Pakistan Journal of Health Sciences

A Climate Wake-Up Call: Pakistan’s Floods Reveal a Healthcare Crisis

Riffat Mehboob — 2025-06-30

Flooding has become a recurring nightmare in Pakistan, exacerbated by both natural and human-induced factors. The devastating monsoon floods of 2022 exposed the country’s deep vulnerability, damaging nearly 2,000 health facilities showing 13% of all in the country, and displacing more than 600,000 people. Vast areas of farmland, including three million acres of cereal crops and over 1.2 million livestock, were lost, severely disrupting food security and livelihoods.

Since July 2022, floods have inundated 116 districts, affecting 33 million people and placing immense strain on the already fragile healthcare system. More than 1,000 people lost their lives, 1,500 were injured, and over 161,000 were forced into overcrowded and unhygienic relief camps. As of now, 66 districts remain critically impacted. This crisis is not just a one-off disaster it is a symptom of worsening climate extremes, poor planning, and under-resourced public infrastructure. In 2025 alone, Pakistan has already witnessed deadly spring weather, including severe hailstorms, which claimed at least 32 lives.

The 2025 Climate Risk Index ranks Pakistan as the world’s most climate-impacted country, based on data from 2022. A third of the country was submerged, over 1,700 lives were lost, and economic damages surpassed $30 billion. At least 6.4 million people still require humanitarian assistance, and healthcare access remains dangerously limited. Although roughly half of the displaced population has returned home, the absence of clean water and sanitation continues to drive the spread of disease.

As the nation reels under relentless monsoon rains and deteriorating conditions, a public health emergency is unfolding silently alongside the visible destruction. The World Health Organization (WHO) has warned that flooding is fueling outbreaks of diseases such as dengue, malaria, acute watery diarrhea, COVID-19, and polio. With immunization campaigns disrupted and stagnant water everywhere, disease is spreading unchecked. Even before the floods, Pakistan had recorded over 4,500 measles cases and 15 instances of wild poliovirus. These fragile public health gains are now at grave risk.

In response, the World Health Organization (WHO) and Pakistan's Ministry of National Health Services are maintaining emergency operations in the affected regions. They are concentrating on long-term preparedness, healthcare restoration, medicine supply, and disease surveillance. However, it is imperative that these endeavors be dramatically increased. Millions of individuals continue to be vulnerable to preventable illnesses due to their lack of access to basic care and proper sanitation. This crisis is no longer solely about water; it is also about the future of healthcare, resilience, and survival in a world that is warming. Pakistan's silent emergency may soon become too loud to ignore if sustained action is not taken.

Effect of Exercise and Nutrition on Oxidative Stress in Females with Polycystic Ovary Syndrome, a Current Status and Future Perspective in Narrative Review

Maria Mustafa — 2025-06-30

Women in their reproductive years are prone to the widespread endocrinological disorder known as Polycystic Ovarian Syndrome (PCOS). To provide in-depth insights into the factors contributing to hormonal imbalances, inflammation, and oxidative stress in women with PCOS. Additionally, it evaluates the impact of exercise and nutritional interventions on oxidative stress and overall metabolic health in PCOS women to improve their quality of life. This review analyzed existing literature and clinical evidence related to endocrine disturbances in PCOS, including hormonal changes such as elevated androgens, insulin resistance, inflammation, and oxidative stress. The effects of lifestyle interventions specifically physical exercise, dietary modifications, and supplementation on these metabolic and hormonal abnormalities were studied. Hormonal Imbalance: Women with PCOS show dysregulated production of Growth Hormone (GH), ghrelin, LEAP-2, Gonadotropin-Releasing Hormone (GnRH), insulin, LH/FSH ratio, androgens, and estrogens. Inflammation and Oxidative Stress: Hyperandrogenism and insulin resistance promote chronic inflammation and increased Reactive Oxygen Species (ROS), leading to oxidative stress, gut microbiome alterations, and metabolic dysfunction. PCOS is a multifactorial disorder influenced by hormonal imbalance, chronic inflammation, and oxidative stress. Lifestyle modifications, particularly tailored exercise regimens and nutritional strategies, play a critical role in mitigating these factors.

