Pakistan Journal of Health Sciences

Prioritizing Health: The Need for Comprehensive Maternal and Child Care in Pakistan

Saleem Muhammad Rana — 2024-10-31

Pakistan grapples with severe maternal and child health challenges, highlighted by persistently high mortality rates that reveal significant shortcomings in the healthcare system.

Over 90% of deaths among children aged five and younger occur in just 40 countries, primarily in South Asia and Sub-Saharan Africa. Pakistan, is a young and densely populated nation with a population of 240,485,658 as of 2023, with 13.21% of its population under the age of five [1]. The country ranks third in the world for newborn mortality and second for stillbirth rates. The relationship between poverty and maternal and child mortality in Pakistan is complex, with a weak healthcare system being a significant contributing factor. Under nutrition is an important factor and has a close link with child mortality. Addressing these health disparities is crucial for improving outcomes for mothers and children in the country. One of the primary reasons for poor health outcomes in Pakistan is the low priority assigned to the health sector by successive governments. A recent survey indicates that only 0.05% of the GDP was allocated to national health accounts. Data from Demographic and Health Surveys indicate a notable increase in awareness and access to healthcare for pregnant women, as well as for children suffering from illnesses like diarrhea and pneumonia. However, these improvements still fall short when compared to developed countries. Pakistan failed to meet the targets for infant and maternal mortality outlined in the Millennium Development Goals. Utilizing a trained healthcare professional instead of an untrained traditional birth attendant (DAI) or a family member for maternal and child health services, particularly for prenatal care and birth attendance, is essential and plays a critical role in ensuring maternal health. Women who have access to healthcare services tend to experience healthier pregnancies and give birth to healthier infants. In countries with robust healthcare systems and heightened awareness, maternal health is prioritized, enabling women to receive quality care during pregnancy and childbirth. An observational study was conducted to explore ways to reduce mortality rates, revealing that significant improvements could be achieved through the implementation of evidence-based care packages provided by available healthcare providers. Implementing primary and secondary care interventions could save nearly two-thirds of newborn and maternal lives. It is crucial to introduce these interventions in community settings, particularly in rural and hard-to-reach populations. These communities urgently require community-based platforms that facilitate problem recognition and referrals for care. The Lady Health Worker Programme is one of the largest initiatives globally and has significant potential to improve Reproductive, Maternal, Newborn, Child, and Adolescent Health. However, this potential can only be realized if access, quality of care, and appropriate referrals to functional facilities are ensured.

Impact of Maternal Depression on Pregnancy and Neonatal Outcomes: A Prospective Analysis

Muhammad Ikram Ul Haq — 2024-10-31

Antenatal depression was common in pregnant women and can cause adverse maternal and neonatal outcomes. Objective: This study was conducted to evaluate the incidence of antenatal depression in hospitalized pregnant women and its association with maternal and neonatal outcomes. Methods: A prospective observational study was conducted in the Gynecology and Obstetrics and Psychiatry Department of the Hospital from July 2023 to July 2024. A total of 300 pregnant women with gestation age 24^0/7weeks or less, admitted to the OBGYN department as high-risk pregnancy patients were selected by consecutive sampling. Women were presented with the Edinburgh Post Natal Depression Scale questionnaire 2-4 times every week for the entire study period along with questionnaires to personal collect data. EPDS was generally used to assess post-partum depression but we used it to evaluate perinatal depression as it is also validated for antenatal depression measurement. Patients were divided into two groups based on EDPS score, the study group contained patients at high risk of antenatal depression with a score of 10 ≤, and the comparison group contained women at low risk of depression with a score <10. Data analysis was done by SPSS version 24.0. Results: The frequency of preterm delivery was significantly higher in the study group with 40% preterm births and 23.4% early preterm births as compared to 19.1% and 12.4% in the comparison group, respectively. Similarly, birthweight was lower in the study group (40%) and low 1-minute (20%) and 5-minute Apgar scores. Multivariate regression analysis revealed an independent and significant relationship between maternal depression and preterm delivery (aOR: 3.27, 95% CI: 1.23-9.47) (p=0.030). However, no independent association was found between NICU admission and antenatal depression (aOR: 3.1, 95% CI: 1.0-5.2) (p=0.087) and risk of C-section (aOR: 0.9, 95% CI: 0.9-1.9) (p=0.731). Conclusions: Antepartum depression was a frequent condition among hospitalized pregnant women independently correlated to preterm births. Depression screening of pregnant women was recommended to prevent adverse maternal and neonatal outcomes.

Knowledge of Primiparous Mothers on Immunization of Children under three Years in Rawalakot, Azad Kashmir

Shugafta Iltaf — 2024-10-31

Immunization was crucial aspect of preventing infectious diseases in early childhood. However, lack of knowledge among parents especially primiparous mothers, can hinder optimal immunization coverage. Objective: To assess and evaluate the knowledge level of primiparous mother regarding immunization and the factor influencing immunization status in children under three years. Methods: A cross-sectional study was conducted with a sample of 210 mothers at Combined Military Hospital, Rawalakot, Azad Kashmir, from April 2023 to February 2024, using consecutive sampling. Data were collected using an adapted questionnaire, which included a demographic section and 37 knowledge items. Analysis was done by using SPSS version 26.0, using descriptive statistics (frequency and percentage) and inferential statistics (Chi-Square test). Results: There was gap in literature about primiparous mothers’ knowledge and this study results showed that 27.6% had low, 50% had moderate, and 22.4% had high knowledge. Complete immunization was achieved for 60.5% of children, highlighting the need for improved awareness, especially among primiparous mothers. Higher education and employment were significantly linked to better knowledge (P < 0.001), with healthcare professionals being the main source (56.6%). The study provided crucial insights for the Ministry of Health and policymakers, demonstrating the need to enhance immunization campaigns by improving primiparous mothers' knowledge for better vaccine coverage. Conclusions: A significant portion of primiparous mothers had moderate to low knowledge about child immunization, contributing to incomplete vaccination rates. Enhanced education and awareness programs, particularly for less informed mothers, were essential to improve immunization coverage in Azad Kashmir.

Coagulopathies in Patients with Liver Cirrhosis Presenting to DHQ Teaching Hospital, Dera Ismail Khan

Salman Khan — 2024-10-31

The liver develops fibrosis and nodules due to persistent damage, altering its natural lobular organization, known as cirrhosis. Various assaults such as toxic substances, viral infections, autoimmunity, or genetic disorders can damage the liver. Each lesion leads to fibrosis, or scar tissue formation, initially maintaining its functionality. Objective: To determine the frequency of coagulopathies occurring in patients with liver cirrhosis. Methods: This descriptive cross-sectional study was conducted in the General Medicine department at DHQ Teaching Hospital, D.I Khan, from June 12, 2022, to December 12, 2022. A total of 240 patients were recruited using non-probability consecutive sampling to determine the frequency of coagulopathies occurring in patients with liver cirrhosis. Coagulation tests, including prothrombin time and activated partial thromboplastin time, were performed. Data on age, gender, diabetes mellitus, hypertension, smoking status, and coagulopathies were recorded on a pre-designed proforma. Analysis was done using SPSS 20.0. Means and standard deviations were calculated for age and frequencies and percentages for categorical variables. Coagulopathies were stratified by gender, diabetes, hypertension, and smoking status to assess effect modifications. Post-stratification chi-square tests were applied, with P < 0.05 as significant. Results: The mean age was 45.56 ± 3.357 years. Males comprised 127 (52.9%) and females 113 (47.1%). Age distribution was 12.9% (20-30 years), 24.6% (31-40 years), 47.5% (41-50 years), and 15.0% (51-60 years). Coagulopathies were present in 74 (30.8%) patients, while 166 (69.2%) had none. Ninety patients (37.5%) had normal PT, lasting less than 15 seconds (mean + SD = 11.28 ± 2.02 sec), while 121 patients (50.4%) had prolonged PT (mean + SD = 22.94 ± 5.93 sec) and indicates a statistically significant difference of PT. Conclusion: Patients with cirrhosis had significantly higher and prolonged PT and APTT values, indicating an increased risk of coagulopathies.

Frequency and Risk Factors Associated with Retinopathy of Prematurity: A Single Centre Study

Muhammad Zeeshan — 2024-10-31

Retinopathy of prematurity is the irregular development of blood vessels in the growing retina of premature infants, which can primarily lead to blindness. Objective: To identify frequency and risk factors associated with retinopathy of prematurity. Methods: A cross-sectional study was conducted on 140 premature infants (gestational age ≤34 weeks) investigated in the Neonatal Intensive Care Unit of Central Park Teaching Hospital, Lahore. Preterm neonates’ weight ≤1.8 Kg and gestational age ≤34 weeks were enrolled. The neonate’s demographic details, risk factors for retinopathy, eye examinations, and follow-up were recorded. Their maternal history included maternal age, gestational age, and maternal risk factors. During their hospital stay, clinical progress, morbidity, and mortality were assessed and monitored. Descriptive statistics were done using SPSS version 26.0. Results: From these 140 premature infants, 74 (52.9%) were male and 66 (47.1%) were female. The average gestational age was 30.4 ± 2.36 weeks, with a mean birth weight of 1.3 ± 0.28 kg. Of total premature infants, 14 (10%) developed Retinopathy of premature whereas 6 (4.3%) infants expired and 21 (15%) lost to follow-up. Grade-I and Grade-II retinopathy of prematurity were developed in 8 (57.1%) and 6 (42.9%), respectively and based on regression analysis, low gestational age, respiratory distress syndrome, and sepsis independently predicted the onset of prematurity. Conclusions: It was concluded that the prevalence of retinopathy of prematurity was 10%. Lower gestational age, blood transfusion, lower birth weight, anemia, bronchopulmonary dysplasia, sepsis, and O₂ therapy were primary factors of risk in retinopathy of prematurity development.

