ZU Journal System (Ziauddin University)
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Morbidity Of Primary Closure of CBD Versus T-Tube Drainage After Laparoscopic Common Bile Duct Exploration
No full textBackground: Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) offer one-stage treatment for choledocholithiasis. However, closure of the common bile duct (CBD) either by primary closure (PC) or T-tube drainage (TD) is associated with a higher bile leakage rate. This study aimed to compare the morbidity of primary duct closure with T-tube drainage after LCBDE for choledocholithiasis
Methods: This prospective and comparative study was carried out in the surgical department of Bahawal Victoria Hospital/Quaid-e-Azam Medical College, Bahawalpur, from 01-01-23 to 31-01-25. 40 patients were equally divided into groups A and B by simple random sampling. After LCBDE, primary closure of the common bile duct in Group A and T-tube drainage in Group B was performed. Data was analysed using SPSS Statistics version 27. The Pearson chi-square test was used for the categorical variables. Whereas continuous variables were analysed with an independent t-test. Results were considered significant when the p-value was ≤ 0.05.
Results: Group A had a shorter operating time (97.65 ± 6.5 vs. 103.35 ± 14.35, p-value 0.411), less intra-abdominal blood loss (97.65 ± 6.5 vs. 103.35 ± 14.35, p-value 0.105), a lower complication rate (15% vs. 25%, p-value 0.346), and a significantly shorter postoperative stay (4.60 ± 0.820 vs. 6.30 ± 3.04, p-value 0.021) as compared to the T-tube drainage group.
Conclusion: Morbidity of primary closure of CBD after laparoscopic exploration of the CBD was lower than T-tube drainage. Primary duct closure can be safely performed after LCBDE in patients with choledocholithiasis
Analysis of Fingerprint Patterns and Gender Variations in Patients with Chronic Disease
No full textBackground: Dermatoglyphics is a recognized method for personal identification and is vital for medico-legal research. This study was conducted to analyze fingerprint patterns and gender variations in patients with a history of chronic disease in Karachi, Pakistan.
Methods: This cross-sectional study was carried out from August 20, 2024, to November 31, 2024, after IRB approval. Proforma was filled, and digital fingerprint samples were collected from the medical OPD of CMH, Malir Cantt, from participants of either gender having a history of chronic diseases (age range 18-65 years). A consecutive sampling technique was used, and the sample size was determined to be 480. Frequency and percentages were calculated for descriptive statistics. Chi-square test was employed to determine differences in fingerprint pattern by gender, with results assessed at p ≤ 0.05.
Results: A Total of 5,100 fingerprints were recorded from 510 participants with equal gender participation. Loop patterns were the most frequent (65.3%) fingerprint pattern in the population studied. Males tend to show a predominance of loops (33%), whereas females display a higher frequency of whorls (13%) and arches (4.3%). Fingerprint patterns varied among participants with different medical histories: whorls were most common in cardiovascular disease (50%), loops in Diabetes Mellitus (55%) and COPD (45%), and both loops and whorls (44.5%) were equally prevalent in hypertension.
Conclusion: Loop patterns emerged as the most frequent fingerprint pattern with distinct gender variation. Furthermore, variation in fingerprint patterns among participants with different medical histories implies that fingerprint patterns may serve as an early biomarker for chronic disease susceptibility, which warrants further investigation
Allgrove Syndrome (AAA Syndrome): Case Report of Dental Management of 15 Years Old Male
No full textAllgrove Syndrome, also known as Triple A Syndrome, is a rare autosomal recessive multiorgan dysfunction. It is characterised by the three ‘A’s’ [hence the name]: Alacrima (a reduced or absent ability to secrete tears), Achalasia (absence of esophageal muscle peristalsis), and Adrenal insufficiency (Addison’s disease). About 1/3rd of the patients present with neurological and autonomic manifestations including gait disturbances, parkinsonism, muscle weakness, mental retardation and peripheral sensory and motor neuropathy.
Here, we report a case of a 15-year-old male who had multiple carious teeth and broken down roots. The patient was first diagnosed at the age of 5 years and had a history of absence of tears, difficulty in swallowing and was on exogenous steroids. Patient had come to the Oral Surgery Department with the complaint of continuous, severe, nocturnal pain in the lower right 1st molar for the last 1 week. So, we doubled the dose of steroids as per protocol and extracted the tooth the following day
The Effects of Urodynamically Proven Detrusor Underactivity on Trans Urethral Surgery Outcome in Benign Prostatic Hyperplasia: A Quasi-Experimental Trial
No full textBackground: Difficult voiding in men can largely be found in detrusor hypo-contractility or bladder outlet obstruction (BOO); still, physicians may miss that both can happen together when only UDs are considered. Initially, there is still no common agreement regarding the urodynamic criteria for diagnosing detrusor hypo-contractility. The purpose of was to evaluate the change in Qmax after treatment with transurethral surgery for benign prostatic hyperplasia.