Diagnostic Accuracy of Chest Ultrasound in Diagnosing Rib Fractures, Keeping CT Chest as Gold Standard

Sara Rashid — 2025-06-30

Blunt chest trauma is a frequent cause of emergency visits with a high risk of rib fractures, timely identification of which is crucial for effective patient management. Objectives: To assess the accuracy of chest ultrasound in diagnosing rib fractures, keeping CT chest as a gold standard. Methods: A cross-sectional validation study was conducted at the Radiology Department, Holy Family Hospital, Rawalpindi, for six months (Jun–Nov 2023). Adult patients presenting with blunt chest trauma in the Emergency Department who fulfilled eligibility criteria were included. The presence of rib fractures was assessed in each patient by chest ultrasound and verified by CT chest. The diagnostic power of the ultrasound method was assessed and reported as sensitivity, specificity and predictive values by comparison with the gold standard. Results: The mean age reported was 35.3 ± 5.93 years; there were 61 (57.5%) male and 45 (42.4%) female. The accuracy of chest ultrasound in detecting rib fracture, with CT-chest as the reference standard, demonstrated 92.1% sensitivity, 95.2% specificity, 96.7% and 88.8% positive and negative predictive values, and an accuracy of 93.3%. Conclusions: It was concluded that chest ultrasound has good diagnostic power (93.3%) to establish the diagnosis of broken ribs in patients with trauma in emergency settings compared with CT-chest scan.

Obstetric Outcomes after Cervical Cerclage in Women with Cervical Insufficiency

Mahjabeena Bilal — 2025-06-30

Most of the local studies in Pakistan have focused only on the prevention of preterm labour after cervical cerclage in women with cervical insufficiency. Still, these studies lack data regarding other outcomes like abortion and premature rupture of membranes after cervical cerclage in women with cervical insufficiency. Objective: To determine the obstetric outcomes after cervical cerclage in women with cervical insufficiency. Methods: This descriptive study was carried out at the Gynaecology Department, Khyber Teaching Hospital, during the period 22^nd May 2024 till 31^st March 2025. Women aged 18-35 years with gestational age 13 to 20 weeks and transvaginal ultrasound showing cervical length <2.5cm were enrolled. Cervical cerclage was performed, and pregnancy outcomes were noted in terms of miscarriage, preterm, PROM, prolonged pregnancy and term pregnancy. Results: Mean age of the participants was 30.42 ± 5.616 years, mean BMI was 24.070 ± 2.704kg/m² and mean gestational age was 24.37 ± 4.844 weeks. 85 patients (50.3%) were aged more than 30 years. Participants with parity up to 3 were 94 (55.6%), and 126 patients (74.6%) were housewives. Preterm was the most common pregnancy outcome, recorded in 58 patients (34.3%), 34 patients (20.1%) had a term pregnancy, and prolonged labor was the least common (n=8, 4.7%). Conclusions: Preterm delivery was the most common pregnancy outcome after cervical cerclage in this cohort of patients. However, a reasonable number of patients were found with a term pregnancy, showing the adequate prolongation of pregnancy with cerclage in cervical insufficiency.

Association of C-Reactive Protein and D-dimer Status with Maternal Outcomes in Pregnant Women with COVID-19

