Current Issue

Background and Objective: Endoscopy is considered the gold standard for evaluating and managing gastrointestinal (GI) disorders. It serves both diagnostic and therapeutic purposes in patients presenting with upper GI symptoms. This study aimed to audit the common indications for upper GI endoscopy and their associated endoscopic findings at Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan.

Methods: This cross-sectional study was conducted on 374 patients presenting with upper GI symptoms (including dyspepsia, dysphagia, epigastric pain, and hematemesis) between January 2021 and April 2024. Patients were recruited from both inpatient and outpatient settings. Demographic and clinical data were recorded. Endoscopic findings were documented and categorized according to indication. Descriptive statistics were applied for frequency distribution. The chi-square test was used to assess associations between presenting symptoms and endoscopic findings, with a p-value <0.05 considered statistically significant.

Results: Of the 374 patients, 62% were male and 38% female. Common indications included dysphagia (29%), epigastric discomfort (21%), dyspepsia (15%), hematemesis (13%), and chronic liver disease (5%). Endoscopic findings revealed esophagitis and gastritis predominantly in dyspepsia and epigastric pain cases, variceal bleeding in CLD and hematemesis cases, and esophageal growth in most dysphagia cases. The association between presenting complaint and endoscopic diagnosis was statistically significant (p < 0.05).

Conclusion: Upper GI endoscopy remains an indispensable tool for accurate diagnosis in patients with persistent upper GI symptoms. 

Background and Objective: Bone marrow examinations are typically safe procedures. Even though complications are uncommon, they can occur and may include significant bleeding in individuals with low platelet counts and infections, usually at the skin puncture site, particularly in immunocompromised patients. The conditions examined include bone disorders, as well as both hematologic and nonhematologic malignancies in the bone marrow.

Methods: This study analysed the retrospective data from Department of Pathology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, including 373 patients who underwent bone marrow trephine biopsy between January 2023 and June 2024. Patient records were reviewed for demographic and diagnostic data. Statistical analysis was performed using the chi-square test, with p < 0.05 considered significant.

Results: Of the 373 patients, 206 (55.2%) were male and 167 (44.8%) were female, yielding a male-to-female ratio of 1.2:1. The most common age group was 21-30 years, comprising 68 cases. Bone marrow aspiration was most frequently performed for suspected acute leukemia, followed by hepatosplenomegaly. Pancytopenia was observed in 59 cases (15.8%), while immune thrombocytopenia was noted in 3 cases. Normal trilineage hematopoiesis was reported in 65 cases. Aplastic anemia and hypocellular marrow were identified in 12 (3.2%) and 29 (7.7%) cases, respectively. Acute leukemia was diagnosed in 77 cases (21%), with acute myeloid leukemia (AML) accounting for 21 cases (5.6%). A statistically significant association was found between age, gender, and AML, with a higher frequency in older male patients (p = 0.04). Multiple myeloma and other plasma cell disorders were diagnosed in 3 cases (0.8%), while myelofibrosis was identified in another 3 cases (0.8%). Hemophagocytic lymphohistiocytosis, myelodysplastic syndrome, and lymphoma were seen in 3, 11, and 8 cases, respectively.

Conclusion: Acute leukemia, particularly AML, was the most frequent diagnosis on bone marrow aspiration, followed by hepatosplenomegaly and pancytopenia. Significant association of AML with older male patients underscores the need for early evaluation in this group. Bone marrow examination remains a valuable diagnostic tool for diverse hematological disorders in our setting. 

Background and Objective: Pneumothorax, an accumulation of air between the pleural layers, can occur spontaneously or post-traumatically. Thoracocentesis, a common procedure for aspirating pleural fluid, is a known cause of iatrogenic pneumothorax, with a prevalence of 13-19%. Despite ultrasound guidance reducing the incidence, complications persist, especially with large fluid volumes. Prior studies offer conflicting evidence on the link between aspirated fluid volume and pneumothorax risk. This study aims to determine pneumothorax frequency in patients undergoing ultrasound-guided thoracocentesis and assess the relationship between pneumothorax and fluid volumes of ≤1000 ml and >1000 ml.

