Journal of Liaquat University of Medical & Health Sciences

South Asian Medical Schools Must Include "Resident as a Teacher", One of the Core Competencies in the Curriculum of Postgraduate Trainees

Rano Mal Piryani — 2025-09-30

Occupationally-Acquired HIV Infection - Role of Occupational Medicine in the Prevention and Management: Challenges and Recommendations

Nasreen Inayat Bughio — 2025-10-01

PPROM and Chorioamnionitis following E. Coli UTI - A Case Report

Faiqa Awais Tullah — 2025-09-30

A female patient, 38 years old, G2+P0+A1, at 20 weeks plus six days of gestation, was admitted to the emergency with a complaint of watery vaginal discharge for the last 72 hours. There was a hind-water rupture of membranes, and the AmniSure test was positive. She had an OPD visit about a month back, and during that visit, her urine was sent for culture and sensitivity report, which showed E. coli, but she had not taken treatment as she did not come back. Her emergency room baseline labs were in the normal range, and high vaginal swab (HVS) and urine culture and sensitivity results returned negative later. She was asymptomatic for chorioamnionitis. A prophylactic antibiotic was started. Two days later, she developed a fever. She was counseled about septicemia and the risk of maternal death, but she refused. A few hours later, she expelled the fetus and went into hypotension. ERPC (Evacuation of retained products of conception) was done, and one unit of packed red cells was transfused. She was shifted to the ICU. Broad-spectrum IV antibiotics were started. All inflammatory markers were high during her illness. Chest X-ray showed bilateral pleural effusion. She stayed in the ICU for three days and was then discharged.

The objective is to discuss a case of septicemia due to preterm premature rupture of membranes (PPROM) and chorioamnionitis, probably following a urinary tract infection (UTI) caused by E. coli, and its management.

Mapping of Research on Knee Osteoarthritis to Analyse the Trends and Collaborations: Bibliometric and Content Analysis

Sulfandy Sulfandy — 2025-09-30

This study employed bibliometric and text analysis techniques to identify collaboration patterns, trends, and key themes in research related to knee osteoarthritis. The keywords used in this study were "knee osteoarthritis", "pain", and "management". Two main databases were used, namely Scopus and WoS. The literature search obtained 191 (56.80%) articles from Scopus and 145 (43.20%) articles from WoS related to the given keywords. Duplicate analysis was carried out, and 123 duplicates were obtained from the combination of the two databases. After that, the data collected consisted of 213 articles, with details from 143 (67.10%) articles in WoS and 70 (32.90%) in Scopus. The dataset identifies Indonesia and Malaysia as the primary contributors, with 93 and 121 publications, respectively. Other countries, such as China, India, the Netherlands, Thailand, and Pakistan, also participated in the collaborative effort. Key Malaysian institutions driving this research include the University of Malaya, Universiti Sains Malaysia, Universiti Kebangsaan Malaysia, Universiti Teknologi Malaysia, International Islamic University Malaysia, Sunway University, and the University of Kuala Lumpur. In Indonesia, the University of Indonesia stands out with 17 publications, accompanied by Universitas Gadjah Mada. In conclusion, both Malaysia and Indonesia have established themselves as key players in the field of knee osteoarthritis research, demonstrating their commitment to advancing scientific knowledge and fostering international collaboration.

SLPs Perspective on Stuttering Intervention through Technological Rehabilitation

Faiza Aziz — 2025-09-30

Objective: To investigate the practising patterns of speech-language pathologists regarding technological rehabilitation for stuttering intervention.

Methodology: This study employed a cross-sectional, quantitative design using a 5-point Likert scale. The data were collected from January to June 2023 at Riphah International University. This study employed convenience sampling techniques. The research focused on finding tools and Software for pattern-based therapy techniques that utilize technological rehabilitation to improve the therapy process. The Data was collected from Speech Therapist Online through Google Forms and Riphah Rehabilitation Clinic. The inclusion criteria consist of only qualified Speech and Language Pathologists (SLPs) who use technological rehabilitation in their therapies; any other disorders and comorbid disabilities were excluded. Data analysis was conducted through SPSS Version 21.