Summera Aslam — 2025-06-30

C-reactive protein (CRP) and D-dimer are crucial biomarkers that play a key role in maternal health, helping to assess risks and minimize complications. Objectives: To find the association of CRP and D-dimer status with maternal outcomes in pregnant women with COVID-19. Methods: The prospective cohort study was carried out at the Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to September 2020. Demographic data, laboratory parameters including COVID-19, D-dimer and CRP levels and maternal outcomes were recorded. Crosstabs and binary logistic regression analyses were performed to measure the risk of adverse maternal outcomes. Results: Among 112 COVID-19 suspects, 58 (51.8%) were diagnosed as COVID-19 positive, 82 (73.2%) tested positive for CRP, and 19 (17.0%) were D-dimer positive. COVID-19 positive women exhibited twice the mean D-dimer levels (0.92 ± 1.36 vs. 0.43 ± 0.70 µg/mL) and a slightly lower mean CRP level (26.47 ± 31.55 vs. 29.30 ± 32.79 mg/L). Ventilator requirement (32.8% vs. 11.1%) and maternal death rate (29.3% vs. 11.1%) were three times higher in COVID-19 positive cases as compared to the COVID-19 negative cases.CRP positive status and COVID-19 positive showed a statistically significant association and higher risk for ventilator requirement as well as maternal death. However, D-dimer positive status did not show any association with ventilator requirement and maternal death. Conclusions: COVID-19 positivity and CRP positivity in pregnant women are associated with adverse maternal outcomes, including increased ventilator requirement and mortality. However, D-dimer positivity was not related to these adverse maternal outcomes.

Prevalence and Effects of Self-Medication Practice among Pharmacy Students: A Cross-Sectional Study in Karachi

Leena Anjum — 2025-06-30

The prevalence of self-medication is notably high among medical students compared to the general population, which is primarily attributed to advanced knowledge of pharmacology and easier access to pharmaceuticals either through educational resources or hospital attachments, potentially underestimating the risks involved. Objectives: To determine the prevalence and effects of self-medication practice among pharmacy students: a cross-sectional study in Karachi. Methods: The study employed a cross-sectional descriptive design conducted on 283 pharmacy students using a structured, self-administered questionnaire developed specifically. The collected data were analyzed by SPSS-21 software. Results: The outcomes revealed the response rate of 92.93%, with the largest group of participants (23%) being first-year students, comprised mainly female respondents (72.24%), between the ages of 21-23. The relationship between both age and year of study with the usage of self-medication without consulting a doctor is found to be significant. Students were engaged in the use of self-medication occasionally. The commonly reported symptoms and conditions practiced were headaches (55.1%). However, a statistically significant relationship was observed between certain medical conditions, particularly fever, diarrhea, and nausea/vomiting, and gender. Further evaluated perceptions of the safety of self-medication, with statistical analysis highlighting significant associations with both age (p=0.036) and year of study (p=0.014). Conclusions: The Prevalence of self-medication among pharmacy students is high. It is needed to focus on developing and implementing programmes about the risks of self-medication, and to ensure self-practices along with a control system and monitoring of drug sales by health decision-makers and policymakers.

Association of Cutaneous Manifestations with Undiagnosed Diabetes Mellitus in Adults

Muhammad Zubair — 2025-06-30

Diabetes mellitus (DM) remains underdiagnosed in resource-limited settings, where access to laboratory screening is constrained. Cutaneous manifestations may serve as visible, cost-effective indicators. Objectives: To determine the association between characteristic skin lesions (acanthosis nigricans, skin tags, xerosis) and undiagnosed diabetes in adults. Methods: A cross-sectional study involving 400 participants was conducted at a Teaching Hospital with adult patients without known diabetes (aged 18–70) attending dermatology and general medicine clinics. Detailed dermatological examinations documented predefined skin manifestations, while biochemical assessments (fasting plasma glucose, HbA1c, and oral glucose tolerance test) classified participants into normoglycemic, pre-diabetic (IFG/IGT), or diabetic groups per ADA criteria. Statistical analysis was done on SPSS version 26.0. Results: The prevalence of cutaneous markers was significantly higher in prediabetes and diabetes groups (p<0.001). Acanthosis nigricans was present in 61.4% of cases, nearly eight times more prevalent than in normoglycemic individuals (8.1%). Similarly, multiple skin tags (≥5) affected 52.9% of diabetics compared to just 12.4% of controls, while xerosis showed a fourfold increase from 9.5% in normoglycemic subjects to 44.3% in diabetics. Conclusions: It was concluded that specific dermatological manifestations exhibit a robust correlation with undiagnosed diabetes and pre-diabetes. Incorporating cutaneous markers into routine clinical examinations may enhance early detection, particularly in resource-limited settings.