Effectiveness of Dynamic Condylar Screw (DCS) in Treating Unstable Proximal Femoral Fractures

Mir Afzal — 2024-10-31

Despite the availability of various treatment modalities for proximal femoral fractures, there remains ongoing debate regarding the optimal fixation method especially those for unstable fractures, particularly in patients with resource-limited areas. Objective: To assess the effectiveness of dynamic condylar screw fixation in treating unstable proximal femoral fractures. Methods: A longitudinal prospective study was conducted from Nov 2021 to Dec 2022. 47 patients aged between 18 to 65 years with unstable proximal femoral fractures (intertrochanteric, sub-trochanteric, or complex fractures involving the femoral neck or shaft), were included in the study and followed up for 1 year. Patients with open fractures, poly-trauma, and ipsilateral hip surgery were excluded from the study. The effectiveness of the dynamic condylar screw in treating unstable proximal femoral fractures was measured through a structured clinical and radiographic follow-up process. Patients underwent open reduction and internal fixation using a 95° DCS to ensure optimal fracture stabilization. Results: The study involved 47 patients with intertrochanteric (42.6%), sub-trochanteric (31.9%), and complex fractures (25.5%). The effectiveness of treatment and postoperative outcomes was reported in 43 patients (91.5%), with unsuccessful outcomes in 4 (8.5%). The acceptable alignment as per the radiological evidence was seen in 38 patients (80.9%), mal-unions were observed in 5 (10.6%), and implant failure in 4 (8.5%). Functional outcomes showed 29.8% excellent, 44.7% good, 17.0% fair, and 8.5% poor results. Conclusions: it was concluded that the study demonstrated a high rate of successful treatment across different fracture types, with no significant differences in success rates.

Correlating SVEAT Score with CT or Coronary Angiography Score in Assessing Coronary Artery Disease Risk in a Tertiary Cardiac Care Center, Rawalpindi

Asifa Jamil — 2024-10-31

Around the world, coronary artery disease is a major source of morbidity and mortality. The coronary artery disease population is estimated to have increased from 9 million in 1990 to 19 million by 2020. Nurses are the major workforce working in emergencies and need a method for early risk stratification of patients. Objective: To find a Correlation between SVEAT score and angiography score to find the relationship between the diagnostic accuracies of both methods in assessing coronary artery disease. Methods: A quantitative cross-sectional study design involving 118 subjects undergoing both angiography and SVEAT score assessment. Samples from the Tertiary Cardiac Care Center's Emergency Reception were chosen using a convenient sampling technique. Data were collected between the period of January 2024 to April 2024. The frequency and percentages of participants categorized by risk levels were calculated. A Spearman correlation was calculated between the SVEAT score and the angiography score. Results: The demographic profile of 118 participants showed that the study included n=88 (74.6%) male and n=30 (25.4%) female. SVEAT score categorizes 44.9% of participants as low risk and safe to discharge and similarly, Angiography categorizes 46.6%. A Spearman correlation between the SVEAT score and angiography (0.790, sig. 0.000) indicated a significant positive association. Conclusion: It was concluded that similar to angiography, the SVEAT score is a useful non-invasive method that nurses can use for identifying early risk of coronary artery disease.

Frequency of Acute Kidney Injury among Neonates with Birth Asphyxia Presenting at Tertiary Care Hospital in Khyber Pakhtunkhwa

Lyaba Atta — 2024-10-31

Perinatal asphyxia signifies a decrease in blood or oxygen supply to the fetus before, during, or following birth. This restriction of blood or oxygen during the time around birth can result in serious physiological and neurologic effects. Objective: To evaluate the frequency of acute kidney injury among neonates with birth asphyxia presenting at tertiary care hospitals from August 2023 to February 2024. Methods: A cross-sectional study was conducted using a consecutive non-probability sampling technique. It was performed on 105-term neonates i.e., born during 37-42 weeks of gestation of either gender who presented with birth asphyxia. Statistical software (IBM SPSS 26) was used to analyze the data. Results: The mean gestational age of the neonates was 39.55 ± 1.48 weeks, 49 (46.66%) were male while 56 (53.33%) were female patients. The prevalence of acute kidney injury in our population was 11 out of 105 (10.5%). The incidence of acute kidney injury in mothers with preeclampsia is 5 (45.5%) and 6 (54.5%) for having no preeclampsia. For birth weight 1.9 to 2.5Kg 7(63.6%) we had Acute kidney injury while for those above 2.5 Kg only 4 (36.4%) had Acute kidney injury. 4 (36.4%) out of 11 acute kidney injury neonates had a gestational age of 37 to 39 weeks and 7 (63.6%) had more than 39 weeks’ gestational age. Conclusion: It was concluded that the frequency of acute kidney injury was 10.5% and no significant difference was found for other variables such as gestational age, and mode of delivery in mothers with preeclampsia history.

Prevalence and Patterns of Omeprazole and H2 Blocker Use in Neonates in a Neonatal Intensive Care Unit Setting

Shahid Iqbal — 2024-10-31

H2 blockers and omeprazole therapy have not been shown to improve clinical symptoms associated with stress ulceration in newborn trials. There were concerns regarding the reliability and efficacy of treating stress ulcers in adults and children with omeprazole and H2 blockers. Objective: To investigate the prevalence and patterns of H2 blocker and omeprazole use in neonates, assess their efficacy, and evaluate potential risks associated with their use. Methods: Sick infants admitted to NICUs within the Department of Pediatrics ‘Sheikh Khalifa Bin Zaid Al Nahyan Hospital’, Rawalakot, Azad Kashmir were included in this retrospective study. Data collection was done from the hospital records from January 2022 to December 2022. All NICU infants who were at least 28 days old, were critically sick participated in this investigation. Results: There was a twice as high frequency of omeprazole use as of H2 blocker use. More frequently used drugs were Omeprazole and Cimetidine. That was from January to December in the year 2023 Omeprazole group rose from 3. 1% to 3. 8% and the H2 blocker group rose from 1. 3% to 1. 9%. Conclusions: Hospitalized neonates including those without GIT issues were commonly exposed to prescriptions of H2 blockers end Omeprazole. The findings depicted the need for controlling and effectively utilizing omeprazole and H2 blockers. Hence there was a need for more research in relation to the safety and efficacy of omeprazole and H2 blockers in infants.

Knowledge of Clinical Frailty Scale among Intensive Care Nurses at Tertiary Care Hospital

Muhammad Ramzan — 2024-10-31

Clinical Frailty Scale (CFS) is an easy way to measure, all elderly ICU patients on a regular basis, especially when advanced care plans are involved. It ought to be applied when making decisions for family members and nurses as well. Objective: To determine the knowledge of the clinical frailty scale among intensive care nurses at Tertiary Care Hospital. Method: The cross-sectional study was conducted at Tertiary Care Hospital of Karachi from 1^st January to 15^th March 2024. Data were collected by a valid and reliable tool through the convenience sampling technique from ICU nurses having minimum of three months of experience, was included. Other nurses who were on leave during data collection and nursing students were excluded from the study. Results: A total of 65 respondents participated in the study, majority 39 (60%) of them were from the age group 25 to 35 years. More than half 36 (55.4%) had a B.S. nursing qualification. Most of the respondents had ≤ 5 years of total clinical experience in 55 (84.6%), and ICU experience in 62 (95.4%). Out of total participants, 60 (92%) of the respondents had poor knowledge, followed by fair 5 (8%) knowledge while 0 (0%) participants had good knowledge about CFS. Conclusions: It was concluded that the knowledge of nurses regarding clinical frailty scale was poor. Knowing more about the knowledge of clinical frailty scale among ICU nurses who frequently care for frail and older patients can help identify frailty and multidisciplinary care. Educating nurses more about frailty may promote nursing care strategies for frail patients

Uptake of influenza Vaccination among Health Care Workers in Federal General Hospital, Islamabad

AS Saba — 2024-10-31

Influenza, a highly contagious respiratory illness, imposes a substantial public health burden globally. Objectives: To identify reasons for not taking influenza vaccination shots and to explore whether healthcare workers are following any Standard operating procedure. Methods: In the present study, a structured questionnaire was employed, which was adapted from a previously published research study. This research was conducted at the Federal General Hospital located in Islamabad. The target population for this study consisted of healthcare workers employed at Federal General Hospital, Islamabad. The questionnaire was designed to gather information regarding influenza vaccination, including uptake rates, and to identify barriers and factors influencing the decision to take influenza vaccination among healthcare workers. Results: Three hundred workers were registered for the following study. About half of the participants, 47.7%, reported receiving immunizations in the past six months, which shows active participation in vaccination practices. A significant association was observed in assessing knowledge of vaccination, with 22.1% of individuals demonstrating knowledge of immunization. There was a strong association for specific knowledge (OR=2.750). No significant association was found for understanding (OR=0.482, p=2.048). No significant association was seen between barriers (OR=0.708) (p-value=1.00) Conclusions: It was concluded that established guidelines and recommendations, a notably small percentage of healthcare workers opted for influenza vaccination. To rectify this situation, comprehensive strategies are required, encompassing various elements. These strategies should include initiatives to heighten awareness regarding the significance of the influenza vaccine and align vaccination practices with international guidelines.

