Precision medicine and patient outcomes in intensive care unit: Culture sensitivity, antibiotics, and APACHE score IV.

Background: In the intensive care unit (ICU), complex medical conditions require specialized care; the threat of antibiotic resistance is significant due to frequent antibiotic use. This study investigates the pivotal role of culture sensitivity testing in shaping antibiotic prescription practices and patient outcomes in ICUs.

Materials And Methods: By using a prospective observational-analytical design, medical data from 640 patients at a Karachi hospital for one year in 2022 were utilized.

Comparison of opportunities and perceptions towards neurosurgery between the public and private sector in Pakistan: a national survey of medical students and recent graduates.

Public and private medical institutes must adhere to the same standards of quality set by the Pakistan Medical & Dental Council (PMDC). However, studies have noted varied learning environments. The current study aims to assess opportunities and compare the differences in perceptions between the two sectors.

Formulation of Quality Improvement Methodology for Risk Mitigation in Congenital Cardiac Catheterization.

The C3PO collaborative, with a history of successful quality improvement (QI) initiatives, leveraged registry participants to develop a multi-center QI initiative to reduce adverse events (AEs) in congenital cardiac catheterization. A 32-person, interdisciplinary working group analyzed audited data for all congenital cardiac catheterization cases from 2014-2017. The primary outcome was the occurrence of any high-severity (level 3/4/5) AE.

Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study.

Background: Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).

Aim: To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.

Methods: Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.

Complete Response with Immunotherapy Alone after Discontinuing VEGF Inhibitor in Advanced Hepatocellular Carcinoma: A Case Report.

Unlabelled: Bevacizumab and atezolizumab combination is one of the preferred combinations for managing advanced hepatocellular carcinoma (HCC), while the evidence on monotherapy with either agent is not convincing. We present a case of a man in his 50s diagnosed with HCC with spinal metastases who showed a good response to combination therapy. However, he developed severe proteinuria and hypertension secondary to bevacizumab, which had to be discontinued after 18 cycles.

Overall Survival and the Impact of Albumin-bilirubin Grade in Patients with Advanced Hepatocellular Carcinoma: Data from a Tertiary Care Hospital in a Lower-middle-income Country.

Background And Aim: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Most patients are diagnosed at an advanced stage, limiting their treatment options. The traditional assessment of liver function using the Child-Pugh score has limitations due to its subjectivity.

Incidence, Risk Factors and Outcomes of Urinary Tract Infections among Patients Undergoing Thyroidectomy: Insights from the ACS-NSQIP.

 Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy.  This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy.  This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019.

Unveiling Pediatric Neurosarcoidosis Mimicking Central Nervous System Tuberculosis: Diagnostic Challenges.

Neurosarcoidosis is a rare chronic inflammatory disease affecting the nervous system. Owing to its varying manifestations that can mimic other central nervous system infectious or autoimmune diseases, and scarcity of literature, it proves to be a challenging diagnosis. We report two cases of possible neurosarcoidosis in the pediatric age group.

Trend of Representation of Women in Gastroenterology, Hepatology, and Endoscopy Conferences in Asia.

Objectives: Despite progress in promoting gender equality, gender bias remains a significant obstacle for women and hinders their academic advancement. We aim to survey and critically analyze women's representation in conferences and changes over time in various regions of Asian countries.

Methods: An international survey was conducted with representatives from East Asia (Hong Kong, China, and Japan), South Asia (India and Pakistan), and Southeast Asia (Vietnam and Thailand).

Doctors' knowledge, practices, challenges, and limitations regarding disclosure of bad news: A multicentre study from Pakistan.

Background: Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan.

Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan.

Indirect determination of hemoglobin A2 reference intervals in Pakistani infants using data mining.

Background: Reference intervals (RIs) are crucial for distinguishing healthy from sick individuals and vary across age groups. Hemoglobinopathies are common in Pakistan, making the quantification of hemoglobin variants essential for screening. Direct RIs are established by measuring values from a healthy reference population, whereas indirect RIs, use statistical analysis of routine lab data to estimate values, making it feasible in settings where direct data is unavailable.

Liver parasites: A global endemic and journey from infestation to intervention.

Parasites have coexisted with humans throughout history, forming either symbiotic relationships or causing significant morbidity and mortality. The liver is particularly vulnerable to parasitic infections, which can reside in, pass through, or be transported to the liver, leading to severe damage. This editorial explores various parasites that infect the liver, their clinical implications, and diagnostic considerations, as discussed in the article "Parasites of the liver: A global problem?".

Efficacy of radiosurgery with and without angioembolization: A subgroup analysis of effectiveness in ruptured versus unruptured arteriovenous malformations - An updated systematic review and meta-analysis.

Background: Congenital arterial defects such as cerebral arteriovenous malformations (AVMs) increase brain bleeding risk. Conservative therapy, microsurgical removal, percutaneous embolization, stereotactic radiosurgery (SRS), or a combination may treat this serious disease. This study compares angioembolization with SRS to SRS alone in ruptured or unruptured brain ateriovenous malformations (BAVM) patients.

Educational interventions to improve pediatric emergency care: A qualitative assessment of the perspectives of African healthcare workers.