Methods: A cross-sectional study was conducted at Memon Medical Institute Hospital, Karachi, from February to August 2024. Patients aged 20-60 years with pleural effusion undergoing ultrasound-guided thoracocentesis were included, excluding those with pre-existing pneumothorax or significant lung disease. The sample size was 266. Patients were divided into Group A (≤1000 ml) and Group B (>1000 ml), with Group B subdivided into B1 (1000-1500 ml) and B2 (>1500 ml). Data were analyzed using SPSS, and the association between fluid volume and pneumothorax was assessed using chi-square (p<0.05).

Results: The mean age was 49.55±7.63 years. Pneumothorax occurred in 8.6% of patients, with 4.5% in Group A and 12.7% in Group B. Subgroup B1 had a 6.9% incidence, and Subgroup B2 had 19.6%. Males had a higher incidence (82.35%) than females (52.94%). Fluid aspiration ranged from 550-950 ml in Group A (mean 778.3±160.8 ml) and 1250-2000 ml in Group B (mean 1669.4±253.9 ml). A significant association was found between fluid volume and pneumothorax (p<0.05).

Conclusion: An 8.6% pneumothorax incidence was observed, with higher risks when aspirated fluid exceeded 1000 ml, especially over 1500 ml, underscoring the need for procedural guidelines to enhance safety.

Background and Objective: Oral potentially malignant disorders (OPMDs) are a group of oral mucosal abnormalities with an increased risk of malignant transformation. Their high prevalence, especially in Asia, poses a significant public health concern. Beyond disease control, understanding the impact of OPMDs on patients’ health-related quality of life (HRQoL) is essential for guiding treatment decisions and optimizing care. This study aimed to identify factors that could affect HRQoL in patients with oral potentially malignant disorders in the local population.

Methods: A cross-sectional study was conducted over 8 months at Ziauddin University and Abbasi Shaheed Hospitals, enrolling 83 patients aged >20 years with clinically and histologically confirmed Oral Potentially Malignant Disorders. Patients with other medical conditions or prior treatments were excluded. Written informed consent was obtained. HRQoL was assessed using the SF-36 questionnaire across eight domains. ANOVA was used to compare HRQoL domains, and Pearson’s correlation tested associations between variables. A p-value < 0.05 was considered statistically significant.

Result: Actinic cheilitis was the most common lesion, predominantly affecting patients aged 51-60 years. Physical health was the most impaired HRQoL domain (p = 0.001), while mental health was the least affected (p = 0.02). Patients ≥40 years reported poorer physical health, whereas those aged 41-50 experienced greater mental health and activity limitations. Pain showed a positive correlation with social health (r = 0.426, p < 0.01) and a negative correlation with emotional health (r = -0.291, p < 0.01). Mental and emotional health were strongly correlated (r = 0.741, p < 0.01).

Conclusion: OPMDs significantly impair HRQoL, particularly physical health and daily functioning. Pain adversely affects social and emotional well-being, while mental and emotional health are closely linked. Findings highlight the need for targeted HRQoL assessment and patient‑centered care to optimize outcomes.

Background and Objective: To determine the enablers and barriers of online learning in adolescents visiting secondary and tertiary care hospitals in Karachi.

Methods: A descriptive cross-sectional study was conducted over 6 months (September 2022-February 2023) in pediatric outpatient clinics of two secondary and one tertiary care hospital in Karachi. Using non-probability convenience sampling, 370 children aged 11-17 years, enrolled in school or hybrid/online learning programs and proficient in Urdu or English, were recruited. Children with physical or mental disabilities affecting online tool use were excluded. Data were collected via a structured questionnaire in Urdu/English covering socio-demographics, online learning experience, technical skills, equipment availability, and learning behaviors. Responses on enablers and barriers were recorded using a 3-point Likert scale. Data were analyzed in SPSS v21, reporting frequencies and percentages for all variables.

