Farooq Hospital

Background  Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (PICUs), but its effect on clinical outcomes in resource-constrained settings is underexplored. Understanding these effects is essential for improving care. Objective Our aim is to evaluate the impact of VAP on clinical outcomes and identify baseline factors associated with VAP among mechanically ventilated pediatric patients. Methods This retrospective cohort study was conducted at the PICU of Jinnah Hospital, Lahore, from January to June 2023. Children aged 1 month to 18 years who required mechanical ventilation for at least 48 hours were included. We categorized patients into VAP and non-VAP groups based on CDC/NHSN 2023 criteria. We compared baseline characteristics and clinical outcomes. Categorical variables were analyzed using the chi-square test. Continuous variables were compared using the Mann-Whitney U test. Results Among 150 patients, 50 (33.3%) developed VAP. Patients with VAP had a significantly longer median duration of mechanical ventilation (12.0 days, IQR: 9.0-16.0) compared to non-VAP patients (5.0 days, IQR: 4.0-6.0; p < 0.001) and a longer median PICU stay (14.0 days, IQR: 10.0-18.0 vs. 7.0 days, IQR: 6.0-8.0; p < 0.001). Prior antibiotic use was documented in all 50 (100%) VAP patients compared to 17 (17.0%) in the non-VAP group (p < 0.001). Mortality was higher in the VAP group (16/50 patients, 32.0%) compared to the non-VAP group (0/100 patients, 0.0%; p < 0.001). Daily oral care with chlorhexidine was strongly protective (risk ratio = 0.46; 95% CI: 0.34-0.63). Standard multivariable logistic regression could not be performed due to the complete separation of data; therefore, Firth penalized logistic regression was performed using R. Conclusion VAP is linked to longer ventilation, extended PICU stay, and higher mortality. These findings stress the need for targeted preventive measures and improved ventilatory practices in resource-constrained PICUs.

Background: Postpartum pelvic floor dysfunction (PFD) is a common maternal health problem that includes urinary incontinence, pelvic organ prolapse, sexual dysfunction, and chronic pelvic pain. Multiple obstetric and maternal factors contribute to its development. Objective: To assess the risk factors associated with postpartum pelvic floor dysfunction and identify opportunities for prevention among postpartum women. Methods: This cross-sectional analytical study was conducted at DHQ Hospital Mardan from June 2024 to June 2025 including 220 postpartum women evaluated within 12 months after delivery. Results: The mean age of participants was 29.8 ± 5.6 years, and the mean BMI was 27.1 ± 4.2 kg/m². Vaginal delivery was reported in 156 (70.9%) women. Overall, 112 (50.9%) participants experienced at least one form of pelvic floor dysfunction. Urinary incontinence was the most common symptom, affecting 84 (38.2%) women. Women with pelvic floor dysfunction had significantly higher age and BMI. Vaginal delivery (aOR 3.18; p=0.001), BMI >30 kg/m² (aOR 2.74; p=0.005), instrumental delivery (aOR 2.41; p=0.02), prolonged labor (aOR 2.63; p=0.01), and birth weight >3.5 kg (aOR 2.29; p=0.02) were significant predictors of pelvic floor dysfunction. Pelvic floor exercises showed a protective effect (aOR 0.42; p=0.01). Conclusion: Postpartum pelvic floor dysfunction is strongly associated with obstetric and maternal risk factors. Preventive strategies including pelvic floor rehabilitation, weight management, and improved obstetric care may reduce postpartum pelvic floor morbidity.