Caregiver-Reported Reasons and Outcomes of Treatment Default among Pediatric Oncology Patients at a Tertiary Care Hospital in Pakistan

Aimen Gull — 2025-06-30

Despite the availability of free care, many children in Pakistan fail to complete cancer therapy, leading to poor outcomes and increased mortality. Objective: To determine reasons and outcomes of pediatric cancer patients defaulting treatment at tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted at Pediatric Hematology/Oncology unit of Children Hospital, Lahore. Total 82 pediatric oncology patients (<16 years) who started treatment but defaulted at any stage between 1st January and 30th June 2024 were included. Caregivers were interviewed regarding default reasons, and relevant clinical data were analyzed using SPSS version 27.0 for descriptive statistics. Results: Most frequently reported contributing factors were financial issues (100%), out-of-pocket expenses (98.8%), long travel distance (92.7%), and poor socioeconomic status (91.5%). Family-related challenges included other responsibilities (89%), parental job issues (84.1%), poor understanding of disease (81.7%), and lack of family support (63.4%). Additional reasons included large family size (72%) and family pressure to abandon treatment (29.3%). Patient-related causes were faith-based healing (50%), perceived long treatment duration (31.7%), consent withdrawal (25.6%), and fear of surgery (18.3%). System-related barriers included treatment unavailability (11%) and dissatisfaction with care (7.3%). Upon return, 54.3% were eligible only for palliative care, 25.6% resumed curative treatment, 14.8% expired, 3.7% were cured, and 2.5% were lost to follow-up. Conclusion: Treatment default in pediatric oncology is driven by financial, social, and systemic challenges. Overcoming these obstacles is essential to enhance treatment adherence and improve patient outcomes.

Beyond Weight Loss: Investigating Irritability and Mood Swings after Bariatric Surgery: A Prospective Study

Mushtaq Ahmad — 2025-06-30

The physical changes after bariatric surgery are evident, but the significant changes in psychological and emotional effects are underscored and have not received much attention. Objectives: To determine the prevalence of Irritability and Mood Swings After Bariatric Surgery and its impact on hormonal and nutritional changes. Methods: This prospective observational study was conducted from February 2022 to January 2023. Patients undergoing any type of bariatric surgery with no existing psychiatric conditions that required medication were included. Structured questionnaires were distributed among the participants, and informed consent was also provided. Results: The study comprised 1,014 patients, with a mean age of 33 ± 13 years. According to the Profile of Mood States (POMS), 679 (67%) of participants had clinically severe mood abnormalities before surgery, which then increased to 844 (83%) at three months and then reduced to 355 (35%) at six months (p<0.001). Compared to 740 (73%) before surgery, 902 (89%) of patients experienced moderate to severe irritation at three months (p<0.001). After six months, this percentage dropped to 446 (44%). Conclusions: The research concluded notable changes in mood, irritability, and hormone levels after bariatric surgery, including increased irritability and mood disturbance at three months, with improvement at six months. Prevalent nutritional deficiencies of vitamins B12 and D regression were also found to be associated with increased mood and irritability. Multiple hormonal variations and nutritional deficiencies were found to result in postoperative mood variation significantly.