Results: The study showed that students were having 5-6 hours of online schooling every day (195, 52.7%). Enabling factors included frequent class participation (200, 54.1%), finding online teaching software easy to use (327, 88.4%), having sufficient technological skills (315, 85.1%), getting sufficient technological assistance from teachers (270, 73.0%), good internet connection (219, 59.2%), backup electricity (255, 68.9%), the availability of a backup device (307, 83.0%), availability of a family member for assistance in understanding a lesson (287, 77.6%), and addressing any disruptions during online classes (304, 82.2%). Factors that were identified as barriers to online learning included fatigue/sleepiness (249, 67.3%), back or neck pain (203, 54.9%), headaches (180, 48.5%), struggling to concentrate
during lessons (225, 60.8%), and feeling distracted (170, 45.9%) during online classes.

Conclusion: A conducive and supportive home environment and online learning space, coupled with adequate technology and IT skills, were found to be the major enablers of online learning. Major barriers identified were feeling distracted, neck or back pain, fatigue, sleepiness, headaches and a feeling of disconnection from their teachers and peers.

Background and Objective: Chronic osteomyelitis of the tibia is a persistent bone infection that, if inadequately managed, can cause significant disability. Antibiotic-loaded intramedullary nails (ALIN) and antibiotic-loaded beads (ALB) are commonly used for infection control and limb preservation, yet their comparative effectiveness remains unclear. This study aimed to compare functional outcomes, pain control, reinfection rates, quality of life (QoL), and complications between ALIN and ALB in managing chronic tibial osteomyelitis in local patients.

Methods: In this randomized comparative study, 60 patients with chronic tibial osteomyelitis were allocated into the Nail Group (n  =  30) receiving ALIN or the Bead Group (n  =  30) receiving ALB. Pain was assessed using the Visual Analog Scale (VAS), limb function via the American Orthopaedic Foot and Ankle Society (AOFAS) score, and QoL with the SF-36 questionnaire. Reinfection was assessed clinically, and complications were recorded. Follow‑up was conducted over 12 months. Independent t-test was used for continuous variables and chi-square test for categorical variables, with p < 0.05 considered statistically significant.

Results: The Nail Group showed superior outcomes in pain reduction (VAS: 1.5 ± 0.4 vs. 2.0 ± 0.5; p < 0.05), functional status (AOFAS: 85 ± 6 vs. 78 ± 7; p < 0.05), and QoL (SF‑36: 72 ± 5 vs. 65 ± 6; p < 0.05). Reinfection rates were not significantly different (27% vs. 31%; p > 0.05). Complications were fewer in the Nail Group, with fewer nail failures compared to bead migration in the Bead Group.

Conclusion: Antibiotic-loaded intramedullary nails offer better pain relief, functional recovery, and QoL than antibiotic-loaded beads in chronic tibial osteomyelitis, without increasing reinfection rates. These findings support ALIN as a preferred option in suitable patients.

Background: Diabetic ketoacidosis (DKA) is a life-threatening acute hyperglycemic complication of diabetes mellitus. Thalassemia major predisposes to diabetes mellitus due to pancreatic dysfunction from iron overload, yet DKA is uncommon in these patients. We report the case of an 18-year-old female with thalassemia major and secondary hemochromatosis who presented with acute shortness of breath, drowsiness, and confusion following one day of diarrhea. On examination, she was profoundly hypotensive (BP 54/21 mmHg), tachycardic (PR 131 bpm), hypoxic (SpO₂ 89%), and exhibited acidotic breathing, pallor, bronze skin pigmentation, and cold extremities. Laboratory evaluation revealed severe anemia, marked leukocytosis (>30,000/mm³), metabolic acidosis with hypokalemia, hyperglycemia, and markedly elevated ferritin (>1,650 ng/l). The patient was treated with insulin infusion, electrolyte correction, blood transfusion, iron chelation therapy, and supportive measures. She improved clinically, achieved metabolic stabilization, and was discharged in stable condition. This case underscores that thalassemia-related iron overload can precipitate disturbances in glucose metabolism and rarely present with DKA. Continuous monitoring of glycemic status is essential in thalassemia patients, even when baseline glucose levels are normal, to enable early detection and management of acute metabolic complications.