National Journal of Health Sciences
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Clinical Profile and Outcome of Patients Undergoing Total Laparoscopic Hysterectomy: A Prospective Study from a Secondary Care Hospital in Karachi
No full textAbstract: Background: The American Association of Gynecologic Laparoscopists recommends that numerous hysterectomies for non-cancerous conditions ought to be performed with laparoscopy. The patient's obstetric history significantly influences the outcomes. Information on the clinical profiles of patients receiving total laparoscopic hysterectomy (TLH) is rarely documented from Pakistan.
Objective: To present our experience of clinical profile of patients undergoing TLH in our secondary care institution at Koohi Goth hospital in Karachi.
Materials and Methods: The present prospective observational study was performed in Obstetrics & Gynecology Department in Koohi Goth Hospital from 1st August 2018 to 31st December 2023 after obtaining the institutional formal ethical approval (Ref: KGH/HR/134). All of the procedures were performed by single gynecologist having more than 5 years of experiences in performing laparoscopic hysterectomy. Information regarding patients’ demographics, clinical characteristics, procedure information and outcomes were documented.
Result: Total 100 cases were analyzed with mean age of 45 ± 7.8 years. Average BMI was 25.3 ± 8.1 Kg/m2. Almost one-third of patients (32%) had history of previous surgery. The commonest surgical indication was uterine fibroids (54%), and while the least of post-menopausal bleeding. Average surgery duration was 124.26±44.74 minutes. Few patients developed complications (7%) including ureter injury (2%), wound infection (2%), vault infection (2%), and bladder injury (2%). All of complications were seen in either obese females or patients with history of previous surgery.
Conclusion: The present study found that minimally invasive TLH is a safe approach which is easily accessible and harmless for patients with minimal complication rate. Patients with previous history of surgery and elevated body mass index should be given additional care and attention to avoid complexity
The Role of Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience in a Tertiary Care Hospital
No full textAbstract: Background: Traumatic brain injury can damage the brain on permanent basis, to protect the brain Decompressive can play a pivot role to protect from secondary brain injury.
Objective: To assess the prognosis and functional outcomes in role of decompressive craniectomy in traumatic brain injury in tertiary care hospital.
Materials and Methods: This study conducted at Jinnah Post Graduate Medical Institute (JPMC) in Karachi from January 2018 to April 2022, comprises of 304 patients who underwent decompressive craniectomy following traumatic brain injury, specifically those with traumatic mass lesions. Our aim was to gain insight into their functional outcomes over a period of six months, utilizing the Glasgow Outcome Score at intervals of one month, three months, and six months, employing the chi-squared test, to identify any parameters that correlated with poor outcomes. This helped us discern potential factors contributing to unfavorable results.
Result: The current study comprised 304 individuals, with a median age of 48 years (IQR: 43-53). The majority of patients (66.1%) were older than 45 years. The median time since injury was 10 hours (IQR: 7-13.75). The median GCS score was (IQR: 5-7). The majority of patients had ASDH + Contusion (44.1%) and ASDH (42.1%) on CT scans. In our study, 38.5% of patients had a good outcome, whereas 61.5% had a poor outcome. The outcome was significantly associated with gender (p=0.033), age group (p <0.001), time since injury (p<0.001), GCS score (p<0.001), midline shift (p<0.001), mass lesion volume (p<0.001), and CT findings (p=0.002).
Conclusion: Decompressive craniectomy stands as a pivotal intervention in the management of severe traumatic brain injury (sTBI) patients grappling with traumatic mass lesions
Frequency of Thrombocytopenia and its Association with Short-Term Outcomes among ICU Patients
No full textAbstract: Background: Thrombocytopenia can result from various etiologies. The development of thrombocytopenia in critically ill patients is associated with increased bleeding and transfusion risk and, hence, higher mortality.
Objective: To determine the frequency of thrombocytopenia and its association with short-term outcomes in patients admitted to the Medical ICU of the tertiary care center.
Materials and Methods: A prospective observational study was conducted in the Medical Intensive Care Unit (MICU) at The Indus Hospital, Karachi, from March to September 2023. The study obtained the permission from the Ethical Review Board of Indus Hospital (IRB#: IHHN_IRB_2023_01_022). Each patient was followed with a platelet count on the first, third, fifth, and seventh day. Patients’ outcomes in terms of aliveness or death were noted on the first, third, fifth, and seventh days.