Predisposing factors and Prevalence of Urinary Tract Infection in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: Evaluating the Effect on Outcome

Rukhsana Tumrani — 2024-10-31

The connection between acute infections and acute cardiovascular events was gaining more attention. There was limited research regarding the incidence and impact of Urinary Tract Infection (UTI) in patients undergoing Percutaneous Coronary Intervention (PCI). Objective: To determine the prevalence and risk factors of urinary tract infection in patients with Acute Coronary Syndrome (ACS) undergone PCI and to determine the effect on outcome. Methods: Cross-sectional study conducted in department of cardiology and pathology, Sheikh Zayed Hospital, Rahim Yar Khan from January 2021 to November 2023. ACS patients aged between 25 to 85 years both genders undergone PCI were included. Patients diagnosed with malignant tumor, cardiogenic shock and pregnant females were excluded. All study subjects grouped on the basis of presence and absence of UTI. Outcome studied were bleeding during hospital stay, in-hospital re infarction, atrial fibrillation and Congestive Cardiac Failure (CCF) after procedure. Results: Mean age of study subjects was 48±9.023years with 207(57.98%) males and 150(42.01%) females. Of the total 357 study subjects, UTI was diagnosed in 102(28.57%) patients. Among all patients with UTI, frequency was high among older individuals (n=68) and females (n=58). UTI was associated with higher rate of re-infarction with 40 patients affected among the total 55 patients with re-infarction. Conclusion: On the basis of this study, it has been concluded that concomitant UTI was frequent in patients undergoing PCI for ACS and associated with advancing age, female gender, responsible for prolonged hospital stay and increased risk of reinfarction.

The Use of Minimally Invasive Techniques in Spinal Surgery: Current Status and Future Directions

Mian Iftikhar ul Haq — 2024-10-31

Minimally invasive spine surgeries have come a long way from their open counterparts in recent years, allowing for less tissue stress, smaller incisions, and quicker recoveries. Objectives: To trace the development of minimally invasive spine surgical procedures from their inception to the present day and to find ways to improve and innovate these methods in the future. Methods: This prospective observational study was conducted at the Neurosurgery Department of Lady Reading Hospital-Medical Training Initiative, Peshawar. 230 individuals were progressively enrolled, and a plethora of spinal disorders were recruited as inclusion criteria. This information was gathered by painstakingly capturing demographics, co-morbidities, surgical procedure details and postoperative results. Statistical analysis identifies the trends. Results: The mean age of the study was 54.7 years and male were higher in numbers. Discectomy was the most commonly performed operation with the degenerative disease of the spine accounting for the highest (26.06%). With an average hospital stay of 5.8 days, problems such as Dural tears occurred during the operation in 10.87% of cases. While problems such neighboring segment illness were observed in 6.52% of patients, follow-up demonstrated improved functional results in 65.22% of cases. Variables such as surgical indication and procedure showed significant relationships (p<0.001) according to chi-square testing. Conclusions: It was concluded that minimally invasive spine surgery draws attention to the need for ongoing innovation and research to improve outcomes and overcome technical challenges in the treatment of complex spinal illnesses. This approach offers less invasive treatments with shorter recovery times and fewer complications

The Rate of Postoperative Infections in Patients with Total Hip Replacement Done In Ayub Teaching Hospital, Abbottabad

Syed Usman Shah — 2024-10-31

After total hip replacement many complications occur postoperatively. One of the serious complications is the surgical wound site infection that can convert into peri-prosthetic joint infection. Objective: To determine the rate of postoperative infection in patients with total hip replacement done in Ayub Teaching Hospital, Abbottabad. Methods: This retrospective cross-sectional study investigated 32 patients underwent total hip replacement in the Orthopedic Department of Ayub Teaching Hospital, Abbottabad from January 2020 to April 2024. All the adult patients underwent unilateral total hip replacement were enrolled. Patient’s demographic details, indication for surgery, co-morbidities, hip deformity, and post-operative complications were recorded. SPSS version 26.0 was used for data analysis. Results: The overall mean age and length of hospital stay was 54 ± 15.9 years and 14 ± 12.8 days. The incidence of post-operative infection was 34.4% (n=11). Wound infection was the most prevalent post-operative infection/complications found in 6 (18.8%) followed by urinary tract infection 3 (9.4%), dislocation 1 (3.1%), and pneumonia 1 (3.1%). According to univariate analysis, American system of anesthesiologist (ASA) grades, hip deformity, and blood transfusion were significantly associated with post-operative infection. Conclusion: It was concluded that several pre-operative risk factors considerably affect the probability of post-operative wound infection following total hip arthroplasty; hence, early diagnosis, management, and treatment are necessary to decrease morbidity and death.

Comparison of Outcomes between Open and Closed Haemorrhoidectomy

Khalid Mahmood — 2024-10-31

Horrhoidectomy can prolong hospital stays due to pain, bleeding, and wound infections. Horrhoidectomy improves postoperative pain and wound healing. This research examined postoperative pain, hemorrhage, operating time, and wound healing after open and closed hemorrhoidectomy. Objective: To determine the post-operative outcomes of open and closed haemorrhoidectomy in terms of wound healing, pain perception and complications. Methods: This comparative study was conducted at Department of Surgery, DHQ Teaching Hospital, Sargodha from 1^st September 2022 to 28^th February 2023. Sixty patients were selected and divided into two groups; open and closed haemorrhoidectomy. Grade-III and grade-IV patients were underwent haemorrhoidectomy on the basis of severity and internal haemorrhoids. SPSS version 26.0 was used to analyse all the data. Results: There were 40 (66.7%) males and 20 (33.3%) females. Approximately 43.3% of the patients from closed group showed mild pain whereas 36.6% of the cases from open group complain mild pain after open haemorrhoidectomy. An open haemorrhoidectomy incision healed in 22 days, but a closed one took 15 days (p=0.56). The early onset of post-operative closed haemorrhoidectomy patients had 3.3%, 6.6%, and 3.3% cases of hemorrhoid, infection, and urinary retention, while the early onset of open patients had 6.6%, 10%, and 6.6%. There was just one patient in the open haemorrhoidectomy group with late-onset anal stenosis, and no other patient in either group developed fissure or faecal incontinence. Conclusion: Almost similar pain perception was observed in both surgical procedures before and after the surgery.

Frequency of TTG Positivity in Diarrhea Predominant IBS Patients at Peshawar, Pakistan

Bughdad Khan — 2024-10-31

Irritable Bowel Syndrome is abdominal discomfort and alterations in bowel habits without an identifiable organic cause. Objective: To determine the frequency of tissue transglutaminase positivity in diarrhea-predominant IBS patients. Methods: This cross-sectional study was done from 1^st January 2021 to 30^th July 2021 in the Medicine department of Khyber Teaching Hospital, Peshawar, Pakistan. Patients of either gender aged between 18-60 years presenting in the medical outpatient department with diarrhea-predominant irritable bowel syndrome. Diarrhea-predominant irritable bowel syndrome was defined as a patient who fulfilled the Rome-IV criteria for irritable bowel syndrome with ≥2 of the features. Tissue transglutaminase antibodies were done for all patients and tissue transglutaminase positivity was defined as anti-tissue transglutaminase IgA or IgG antibody levels ≥10 AU/ml on laboratory tests performed by the chemi-luminescence immunoassay technique. Results: In a total of 96 patients, 59 (61.5%) were male. The mean age, weight, and duration of diarrhea were 37.64 ± 6.28 years, 81.48 ± 7.70 kg, and 11.67 ± 3.81 months, respectively. The tissue transglutaminase positivity was seen in 12 (12.5%) of patients. Duration of disease above 6 weeks was found to have a significant association with tissue transglutaminase positivity (p<0.001) as all tissue transglutaminase-positive patients had a duration of disease above 6 months. Conclusions: It was concluded that the frequency of tissue transglutaminase positivity was high in diarrhea-predominant irritable bowel syndrome patients. Screening for celiac disease in irritable bowel syndrome patients can be worth considering especially in cases with relatively longer duration of irritable bowel syndrome diarrhea predominant symptoms.

Use of YouTube for Mastery of Clinical Skills in Dental Education

Muhammad Ammar Qureshi — 2024-10-31

The increasing integration of digital platforms has transformed the way clinical skills are taught in dental education. YouTube has emerged as a prominent resource, offering an array of instructional videos that can supplement traditional learning. However, the extent to which dental students in Pakistan utilize this platform for clinical skill acquisition remains underexplored, highlighting a significant gap in the existing literature. Objectives: To evaluate the utilization and effectiveness of YouTube as a learning tool for clinical skills among dental students and house officers. Methods: A cross-sectional survey was conducted with 150 dental students and house officers at Combined Military Hospitals, Lahore Medical College, Institute of Dentistry. House officers from other medical professions were excluded. The sample size of 150 was calculated through the M Calculator. Participants completed a 19-item questionnaire. The collected data were analyzed using SPSS version 26.0. For the data analysis, descriptive tests, frequencies, chi-square and the Kruskal Wallis tests were employed. Results: Most students (87.3 %) solely depended on internationally produced videos. 26.7% of the participants used the platform for educational purposes. Only 44% of the participants used YouTube as a supplement to learn clinical procedures. 47.3% reported watching YouTube videos before their first attempt at a procedure. Conclusions: It was concluded that YouTube is a valuable source of learning and presents the necessity of incorporating technology-enhanced tools, such as YouTube, into dental schools.