Methods: A quasi-experimental study was conducted over six months (from May 4 to November 4) at the Department of Urology, SIMS, using a non-probability consecutive sampling technique. A total of 78 patients with BPH underwent TURP (transurethral resection of prostate). Urodynamic assessments measured bladder function using the DUET® LOGIC G2 system, with BCI <100 as the inclusion criterion. TURP was performed under spinal anesthesia, and postoperative Qmax changes were evaluated at three months. Data were analyzed using SPSS version 22, with statistical significance set at p ≤ 0.05. The study assessed TURP outcomes in patients with detrusor underactivity.
Results: The International Prostate Symptom Score (IPSS) was used to assess symptom severity. The mean IPSS (International Prostate Symptom Score) score before and after 3 months of procedure was 25.24 ± 1.95 and 9.91 ± 3.38, respectively (p < 0.001). The mean residual urine output before and 3 months of procedure was 104.21 ± 14.46 and 49.08 ± 17.57. The mean Q-max before and after 3 months of procedure was 7.08 ± 1.48 and 15.64 ± 3.52, respectively. The mean change in Q-max after 3 months was 8.56 ± 2.10.
Conclusion: The study concluded that men with an enlarged prostate and a weak detrusor muscle should consider TURP when medical treatment does not work well for them
Effectiveness of Adherence to Procalcitonin-Guided Antibiotic Protocol in Patients with Severe Sepsis
No full textBackground:
The misuse of antibiotic therapies in hospitalized sepsis patients increases hospital length of stay and antimicrobial resistance. Procalcitonin (PCT) is a bacterial infection biomarker that can guide doctors in their decisions about whether to continue antibiotic therapy. The study aimed to compare hospital length of stay and duration of antibiotic therapy in patients managed with PCT decision protocols against comparable patients managed with standard care without PCT.
Method:
A randomized controlled trial was conducted in the Department of Medicine, MTI/Khyber Teaching Hospital, Peshawar, over six months. A total of 104 patients with severe sepsis were reviewed and randomized into two equal groups. PCT-guided antibiotic therapy was given to Group A patients while Group B patients received standard treatment without PCT. Patients were followed to discharge. Outcomes assessed were hospital length of stay and duration of antibiotic therapy. Data was analyzed using SPSS version 25, with a p ≤ 0.05 considered statistically significant.
Results: The mean length of hospital stay was shorter in the PCT-guided group (14.2 ± 4.6 days) than the standard group (18.1 ± 5.3 days; p = 0.0001). The mean length of antibiotic therapy was also reduced in Group A (7.9 ± 2.3 days) versus Group B (11.6 ± 3.1 days; p = 0.0001).
Conclusion: PCT-guided antibiotic protocol significantly reduces antibiotic exposure in addition to hospital stay for patients who present with severe sepsis. As a result, this treatment fostered antimicrobial stewardship and positively impacted clinical outcomes
Challenges In Managing Supratentorial Tumors Without Neuronavigation: Institutional Experience and Alternatives
No full textBackground: Supratentorial tumors, which including gliomas, meningiomas, and metastatic lesions, account for 70% of primary malignant tumors and represent a significant clinical challenge globally. Neuronavigation (NN) optimizes outcomes but remains inaccessible in places like Peshawar, Pakistan, due to cost and infrastructure barriers. This study documents challenges and alternatives in managing tumors without neuronavigation.
Methodology: A mixed-methods cross-sectional study was conducted over 8 months in three neurosurgical departments (Khyber Teaching Hospital, Hayatabad Medical Complex, and Lady Reading Hospital) in Peshawar. Quantitative data from 86 patients undergoing supratentorial tumor resection without NN were analyzed alongside qualitative interviews with 15 neurosurgeons. Variables included tumor characteristics, surgical techniques (anatomic landmarks, intraoperative ultrasound (IOUS), stereotactic frames), operative time (>4 hours defined prolonged), complications, residual tumor (>10%), and hospital stay. Quantitative data were analyzed using SPSS v26 with chi-square, t-tests, and logistic regression; surgeon experiences were analyzed using Braun and Clarke\u27s reflexive thematic analysis.
