BACKGROUND:Severe acute pancreatitis (SAP) is a clinical dilemma that is hard to diagnose early and is associated with high morbidity and mortality. There are readily accessible inflammatory markers that could help with timely and effective management and risk stratification. PURPOSE:The purpose of the study is to determine the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) in determining the severity of acute pancreatitis (AP). METHODS:This retrospective multicenter cohort study included 272 adult patients admitted to two tertiary care hospitals in Pakistan (Lahore, n=142; Islamabad, n=130) with confirmed AP between September 2025 and December 2025. The revised Atlanta Criteria were used to classify the disease as severe or non-severe. Admission values were used to study the initial 24-hour values of the NLR, PLR, and CRP. Group comparisons were performed using nonparametric tests, and Spearman correlations were used; univariable logistic regression was employed to assess predictive performance given the high multicollinearity among predictors. FINDINGS:Patients with SAP had a significantly greater median NLR when compared to those with non-SAP (Mdn 9.4 vs 4.8; U = 1026.50, p < 0.001). The median CRP was also higher among severe ones (Mdn 168mg/L vs 68mg/L; U = 1013.50, p < 0.001). NLR (r = 0.766) and CRP (r = 0.767) showed strong positive correlations with severity. A high predictive accuracy (95.2%) was observed in the study dataset, with elevated odds of severe pancreatitis associated with NLR (OR = 3.78, 95% CI: 2.83-5.06) and CRP (OR = 1.06, 95% CI: 1.05-1.08). PLR had a weak negative association with severity (0.208) and reduced predictive accuracy (74.6%). Male patients (82/155 (52.9%); χ²(1) = 10.840, p = 0.001) and patients aged 60 years and older (65/102 (63.7%); χ²(3) = 10.930, p = 0.012) had higher chances of developing severe disease. Further analyses revealed that these subgroups also exhibited significantly higher median NLR and CRP levels than those of female patients and younger patients (p < 0.05), indicating that demographic risk factors are associated with elevated inflammatory responses. CONCLUSION:Elevated NLR and CRP on admission were strongly associated with SAP and demonstrated higher predictive performance than PLR. These findings suggest that simple inflammatory markers may assist early risk stratification, although further prospective validation is required.
Aortic Dissection (AD) is a life-threatening condition and one of the major causes of death in the U.S. Despite its clinical significance, trends in AD related mortality remain understudied. We aim to analyze nationwide mortality trends in AD in the U.S. Data from CDC WONDER (1999–2024) identified U.S mortality rates in adults aged ≥ 25 years with AD (ICD-10: I71.0). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). From 1999 to 2024, a total of 115,449 deaths from AD were recorded. The AAMR increased from 2.1 in 1999 to 2.4 in 2024 (AAPC of 0.46; 95
Objective: To determine early breastfeeding initiation rates, identify factors causing delayed initiation, andrecommend interventions for improved early breastfeeding.Material and Methods: A cross-sectional study was conducted at Jinnah Hospital, Lahore, involving 150women aged 18-40 with singleton term deliveries. The study included women with no significantcomorbidities, and the data was collected using a structured proforma. The data was checked forcompleteness and transferred to SPSS version 25 for analysis. The Chi-square test was applied to assessassociations between categorical variables, and statistical significance was set at p < 0.05.Results: A study of 150 patients found that 62% were older than 25 years, 36% had primary education, and27.3% were illiterate. Most were from lower socioeconomic classes and lived in joint families. Earlyinitiation of breastfeeding within one hour was reported by 18 %, while only 15.3% received antenatalcounseling. Younger age, middle socioeconomic class, primiparity, and caesarean delivery were significantlyassociated with delayed or non-initiation. Major barriers included lack of healthcare provider support,absence of skin-to-skin contact, prelacteal feeding, and withholding colostrum.Conclusion: The study reveals a low prevalence of early initiation of breastfeeding (EIBF) in tertiary carehospitals, with sociodemographic factors, healthcare practices, and delivery mode being significant barriers.Keyword: early breastfeeding initiation, socioeconomic factors, health personnel, barriers, cesarean section.How to cite: Tasneem S, Bano B, Mubeen S, Tazion S, Khalid H. Early Initiation of Breastfeeding At A TeachingHospital: Barriers and Facilitators For Mothers. Esculapio - JSIMS 2026;22(03):DOI: 10.51273/esculap.v22i03.1480
Primary caregivers of critically ill ICU patients experience substantial psychological stress, yet this burden remains understudied in lower middle-income countries such as Pakistan. This study assessed the magnitude and predictors of perceived stress among primary family caregivers of patients admitted to medical and surgical ICUs at three tertiary care hospitals in Karachi. A cross-sectional study was conducted among 161 primary caregivers at Jinnah Postgraduate Medical Center, Civil Hospital Karachi, and Liaquat National Hospital. Data were collected through interviews using the Perceived Stress Scale (PSS-10; range 0–40). Ethical approval and informed consent were obtained. Univariable multinomial logistic regression identified factors associated with stress levels, followed by multivariable multinomial logistic regression including significant or clinically relevant predictors. Overall, 65.8
Bilateral adrenal diffuse large B-cell lymphoma (DLBCL) is an exceedingly rare entity. Presentation as bilateral adrenal masses without an identifiable extra-adrenal primary poses a formidable diagnostic challenge, frequently mimicking adrenal metastases or primary adrenal malignancy. A 70-year-old normotensive, non-diabetic male presented with a one-month history of weight loss, generalized dull abdominal pain, and anorexia. Contrast-enhanced computed tomography (CECT) revealed bilateral adrenal masses (right 56 × 28 × 55 mm; left 61 × 30 × 54 mm) with imaging characteristics indistinguishable from metastatic disease. Extensive workup—including CT of the neck and chest, colonoscopy, and biochemical adrenal profiling—failed to identify a primary extra-adrenal malignancy or hormonal excess. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a 22-gauge needle provided tissue confirming diffuse large B-cell lymphoma (DLBCL) with CD20 and PAX-5 positivity. The patient was referred to oncology and commenced on rituximab-based chemotherapy. This case underscores the indispensable role of EUS-guided tissue sampling in the evaluation of bilateral adrenal masses when non-invasive workup is inconclusive. Early tissue diagnosis of adrenal DLBCL is critical, as it is a potentially curable disease amenable to immunochemotherapy rather than surgery.
