Hayatabad Medical Complex Peshawar

Escherichia coli (E. coli) is a leading cause of urinary tract infections (UTIs) and diabetic foot ulcers, especially in individuals with weakened immune systems. Pathogenic strains (PEC) employ virulence genes including fimH, hlyA, usp, traT, and papC to establish infection, evade immune responses, and cause tissue damage. However, despite its clinical significance, there is a lack of integrative studies profiling virulence genes and identifying mutations in PEC, which may contribute to pathogenicity, antimicrobial resistance, and limitations in targeted therapy. In this study, 210 E. coli isolates were collected from diabetic patients with UTIs or foot ulcers at Hayatabad Medical Complex (HMC), Peshawar. Identification was performed through biochemical profiling and confirmed via PCR targeting 16S rRNA. Antibiotic resistance was assessed using the Kirby-Bauer disk diffusion method. The presence of virulence genes was detected by PCR, and sequencing data were analyzed using bioinformatics tools such as Multiple Sequence Alignment, PROVEAN, InterProScan, and SWISS-MODEL. A significantly higher prevalence of all five virulence genes was observed in diabetic isolates (fimH OR = 2.63; hlyA OR = 3.17; usp OR = 3.57; traT OR = 3.31; papC OR = 3.45; p < 0.001). Several mutations were identified, with PROVEAN predicting deleterious mutations including V20G (FimH), S130L (HlyA), G3R (USP), G1V and Q104L (PapC), and E27K (TraT). Structural modeling revealed localized conformational shifts, while InterProScan indicated conserved functional domains. Phylogenetic analysis showed that mutated genes formed distinct clusters, pointing to evolutionary divergence. This study emphasizes the value of molecular monitoring and the development of targeted therapies to control antibiotic-resistant E. coli infections in diabetic patients.

Impaired gait speed (GS) is a powerful predictor of disability and mortality in congestive heart failure (CHF), yet molecular determinants of this functional decline remain poorly defined. Existing studies have focused largely on cardiac parameters, leaving a critical gap in identifying biomarkers that capture multisystem involvement. Here, we investigated plasma osteonectin (OSN), also known as secreted protein acidic and rich in cysteine (SPARC), as a novel biomarker for impaired GS in a cohort of 286 CHF patients. We evaluated cardiac function (LVEF), GS, and plasma levels of OSN, zonulin (gut permeability marker), and C-reactive protein (CRP). CHF patients exhibited significantly elevated OSN, zonulin, and CRP, all inversely correlated with GS (p < 0.0001). Multivariable adjusted analysis revealed a robust independent dose-response relationship, where every 0.1 m/s decrease in GS was associated with a significant increase in plasma OSN levels (t = 6.614, p < 0.0001). ROC curve analysis further confirmed this relationship, with OSN demonstrating high diagnostic accuracy (AUC = 0.822) for identifying poor functional performance. In the poor GS subgroup, OSN and zonulin were uniquely linked to CRP (p < 0.0001), suggesting a potential association between gut-barrier dysfunction, systemic inflammation, and OSN-related musculoskeletal remodeling. Collectively, these findings suggest that plasma OSN is an independent biomarker of functional impairment in CHF. While the cross-sectional design limits causal inference, OSN represents a promising tool for risk stratification and a potential therapeutic target to mitigate mobility loss in CHF.

OBJECTIVE:Propofol is widely used for gastrointestinal (GI) endoscopies but may cause respiratory depression and hemodynamic compromise when used alone. Adjuncts such as ketamine or esketamine and fentanyl-class opioids (fentanyl, alfentanil, and sufentanil) are used to optimize sedation, yet their comparative efficacy and safety remain uncertain. This meta-analysis evaluated ketamine or esketamine plus propofol (KP regimens) versus fentanyl/alfentanil/sufentanil plus propofol (FP regimens). METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Scopus, Cochrane Library, and Google Scholar from inception to February 2025 for randomized controlled trials (RCTs). Eligible studies included patients undergoing GI endoscopy (Population), receiving ketamine or esketamine with propofol (Intervention), compared with fentanyl-class opioids with propofol (Comparison), and reporting outcomes including propofol dose, comfort, adverse events, recovery time, or procedure time (Outcomes). Risk of bias was assessed with the Cochrane tool. Heterogeneity was evaluated using Cochran's Q test and the I2 statistic, and clinical heterogeneity was considered based on study design and population differences. Sensitivity analyses were conducted to test robustness of findings. RESULTS:Fifteen RCTs (1492 participants) were included. KP regimens significantly reduced total propofol use compared with FP (mean difference [MD] -0.42; 95% confidence interval [CI] -0.66 to -0.19; P = .0005), with greater benefit observed for esketamine (p for subgroup = 0.001). No significant differences were found in sedation (MD 0.01; 95% CI -0.40 to 0.43; P = .95) or pain scores (MD 0.24; 95% CI -0.18 to 0.65; P = .26). Safety outcomes were comparable across groups, with no significant differences in desaturation, nausea/vomiting, bradycardia, or tachycardia, except for hypotension, which was lower with KP (risk ratio [RR] 0.56; 95% CI 0.39 to 0.82; P = .003). Recovery and procedure times were similar between groups. CONCLUSIONS:Both KP and FP regimens are effective and safe for GI endoscopy. KP regimens reduce total propofol requirements and significantly lower the risk of hypotension, while showing comparable sedation quality, analgesia, and recovery profiles to FP. These findings suggest KP may offer safety and dosing advantages, though larger standardized trials are needed to confirm its clinical superiority.

Obesity is becoming increasingly common around the world and is often co-occurring with chronic diseases that could complicate surgical treatment. Partial Nephrectomy is a complex surgical procedure and obesity may influence surgical complexity, postoperative recovery and resource use. Previous studies have produced mixed results, and many are limited by small sample sizes or single-center data. This study assesses how obesity affects in-hospital perioperative outcomes by analyzing data from a large national dataset. We performed a retrospective analysis of the National Inpatient Sample from 2018 to 2020, including adult patients with non-metastatic RCC who underwent open, laparoscopic, or robot assisted partial nephrectomy. Outcomes included in-hospital mortality, complications, discharge disposition, length of stay, and total hospital charges. Survey-weighted methods and multivariable regression models were employed to adjust for measured demographic, clinical, and hospital-level factors. Among 40,300 weighted hospitalizations, 10,270 patients were obese, younger and had higher comorbidity burdens. Surgical approaches were similar across groups, with robotic partial nephrectomy most frequent. Unadjusted analyses showed higher postoperative complication rates in obese patients. However, after adjusted analysis, obesity was not independently linked to in-hospital mortality, major complications, non-home discharge, length of stay, or hospital costs. Robotic surgery was associated with lowest adjusted odds of complications, mortality, and shorter hospitalization. The comorbidity index proved a reliable predictor for mortality, complications, length of stay, and total charges. Obesity alone was not an independent predictor of adverse in-hospital perioperative outcomes following partial nephrectomy. It is of utmost importance to manage the underlying conditions, as the comorbidity index remains the strongest determinant of worse outcomes and higher hospital costs. The robotic partial nephrectomy was associated with lowest adjusted odds of complications and shorter hospitalization within contemporary practice patterns.

This case highlights the rare manifestation of a less prevalent form of chronic autoimmune thyroiditis, serum-negative chronic autoimmune thyroiditis, within a sibling cluster without detectable autoantibodies and unclear genetic links, with no familial history, challenging current understanding of autoimmune thyroid disease. Ultrasound findings remain crucial for diagnosis, underscoring the need for clinical vigilance in atypical pediatric hypothyroidism.