Results: Residual tumors occurred in 24.4% of cases, significantly exceeding the hypothesized >10% threshold. Long operative times (>4 hours) were seen in 74.4% of surgeries. Anatomic landmark techniques had the highest residual tumor rates (31.7%) and complications (52.4%). IOUS reduced operative times (mean: 4.6 hours) but 25% still showed residual tumors. Logistic regression identified temporal lobe location (OR: 3.2, p=0.02) and surgeon experience <10 years (OR: 2.8, p=0.04) as predictors of residual tumors. Qualitative analysis revealed spatial disorientation challenges (93% of surgeons), technical limitations of alternatives (73%), and psychological impact on practice (87%).
Conclusion: Supratentorial tumor resections without neuronavigation produce suboptimal outcomes with 24.4% residual tumor rates, significantly higher than NN-assisted benchmarks. Surgeons reported substantial spatial uncertainty and professional stress, particularly in eloquent areas. These findings highlight the need for policy interventions to improve NN access and surgeon training in resource-limited settings
Effect of Semaglutide on Weight, HbA1c Reduction, and Side Effect Profile in Type 2 Diabetes Patients
No full textBackground:Type 2 Diabetes Mellitus (T2DM) is a major public health challenge, with a rising prevalence in Pakistan and globally. Poor glycemic control and obesity are common among patients with T2DM, increasing the risk of complications. Semaglutide, a once-weekly GLP-1 receptor agonist, has shown promise in reducing both HbA1c levels and body weight. This study aimed to evaluate the impact of Semaglutide on glycemic control and weight loss, and to assess the frequency of its side effects in patients with T2DM.
Methodology:A quasi-experimental study was conducted over six months at the Department of Medicine, Rehman Medical Institute, Peshawar over six months i-e from 1th March 2025 to 31st August 2025. A total of 101 patients with T2DM, aged 25–60 years, with a BMI ≥27 kg/m² and HbA1c >7.5%, were included using non-probability consecutive sampling. Semaglutide was administered weekly for 12 weeks. Baseline and post-treatment weight and HbA1c were recorded. Side effects were also documented. Data were analyzed using SPSS v20; paired t-tests were applied with p ≤ 0.05 as statistically significant.
Results:Mean HbA1c decreased from 9.1 ± 1.2% to 7.5 ± 1.1% (p < 0.001) and mean weight reduced from 88.5 ± 9.3 kg to 82.9 ± 8.7 kg (p < 0.001). Common side effects included nausea (27.7%), diarrhea (11.9%), and vomiting (8.9%); 40.6% reported no side effects.
Conclusion:Semaglutide significantly improved glycemic control and promoted weight loss with an acceptable safety profile. It is an effective therapeutic option for managing T2DM in real-world clinical settings
Frequency Of Dyspareunia After Normal Vaginal Delivery With Episiotomy
No full textBackground:Episiotomy, though widely practiced during vaginal delivery, remains controversial due to uncertain benefits and well-documented complications. Dyspareunia, or pain during sexual intercourse, is a significant yet under-recognized morbidity that can adversely affect postpartum quality of life. Local data on its frequency following episiotomy are limited in Pakistan.To determine the frequency and severity of dyspareunia six weeks after normal vaginal delivery with episiotomy in women at a tertiary care center in Mardan, Pakistan.
Methods:This descriptive, cross-sectional study included 131 women aged 15–35 years who underwent normal vaginal delivery with mediolateral episiotomy at Bacha Khan Medical College/Mardan Medical Complex. Women with pre-existing gynecologic, obstetric, or medical conditions likely to confound outcomes were excluded. Dyspareunia was assessed at six weeks postpartum using the validated Visual Analog Scale (VAS), with pain severity classified as mild (1–3), moderate (4–6), or severe (>6). Data were analyzed using SPSS v19.0; frequencies, percentages, and stratified analyses (Chi-square/Fisher’s exact) were performed, with p ≤ 0.05 considered significant.
Results:Of 131 participants, 36 (27.5%) reported dyspareunia at six weeks postpartum. Most cases were classified as mild (13/131, 9.9%) or moderate (15/131, 11.5%), with severe pain in 8 (6.1%). No statistically significant associations were observed between dyspareunia and maternal age, BMI, education, residence, or neonatal factors. The majority of women reported resolution or substantial improvement of symptoms by the end of follow-up.