Correlation of Developmental Dysplasia of Hip in Newborns with Mode of Presentation on Graf Method Ultrasound

Nasim Marvi — 2024-10-31

Developmental dysplasia of hip (DDH) affects 1.5-20/1000 live births. Early detection and treatment have spared many patients from crippling. The dislocation of the hip is always postnatal. Defects in hip occur because of the flexibility of the joint capsule at birth, underdeveloped hip acetabulum and immature femur head. Objective: To correlate incidence of developmental dysplasia of hip in newborns with modes of presentation at birth (vertex, breech and transverse) using Graf method ultrasound. Methods: The six-month analytical cross-sectional study was conducted after ethical approval and informed parental consent. A total of 115 healthy newborns below 28 days age were inducted in the study. The study excluded neuromuscular disease, neural tube defects and genetic anomaly cases. The bilateral hip angles were measured on ultrasound, categorized and recorded. Modes of presentation (vertex, breech and transverse) and physical exam findings were included. Results: Hip angles were measured in 115 newborns. The vertex presentation was the most common; 96 (83.48%). Infants with vertex presentation had the significantly smaller frequency of dysplasia (p<0.001). Breech presentation had significantly high incidence of hip dysplasia (p<0.001). Bilateral pathological immature hip (2a-) and centered unstable (2c) hip dysplasia types were most common in all groups. Severe dysplasia types D and 4 were seen in the vertex and breech groups. Conclusions: Developmental dysplasia of hip occurs with vertex, transverse and breech presentation postnatally. The most frequent variants are the immature pathological and centered unstable hips. The severe forms of dysplasia occur in vertex and breech presentations

Assessment of Post-Operative Pain Score after Lichtenstein Repair of Inguinal Hernia

Atif Iqbal — 2024-10-31

The Lichtenstein inguinal hernia repair has become the gold standard due to its simplicity, effectiveness, and low recurrence rates. Despite its benefits, post-operative pain remains a critical concern impacting patient recovery and satisfaction. Objective: To evaluate the post-operative pain experienced by patients undergoing Lichtenstein repair of inguinal hernia. Methods: It was a quasi-experimental study conducted at department of general surgery, Jinnah international hospital, Abbottabad from April 2023 to April 2024. 150 patients who were to undergo Lichtenstein hernia repair were included and the Visual Analog Scale (VAS) was used to measure pain at multiple time points: 6 hours, 24 hours, 48 hours, 1 week, 1 month, and 3 months post-operatively. Pain scores were assessed at rest and on movement along with patient-reported outcomes were recorded. Data were analyzed using SPSS version 24.0. P-values of ≤0.05 will be considered significant. Results: The mean age was 39.2±8.3 years. The average Body Mass Index (BMI) was 25.1±4.7 kg/m2. At 6 hours’ post-surgery, the mean pain scores were 4 ± 0.45, decreasing to 2.8 ± 0.31 24 hours and further to 2.1 ± 0.17 at 48 hours’ post-operation. By one week, the pain score had reduced to 1.8 ± 0.12. The pain score further reduced to 1.2 ± 0.25 at one month and 1.0 ± 0.58 at 3 months (p<0.01). Conclusion: Lichtenstein repair was effective in minimizing immediate post-operative discomfort. However, further investigations may be warranted to explore additional factors influencing pain outcomes

Sensitivity and Specificity Assessment of Histopathology and GeneXpert in Diagnosing Extrapulmonary Tuberculosis at Gulab Devi Hospital, Lahore, Pakistan: A Retrospective Study

Rameesha Mohsin — 2024-10-31

Extrapulmonary Tuberculosis (EPTB), including Spinal Tuberculosis (STB), poses diagnostic challenges due to diverse clinical presentations and limitations of conventional diagnostic methods. Objective: To assess the sensitivity and specificity of Gene Xpert and histopathology in diagnosing EPTB at Gulab Devi Chest Hospital, Lahore, Pakistan. Methods: Data from patients diagnosed with EPTB between May 15th and October 15th, 2024, were analyzed. Gene Xpert and histopathology results were compared with Culture as the gold standard. Results: The study included 299 individuals, 61.2% of whom were females and 38.8% of whom were males. Gene Xpert demonstrated a sensitivity of 90.48% and specificity of 59.75%, while histopathology exhibited a sensitivity of 88.89% and specificity of 60.17%. Conclusion: Gene Xpert and histopathology were valuable tools for diagnosing EPTB, complementing traditional methods.

Prevalence of Metabolic Syndrome in Hepatitis B Virus Infection

Rana Zohaib Munawar — 2024-10-31

Hepatitis B virus infection is a universal healthcare concern leading to the development of decompensated liver disease, cirrhosis, liver cancer and premature mortality. Likewise, metabolic syndrome caused by unhealthy lifestyle and poor eating habits further increases this risk. Objective: To estimate the prevalence of metabolic syndrome in Hepatitis B virus patients. Methods: This cross-sectional study was executed in the Medical Department of King Edward Medical University, Mayo Hospital, Lahore from 1^st August 2022 to 31^st July 2023. A total of 200 patients with Hepatitis B virus infection were selected via a non-probability consecutive sampling technique. Waist circumference, blood pressure, serum triglycerides, high-density lipoprotein and blood glucose levels were measured. Patients fulfilling 3 out of 5 criteria were labelled as having metabolic syndrome (MetS). Results: Out of 200 patients of Hepatitis B virus, 153 (76.5%) were male and 47 (23.5%) were female, 136 (68.0%) belonged to the age bracket of 18-40 years and 64 (32.0 %) in the 41-75 years’ age group. The mean age was calculated to be 38.79 ± 5.37 years, the mean BMI was 27.34 ± 5.49 kg/m2 and the duration of Hepatitis B virus infection was 8.84 ± 3.15 months. The prevalence of MetS was observed in 50 (25%) patients of Hepatitis B virus infection. Conclusion: It was concluded that there is a significant proportion of metabolic syndrome among Hepatitis B virus-infected individuals.

Comparing the Clinical Effectiveness of High-Dose and Low-Dose Statin Therapy in Patients with Atherosclerotic Coronary Artery Disease (CAD)

Adnan Ghafoor — 2024-10-31

Coronary artery disease is associated with the circulatory system and leading cause of death around the globe, Objective: To compare the mean changes in low-density lipoprotein cholesterol with high and low doses of statin therapy. Methods: A non-randomized controlled trial at the Department of Cardiology, Fauji Foundation Hospital Rawalpindi was conducted from January 26-2023 to July 25-2023, among patients aged 45-75 years of both genders with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. Patients were divided into groups using a convenience sampling technique. Patients in Group A were given high-dose statin therapy atorvastatin 40mg orally daily. While Group B received low-dose statin therapy atorvastatin 20mg orally daily. The low-density lipoprotein cholesterol level was repeated after 3 months. Data were entered and analyzed using SPSS version 23. Results: The mean age of Group A was 56.14 ± 8.9 years and Group B was 57.5 ± 9.7 years, as per gender distribution group A showed 57.1% and Group B 68.6%, whereas, the females in Group A, were calculated as 42.9% and in Group B 31.4%. The mean changes observed in low-density lipoprotein cholesterol were significantly higher in groups in comparison to the group with low-dose statin therapy. The changes observed were significant at 35 ± 27.8mg/dl in higher statin therapy versus 21.4 ± 20 mg/dl with a p-value of 0.024. Conclusions: It was concluded that high-dose statin causes a greater reduction in low-density lipoprotein cholesterol levels. The high-dose therapy could be a great option in treating the low-density lipoprotein in initial management.

Effect of Intraumbilical (IU) Vein Oxytocin Injection on Duration of Third Stage of Labour: A Comparative Study

Anila Sabir — 2024-10-31

Effective management for reducing the duration of 3^rd stage of labour can prevent serious complications such as post-partum hemorrhage. Objective: To evaluate the effect of intraumbilical venous oxytocin injection compared to placebo on reducing the duration of the third stage of labour in normal vaginal deliveries. Methods: In this quasi-experimental study, 100 pregnant female fulfilling the selection criteria were included from the Obstetrics and Gynecology Department of Sharif Medical and Dental City Hospital, Lahore. Informed consent was attained from participants. Participants were divided into 2 groups. In Group A, the female was given intraumbilical oxytocin and in Group B, a placebo (normal saline) was used. All female was followed up till delivery of the fetus and time was noted from delivery of the fetus to the placenta. Data were analyzed using SPSS version 26.0. Results: In Group in. Intraumbilical oxytocin, duration of 3^rd stage of labour was less than 3.68 ± 1.49 minutes as compared to placebo group 7.02 ± 2.85 minutes (p<0.01). Data stratification concerning age, gestational age and parity also showed a significant difference of 3^rd stage duration among groups with p<0.01. Conclusions: It was concluded that intraumbilical oxytocin was found to be useful in decreasing the third stage of labour duration. Its use may help prevent cases of prolonged third stage, which could otherwise lead to adverse outcomes. These findings support the potential clinical benefits of IU oxytocin in the third stage of labour.

Assessment of the Proximal Femoral Nailing and Dynamic Hip Screws in Intertrochanteric Fractures

Muhammad Rizwan Ali — 2024-10-31

An intertrochanteric fracture is one of three types of proximal femur fractures, occurring in the proximal part of the femur. The other two types are subtrochanteric fractures, which occur below the trochanters, and proximal (or cephalad) fractures of the femoral neck. Objective: To assess the differences in hospital stay, blood loss, and operative time between proximal femoral nailing and dynamic hip screws in the management of intertrochanteric fractures of the femur. Methods: Quasi-experimental study was conducted in Unit II of the Orthopedic Surgery department at Jinnah Hospital Lahore. It included eighty patients whose demographic profiles (name, age, gender, and BMI) were collected. Using a non-probability consecutive sampling technique, patients were divided into two groups: Group A underwent Dynamic Hip Screw (DHS) surgery, while Group B received Proximal Femoral Nailing (PFN) surgery. Data on operative time, blood loss, and hospital stay were analyzed using SPSS version 21.0, with outcomes compared via independent sample t-test at p < 0.05 significance. Results: Regarding hospital stay, blood loss, and operating time, DHS and PFN differed significantly. Compared to the DHS group, the PFN group's operating time, blood loss, and length of hospital stay were much lower. Conclusion: This study has demonstrated that PFN is a far superior option to DHS for treating femur intertrochanteric fractures. Going forward, suggested PFN rather than DHS for femur fractures of this kind.