Result: The study included 152 patients with a mean age of 42.50 ± 18.11 years. On admission, thrombocytopenia was seen in 42%. The frequency at day 3, day 5, and day 7 was 50%, 56.1%, and 50.4%, respectively. At day 5, a significant association was found between mortality and thrombocytopenia, with 68.5% mortalities among thrombocytopenia patients and 31.5% mortality among patients without thrombocytopenia (p=0.002). The association becomes even more obvious by day 7, where thrombocytopenia was found to be strongly linked to mortality, with a higher mortality rate of 68% among those with thrombocytopenia than a 31% death rate among those without thrombocytopenia (p<0.001).
Conclusion: Thrombocytopenia was common in MICU and correlated with short-term mortality. The findings indicate the prognostic role of platelet count. To confirm these findings, more multicenter investigations with a bigger sample size and modified analysis are required
Evaluation of Sensory Deficit in Foot Following Sural Nerve Graft
No full textAbstract: Background: The sural nerve is the most commonly used donor nerve for autologous nerve grafts in reconstructive surgery. The functional outcomes may be impacted with harvest of SNG as it may lead to sensory deficit at donor site.
Objective: To evaluate sensory deficit and patients’ experiences of functional impairment after sural nerve graft.
Materials and Methods: The present prospective observational study was performed in Plastic & Reconstructive Surgery Department of Dr. KM Ruth Pfau Civil Hospital during 1st August 2024 to 28th February 2025. This study received approval from the Institutional Review Board (IRB) at the Dow University of Health Sciences with reference number IRB-3502/DUHS/Approval/2024/176. Sensory examination was performed via Semmes-Weinstein monofilaments. Patients were also asked to report their experience regarding postoperative discomfort, sensory deficits, pain, cold intolerance, and their effect on daily activities, sleep, work, and leisure.
Result: A total of 73 patients were studied with median age of 41 (IQR=26.5-49) years. Some of the patients achieved sensation of 0.5g (30.1%). Majority of patients (42.5%) had mild sensory deficit with who achieved 2.0 g sensation. Around quarter of patients had moderate to profound sensory loss (27.4%). Absence of sensation was not seen in any of the patient. Few patients reported any discomfort in their foot (16.4%), loss of sensation (12.3%), pain in operated leg (11%), cold intolerance (9.6%), sensory deficit effecting daily life (9.6%), sleep (9.6%), work or their attendance (11%) and leisure activities (15.1%).
Conclusion: The findings of present study suggested that according to monofilament examination system nearly a quarter of patients had moderate to severe sensory deficit. However, a smaller proportion of patients reported that their functional activities were impacted substantially after sural nerve graft
Perceptions of Young Doctors Regarding Serving in Public Sector Primary Care Level Facilities in Rural Areas of Bahawalpur District
No full textAbstract: Background: Primary healthcare is essential for achieving social goals, and should be properly supported to promote health.
Objective: This study was performed to assess the understanding and factors of reluctance among young doctors regarding serving in public sector primary care level facilities (BHUs, RHCs & local dispensaries) situated in rural areas of Bahawalpur district, South Punjab, Pakistan.
Materials and Methods: This cross-sectional study was accomplished at BHUs, RHCs, and local dispensaries in Bahawalpur, Pakistan, from 15th September 2024 to 30th March 2025 (IRB approval No. 2651/DME/QAMC/Bahawalpur). A total of 164 doctors of both genders, aged between 25 to 35 years with MBBS, BDS, or higher degrees and working at BHUs, RHCs, or local dispensaries in Bahawalpur district were included. Along with demographic features and other necessary information, perceptions and related factors of doctors working at rural health facilities were assessed.
Result: The study involved 164 doctors (68.9% male, 31.1% female) with a mean age of 30.55±3.28 years. Residential conditions were poor for 101 (61.6%). Facility structures were old but renovated for 83 (50.6%), with 96 (58.5%) reporting poor equipment and electricity. Auxiliary staff had no training in 83 (50.6%). Local cultural challenges affected 53 (32.3%), and 61 (37.2%) faced gender-based issues. Recreational facilities were reported by 23 (14.0%), with 117 (71.3%) feeling government incentives were insufficient. There were delays in post-graduation for 135 (82.3%) and a lack of skill development for 143 (87.2%).
Conclusion: This study highlighted the challenges faced by healthcare professionals in rural settings, such as poor living conditions, inadequate infrastructure, and insufficient professional development opportunities
Mini Cholecystectomy versus Conventional Cholecystectomy: A Comparative Interventional Study among Cholelithiasis Patients Operated at DHQ Teaching Hospital, Dera Ghazi Khan
No full textAbstract: Background: Gall-bladder-associated diseases, specifically Cholelithiasis, is among the most common Hepatobiliary tract disorders, and hence, cholecystectomy remains the most frequently performed surgical procedure worldwide, many incisional approaches for cholecystectomy have been demonstrated.
