Cerebral Palsy: A Randomized Clinical Trial
Full text linkObjective: To evaluate the comparative effects of pediatric endurance and limb strengthening (PEDALS) program versus lower limb strength training in diplegic cerebral palsy (CP). Methodology: This Randomized clinical trial on a sample of 24 children with CP enrolled consecutively was completed after ethical approval. Group A (n=12) received the PEDALS program and group B (n=12) received lower limb strength training. PEDALS program was applied for 30 minutes, 3 days/week for 12 weeks and Group B received the intervention 6-8reps, 1-3sets for3 days/ week for 12 weeks. Outcome was measured with GMFM-88, Six-minute walk test and range of motion using goniometer pre and post treatment.
Results: Mean age was 9.95±2.21 years. Post treatment mean value for total GMFM score for Group A was 64.916±8.129 and Group B was 65.33±9.92 with p-value > 0.05 respectively. Post treatment mean value for six minutes' walk test for Group A was 199.58±13.55 and for Group B was 195.50±15.71 with p-value >0.05 and post treatment ROM for Group A and Group B with p-value>0.05, there was no significant difference between these techniques.
Conclusion: PEDALS program as well as lower limb strength training is equally effective in improving endurance, gross motor function and ROM in children with diplegic CP .
Keywords: Cerebral palsy, endurance, pediatric, strength, training
Perceived Social Support and Mental Health among Caregivers of Patients with Chronic Illnesses in Pediatric Departments: An Observational Study
Full text linkObjective: The objective of the study was to assess the perceived social support and mental health ofcare givers of children suffering from chronic medical conditions.Methodology: The research design of current study was cross-sectional in nature. Data was collectedfrom Pediatric Departments of one public and one private sector hospitals. Sampling technique waspurposive sampling comprising of 151 mothers of children with chronic medical conditions. Forassessment purpose demographic form, Depression Anxiety Stress Scale (DASS-21) for evaluation ofgeneral mental health and Multidimensional Scale of Perceived Social Support Scale (MSPSS) forassessment of perceived social support were used. P value≤0.05 was considered as significant.Results: Regression analysis showed social support measured by MSPSS to be a significant predictorof stress (p<0.000), anxiety (p<0.000) and depression (p<0.000) in mothers of children with chronicillnesses which were inpatients in pediatric departments.Conclusion: In conclusion, the mental health of mothers taking care of their children who weresuffering from chronic illnesses in the pediatric departments was influenced by various factors, withperceived social support playing a pivotal role in the current study.Keywords: caregivers, social support, mental health, pediatric department
A Comparison of Ureterorenoscopy and Extra-Corporeal Shock Wave Lithotripsy for the Treatment Of Upper Ureteric Stone Measuring Less than 1cm.
Full text linkObjective: To compare the efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS) in the management of upper ureteric stone measuring <1cm.Methodology: Randomized clinical trial (RCT) was conducted by targeting the patient admitted in urology ward, Jinnah Hospital Lahorethrough a period of one year. A sample size of 132 patients fulfilling inclusion criteria were selected by employing Non-probability consecutive sampling technique was employed to select 132 (sample size) patients fulfilling inclusion criteria. Patients were randomly allocated into two groups (66 in each group A&B) using lottery method. In group-A, stones were treated using ESWL, while in group-B, URS was performed, and stones were broken with pneumatic energy. Data were analyzed using SPSS version 27, and a Chi-square test was conducted to compare the proportions of qualitative variables, while an independent sample t-test was applied to assess mean differences between two groups of quantitative variables. Asignificance level of ≤0.05 was adopted for determining statistical significance.Results: The sociodemographic profile of the two groups was comparable. It was seen that stone free rate nextto first session was higher in URS (81.8%) as compared to ESWL (63.6%) which later increased to 87.7% after completion of three session. The complaint of pain in ESWL was more as compared to URS (22.7% vs 12.1% p= 0.05)while the differences betweenthe rate of complications like fever, UTI, mucosal abrasion, hematuria or perforation were not statistically significant in both group. (p> 0.05)Conclusion: ESWL outperforms URS for the treatment of upper ureteric stones measuring <1cm in terms of efficacy and safety.Although not statistically significant, ourfindings suggest that URS achieves stone-free rates earlier than ESWL. However, according to our findings, ESWL is recommended as the treatment of choice for the majority of patients due to better compliance.Keywords: Extra-corporeal Shock Wave Lithotripsy, Nephrolithiasis, Ureterorenoscop
Integrated Health care services in Accident and Emergency department of a Tertiary Care Hospital: Doctors and Patients Feedback
Full text linkObjective: To determine the perceptions of doctors and patients on Provision of Laboratory, Radiological and Pharmacy Services Under One Roof in Accident and Emergency of a Tertiary Care Hospital.Methodology: A cross-sectional study was conducted at the A&E and Trauma Centre of CMH Peshawar with written approval from the ethical review board of this institute from January 2023- March 2023. The calculated sample size was 412 participants. Structured questionnaires, tailored separately for doctors and patients, were utilized to assess their perceptions regarding current trends and the quality of medical care. The data collected was analyzed using the statistical package SPSS version 22, and the findings were presented as frequency and percentages.Results: The study revealed high satisfaction among physicians with hospital administration (89%) and effective workload sharing in the A&E department (90%). A significant