Background: A major healthcare problem is the length of hospital stay following surgical procedures because of the cost, use of healthcare resources, and the risk of hospital-acquired infections. This study aims to see the demographic, clinical, and perioperative factors responsible for prolonged hospital stay in surgical patients. Methodology: A cross-sectional, analytical study used a consecutive sampling technique for the patients (18 years and above) undergoing elective and emergency surgical procedures (n=120). A structured proforma and hospital records were used to gather demographic data, comorbidities, type and duration of surgery, and postoperative complications. These were categorized as normal or extended (>7 days) hospital stay. The data were analyzed with SPSS version 25.0 (p-value<0.05). Results: 37.5% of the patients (120) were admitted to the hospital for a prolonged period. Results: The mean age was 48.9 ± 14.7 years, and 56.7% were male. Long operative time (>4 hours), postoperative infection, wound complication, hospital admission in the intensive care unit, diabetes mellitus, and obesity were significantly associated with long hospital stay (p<0.05). The risk of the patients being hospitalized for a long duration was the highest in the patients with postoperative infection (OR = 3.74, 95% CI: 1.89–7.41). Other factors that were strong predictors of a prolonged surgical stay included emergency surgery (OR = 2.61) and surgery time (OR = 3.05). The regression model was statistically significant (R² = 0.50, p < 0.001). Conclusion: Prolonged hospital stay after surgical procedures is greatly influenced by patient-related and surgical factors. These are the most important predictors: postoperative infection, emergency surgery, and greater operative duration.

Background: Emotional well-being, self-esteem, social interactions, and quality of life are all impacted by chronic skin conditions. This study aimed to determine the psychological health of affected individuals and identify factors associated with moderate-to-severe psychological distress. Methods: This study included 180 consecutively recruited adults with chronic dermatological conditions at a tertiary care teaching hospital. The disease characteristics, duration, frequency of flares, visibility of the lesions, dermatology activity, psychological health, social functioning, coping strategies, and dermatology-related quality of life were evaluated by interview, validated questionnaires, clinical examination, and medical-record review. The data were analysed using SPSS version 26.0. Descriptive statistics were used to summarize the characteristics of the participants, and Chi-square or Fisher's exact tests were used to assess the association. Moderate to severe psychological distress was predicted by independent variables using multivariable logistic regression, with a P-value <0.05 as significant. Results: The mean age was 36.8 ± 13.7 years, and 57.2% were female. The most common diagnoses were psoriasis 64 (35.6%) and eczema 54 (30.0%). 110 (61.1%) had moderate-to-severe psychological distress, 99 (55.0%) had lowered self-esteem, and 98 (54.4%) had social avoidance. Frequent flare-ups (AOR=2.96), reduced self-esteem (AOR=2.58), disease duration >5 years (AOR=2.39), female gender (AOR=1.94), and visible skin lesions (AOR= 3.44) were the strongest independent predictors of distress. Conclusion: Psychological and social impairments were significant with chronic skin diseases. Psychological assessment, counselling, and referral should be a part of dermatology care. Future multicenter longitudinal studies should assess integrated long-term dermatological and psychological management.

Background Spinal anesthesia-induced hypotension is a frequent and critical problem during cesarean section, carrying risks for both mother and fetus. Prophylactic vasopressors and mechanical manipulation of the uterus are common preventative methods. The primary aim of this study was to assess the effectiveness of prophylactic phenylephrine bolus versus 15° left lateral tilt in preventing maternal hypotension. Material and methods In this randomized comparative study, 144 women who were planned to undergo elective cesarean delivery under spinal anesthesia were divided into two groups. Group A (n=72) was given a prophylactic intravenous bolus of 100 mcg of phenylephrine immediately after spinal injection. In group B (n=72), patients were placed in a 15° left lateral tilt with an obstetric wedge. The only outcome was the occurrence of hypotension (systolic pressure 20% decrease from baseline). Results Hypotension occurred in 65.3% (n=47) of patients in the phenylephrine group and 54.2% (n=39) of patients in the left tilt group. The difference between these groups was not statistically significant (p=0.159). Patients with a BMI over 30 kg/m² showed a higher incidence of hypotension after spinal anesthesia. However, there was no statistically significant difference in hypotension rates between those receiving phenylephrine and those positioned in a 15° left lateral tilt within this subgroup. Similarly, low baseline systolic blood pressure (SBP; 100-120 mmHg) was also a significant predictor of hypotension in both groups. Conclusion There was no benefit of phenylephrine 100 mcg bolus over a 15° tilt in the prevention of spinal anesthesia-induced hypotension for elective cesarean delivery. Both methods are popular options, but they may not be enough as individual prophylactic measures, and this might indicate the necessity of combination or more aggressive therapy.