Results: The study sample consisted of 242 respondents, including qualified speech-language pathologists (SLPs) and rehabilitation therapists from public and private hospitals and clinics. Results of the study show the highest frequency of Using technological rehabilitation is beneficial for patients (117), Use of Technology helps to overcome lifelong challenges (111), Use of Software and devices in stuttering therapy (120), and Cost of Software is high (100)

Conclusion: The technological Rehabilitation in stuttering therapy; the majority of respondents give preference to using it, and they also recommend it to their peers. A similar number of respondents believe that technological rehabilitation needs Software and devices that are costly, but they are hopeful about its future. The research emphasizes the call for future research on low-cost, accessible technology tools and longitudinal studies to measure their effectiveness.

Investigation of Cancer Coping Attitudes of Children Receiving Cancer Treatment between the Ages of 10-18

Çiğdem Müge Haylı — 2025-09-30

OBJECTIVE: This study aimed to examine the coping attitudes of children between the ages of 10-18 who are receiving cancer treatment.

METHODOLOGY: The data for this research were collected online between September to November 2024. The study group consisted of children between the ages of 10-18 who were receiving cancer treatment. Online questionnaire method, sociodemographic questionnaire form and Pediatric Cancer Coping Scale (PCCS) were used from 85 individuals receiving cancer treatment between the ages of 10-18 who voluntarily participated in the collection of research data and were selected by convenience sampling method, one of the improbable sampling methods, with written consent from their parents. SPSS 25.0 data analysis program was used.

RESULTS: Among children between the ages of 10-18 who received cancer treatment, 65.5% were male and 34.4% were female. Examining the coping attitudes of children between the ages of 10-18 who were undergoing cancer treatment, no statistically significant difference was found with the characteristics of gender, age, education level, diagnosis, age at diagnosis, current treatment, duration of treatment, and it was observed that their coping perceptions towards cancer were similar.

CONCLUSION: As a result, it is recommended that children between the ages of 10 and 18 who are receiving cancer treatment have personal coping strategies that do not vary according to the characteristics of their cancer and that alternatives for children to cope with cancer should be developed in cooperation with families and nurses.

The Effect of Combination of Citronella Oil and Back Massage on Sleep Quality and Stress Levels in Postpartum Mothers

Heyrani Heyrani — 2025-09-30

OBJECTIVE: This study aimed to investigate the impact of combining citronella oil with back massage on sleep quality and stress levels in postpartum mothers.

METHODOLOGY: This study employed a quantitative, quasi-experimental design with two groups, utilizing pre- and post-tests. This study was conducted from August 2024 to April 2025 in the Wawolesea, Lembo, and Saka sub-districts of the North Konawe Regency. A total of 196 samples were collected using purposive sampling. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality, and the Perceived Stress Scale-10 was used to measure stress levels. The data were analysed using both univariate and bivariate methods.

RESULTS: The intervention group experienced 79 cases of negative sleep quality, with a p-value of 0.000, indicating that the intervention significantly improved sleep quality. In contrast, the control group showed seven positive cases with a p-value of 0.157, which was not statistically significant. For stress levels, the intervention group reported 86 negative cases, with a p-value of 0.003, indicating significant effectiveness, whereas the control group reported a p-value of 0.076. The intervention group had a mean sleep quality score of 24.50 compared to 36.50 in the control group (p < 0.001), as well as a stress level score of 25.47 versus 35.53 (p = 0.011).

CONCLUSION: The combination of citronella oil and back massage not only improves sleep quality but also significantly reduces stress levels in postpartum mothers.

The Effect of Using the Ebumil Android Application on Knowledge and Independence of Pregnant Women about Pregnancy Care

Kartini Kartini — 2025-09-30

OBJECTIVE: This study aimed to analyze the effect of using the Ebumil Android application on the Independence and knowledge of pregnant women regarding pregnancy care.

METHODOLOGY: This study employed a quasi-experimental design to investigate pregnant women at four Community Health Centres in Kendari City, spanning from April to October 2024. The study involved 120 pregnant women divided into two groups: those who were given an online application and those who received leaflets, using a simple random sampling technique. The study used the Friedman statistical test.