Objective: To compare the surgical outcomes of mini cholecystectomy with conventional cholecystectomy in the management of Cholelithiasis.
Materials and Methods: This comparative interventional study was conducted at the Department of Surgery in Allama Iqbal Teaching Hospital, Dera Ghazi Khan, from Feb 2022 to Jan 2023. A total of 100 Cholelithiasis patients were included and randomly assigned to the treatment groups (A and B) in equal proportion. Group A patients were treated with Mini-cholecystectomy, while in group B, conventional open cholecystectomy was performed. The patients of both treatment groups were followed up a day after surgery (24 hrs.) for pain assessment via visual analogue scale (VAS), and SOS analgesic consumption was also monitored. The 2nd follow-up was planned on the 10th postoperative day for the assessment of wound infection.
Result: The mean age of patients in group A (Mini Cholecystectomy) and group B (Conventional Cholecystectomy) was 44.92±11.16 and 45.64±9.79 years, respectively. Females represented 77% of the study population. There was a significant difference in the mean hospital stay among group A and B patients, i.e. 1.22±0.42 days vs. 1.5±0.5 days (p=0.026). Furthermore, 7% of patients in group A and 14% of group B had wound infections. It was also observed that moderate to severe pain was reported in 6% and 17% of group A and B patients respectively, while no pain was reported among 68% and 58%, respectively.
Conclusion: Mini cholecystectomy is a better and more reliable approach than conventional cholecystectomy in terms of decreased post-operative pain, hospital stay and lesser chances of wound infection
Association of Xmn-1 Polymorphism with HbF Levels in Patients Presenting with Sickle Cell Disease at Tertiary Care Hospital, Karachi
No full textAbstract: Background: Sickle cell anemia is a common hereditary disease in Pakistan, which still maintains significant inter patient variation in disease manifestations and the reasons behind such variations remain uncertain. Among other genetic modifiers the XmnI polymorphism has been noted to influence HbF levels, response to HbF augmenting drugs and milder phenotype of disease as observed in studies conducted in various parts of world and subcontinent. XmnI polymorphism frequency and its association with HbF levels have not been investigated in Pakistani patients of sickle cell disorder. This study aims to determine different genotypes of XmnI polymorphism, and association with high HbF levels in patients of homozygous sickle and sickle/? thalassemia.Objective: This study aimed to ascertain the association of XmnI polymorphism with HbF levels among patients with sickle cell disorders treated at Karachi's Tertiary Care Hospital.Materials and Methods: A cross-sectional investigation was conducted at the National Institute of Blood Diseases & Bone Marrow Transplant in Karachi after obtaining approval from the Ethical Review Board bearing number IBD/RD-208/09-2020. Data collection spanned twelve months from January 01 to December 31 2021. Prospective data collection involved obtaining verbal consent from 150 patients who were diagnosed on the basis of DNA mutation analysis and fulfilled eligibility criteria. 66 sickle homozygous (HbSS) and 84 sickle ? thalassemia patients (Hb S/ß Th) were enrolled. XMN1 polymorphism analysis was performed through Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) and both groups were stratified by presence of XMN-1 polymorphism i.e. homozygous (+/+), heterozy-gous (+/-) and negative (-/-) to compare frequencies of demographic factors while one-way and Welch’s ANOVA tests were applied to analyze variance among these groups.Result: The study reported a mean age of 11.43±7.19 years and hemoglobin levels averaging 8.53±1.50 mg/dL. Gender distribution was slightly male-skewed, and ethnicity showed a predominance of individuals from Baluchistan. The frequency of XmnI polymorphism was higher in sickle homozygous patients as compared to sickle ß-thalassemia patients, significantly affecting HbF, MCV, and MCH levels. HbF levels differed across XmnI polymorphism categories, with +/+ having the highest mean. The family history of thalassemia and consanguineous marriages were more common in those with the +/- and -/- genotypes. The most common ?-globin mutation in sickle ß-thalassemia patients was found out to be IVSI-5.Conclusion: This study concludes that XmnI polymorphism influences HbF levels of sickle cell patients in Pakistan, emphasizing the need for further comprehensive studies
Correlation of Oropharyngeal Airway Volume and Transverse Dental Arch Form: A Cone Beam Computed Tomography (CBCT) Study
No full textAbstract: Background: Variations in transverse dental arch form can significantly impact airway and breathing. With the advent of cone beam computed tomography, accurate evaluation of airway can be performed, overcoming two-dimensional limitations of lateral Cephalogram.