Frequency of Covert Urinary Retention in Women after Vaginal Birth of Baby

Iqra Zafar — 2024-10-31

Postpartum Covert Urinary Retention (PPUR) is a medical condition in which a woman’s spontaneous ability to micturate is present and the patient passes urine but the problem lies with the residual volume of urine as it was higher than normal. Sufficient data were lacking so this study will help us to determine the disease burden in our population to do better management. Objective: To determine the frequency of postpartum covert urinary retention in females after the birth of a baby through the vaginal route. Methods: It was a cross-sectional survey, conducted in Lady Willingdon Hospital, Lahore, from April 2019 to October 2019. A total of 383 patients fulfilling the inclusion and exclusion criteria were taken by non-probability consecutive sampling. As soon as the patients pass urine after the vaginal birth of the baby, a transabdominal ultrasound was planned to get an estimated value of postvoid residual urine volume. All gathered data were entered and analyzed using SPSS version 22.0. Results: The mean age was 30.14 ± 5.06 years. The mean gestational age was 39.58 ± 1.73 weeks. In 163 (42.6%) females, epidural analgesia was used, among 152 (39.7%) females, episiotomy was done and 225 (66.6%) females had prolonged duration of labor. In 200 (52.2%) females, had covert urinary retention while 183 (47.8%) did not. Conclusions: It was concluded that more than half i.e. 52.2% of the females had covert urinary retention. Hence appropriate attention must be ensured to nationally accepted definitions and management algorithms in the post-natal stage to reduce the burden of disease in our community.

Alkaline Phosphatase as Marker of Hepatocellular Carcinoma

Atif Hussain — 2024-10-31

Hepatocellular carcinoma (HCC), the fifth most common cancer worldwide, is often detected at a late stage and is frequently fatal.. Liver resection is the main treatment for cases originating from normal liver tissue, but most cases arise from diseased liver parenchyma, such as HBV-related cirrhosis. While many studies link alkaline phosphatase (ALP) to HCC, its diagnostic accuracy in distinguishing HCC from other liver disorders remains limited.. Objective: To assess the diagnostic accuracy of rising ALP levels as an indicator for hepatocellular carcinoma. Methods: The cross-sectional study at Sheikh Zayed Hospital, Lahore, included 130 non-probability sampled patients. Individuals aged 18–65 suspected of first-time hepatocellular carcinoma (HCC) were included, excluding those with prior HCC diagnosis or biliary obstructions. Triphasic CT scans confirmed HCC and assessed ALP/AFP. Data were analyzed using SPSS version 23.0, showing numerical variables as mean ± SD and categorical variables as frequency/percentage. Results: In 130 patients, ALP-based detection outperformed CT scans (81.40%, 9.20%) in sensitivity (93.00%) and positive predictive value (95.00%). HCC detection and performance vary greatly by age and gender. ALP is sensitive across age (95.00%) and gender (98.00% male, 86.00% female). In 108 positive (83.08%) and 22 negative (16.92%) HCC detections on ALP, demographics affect specificity, supporting nuanced ALP interpretation for accurate HCC diagnosis. Conclusions: Elevated ALP levels serve as risk predictors in HCC patients. The prognostic model proposed in this study has the potential to influence outcomes for patients across different risk groups.

Comparison of Serum Uric Acid-to-HDL Ratio and Triglyceride Glucose Index in Relation to Glycemic Control Among Patients with Type 2 Diabetes Mellitus

Hafiza Farah Masood — 2024-10-31

Diabetes mellitus, which is a case of impaired metabolism related to insulin production or resistance occurs. Serum uric acid levels elevating to some extent were related to diabetes and metabolic syndrome. Hyperuricemia is a serious health risk that may underlie metabolic disorders, such as type 2 diabetes and metabolic syndrome. Objective: To investigate the correlation of uric acid and triglyceride variables with glycemic control in patients with Type 2 Diabetes Mellitus (T2DM). Methods: A Comparative cross-sectional study was conducted on 167 patients categorized into non-diabetic (n=59), diabetic with good glycemic control (n=41), and diabetic with poor glycemic control (n=62) groups. Sociodemographic data and serum variables were recorded. Statistical analysis was performed using SPSS version 26.0, employing one-way ANOVA and Pearson correlation tests. Results: Patients with poor glycemic control exhibited significantly higher fasting blood sugar levels and triglyceride glucose index compared to non-diabetic and well-controlled diabetic individuals. However, there were no significant differences in serum uric acid levels and UHR among the study groups. A positive correlation was observed between the triglyceride glucose index and HbA1c, highlighting the association between intermittent blood glucose rises and worse glycemic outcomes. Conclusion: The triglyceride glucose index revealed the potential to be an inexpensive indicator to evaluate blood sugar levels and should be taken into consideration together with the other generally used indicators like HbA1c to strengthen diabetes management.

Prevalence of Post-Surgical Pain and Quality of Life After Total Knee Replacement

Abdul Hannan — 2024-10-31

Total knee arthroplasty appears to be particularly advantageous for patients with significant knee joint disorders such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Objective: To investigate the prevalence of post-surgical pain after total knee replacement and its impact on quality of life. Methods: This cross-sectional study was conducted at The University of Lahore Teaching Hospital during the period of 5^th April, 2023 to 5^thJanuary, 2024 on 185 participants using a non-probability convenience sampling technique. It included both male and female patients between age of 50 to 80 years, undergoing TKR following diagnosis of osteoarthritis only, and patients who had undergone a TKR operation at least six months previously. A numeric pain rating scale was used for data collection. Data were analyzed using IBM SPSS version 25.0. Results: The participants' average age was 62.94 ± 6.33 years. 79 (42.7%) participants reported light pain, 82 (44.3%) reported moderate pain, and 24 (14.0%) reported severe pain. The mean and standard deviation of pain is 4.62 ± 2.08 and quality of life is 61.05 ± 15.16. The results showed a moderately negative correlation (r = -0.482, p=0.000) between pain and quality of life, demonstrating that there is a substantial decrease in quality of life with increasing pain levels. Conclusions: This study demonstrates that a significant percentage of individuals following total knee replacement have moderate to severe post-surgical pain. The findings indicate a clear relationship between higher pain levels and a decrease in quality of life.

Perceptions of Undergraduate Medical Students on Quiz-based Formative Assessment with Immediate Feedback in Integrated Clinical Biochemistry Teaching-learning sessions

Sumreena Mansoor — 2024-10-31

Historically, medical education has used quizzes to provide knowledge assessments and feedback. This study investigates the impact of a quiz-based formative assessment with instantaneous feedback on the learning experiences of medical students, specifically focusing on retention, comprehension, and engagement. Objective: To examine the impact of quizzes on medical students’ comprehension of material, focusing on their perception of the effectiveness of a questionnaire-based pre and post-quiz evaluation approach and its effects on psychological factors like motivation, self-confidence, critical thinking, and receptive capacity. Methods: Quantitative data were collected from 100 second-year MBBS students through a cross-sectional survey. Expert input and suggested modifications were implemented in conjunction with a modified validated questionnaire. Data were analyzed using descriptive statistics, with frequencies and percentages reported. Results: The study indicated that approximately 63.2% of students felt quizzes helped them focus on relevant material and save study time. Additionally, approximately 55% found quizzes beneficial for understanding metabolic processes in clinical contexts, while approximately 54% reported that quizzes encouraged deeper research and increased engagement. However, some students raised concerns about anxiety and time pressures. Conclusion: Overall, formative evaluation via quizzes enhances students' engagement and comprehension and can be optimized based on feedback to improve medical education.

Emotional Intelligence and Academic Performance in First-Year and Third-Year Promoted Medical Students

Mohi Ud Din — 2024-10-31

Emotional intelligence association with academic performance is assessed as it may be linked to higher academic achievement and improved empathy. Objectives: To fill the gap in existing research by examining the relationship between emotional intelligence and academic performance among first-year and third-year medical students. Methods: An analytical cross-sectional study in a private medical college of Faisalabad was done from September 2022 to August 2023. The academic performance of medical students was measured using their recent professional examination results. The first- and third-year promoted students were invited to participate. Students filled online Google-generated questionnaire form. Data were examined using SPSS version 22.0. Pearson correlation was employed to measure the association between emotional intelligence and academics and an independent sample T-test was used to compare means between MBBS classes. Results: 176 medical students (84 first-year promoted and 92 third-year promoted) participated in this study. A weak positive correlation between last exam marks and emotional intelligence was observed with significant p-values between exam marks and self-awareness (0.25, p=0.001); self-management (0.02, p=0.005); social awareness (0.19, p=0.006) and relationship management (0.19, p=0.006). The mean of all four elements (Self-assessment, self-management, social awareness, and relationship management) of emotional intelligence was higher (17.47, 17.11, 17.36 and 17.46) in third-year promoted students than first-year promoted students (15.76, 15.61, 15.79 & 15.64) respectively. Conclusions: It was concluded that third-year promoted medical students found more emotionally intelligent performed better in their recent professional examination than first-year promoted medical students found weaker in emotional intelligence.