RESULTS: The study found that the Intervention led to a significant increase in knowledge among the respondents compared to the control group. The intervention group showed a slight increase in knowledge at the second post, whereas the control group showed no growth. The p-value was < 0.05. The study found that online applications significantly increased knowledge about pregnancy care, with a faster increase in Independence compared to leaflets and a significant effect on the intervention and control groups (p = 0.000 for both knowledge and Level of Independence).

CONCLUSION: Ebumil application can improve knowledge and level of Independence better than conventional leaflets.

Postpartum Massage and Traditional Herbs on Accelerating Uterine Involution in Postpartum Mothers

Arsulfa Arsulfa — 2025-09-30

Objective: To analyze the effect of postpartum massage and traditional herbs on the acceleration of uterine involution in postpartum mothers

Methodology: A purposive sampling technique was used to select participants from among postpartum mothers who visited the health center. This study included 120 postpartum mothers aged 18-35 who had given birth normally. Participants were excluded due to potential complications during labour. The study, conducted at the Puuwatu Health Centre in Kendari, Indonesia, employed a quasi-experimental design with a pretest-posttest control group approach involving postpartum mothers. Data collection tools included questionnaires for demographic assessment, as well as experiences with postpartum massage and herbal treatment, and tapes for the direct measurement of UFH at baseline and post-intervention intervals. Data were collected at four postpartum intervals, and the results were analyzed using the Kruskal-Wallis and Mann–Whitney tests.

Results: There was a significant difference in the acceleration of uterine involution between Groups 1 and 2 and the control group (p = 0.001). The comparison between intervention group 1 and the control group yielded a p-value of 0.000, indicating a statistically significant difference in the acceleration of uterine involution, with intervention group 1 showing the most favourable results. The comparison between intervention group 2 and the control group yielded a p-value of 0.001, indicating a statistically significant difference, with intervention group 2 showing better results than the control group.

Conclusion: Postpartum massage intervention and the use of traditional herbs had a significant positive effect on the acceleration of uterine involution in postpartum mothers.

The Association of Body Mass Index and Incidence of Diabetic Retinopathy in newly diagnosed Type 2 diabetes: A longitudinal Study in Karachi

Iftikhar Ahmed — 2025-09-30

OBJECTIVE: To elucidate the relationship between BMI, 25-29.9 kg/m²/obesity, and the incidence of Diabetic Retinopathy (DR) among DM patients.

METHODOLOGY: This is a prospective cohort study. The newly diagnosed type 2 diabetes mellitus patients were enrolled, with a baseline of 1675 subjects. Systematic random sampling was used to select the recruited patients at the Ophthalmology Department of Sindh Government Qatar Hospital, Karachi. Incident diabetic retinopathy (DR) was determined if any of the photos received a high rating for DR. Exclusively, participants with DR grades available results from the 2022 subsequent examinations were considered for inclusion in this study. Diabetic Retinopathy (DR) is classified into five stages per the ICDR scale: (1) no retinopathy, (2) mild NPDR, (3) moderate NPDR, (4) severe NPDR, and (5) PDR. BMI criteria: <25 kg/m² (normal/underweight), 25–29.9 kg/m² (overweight), and ?30 kg/m² (Obese). Univariate and multivariate logistic regression models were employed by SPSS version 27.

RESULTS: In total, a mean (SD) age of 61(7.5) years. Of these participants, 59.5% were male. A significant number of the participants were <25 kg/m² 821(49%). 856 (51%) of the patients came for follow-up after approximately 365 days. Diabetic Retinopathy was present in 197 (23%) of the patients.

CONCLUSION: In summary, our study, conducted within a substantial cohort of adults, demonstrated a correlation between higher Body Mass Index (BMI) and an increased risk of incident Diabetic Retinopathy (DR) over a 1-year follow-up period.

Pre-clinical evaluation of Fagonia cretica L. extract against CCl4-induced hepatotoxicity in male Wistar Rats

Fatima Arshad — 2025-09-30

OBJECTIVE: To investigate the hepatoprotective effects of Fagonia cretica L. (F. cretica) extracts against CCl₄-induced hepatotoxicity in rats.