Prevalence of Vitamin D Deficiency in Pregnant Women and Its Association with Musculoskeletal Pain: A Cross-Sectional Study

Muneeb Ur Rehman — 2025-06-30

Vitamin D deficiency is recognized as widespread public health issue especially prevalent in pregnant women, has been associated with negative maternal health consequences, including musculoskeletal pain. Objective: To assess vitamin D levels during pregnancy and explore their association with musculoskeletal pain in pregnant women Methods: A cross-sectional study was performed at a teaching hospital in Sargodha over a 16-month period (09/2023-12/2024). Biochemical assessment of vitamin D status was performed through serum 25(OH)D quantification, while musculoskeletal symptoms were documented using structured pain questionnaires. Statistical evaluation, including chi-square analysis of associations, was performed using SPSS Statistics version 26.0. Results: Out of 250 pregnant women, 72.4% (n=181) had deficiency of vitamin D (<20 ng/mL), while 18% (n=45) had insufficiency (20-30 ng/mL). The association revealed between vitamin D deficiency and musculoskeletal pain was significant as (p <0.001), moderate to severe pain was evident in 68.2% of deficient women compared to 31.8% in the sufficient group (≥30 ng/mL). Conclusions: Current evidence reveals alarmingly high rates of vitamin D deficiency among pregnant women and is significantly associated with musculoskeletal pain. Routine screening and supplementation should be considered to improve maternal health outcomes.

Association Between Anemia and Prevalence of Gestational Diabetes vs Non-Gestational Diabetes among Pregnant Women

Safder Ali Pervez — 2025-06-30

Gestational diabetes mellitus (GDM) affects a large number of pregnant women globally and generates significant health complications for both mothers and their newborns. Objectives: To establish anemia prevalence among pregnant women with and without gestational diabetes mellitus (GDM) by investigating how various demographic and clinical factors influence this relationship. Methods: A six-month comparative cross-sectional study was conducted at Khairpur Medical College, Khairpur Mir’s. The study enrolled pregnant women n=200 between 18-40 years of age who had single child pregnancies during the gestational period of 24 to 28 weeks. The criteria established by WHO distinguished anemia while the diagnosis of GDM followed the OGTT results using a 75g Oral Glucose Tolerance Test (OGTT) as per WHO/ADA 2013 guidelines. Data were analyzed using descriptive statistics with chi-square tests and logistic regression. Results: The mean age of maternal individuals (29.8 years) along with body mass index (BMI 29.4 kg/m²) was higher in GDM group members than in non-GDM group individuals; p<0.001. GDM mothers had higher anemia prevalence at 78.3% compared to 57.1% in the other group (p=0.004), alongside lower average hemoglobin measurement results (9.8 g/dL compared to 10.5 g/dL, p=0.001). The analysis using logistic regression established both anemia along BMI and maternal age as independent risks for GDM diagnosis (OR: 2.35, p=0.006). Conclusion: It was concluded that anemia occurs more frequently in pregnant women with GDM, while remaining an independent GDM factor, which also correlates with elevated maternal age and BMI compared to non-GDM women.

Changes in Blood Pressure and Pulse Rate in Patients Following the Injection of Lidocaine with 2% Adrenaline in A Mandibular Nerve Block

. Misbah — 2025-06-30

Local anaesthetic like lidocaine are commonly used in dental and maxillofacial procedures, but their systemic vasoconstrictive effects can cause physiological changes, especially in cardiovascular parameters. Objectives: To evaluate the blood pressure and pulse rate alterations in patients after administering a mandibular nerve block using 2% lidocaine with adrenaline. Methods: Three hundred patients aged 14-60 who came for extraction were selected through non-probability consecutive sampling. Clinical examinations were performed, and diastolic, systolic blood pressure, and pulse rate were recorded with an automatic digital blood pressure monitor in four stages (before local anesthesia (5 minutes’ rest), before local anesthesia (sitting at chair), after local anesthesia (immediate) and after local anesthesia (10 minutes)). Results: A study of 300 mandibular nerve block patients found that male patients (69.3%) and female patients (30.7%) had a mean age of 32.95 ± 11.19 years. Blood pressure, pulse rate, and oxygen saturation significantly varied in all four stages. In the first stage, most patients had normal blood pressure (120/80 mmHg), while in stages 2-4, most had stage 1 blood pressure (139/89 mmHg). In stages 3 and 4, patients had stage 2 blood pressure (140/90 mmHg), and in stage 4, 1.3% experienced hypertensive crisis. In stages 1-4, most patients had normal pulse rate, followed by tachycardia and bradycardia. Conclusions: The study found significant differences in blood pressure and pulse rate among patients after administration of a mandibular nerve block using 2% lidocaine with adrenaline.