Early Blood Pressure Changes in Neonatal Sepsis and the Risk of Mortality

Kamran Ali — 2024-10-31

Neonatal sepsis is an increasingly common cause of mortality and morbidity in newborns, with hemodynamic abnormalities impacting prognosis. Objectives: To evaluate the relationship between blood pressure levels and in-hospital mortality rate in newborns with sepsis. Methods: The comparative cross-sectional study was conducted for six months from August 2023 to January 2024 at the Department in the Neonatal Intensive Care Unit of Khairpur Medical College to Khairpur Mir’s Medical College Teaching Hospital. The total number of participants was n=300 (n=150 participants per group). Blood pressure was monitored at three different periods: 0-24 hours, 24-48 hours, and 48-72 hours. Data were analyzed using t-test independent, chi-square and multivariable logistic regression to assess the association between blood pressure parameters and in-hospital mortality. Results: Our findings indicated that lower systolic, diastolic, and mean blood pressures at all measured time points were closely linked to higher mortality rates in newborns. At 72 hours, culture-positive infants had a median systolic blood pressure of 64 mmHg, while those with clinical signs had a median of 70 mmHg (p=0.008). Each unit's reduction in blood pressure corresponded to a significant increase in the risk of death. Conclusions: It was concluded that neonates with sepsis had lower mean, diastolic, and systolic blood pressures have a higher mortality rate in hospitals which shows that sepsis with positive culture has a higher risk of severe hemodynamic instability when compared to sepsis with clinical signs.

Knowledge, Skills, and Perceived Competency in Handling Medical Emergencies among Dental House Officers and General Dentists

Malik Adeel Anwar — 2024-10-31

Dental practitioners frequently encounter medical emergencies due to the nature of their work and the inherent stress within a dental office. Adequate preparation and confidence in handling such emergencies are very important for patient safety. Objectives: To assess the knowledge, skills and perceived competency of house officers and general dentists in managing medical emergencies in dental practice. Methods: A cross-sectional survey was conducted in Lahore among house officers and general practitioners. The survey included a pre-valid questionnaire on medical history documentation, attendance at medical emergency workshops, confidence in performing cardiopulmonary resuscitation, administering intravenous drugs, and managing common emergencies like syncope and hypoglycemia. Statistical analysis was performed with Chi-square and Fisher’s exact tests applied to assess associations. Results: The majority of participants demonstrated adequate knowledge of medical emergency protocols, with 68% aware of the need to record medical history and 73% familiar with universal precautions. However, 45% reported being trained in administering cardiopulmonary resuscitation and 29% in administering intravenous drugs. Confidence in handling emergencies such as syncope (0.004) and unconscious hypoglycemic patients (p-=0.03) was significantly higher among dentists with more experience. Conclusions: It was concluded that while dental practitioners generally possess knowledge about medical emergency protocols, there is a gap in training and confidence particularly in administering lifesaving procedures. More experienced dentists demonstrated higher confidence compared to house officers.

Patterns of Infraorbital Nerve Injury in Zygomatic Maxillary Complex Fractures: A Study from A Public Hospital in Karachi

Qasim Saleem — 2024-10-31

The zygomatic region is highly susceptible to zygomatic maxillary Complex fractures, making it the second most common facial fracture in the lateral midface. Objective: To determine the types and frequencies of infraorbital nerve injuries (anesthesia, paresthesia, dysesthesia, and hypoesthesia) in patients with zygomatic maxillary complex fractures. Methods: A cross-sectional study was conducted over six months at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi. The total sample size of 72 was determined using OPEN-EPI software, based on a 95% confidence interval, 7% margin of error, and an assumed 89.77% proportion of infraorbital nerve injury in zygomatic maxillary fractures from a previous study. Non-probability consecutive sampling was employed. Demographic data (gender, age, residence, Body Mass Index) and infraorbital nerve injuries were recorded, and categorized into hypoesthesia, paresthesia, dysesthesia, and anesthesia based on clinical examination and radiographs. Data were analyzed using SPSS version 20.0, with means and percentages used for analysis. The chi-square test was utilized to explore associations between categorical variables. Results:
Among 72 patients, 62.5% were male, with a mean age of 37.43 ± 11.04 years. Urban residents made up 65.3%. The mean Body Mass Index was 24.77 ± 3.0 kg/m², and 19.4% were obese. Infraorbital nerve injury was present in 75% of cases, with paresthesia the most common (59.7%), followed by hypoesthesia (8.3%), dysesthesia (4.2%), and anesthesia (2.8%). Conclusion: It was concluded that infraorbital nerve injuries are frequent in zygomatic maxillary fractures, with paresthesia being the most common. Early detection and treatment are essential to improve patient outcomes.

Stanniocalcin 2 Expression: A Significant Marker in the Prognosis of Colorectal Carcinoma

Salman Zafar — 2024-10-31

Colorectal Cancer (CRC) is one of the most common cancers worldwide and causes significant morbidity and mortality. Biomarkers that predict tumor behavior and prognosis were essential. Stanniocalcin-2 (STC2) was a glycoprotein hormone involved in tumor progression but its association with clinicopathological parameters in colorectal cancer needs to be studied. Objective: To evaluate the correlation of Stanniocalcin-2 expression with clinicopathological features of colorectal cancer including tumor grade, invasion, lymph node metastasis, perineural invasion, and disease prognosis. Methods: This retrospective observational study was conducted at Life Care Molecular and Polymerase Chain Reaction Lab Services, Karachi in collaboration with Fazaia Ruth Pfau Medical College. 60 paraffin-embedded blocks from colorectal cancer patients diagnosed between January 2020 and December 2022 were included. 10 colonic biopsies negative for malignancy were taken as controls. Immunohistochemically analysis of Stanniocalcin-2 was compared with clinicopathological parameters including tumor grade, invasion, lymph node status, and perineural invasion. Statistical significance was calculated at a 95% confidence level and 5% margin of error. Results: Stanniocalcin-2 was significantly associated with higher tumor grade, invasion, lymph node metastasis, and perineural invasion (p<0.05). Strong stanniocalcin-2 expression was associated with poor disease prognosis and aggressive tumor behavior. Conclusions: Stanniocalcin-2 was a poor prognostic marker in colorectal carcinoma and was linked to aggressive tumor features. Stanniocalcin-2 can be a useful biomarker to predict disease progression and treatment strategy.

Etiology and Outcome of Acute Kidney Injury; A Single Centre Study

Mubashar Nazar — 2024-10-31

Acute kidney injury is a syndrome defined by the rapid decline of renal excretory function, commonly identified through the accumulation of nitrogenous waste products. Objective: To identify the etiology and outcome of acute kidney injury. Methods: The study was carried out from September 2023 to April 2024. 135 patients diagnosed with acute kidney injury, aged 18-75 years were included. To categorize the causes of acute kidney injury into pre-renal, intra-, and post-renal categories, comprehensive histories, clinical evaluations, laboratory tests, and kidney imaging using ultrasound were performed. Outcomes were assessed as full recovery, partial recovery, or failure to recover within three months of diagnosis. Descriptive statistics and SPSS version 23.0 were used for analysis. The chi-square test examined the relationship between age, gender, etiology and outcomes; a p-value<0.05 is considered significant. Results: The patients were 41.63 ± 14.55 years old on average. Pre-renal causes were identified in 135 cases, with sepsis 77 (54.8%) being the most common etiology, followed by diuretic overuse 44 (32.6%). Intra-renal causes included acute tubular necrosis 63 (46.7%) and glomerular diseases 48 (35.6%). Post-renal causes were predominantly due to renal stones 68 (50.4%). Full recovery was achieved in 92 (68.1%) cases, partial recovery in 28 (20.7%), and 15 (11.1%) patients failed to recover. Conclusions: It was concluded that the maximum number of patients with acute kidney injury fully recovered. Sepsis is the leading pre-renal cause of acute kidney injury, while acute tubular necrosis is the most common intra-renal cause. Renal stones are the primary post-renal cause.

The Effectiveness of Azithromycin versus Cefixime in the Treatment of Typhoid Fever in Children

Rafique Ahmed Ujjan — 2024-10-31

Typhoid fever is brought on by the Salmonella Typhibacteria. Typhoid fever can present with a wide range of clinical symptoms, making diagnosis difficult. Salmonella Typhi isa bacterium that spreads quickly in unsanitary environments. In addition, this disease is more prevalent in places with inadequate hygienic conditions,economically unsustainable poor people, and rural areas with a lack of safe drinking water supply are at high risk ofdeveloping typhoid fever. Objective: To compare the results of azithromycin versus cefixime in the treatment of typhoid fever in children. Methods: A clinical/Quasi-Experimental study was conducted in the pediatric ward, Liaquat University HospitalJamshoro/Hyderabad by convenience sampling technique within the time frame of six months.SPSS Version 26.0 was employed to analyze the data,by using chi square test. Results: Out of 270 subjects, Individuals of age group (2-5 years) were more affected (53.4%). The male population was more affected (57.8%). Signs and symptoms like fever, abdominal pain, diarrhea and constipation were observed and calculated in this study.Clinical cure occurred in 110 (81.4%) of 135 patients treated with azithromycin, compared with 68(50.3%) of 135 patients treated with cefixime (p-value=<0.001). Conclusions: It was concluded that everyday taking of oral azithromycin may present a plain cure for typhoid fever brought on by drug-resistant or susceptible strains of Salmonella Typhi, which makes it potentially useful in places with limited access to healthcare services. Most of the children aged between 2 to 5 years with male predominance were affected.