METHODOLOGY: The study evaluated the hepatoprotective effects of ethanol and hexane extracts of F. cretica against CCl₄-induced liver toxicity in 35 Wistar albino rats divided across five experimental groups. Hepatotoxicity was induced in groups II to V with CCl₄, while groups III and IV received plant extracts. Group V was treated with cisplatin, which was used as a standard drug. Alterations in liver damaging and oxidative stress biomarkers were assessed after treatment.

RESULTS: The results showed the hepatoprotective effects of EFC (ethanol extract of F. cretica) and HFC (hexane extract of F. cretica) in CCl₄ induced hepatotoxicity using male Wistar rats. The extracts demonstrated therapeutic efficacy by normalized liver enzyme levels (ALT, AST). Treatment with plant extracts significantly reduced oxidative stress markers (MDA, NO), while substantially restoring the antioxidative activity of GSH and CAT). Additionally, the extracts effectively downregulated immunological markers (MMP-9 and TGF-?). Histopathological analysis showed enhanced liver regeneration with F. cretica extracts, restoring near normal tissue architecture and minimizing hepatocyte damage and fibrosis. These findings suggest that F. cretica extracts possess potent hepatoprotective effects against chemical-induced liver injury.

CONCLUSION: The findings of the study revealed the promising antifibrotic potential of F. cretica extract on liver tissues. Further studies are needed to isolate specific antifibrotic phytochemicals and their cellular targets to advance the treatment options against liver fibrosis and hepatotoxicity.

Implementation of Essential Newborn Care and Factors Associated with Knowledge and Practices among Postnatal Mothers in the Slum Area of Karachi, Pakistan

Mehrozia Nuzhat — 2025-09-30

OBJECTIVE: To determine the implementation of essential newborn care (ENC) and factors associated with knowledge and practices among postnatal mothers in the Slum Area of Karachi, Pakistan.

METHODOLOGY: This cross-sectional study was conducted in the outpatient and inpatient departments, postnatal ward/well baby clinic/immunization clinic, Jinnah Medical College Hospital (JMCH), Karachi, Pakistan, from January - June 2024. A total of 233 postnatal mothers aged between 18-35 years, within 2 months after delivery, and without complications who delivered babies (gestational age 38-42 weeks) without any congenital anomalies or disability were analyzed. A non-probability consecutive sampling technique was adopted. Data about ENC was collected on a structured and comprehensively validated questionnaire. Data was analyzed using IBM-SPSS Statistics, version 26.0.

RESULTS: In a total of 233 participants, the mean age was 26.27±4.69 years. 54 (23.2%) received health education on ENC during pregnancy, and 167(71.7%) after delivery. Fifty (21.5%) mothers practiced skin-to-skin contact, and 161(69.1%) delayed the first bath for more than 24 hours. The time of initiation of breastfeeding was within one hour, found in 70(30.0%) participants. Washing hands before and after 54(23.2%) mothers reported diaper changes. 108 (46.4%) mothers reported recognition of all danger signs.

CONCLUSION: The study concludes that implementing ENC among postnatal mothers in the slum area of Karachi is sub-optimal, with significant gaps in knowledge and practices. Key areas requiring improvement include antenatal care attendance, hygiene practices, and late initiation of breastfeeding.

Cupping Therapy Drains the Extra Lipids in Migraine Headache Patients

Zeba Hussain Soomro — 2025-09-30

OBJECTIVE: To determine how wet cupping affects the clinical and laboratory parameters of individuals with migraine headaches.

METHODOLOGY: This cross-sectional study was conducted at the Department of Neurology, Dr Ruth K M Pfau Hospital, Karachi and Hamdard University in collaboration with the Institute of Biochemistry, University of Sindh, Jamshoro, from January 2021 to December 2023. A total of 102 migraine headache patients aged 15 to 70 years, including 32 males and 70 females, with evidence of migraine headache and normal EEG, who confirmed the migraine, participated in the study after providing written informed consent. Patients with abnormal EEG tests younger than 15 were excluded from the study. The patients underwent wet cupping; 5ml intravenous blood samples were collected before the procedure, 5ml from the cups, and 5ml intravenous blood was collected after one week of cupping therapy. The spectroscopic method analyzed all the samples for serum lipid profile. Data analysis was performed using SPSS Version 26, with a significance level set as p<0.05 at a 95% confidence interval.