Assessing the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Pyelolithotomy or Nephrectomy Patients

Sumayya Tariq — 2025-06-30

Nephrectomy and pyelolithotomy are invasive surgical procedures often associated with significant postoperative pain, necessitating effective analgesia for optimal recovery. Objectives: To evaluate the efficacy of ultrasound-guided erector spinae plane block (ESPB) in patients undergoing nephrectomy or pyelolithotomy, with a focus on pain relief, dermatome coverage, and duration of analgesia. Method: This quasi-experimental study was conducted over 12 months in the Anesthesia Department of Sharif Medical City Hospital, Lahore, enrolling 66 patients. After receiving ESPB, postoperative pain was assessed using the Visual Analogue Scale (VAS) at rest, where 0 indicated no pain and 10 indicated the worst possible pain. Dermatomal coverage was evaluated via pinprick testing, and the time to first rescue analgesia was recorded. Data analysis was performed using SPSS version 25.0. Results: Out of the 66 patients, 47 were male and 19 female. VAS scores showed a significant reduction from 2.98 ± 1.31 at 24 hours to 0.87 ± 0.83 at 72 hours (p=0.000). Pain on movement significantly decreased (p=0.000), while sleep quality showed no significant improvement. The proportion of patients reporting adequate pain relief rose from 67.3% at 24 hours to 81.5% at 72 hours (p=0.000). Peak rescue analgesia demand occurred at 15–16 hours postoperatively (25 patients), indicating prolonged initial analgesia. Conclusions: It was concluded that the ultrasound-guided erector spinae plane block (ESPB) effectively manages pain, significantly reducing VAS scores over 72 hours. This method delivers high-quality analgesia with consistent dermatome coverage following pyelolithotomy and nephrectomy.

Barriers to the Implementation of Evidence-Based Practice in A Tertiary Care Hospital Mirpur, Azad Kashmir, Pakistan: A Cross-Sectional Study

Safia Noreen — 2025-06-30

An approach to providing care to patients is based on problem-solving decisions on the greatest reliable and current data is known as Evidence-Based Practice (EBP). Objective: To assess the organizational and individual barriers to implementing Evidence-based practice among registered nurses in a tertiary care hospital in Mirpur, Azad Kashmir. Methods: A descriptive cross-sectional study was conducted from December 2023 to July 2024 at a tertiary care hospital in Mirpur, Azad Kashmir. Data were collected from 120 registered nurses from different departments with more than one year of clinical experience. The sample size was determined using the Yamane formula. Before starting the data collection process, the study protocol was approved by the Institutional Review Board, and written informed consent was obtained before data collection. A validated questionnaire comprises 24 statements on a five-point Likert scale from strongly disagree to strongly agree was used. Results: The most significant organizational barriers are lack of financial encouragement for using evidence-based practice (M = 4.41), inadequate resources at the workplace (M = 4.25), limited access to updated nursing journals (M = 4.39), and lack of human resources to implement EBP (M = 4.24). Resistance to adopting new strategies (M = 4.22) and limited autonomy in modifying procedures (M = 4.15) are the most common individual barriers. Conclusions: The study highlighted the prevalence of practical barriers that prevent nurses from implementing evidence-based practice and emphasizes the need for healthcare organizations to address them.