proportion (87%) indicated a lack of opportunities for tea breaks during working hours. Physicians strongly agreed that unnecessary referrals significantly increase A&E workload (91%) and confirmed receiving all necessary investigations (88%) within the department. They acknowledged the availability and importance of radiological and laboratory services (95%) and high satisfaction (95%) was expressed with the availability of pharmacy services, From the patients' perspective, a substantial percentage experienced short waiting times in A&E (76% less than 10 minutes) and felt doctors allocated adequate time during consultations (91%). Integrated services were highly appreciated, with 89% agreeing on the availability of radiological, laboratory, and pharmacy services under one roof. Conclusion: These findings underscored positive perceptions from both physicians and patients regarding hospital operations and service delivery in the A&E department, while also highlighting areas for potential improvement in workload management and staff well-being.Keywords: Health care services, Doctors Perspective, Patients Feedbac
Screening for Renal Function Impairment in Patients with Chronic Type II Diabetes Mellitus in a Tertiary Care Hospital of Pakistan
Full text linkObjective: The objective of the present study was to detect early biochemical changes, in type IIdiabetics, indicating renal function impairment leading to Chronic Kidney Disease (CKD).Methodology: This study was conducted in the Department of Biochemistry at Shaikh Zayed FPGMI,Lahore during September 2016 to April 2017. It was a cross-sectional analytical study and was donethrough nonprobability convenient sampling The study comprised of 50 diagnosed patients of typeII diabetes mellitus (for the last 10 years) and 50 healthy subjects. Both male and female participantsin equal number between the age of 35-75 were included in the study. Blood glucose level (random),blood urea, serum creatinine, urinary albumin and urinary creatinine were estimated and albumin tocreatinine ratio (ACR) in mg/g was calculated. eGFR was also calculated using S/creatinine. The labvalues of the study parameters were recorded on the designed proforma after getting proper writtenconsent from the participants. SPSS 20.0 was used for data entry and analysis.Results: Mean values of random plasma glucose level, blood urea, serum creatinine, urine albumin,urine creatinine, ACR and eGFR of patients when compared with those of healthy group showedsignificant p-values (≤0.05).Conclusion: There was a significant difference in renal laboratory parameters between diabeticpatients and healthy controls indicating the presence of CKD. In a developing country like Pakistantype II diabetes mellitus is an incidental finding due to lack of regular health monitoring and it is verydifficult to determine the exact duration of the disease. Patients of type II DM develop CKD (ChronicKidney Disease) due to persistent high plasma glucose levels. Therefore good control of DM andregular monitoring of renal parameters will be helpful in preventing the development of CKD.Key Words: Diabetes Mellitus, Nephropathy, Chronic Kidney Disease, Urinary Albumin toCreatinine ratio
A Case of Persistent Methicillin- Resistant Staphylococcus Aureus (MRSA) Bacteraemia with no Identifiable Source: A Peculiar Clinical Challenge
Full text linkWith the increase in antibiotic resistance, Methicillin-resistant Staphylococcus aureus (MRSA) hasbecome a global health challenge. We present a case of a 74-years-old female who was unwell withcomplaints of dizziness, shortness of breath on exertion and palpitations. She had presented withparoxysmal atrial fibrillation and Methicillin-Resistant Staphylococcus aureus (MRSA) bacteraemiawith concerns for possible endocarditis. Transesophageal Echocardiogram (TEE) performed ruledout any evidence of endocarditis. MRSA sepsis was established based on blood cultures with unclearsources. After 7 days on Vancomycin and Ceftaroline, her repeated blood cultures were still positivefor MRSA, so she was started on IV Cefazolin 2g and IV Daptomycin 6mg/kg every 24 hours. Herblood culture cleared after 5 days of this therapy. Treatment strategies for patients of MRSAB need tobe individualized to achieve infection clearance, while guidelines do serve to provide a basicblueprint of treatment plans for physicians.Keywords: Methicillin-Resistant Staphylococcus Aureus, Bacteremia, Sepsis
Relationship of Histopathological Grades of Urothelial Carcinoma with Age and Gender
Full text linkObjectives: To assess the grades of urothelial carcinoma and their relationship with the demographicdeterminants of age and gender.Methodology: This descriptive cross-sectional study was conducted at the Department of Histopathology,Combined Military Hospital, Lahore from May 2020 to January 2021. A total of eighty-five patientsirrespective of age and gender diagnosed by histopathology report as urothelial carcinoma alongwith World Health Organization (WHO) Grading were included in the study. All the results weresubsequently analyzed using SPSS Version 23. Chi square test was applied to find the associationwith p value≤0.05.Results: Mean age of participants was 63.96±10.13 years ranging from 40 to 90 years. Most frequent(41%) age group was 60-69 years and the least (7%) was 80-89 years. Of these 85 cases, 77 (90.59%) weremales and 8 (9.41%) were females. Regarding histological grade, 28 (32.9%) cases revealed low-gradecarcinoma and 57(67.1%) were high-grade urothelial carcinoma. Among high-grade cases, the mostfrequent ones i.e. 22/57 lie in the age group 60-69 years while the least frequent cases i.e. 3/57 are in theage group 40-49 years. Thus, the relation of age group with histopathological grades of urothelialcarcinoma was found to be significant (p-value 0.01) while it was not significant for gender (p-value 0.06).Conclusion: The relation of the demographic factor, age with histopathological grades of urothelialcarcinoma was found to be significant while this relationship of grades was insignificant for gender.Keywords: Urothelial carcinoma, low grade, high grade, age, gende