RESULTS: Most migraine patients were female. The wet cupping samples exhibited significant increases p<0.05 in lipid and liver profiles compared to pre-cupping samples, although they remained within normal ranges. No significant variations were observed in gender-specific comparisons for serum lipids. Additionally, age-wise comparisons revealed no significant differences among migraine patients of various age groups in pre-cupping and cupping samples.

CONCLUSION: Wet cupping therapy drains the extra serum lipids and reduces migraine headaches.

Comparative Effects of Kinesiotaping and Electrical Muscle Stimulation on Low Back Pain and Disability Associated with Diastasis Recti

Aiza Komal — 2025-09-30

OBJECTIVE: To compare the effects of Kinesio taping and electrical muscle stimulation on low back pain and disability associated with diastasis recti.

METHODOLOGY: A randomized clinical trial was conducted on a sample size of 48 postpartum females of diastasis recti. All participants were randomly allocated to either the EMS group or the Kinesio Taping group for a total of 4 weeks. A protocol was followed, consisting of 3 sessions per week, each lasting 40 minutes, for both groups. The outcome was measured using the two-finger method to assess inter recti distance and manual muscle testing (MMT) for abdominal muscle strengthening, as well as the Numeric Pain Rating Scale (NPRS) for low back pain and the Ronald-Morris Disability Questionnaire (RMQ) for level of disability.

RESULTS: The statistically significant p-value of MMT for the pre-treatment session of both groups was .013, post- treatment session value was .002, and in both groups, the p-value of NPRS for the pre-treatment session was 0.081 and the post-treatment value of .001, while the p-value of RMQ.105 for pre-treatment for both groups and .0000 for post-treatment, which shows a significant decrease in pain and disability level in both groups after taking the intervention. In both groups, the total IRD to measure inter-rectal distance was 4.00 at the pre-level and 3.00 at the post-level.

CONCLUSION: The group receiving EMS shows more significant results in terms of improving low back pain, disability, and RA strength compared to the group receiving KT treatment.

High-grade Astrocytoma is Associated with Significant Expression of the Wilms Tumor Gene (WT-1) Protein

Asma Jalbani — 2025-09-30

OBJECTIVE: To investigate the association between different astrocytoma grades and WT-1gene protein immunoexpression at the Pathology Department of a tertiary care hospital.

METHODOLOGY: In this cross-sectional study, sixty biopsies of Astrocytoma were incorporated using non-probability convenience sampling. All cases of various grades of Astrocytoma received in the Department of Pathology, Basic Medical Sciences Institute, JPMC, Karachi, from January 2019 to December 2022, were thoroughly reviewed and included in this research. Biopsy samples with an insufficient amount of material, metastatic Carcinoma and CNS tumors other than Astrocytoma were excluded. Results were analyzed using IBM-SPSS version 23.0. The Pearson Chi-Square test of independence was applied, and P-values less than 0.05 were considered significant.

RESULTS: A total of 60 cases of astrocytomas were immunostained for WT-1. Of the 56 samples, 93.3 percent had positive WT-1 cytoplasmic immunostaining. A statistically significant correlation (p < 0.001) was found between the WT-1 score and tumour grade, with low-grade (grades I and II) astrocytomas scoring lower and high-grade (grades III and IV) astrocytomas scoring higher.

CONCLUSION: The research confirms WT-1's role in astrocytoma carcinogenesis and aims to assess its expression across different histological grades. Low expression correlates with lower tumour grades, while high expression indicates higher tumour grades. WT-1 can help distinguish between grades, making it a useful immunohistochemical marker. Its frequent expression in astrocytic tumors supports its potential in immunotherapy, aiding in the identification of candidates for targeted treatment. WT-1 regulates key cellular processes, making it a promising target for improving treatment outcomes in astrocytoma patients.