Labor Augmentation in Primigravida: A Comparative Evaluation of Drotaverine and Tramadol

Maria Tasneem — 2025-06-30

Prolonged labor increases maternal and fetal risks. Pharmacological agents such as Drotaverine hydrochloride and Tramadol have been utilized to shorten the duration of labor by facilitating cervical dilation and uterine activity. However, comparative evidence regarding their efficacy and safety remains limited. Objective: To compare the effectiveness of Drotaverine hydrochloride and Tramadol in reducing the duration of active labor in primigravida women, and to assess associated maternal and neonatal outcomes. Methods: This quasi-experimental study was conducted at the Department of Obstetrics and Gynecology, Niazi Medical and Dental College, Sargodha. A total of 146 primigravida women in active labor were divided into two groups (n=73 each) using non-probability consecutive sampling. Group A received intravenous Drotaverine hydrochloride (40 mg every 2 hours, up to 3 doses), while Group B received intramuscular Tramadol (100 mg, single dose). Duration of labor stages, cervical dilation rate, maternal side effects, and neonatal outcomes were recorded and analyzed using SPSS version 20.0. A p-value ≤ 0.05 was considered significant. Results: The first stage of labor was significantly shorter in the Drotaverine group (208.7 ± 38.5 min) compared to the Tramadol group (228.9 ± 42.3 min, p = 0.001). Drotaverine also showed a significantly higher cervical dilation rate and fewer maternal side effects such as nausea and dizziness. Neonatal outcomes were comparable between both groups. Conclusion: Drotaverine hydrochloride was more effective than Tramadol in shortening the first stage of labor with fewer maternal side effects, making it a preferable agent in primigravida labor management.

Comparison of Pressure Support versus T-Piece Trial for Weaning from Mechanical Ventilation

Sheeza Bashir — 2025-06-30

Post-operative patients are particularly vulnerable to hazardous effects of prolonged ventilation owing to their limited reserves, catabolic state and acute injury related to surgical incision and dissection. Thus, early weaning protocols are required for better outcome in this population. Objective: To compare PSV versus T-Piece trial for weaning from Mechanical Ventilation. Methods: The quasi experimental study was conducted at ICU of Mayo Hospital Lahore from 28-05-2021 to 28-11-2021. Total 60 patients undergoing elective post-operative mechanical ventilation were selected after taking written informed consent. Patients were divided in two groups, Group A: Pressure support ventilation and Group B: T piece ventilation. Frequency and percentage of successful extubation were recorded in both groups. Data were analysed with SPSS version 26.0. Frequency of successful extubation was compared using chi square test taking p-value ≤0.05 as significant. Results: In Group A, 93.33% (n=28) of patients had successful extubation, while only 66.66% (n=20) patients in Group B had successful extubation, p-value=0.009. Conclusion: This study indicated that PSV results in successful extubation and liberation from mechanical ventilation than T piece trial.

Comparing Probiotics Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy

Omer Hassaan Aftab Ahmad — 2025-06-30

A neuropsychiatric condition known as hepatic encephalopathy (HE) is brought on by liver malfunction, which accumulates poisons like ammonia and impairs brain activity. Objectives: To compare the viability of combining probiotics with lactulose versus utilizing lactulose alone within the treatment of obvious hepatic encephalopathy. Methods: This quasi-experimental study took place in the Gastroenterology and Hepatology Department at the Pakistan Institute of Medical Sciences in Islamabad from August 2019 to January 2020. A total of 160 patients diagnosed with overt HE were included and divided into two groups. Group A received a combination of probiotics and lactulose, while Group B received lactulose alone. Treatment outcomes were evaluated over six months based on improvement in HE symptoms, Model for End-Stage Liver Disease (MELD) scores, length of hospital stay, and potential precipitating factors. Results: The mean age of participants was 44.08 ± 11.31 years. Group A comprised 64 males (80%) and 16 females (20%), while Group B had 30 male (37.5%) and 50 female (62.5%). The MELD scores were comparable between groups (p=0.648). However, the mean hospital stay was significantly shorter in Group A (2.34 ± 0.56 days) than in Group B (2.42 ± 0.63 days; p<0.05), indicating enhanced recovery in the combination therapy group. Conclusions: The addition of probiotics to lactulose significantly improves clinical outcomes in patients with overt hepatic encephalopathy by reducing hospital stay and enhancing treatment efficacy.