Conclusion: Dyspareunia is a common complication following episiotomy in this population, affecting more than one in four women at six weeks postpartum. While most cases are mild to moderate, the impact on postpartum recovery and quality of life is considerable. These findings underscore the
Prevalence of Complications of Patients Presenting in Surgical Outdoor with Gallbladder Stones
No full textBackground: Gallstones are a prevalent gastrointestinal disorder that does not provide symptoms in many cases, but a considerable number of patients experience complications that result in surgical treatment. The study aimed to determine the pattern and frequency of complications due to gallbladder stones in symptomatic patients attending the surgical outpatient department.
Methods: A descriptive cross-sectional study was conducted in the surgery outpatient unit of a tertiary care hospital during six months. The postoperative assessment of 246 adult patients who had received surgery in response to gallbladder stones was evaluated. The included patients were those who were not asymptomatic and were released within 24 hours of the surgical procedure. The emergence of complications, like biliary colic, etc., and other less common consequences, was evaluated using the clinical assessment and imaging, consisting of ultrasound. Data were analyzed through SPSS v27.0, and the chi-square and t-tests were employed (p-value <0.05, significant).
Results: There were 246 patients, with 199 (80.9%) patients showing one or more complications. The most prevalent one was the biliary colic in 123 patients (50.0%), followed by acute cholecystitis (36; 14.6%) and acute biliary pancreatitis (16; 6.5%). Unusual complications were gallbladder perforation in 12 patients (4.9 %), hydrops (5; 2.0%), cholangitis (4; 1.6%), gallstone ileus (3; 1.2%), and Bouveret syndrome (1; 0.4%). Most patients were female (172; 70.0%) with a mean age of 47.5 ±12.6 years.
Conclusion: A substantial percentage of patients with gallstones experience complications, and the most common ones are biliary colic and acute cholecystitis. In symptomatic patients, routine follow-up with early elective cholecystectomy must be encouraged to alleviate outpatient surgical load and morbidity due to complication
Biochemical Assessment of Oxidative Stress, Antioxidant Status, and Lipid Profile in Pulmonary and Abdominal Tuberculosis Patients Receiving Anti-Tubercular Therapy
No full textBackground: Tuberculosis (TB) remains a significant global health burden, particularly in developing countries like Pakistan. Beyond its infectious nature, TB is associated with increased oxidative stress and metabolic alterations. However, limited data exist on the biochemical response to anti-tubercular therapy (ATT) in both pulmonary and abdominal TB cases. Therefore, this study aimed to evaluate the effect of ATT on oxidative stress markers, antioxidant enzymes, and lipid profiles in patients with pulmonary and abdominal TB.
Methods: A prospective observational study was conducted over a 12-month period (March 2023 to February 2024) on 83 patients with pulmonary or abdominal tuberculosis at multiple tertiary care hospitals across Pakistan. Patients were recruited using a non-probability purposive sampling technique. Blood samples were collected at baseline (before treatment) and after two months of standard ATT. Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), total antioxidant capacity (TAC), and lipid profile parameters were analyzed. Data were analyzed using SPSS version 26, and paired sample and independent t-tests were applied with a significance level set at p < 0.05.
Results: Among the 83 tuberculosis patients enrolled, 47 (56.6%) were males and 36 (43.4%) females, with 47 (56.6%) having pulmonary TB and 36 (43.4%) abdominal TB. Significant reductions in oxidative stress markers were observed post-treatment: MDA decreased from 5.26 ± 1.31 to 2.79 ± 1.01 and NO from 4.82 ± 1.00 to 3.95 ± 1.02 (p < 0.001 for both). Antioxidant enzymes showed marked improvement: SOD increased from 2.02 ± 0.65 to 3.28 ± 0.87, CAT from 2.54 ± 0.99 to 4.46 ± 1.00, GPx from 1.91 ± 0.57 to 3.08 ± 0.72, and TAC from 0.94 ± 0.31 to 1.62 ± 0.32 (all p < 0.001). Lipid markers also improved, with total cholesterol rising from 127.71 ± 18.18 to 154.53 ± 19.75, LDL from 71.27 ± 15.05 to 88.05 ± 16.61, HDL from 31.59 ± 5.95 to 39.54 ± 7.23, TG from 107.98 ± 19.84 to 122.97 ± 20.15, and VLDL from 22.35 ± 3.81 to 25.69 ± 4.62 (all p < 0.001). No significant differences were found in these biochemical changes between pulmonary and abdominal TB groups (p > 0.05).
Conclusion: Anti-tubercular therapy leads to a marked reduction in oxidative stress and improvement in antioxidant and lipid profiles in both pulmonary and abdominal TB patients. These findings highlight the systemic impact of TB and underscore the biochemical recovery that follows treatment.