Stepping Into Danger: Risk Factors for Diabetic Foot Infections in Pakistan

Shazia Nazar — 2025-09-30

OBJECTIVE: This study aimed to identify the patient-related risk factors for diabetic foot infections and assess their impact on disease progression.

METHODOLOGY: A Cross-sectional study was conducted at Dow University Hospital, Karachi, from June to December 2023. A total of 150 diabetic patients were included using a non-probability purposive sampling technique.

The inclusion criteria for this study consisted of diagnosed diabetic patients aged (57.11±9.83) years, with or without diabetic foot infections, who were willing to participate and provide consent. The exclusion criteria included non-diabetic individuals, patients with foot ulcers or infections unrelated to diabetes (e.g; trauma), those with incomplete clinical records or missing data, and individuals unwilling to participate. Data were collected using a self-designed questionnaire and clinical records, focusing on demographics, biochemical markers, and clinical factors such as peripheral neuropathy, peripheral arterial disease, osteomyelitis, and smoking history. Statistical analysis was performed using SPSS version 23.

RESULTS: The study revealed that peripheral neuropathy (OR = 3.2), peripheral arterial disease (OR = 3.1), and smoking (OR = 2.0) were significant independent risk factors for diabetic foot infections. Infected patients also exhibited poor glycemic control, as evidenced by elevated HbA1c levels and an abnormal lipid profile characterized by higher LDL-c and lower HDL-c levels compared to the uninfected group.

CONCLUSION: Peripheral neuropathy, Peripheral arterial disease, and smoking are major risk factors for diabetic foot infections.

A Prospective Cohort Study on Factors of Mortality Due to Acute Organophosphate Poisoning

Shaib Muhammad — 2025-09-30

OBJECTIVE: This study assessed the association of demographic characteristics, causes of poisoning, pre-hospital care, clinical manifestations, and treatment with outcomes of organophosphate poisoning.

METHODOLOGY: This prospective cohort study was conducted in the emergency department, medicine wards, and intensive care units of a tertiary care hospital in Sindh, Pakistan, from July 2023 to June 2024. The data were collected using a non-probability purposive sampling technique, as outlined in a questionnaire designed after reviewing the literature. IBM SPSS version 29 was used for analysis using various statistical tools. The categorical variables were presented as frequencies and percentages. A Chi-squared test (Fisher's exact test where required) was used to determine the association between variables.

RESULT: During the study period, 605 patients were enrolled. Organophosphate poisoning (OPP) was prevalent in males (57.2%). Majority of patients were uneducated (70.9%), belonged to rural areas (96.4%), and were aged ?30 years (82%). Poisoning was mainly intentional (92.2%), through oral route (96.9%). Most common clinical manifestation was emesis (55.9%), and circulatory support was provided to 99.3% of patients as a therapeutic intervention. The majority of patients were mildly affected (84.0%) due to OPP, and the death rate was 5.5%. The vital signs, clinical manifestations, interventions, and hospital management had a significant impact on mortality, with p < 0.05.

CONCLUSION: This study's findings emphasize the necessity for healthcare providers to prioritize the rapid assessment and intervention of baseline vitals, typical OPP symptoms, intensive management, duration of hospital stay, and poisoning severity to achieve better outcomes in patients with OPP.

Examining Depression in Parkinson's Disease in Sociocultural Contexts: Moving from Stigma to Care

Farhat Yasmin Minhas — 2025-09-30

OBJECTIVE: To estimate the prevalence of depression and to explore socio-demographic and clinical risk factors among tertiary-care patients with Parkinson's disease (PD) in Pakistan.

METHODOLOGY: This cross-sectional analytical design study was conducted in the outpatient department (OPD) of a tertiary care medical facility (CMH), Lahore, from March to May 2023. Ninety-four consecutive idiopathic PD patients were recruited for the cross-sectional analytical study from CMH Lahore. The study utilized a self-report questionnaire and the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) to gather data on patients' age, sex, marital status, employment status, and disease duration. In the study, adult patients with idiopathic Parkinson's Disease without any severe medical conditions were included.