Objective: The aim of the study is to compare oropharyngeal airway volume and index of inter-canine width relative to the intermolar width (ICW/IMW), and internal angles; interincisor, canine, and molar angle of the maxillary and mandibular arches using CBCT. The study also aims to compare gender and oropharyngeal airway volume and all transverse dental arch form variables.
Materials and Methods: This cross-sectional study was conducted in the duration of January 2024 to June 2024 at Margalla Institute of Health Sciences, Rawalpindi. The Ethics Review Committee of Margalla Institute of Health Sciences Rawalpindi, granted approval, (Ethical Approval Number: DM/199/23). The SPSS software version 23 was employed for data analysis. Independent T test was applied for gender comparison of OPV and all transverse dental arch form variables while correlation between OPV and transverse dental arch form variables was determined using Pearson’s coefficient (r).
Result: A positive significant correlation was found between OPV and maxillary inter-incisor angle(r=0.363), maxillary canine angle (r=0.393) and mandibular inter-incisor angle. (r=0.476). Significant negative correlation was observed between OPV and maxillary molar angle (r=-0.348), mandibular canine angle (r=-0.559), ICW/IMW ratio of mandible (r=-0.224). There was insignificant negative correlation of OPV with maxillary ICW/IMW ratio (r=-0.151) and mandibular molar angle (r=-0.004).
Conclusion: Oropharyngeal volume was significantly positively correlated with transverse dental arch morphology. These results indicate a complex interdependence between transverse dental arch form and airway volume and call for airway assessment in conjunction with the dental arch form
Beyond Blood Sugar: The Effects of Weight Change on HbA1c and Diabetes
No full textAbstract: Diabetes, a chronic disease characterised by hyperglycaemia, affects millions worldwide. Despite various treatments, weight management may affect the complications of disease. Weight gain and diabetes have been researched for decades. This review examined the relationship between weight loss and HbA1c level improvements among diabetes, the effects of weight loss on other diabetes outcomes, the factors of individual response to weight management, long-term HbA1c control, and the conditions under which weight reduction may be effective. Hence, diabetes, weight change, HbA1c, and other MeSH terms and keywords were searched in PubMed, Medline, EMBASE, Cochrane Library, Scopus, and CINAHL. We cross-referenced relevant articles' reference lists and intensively searched grey literature including conference proceedings, preprints, government reports, and institutional research papers. This research reveals that diabetics' HbA1c control improves with sustained weight loss. Despite individual variation and restrictions, the findings underline the need of weight management in diabetes therapy. The findings emphasis the need of including weight-management strategies into comprehensive diabetes treatment plans, while acknowledging both individual differences and constraints. Subsequent studies should include these characteristics and modify the suggestions appropriately, while also evaluating the long-term outcomes and determining effective strategies for achieving weight reduction in individuals with diabetes
Job Stress in Administrative Employees of Public Medical Institutes in Punjab, Pakistan
No full textAbstract: Background: Job stress arises when job demands exceed an individual’s coping capacity, leading to physical and psychological strain. Factors include excessive workload, tight deadlines, and lack of support.
Objective: To measure the job-related stress in the administrative employees in public medical institutes of Punjab.
Materials and Methods: This descriptive cross-sectional study took place at three public medical institutes in Punjab from Nov 2022 to July 2023, after the approval of the ethical review board. The data was collected through an interview-administered questionnaire. A well-structured questionnaire was devised using the Likert scale to collect the required data, with a score of 1 denoting no stress and 5 denoting extreme stress. A sample of 150 subjects was taken by purposive sampling technique. The collected data was entered and analyzed on SPSS software version 20.
Result: The mean age was 31.03±8.90. The overall mean job stress score reported in the present study was 3.35±0.59. The mean stress score regarding the nature of the task was 3.56±0.68, for the boss behavior was 3.30±0.36; regarding the organizational environment, it was 3.10±0.67; and for job-related tension, the mean stress score was 3.69±0.68, indicating that the participants were experiencing moderately to higher stress levels. Factors like workload, irritating noisy environment, lack of appreciation, and critical boss significantly contributed to higher stress levels.
Conclusion: The study indicated that most employees had moderate to high levels of job stress during work owing to several factors such as working overtime, unfamiliar duty, excessive criticism, heavy workload, and lack of authority