Challenges and Barriers In Research Writing-Dental House Officers’ Perspective

Rana Ammar Ahmad — 2024-10-31

Professional development in medical and dental sciences requires research. There was limited information about the research barriers faced by students in this region. Objective: To find out the common challenges and barriers faced by the house officers when writing research proposals. Methods: Dental house officers of 3 private dental colleges in Punjab were recruited for the cross-sectional study. Data collection was done using a self-administered, structured questionnaire. Closed-ended questions were designed to cover 4 domains of research barriers, e.g., personal, educational, environmental, and technical. 16 items of perceived research conduction barriers on three-point Likert scale (Disagree, Agree and Neutral) were included. Results: The most frequently evident barriers were personal 2.26 ± 51.8% and educational 2.00 ± 51.8%, followed by environmental 1.96 ± 51.8% and technical 1.87 ± 51.8%. House officers disagreed that they were not interested in research writing. 68.9% didn’t have any undergraduate research writing experience. 53.6% believe that research contributes to professional development. 45.0% disagree that they will not do research during a house job. 51.4% believed that there was a lack of time for conducting research. 73.4% regarding lack of financial funding was reported. 57.7% believed that inadequate equipment and facilities were the main hurdles in conducting research. 64.4% of participants were of the view that they lack knowledge. 59.9% believed that supervisors do not give adequate time. Conclusions: In order of importance, the most commonly reported barriers in writing research proposals by the dental house officers were personal and educational, followed by environmental and technical barriers.

Impact of Passive Smoking on Low Birth Weight among Pregnant Women in Active Labor

Ayesha Akhter — 2024-10-31

Passive smoking during pregnancy, also called second-hand smoke exposure or environmental tobacco smoke, pretenses a substantial threat to fetal and maternal health. Objectives: To evaluate the association between passive smoking exposure and adverse birth outcomes in low birth weight in pregnant women. Methods: A case-control study was conducted at the Department of Obstetrics and Gynecology, Sughra Shafi Medical Complex, Narowal, from January 2024 to June 2024, involving 150 pregnant women presenting in active labour. Non-probability consecutive sampling techniques were used. Passive smoker’s women were assessed for adverse birth outcomes like low birth weight. Data were analyzed using SPSS-23.0. The chi-square test was used to calculate associations between exposure and outcomes. Odds ratios were calculated with 95% confidence intervals, with p≤0.05 considered statistically significant. Results: 56.7% of the study population was exposed to passive smoking, of which 48.7% delivered Low Birth Weight infants as compared to 25.3% preterm births. Passive Smoker women had significantly higher odds of preterm births (OR: 2.7, p<0.05) and low birth weight (OR: 2.08, p<0.05). Additional risk factors for low birth weight included abnormal BMI (OR: 2.79, p<0.05), multiparity (OR: 6.43, p<0.05), and maternal age over 30 years (OR: 5.7, p<0.05). Conclusions: It was concluded that a significant association between passive smoking and adverse birth outcomes was found, especially Low Birth Weight and preterm. The risks were markedly higher among women over age 30 years, those with multiparity and abnormal BMI. Results highlight the need for directed interventions to decrease passive smoking exposure in pregnant women.

Prevalence and Risk Factors of Coronary Heart Disease in Nawabshah: A Case-Control Study

Yasir Akbar Jamali — 2024-10-31

One of the top causes of mortality globally was Coronary Heart Disease (CHD), and South Asian nations were exhibiting a particular trend in this regard. Objective: To determine the prevalence and identify its associated risk factors in the Nawabshah population. Methods: For ten months, from October 5, 2023, to May 27, 2024, this case-control research was carried out at the Peoples University of Medical and Health Sciences Hospital in Nawabshah. The participants underwent a complete clinical assessment, including laboratory testing, physical examination, and medical history review. Based on known diagnostic criteria such as Electrocardiogram (ECG) analyses, cardiac enzyme levels, and imaging examinations, the attending physicians diagnosed Coronary Heart Disease (CHD). Results: In the study population, 52.5% of the cases were classified as obese, and 64.3% had hyperlipidaemia. Additionally, 31.1% of the patients in the case group had diabetes, 66.4% were smokers, and 73.5% had hypertension. Physical inactivity was prevalent in 55.5% of the patients in the case group. According to the sex distribution, there were more women in the case group (53.4% versus 45.0%). Conclusions: The high prevalence of hypertension, hyperlipidaemia, obesity, and smoking in Nawabshah is one of the modifiable risk factors for coronary heart disease that this research emphasizes. Public health measures that aim to improve people's lifestyles and prevent diseases should be implemented immediately considering these results.

Prevalence of Hypothyroidism in Non-Alcoholic Fatty Liver Disease (NAFLD) Patients

Mohammad Khalid Hamidi — 2024-10-31

Non-alcoholic fatty liver disease is a leading cause of chronic liver disease and has a high prevalence globally. The principal causes range from obesity, hypertriglyceridemia, diabetes mellitus and other endocrinopathies to drugs and certain metabolic disorders. Hypothyroidism associated with non-alcoholic fatty liver disease has raised concerns over recent years but there is limited substantive data to support this evidence. Objective: To ascertain the existing prevalence of hypothyroidism in non-alcoholic fatty liver disease patients presenting to a tertiary care hospital. Methods: It was a descriptive cross-sectional study that was executed in the Medical Department of King Edward Medical University, Mayo Hospital, Lahore from 30^th July 2022 to 29^th July 2023. A total of 215 patients with diagnosed non-alcoholic fatty liver disease on ultrasound were enrolled after taking informed consent and their Thyroid profile i.e., measurement of serum thyroid stimulating hormone, free tri-iodothyronine and free thyroxine was done. Results: From a total of 215 patients, 7 (3.3 %) belonged to the age bracket of 20-40 years and 208 (96.7 %) in the age range of 41-60 years with a female preponderance of 118 (54.9%) and male 97 (45.1%). Mean age was reported to be 50.79 ± 3.95 years and BMI was 23.09 ± 3.93 kg/m². The overall prevalence of hypothyroidism was reported in 42 (19.5%) patients. Conclusion: It was concluded that there is a high prevalence (19.5%) of hypothyroidism in patients with non-alcoholic fatty liver disease.

Indicator Variables for Road Traffic Injury Severity in District Gujrat, Pakistan

Sajid Hameed — 2024-10-31

Road Traffic Injuries (RTIs) are unexpected and unpredicted events involving at least a single vehicle. They claim the lives of around 1.3 million people every year. Objective: To determine the indicator variables that play roles in forecasting the injury severity levels (slight, moderate, and severe) of road traffic accidents in the populous city of Gujrat and correspondingly design explicit health policies for the public health system. Methods: An analytical cross-sectional study was conducted for six months from June 2023 to December 2023 on 342 subjects with and without fatalities; excluded were the ones with non-RTA emergencies. The response variable, injury severity, was divided into three categories: slight, moderate, and severe. Chi-square and multiplicative logit tests were applied to determine a predictive model using Stata version 15, respectively. Results: Pearson X² associated p-values for ‘time lapse until help’ and marital statuses were 0.086 and 0.123, respectively. A multinomial logit model of road accident injury severity concluded that if distance from first aid increases along with foggy weather, the chances of severe injuries are e higher. The increase in education level will decrease the frequency of severe injuries. Licenses gained without training result in 116 times more severe injuries. Conclusions: This study showed that distance from first aid, weather, age, education, and license gained affect the risks of severe injuries. The public health care sector should take on recommended initiatives to manage the resource burden of RTA in tertiary care hospitals that could be used for combating other systemic illnesses.

Cultural and Socioeconomic Determinants of Mother’s Complementary Feeding Practices on Nutritional Status of Children Under Five: A Cross-Sectional Study in Lahore, Pakistan

Misha Shahbaz — 2024-10-31

Optimal nutrition and appropriate feeding practices in children determine the life and health of the child. Objectives: To investigate the cultural and socioeconomic determinants influencing mothers' complementary feeding practices, to evaluate mothers' knowledge, attitudes, and practices regarding complementary feeding, and to analyze the association between these factors and the nutritional status of children under 5. Methods: A cross-sectional study recruited 120 participants through a purposive sampling technique. Mothers with children under 5 were the targeted population living in Lahore. Data were collected through an online Google form and a self-administered, paper-based questionnaire divided into four sections: sociodemographic questions, questions on knowledge, attitude, and practices of complementary feeding, cultural practices, and questions related to the child's nutritional status. SPSS software version 27.0 was used for data analysis. Results: Almost (64.5%) of mothers knew that the correct age of initiation of complementary feeding was six months and were also aware of the risks of early initiation. The mother’s age (p-value=0.022) and literacy levels (p-value=0.010) were significant factors. Other factors included place of residence and age of initiation of complementary feeding (p-value=0.042), feeding environment (p-value<0.001), and responsive feeding practices (p-value<0.001). Conclusions: It was concluded that cultural beliefs and feeding practices that affect complementary feeding in Lahore were analyzed, with the results cementing the need for culturally responsive interventions and empowerment of mothers to mitigate malnutrition. The findings offer valuable insights contributing to the development of targeted interventions for similar communities.