Pediatric emergency care (PEC) training for health care workers (HCWs) is commonly offered in the form of short courses. This study gathers the perspectives of HCWs from eight African countries on how to best deliver and implement short training courses in PEC. This is a qualitative study using semi-structured key informant (KI) interviews.

Occult Breast Cancer in High-Risk Gene-Positive Pakistani Women Undergoing Contralateral Prophylactic Mastectomy/Prophylactic Mastectomy: Implications for Sentinel Lymph Node Biopsy.

Introduction: Sentinel lymph node biopsy (SLNB) of the axilla is standard in breast cancer (BC) management; however, its role in prophylactic/contralateral prophylactic mastectomy (CPM) is still questioned. To avoid future consequences on surgical morbidity and socioeconomic aspects in low and middle-income countries (LMICs), we intend to determine the prevalence of occult breast cancer (OBC) among CPM cases.

Objective: To determine the prevalence of OBC in patients undergoing prophylactic mastectomy (PM).

Management of Scapula Fractures at a Level 1 Trauma Centre in the United Kingdom.

Background Scapular fractures, an uncommon injury that can be brought on by a high-energy mechanism because of its proximity to the pectoral and shoulder muscles, are frequently linked to fatal injuries. This study aimed to compare surgical versus conservative treatment of scapular fractures and the results of treated patients. Methods The traumatic scapular fracture patients in this cross-sectional study (n = 391) were treated at a major trauma centre (level 1) in the United Kingdom between 2012 and 2018.

Self -reported bruxism in patients undergoing Orthodontic treatment - a cross-sectional study.

Background: Orthodontic treatment involves manipulation of tooth position that can temporarily lead to occlusal interferences capable of inducing bruxism. The objectives of this study were to determine the self-reported incidence of bruxism and its association with factors such as facial type, divergence, skeletal and dental malocclusions in orthodontic patients.

Materials And Methods: 80 patients who underwent a minimum of six months of orthodontic treatment were surveyed using a validated self-reported bruxism questionnaire for the presence or absence of bruxism.

Preconception care interventions among adolescents and young adults to prevent adverse maternal, perinatal and child health outcomes: An evidence gap map.

Objective: To identify gaps in existing evidence on preconception health interventions to improve the health outcomes of adolescents, young adults, and their offspring.

Study Design: Evidence gap map (EGM) METHODS: Following the Campbell guidelines, we included reviews and interventional studies identified through searches on Medline and other electronic databases from 2010 to July 18th, 2023. Dual screening of titles/abstracts and full texts was conducted on Covidence software, followed by quality assessment and development of 2D-EGM using the EPPI-Reviewer and Mapper software.

Radiological Outcomes According to the Matta Score After the Surgical Fixation of Acetabular Fractures.

Background Acetabular fractures, a rising concern in developing countries, pose a significant challenge due to their complexity and association with post-operative complications. Often caused by high-energy mechanisms like falls and motor vehicle accidents, these fractures require accurate reduction to prevent long-term issues and the potential need for hip replacement. This study investigates the radiological outcomes of acetabular fracture surgery at six months, focusing on the effectiveness of achieving anatomical reduction using the Matta criteria in a low-and middle-income country (LMIC) setting.

Diagnostic Accuracy of High-Resolution Computed Tomography (HRCT) in Detecting Pneumocystis carinii in Renal Transplant Patients With Pulmonary Infection: A Study Using Bronchoalveolar Lavage As the Gold Standard.

Introduction: Patients receiving renal transplants have weakened immune systems and are more vulnerable to lung infections.

Objectives: To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) in detecting pneumocystis carinii in renal transplant patients presenting with pulmonary infection in a tertiary care transplant center, keeping bronchoalveolar lavage (BAL) as the gold standard.

Methods:  This cross-sectional study was conducted at the Department of Radiology, Sindh Institute of Urology and Transplant, Karachi, from February 14, 2023, to August 13, 2023.

Surviving the Nightmare: Massive Bleeding From Large Intraoral Arteriovenous Malformation During Airway Management for Angioembolization Procedure.

Arteriovenous malformations (AVMs) in the head and neck present significant challenges due to airway management complexities and hemorrhage risks. This case report describes a 15-year-old female with a congenital facial AVM causing dyspnea and obstructive symptoms. The patient required angioembolization of the AVM, but many hospitals deferred the procedure due to the anticipated difficult airway and severe bleeding risks.

Persistent Post-dural Puncture Headaches One Year After Lumbar Puncture: A Case Report.

Post-dural puncture headaches usually occur when the cerebrospinal fluid (CSF) leaks due to trauma to the dura mater. This often results in spontaneous intracranial hypotension characterized by orthostatic headaches, neck stiffness, and nausea. In this case report, we discuss a 20-year-old male patient who developed symptoms of intracranial hypotension one year following a lumbar puncture.

Thirty Days Outcomes of Limb Salvage Surgery in Pediatric Patients Treated at a Tertiary Care Hospital.

Background Managing primary bone and soft tissue sarcomas in pediatric patients poses significant challenges, with surgical resection remaining essential for cure. While limb salvage surgery has emerged as the standard approach, concerns persist regarding post-operative complications. Our study aims to evaluate the 30-day morbidity and mortality of limb salvage surgery in pediatric tumor patients, bridging critical knowledge gaps and contributing to enhancing the standard of care in low- and middle-income countries (LMICs).