RESULTS: The patients were 53 males and 41 females. The prevalence of depression in the study population was 39.36% (N 94). Most of the patients were diagnosed in the age group 51-60 years, and they were found to be more depressed than the younger patients. The most often reported symptoms of depression among individuals who were more depressed were low energy, trouble focusing or making decisions, feeling hopeless, feeling blue, and having trouble sleeping. All analyses were done on SPSS version 26.0 for Windows.

CONCLUSION: In Parkinson's disease (PD), depression symptoms are prevalent, particularly in individuals with more severe cognitive impairment who are more likely to have or aggravate depression. Thus, it is equally important to identify and treat the disease along with any associated depression.

Silverman-Anderson Score and Downes Score for Assessing Respiratory Distress in Newborns

Abdul Salam Memon — 2025-09-30

OBJECTIVE: To compare the effectiveness of the Silverman-Anderson and Downes scoring systems in predicting respiratory distress in newborns admitted to pediatric nursery.

METHODOLOGY: A descriptive cross-sectional study was conducted in the neonatal nursery of Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan, from July - December 2024, using non-probability consecutive sampling. The study included neonates within the first 24 hours of life of either gender and encompassed both term infants and preterm infants. Respiratory distress was defined by symptoms such as tachypnea, retractions, grunting, or cyanosis. The severity of respiratory distress was assessed using the Silverman-Anderson scoring system, which evaluated upper and lower thoracic depression, subxiphoid depression, nasal flaring, and expiratory grunting, and the Downes scoring system, which analyzed respiratory frequency, cyanosis, chest retractions, grunting, and lung sounds. Data were analyzed using SPSS version 24.

RESULTS: Of 255 patients, the diagnostic accuracy of the Silverman-Anderson Scale in predicting respiratory distress showed a sensitivity of 91.04%, specificity of 63.3%, positive predictive value (PPV) of 46.92%, negative predictive value (NPV) of 95.2 % and an overall accuracy of 70.59%. The Downes Scoring demonstrated higher sensitivity (94.03%), specificity (68.09%), PPV (51.22%), NPV (96.97%), and overall accuracy (74.09%). The area under the curve (AUC) for Silverman-Anderson Scoring was 0.831 (95% CI 0.78–0.89), whereas Downes Scoring achieved a higher AUC of 0.885 (95% CI 0.84–0.93), indicating slightly better performance in diagnosing respiratory distress.

CONCLUSION: While both systems demonstrated high diagnostic performance, the Downes score exhibited marginally superior diagnostic accuracy and predictive value.

Frequency of Bacterial Spectrum in Patients Presenting with Acute Appendicitis

Muhammad Abdullah — 2025-09-30

OBJECTIVE: To define the incidence of bacterial spectrum in individuals with acute appendicitis.

METHODOLOGY: This Descriptive cross-sectional study was conducted at the Department of Surgery, Pak Emirates Military Hospital, Rawalpindi, from November 2023 to April 2024. Statistics were obtained from individuals after written approval. A non-probability consecutive sampling technique was used. 145 Patients who presented with acute appendicitis were included. Non-consenting patients, patients with a history of tuberculosis, pneumonia, urinary tract infection and lower abdominal inflammatory conditions other than appendicitis were excluded. Numerical values were expressed as numbers, mean, and standard deviation and qualitative data were expressed as frequency and percentages. Outcome changers were measured by stratification to determine their efficacy, with a p-value of ?0.05 considered substantial. Statistics were analyzed on SPSS version 20

RESULTS: 145 individuals were involved. The mean age was 43.93±4.28 years. 83 (57.2%) were male and 62 (42.8%) were female. Out of 145 patients with acute appendicitis, the bacterial spectrum showed E. coli (34.5%), Staphylococcus aureus (5.5%), Pseudomonas aeruginosa (30.3%), Klebsiella pneumoniae (11%), Streptococcus (13.8%), Enterococcus saprophyticus (33.1%), and Bacteroides fragilis (38.6%).

CONCLUSION: The greater rate of isolation of pathogenic bacteria in patients with acute appendicitis supports its pathogenic role. Gram-negative microorganisms are most common in inflammation of the appendix, equating with gram-positive microorganisms.