Modelling Predictive Factors of Knowledge, Attitudes and Practices towards HIV/AIDS Transmission and Their Interlinked Role: A Facility-Based Cross-Sectional Study Among HIV/AIDS Patients in Lahore, Pakistan

Fatima Majeed — 2024-10-31

HIV/AIDS remains a significant global health challenge that disproportionately affects low and middle-income countries, including Pakistan. Understanding Knowledge, Attitudes, And Practices (KAPs) and their interlinked role in preventing HIV/AIDS was of utmost importance for effective prevention and control efforts. Objective: To explore the current state of KAP related to HIV/AIDS in Pakistan, emphasizing the interlinkage of these factors with each other. Methods: The present study was a facility-based cross-sectional study carried out with a sample size of 114 HIV patients who were enquired about their KAP using a predesigned questionnaire. The data were entered and analyzed using SPSS (version 24.0), chi-square tests, and binary logistic regression. Results: Approximately half of the respondents had good knowledge (43.9%) and attitudes (48.1%), while slightly more of them reported good practices (56.1%) regarding HIV/AIDS. The predictive model of KAP regarding HIV/AIDS showed that males (OR=4.25; 95%CI=1.42-12.73), females (OR=3.69; 95%CI=1.05-12.95), literate individuals (OR=2.90; 95%CI=1.35-6.25), and employed individuals (OR=2.35; 95%CI=1.08-5.13) were more likely to have sufficient levels of knowledge, with patients with good knowledge 2.54- and 3.30-fold more likely to have better attitudes (95%CI=1.19-5.44) and better practices (95%CI=1.50-7.28), respectively, and patients with better attitudes 12.59-fold more likely to have better practices (OR=12.59; 95%CI=5.06-31.29) regarding HIV/AIDS. Conclusions: Conclusively, the trends of KAP related to HIV/AIDS were taking a positive turn in Pakistan; however, there was still a large gap that has yet to be filled. There was a need to destigmatize the disease by disseminating the right information with concerted efforts.

Variations in Elbow Carrying Angle Associated with Age, Gender, Height, and Weight: An Analytical Cross-Sectional Study

Jawad Khan — 2024-10-31

The elbow's carrying angle is a critical biomechanical feature that varies between genders and with physical characteristics like Body Mass Index. Objective: To determine the elbow carrying angle and analyze its correlation with physical attributes such as age, gender, height, and weight in a cross-sectional cohort.” Methods: A cross-sectional study was carried out on 203 patients. The participants were divided into groups according to their height, weight, age, and gender. the mean carrying angles of the elbows on the left and right were measured and compared. Data were collected and analyzed using SPSS version 25.0, and the significance of the differences in carrying angles between the groups was determined by computing p-values. Results: There were 76 patients (37.43%) and 127 male patients (62.56%) in the study population. Sixty-six percent of the patients belonged to the 46–60 age range. For the left elbow, the mean carrying angle was 4.6° (±0.23), while for the right elbow, it was 4.5° (±0.12). Gender, limb side, height, and weight all showed significant changes in carrying angles; p-values<0.05 indicated that these variances were statistically significant, especially when comparing different body types and demographic groups. Conclusions: It was concluded that the right arm typically exhibits a slightly wider angle than the left when it comes to elbow carrying angles; gender, height, and weight all significantly influence these angles.

Nervous Discrepancy of Spinal Cord Schwannoma Causing Posterior Neck Swelling

Soobia Saeed — 2024-10-31

A 20-year-old man with chronic cervical pain has been diagnosed with cervical spinal schwannomas, a benign tumor in the posterior neck. Objective: To analyze the spinal cord schwannomas causing posterior neck swelling. Methods: In the first step, the vertebral canal portion of the tumor at C4 was removed entirely with a midline approach to the posterior spinal column. The patient underwent a laminectomy procedure in the second surgical session to remove tumors at C2 and C3, resulting in no neurological issues upon discharge from the hospital. Results: Schwannomas was diagnosed histopathologically. In patients with cervical intra-spinal schwannomas that have spread to the extra vertebral paravertebral neck region, the first goal of surgery is to treat the neurological deficits. Conclusions: It was concluded that the posterior midline and laminectomy approach approaches are combined in the same session or at different times in the surgical strategy.

The Impact of Integrated Community-Based Management of Respiratory Infections in Reducing Child Mortality

Babar Hayat — 2024-10-31

Pneumonia alone is reported to be the leading reason for child death especially within developing countries which have inadequate health care facilities. So, it is necessary to assess the effect of Integrated Community Based Management interventions in reducing the child mortality rate caused by respiratory diseases. Objectives: To assess the effectiveness of early intervention to raise public awareness, ensure that individuals adhere to their treatments and use community health workers to decrease mortality in Low- and middle-income countries and to identify the key factors that contribute to success. Methods: The articles which are purely research articles were retrieved from databases including PubMed, Science Direct, Nature Journal and Google Scholar from January 2013 to April 2024. Peer-reviewed papers published on the management of respiratory diseases in the communities including youngsters below the age of 5 years were included from Africa, South Asia, America and Europe. Only those studies that met the identified criteria for methodological quality, and reporting on the outcomes of interventions and decrease in mortality were considered for inclusion. Results: The findings showed that community health workers played a significant role in the early diagnosis and prevention of respiratory tract disorders and other harmful diseases. There was a significant reduction of 30% in mortalities of infants and preschoolers in communities where the implementation of interventions was made necessary. Conclusions: It was concluded that the implementation of integrated community-based management of respiratory infection is a viable approach used to address child mortality in low-income areas and raise public awareness.

The Key Role of Brain-Derived Neurotrophic Factor (BDNF) in Pathophysiology of Glaucoma and Its Therapeutic Potential

Muhammad Usman Durrani — 2024-10-31

Glaucoma, a leading cause of irreversible blindness, is increasingly recognized as a neurodegenerative disease affecting broader neuro-ophthalmic pathways. Brain-derived neurotrophic Factor is a crucial neurotrophin, that supports the growth, maintenance, and survival of neurons and has been implicated in glaucomatous damage where its levels are diminished. Objectives: To focus on the role of Brain-Derived Neurotrophic Factor in the pathophysiology of glaucoma and its therapeutic potential by enhancing the survival of retinal ganglion cells. Methods: The studies in this review are taken from well-known public libraries for scientific research such as PubMed (60%), Science Direct (25%) and Springer Link (15%), in line with PRISMA guidelines. Various works conducted over the past decade from different parts of the world, including North America, Europe, and Asia, have provided evidence that the augmentation of Brain-Derived Neurotrophic Factor signalling may be a very effective approach to managing or halting the progression of glaucomatous optic neuropathy through neuroprotection and improving retinal ganglion cells survival. Results: Studies in both animals and humans indicate that Brain-Derived Neurotrophic Factor and its downstream signals promote the survival of retinal ganglion cells and decrease the extent of apoptotic cell death, oxidative stress, and inflammation in glaucoma. Moreover, enhancements of Brain-Derived Neurotrophic Factor neuroprotective effects are supported by factors such as Nerve growth factor and Brain-Derived Neurotrophic Factor. Conclusion: It was concluded that Brain-derived neurotrophic Factor has the potential to be used as a diagnostic marker for Glaucoma as well as it could be evaluated for its therapeutic potential against the disease.

Evaluating Preventive Health Strategies: Salivary Biomarkers as Non-Invasive Indicators of Caries Risk in School Children

Arhana Surwaich — 2024-10-31

Dental caries, a prevalent oral health condition affecting 514 million children aged <6 years, globally, was a significant public health concern. Salivary biomarkers offer a non-invasive approach to assessing caries risk. However, research on the specific role of salivary components in caries progression and prevention was limited. This systematic review aimed to evaluate the potential of salivary biomarkers as a valuable tool for predicting caries risk in school children. Objective: To evaluate the role of Salivary Biomarkers in risk assessment of caries in school children. Methods: A systematic review of literature published between January 2009 and February 2024 focused on studies investigating the association between salivary biomarkers and caries risk in school-aged children. PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched, and the PRISMA guidelines were followed. 500 full-text papers were screened for eligibility, and 43 studies meeting the inclusion criteria were evaluated, relevant information was extracted, and a systematic review was conducted with 43 included studies. Results: Salivary biomarkers, including proteomics, microbiota, sugar metabolization, IgA levels, and salivary metabolic profiles, were significantly correlated with the risk of developing caries. Salivary samples demonstrated superior sensitivity, specificity, cost-effectiveness, and patient acceptance compared to blood samples for predicting caries risk. Conclusions: The findings suggested that salivary biomarkers hold promise as valuable non-invasive tools for stratifying caries risk in school children. Further research was needed to validate these biomarkers and integrate them into routine dental care to improve preventive strategies.

Comprehensive Insights into the Neutrophil Percentage to Albumin Ratio (NPAR): An Emerging Integrated Biomarker for Inflammation and Prognosis

Maeesa Wadood — 2024-10-31

Neutrophil Percentage to Albumin Ratio is a new biomarker that measures inflammation severity and prognosis in many inflammatory diseases. Objectives: To systematically assess the role of neutrophil percentage to albumin ratio in predicting inflammation and patient prognosis compared to conventional biomarkers C-reactive protein and procalcitonin, in inflammatory diseases. Methods: PRISMA guidelines were followed by electronic databases such as PubMed, Science Direct, and Google Scholar using keywords including 'Neutrophil Percentage to Albumin Ratio', 'inflammation', 'biomarkers' and 'prognoses’ from 2014 to 2024. Some studies examined the interaction between neutrophil percentage to albumin ratio with systemic inflammation, immune dysfunction and organ injury. Two aspects were analysed comprehensively regarding the comparison of neutrophil percentage to albumin ratio with conventional inflammation biomarkers with consideration of age, baseline characteristics, and comorbidity along with the neutrophil percentage to albumin ratio evaluation in the spectrum of various disorders. A total of 99 studies were taken into consideration for initial screening, finally, 18 studies were taken for in-depth analysis. Results: The review showed a significant correlation between higher values of neutrophil percentage to albumin ratio and inflammation, organ, and clinical deterioration. neutrophil percentage to albumin ratio demonstrates higher accuracy in evaluating the severity of inflammation and patient prognosis compared to classical markers, particularly in critical conditions. Conclusions: It was concluded that neutrophil percentage to albumin ratio becomes ideal as a stable multiple biomarker to measure inflammation and the overall patient prognosis. Utilization of markers in clinical practice could lead to improved recognition of severe inflammation states