Lady Reading Hospital

Abstract Background Forgotten double-J (DJ) ureteral stents represent a preventable complication with significant morbidity. Limited data exist on patient-level determinants and systematic risk factors in low- and middle-income countries (LMICs). This study primarily evaluated the burden and clinical consequences of forgotten DJ stents and secondarily identified independent predictors of stent encrustation at a tertiary care center in Pakistan. Methods This retrospective observational study included patients with DJ stents retained 3 or > 3 months beyond the advised removal date without clinical justification, from May 2023 to April 2025. The primary outcome was encrustation. Multivariable logistic regression identified independent predictors of encrustation, with multicollinearity assessed using the variance inflation factor (VIF). Spearman’s correlation evaluated the relationship between stent duration and complication severity. Results Ninety-four patients were included (64.9% male; mean age 41.3 ± 12.2 years). The majority (86.2%) had not completed high school, reflecting low overall educational attainment in the cohort. Total stent dwell time was 3–4 months in 45.7%, 4–6 months in 18.1%, 6–12 months in 16.0%, 12–24 months in 17.0%, and > 24 months in 3.2%. Primary reasons for delay were unawareness (50%), financial constraints (24.5%), and neglect (11.7%). Complications included encrustation (43.6%), stone formation (22.3%), fragmentation (18.1%), and migration (16%). Single-session removal succeeded in 64.9% of patients; 25.5% required two sessions, and 9.6% needed more than two interventions. One nephrectomy was performed (1.1%). On multivariable analysis, factors independently associated with encrustation were low educational status (adjusted OR 9.72, 95% CI 1.66–56.82, p = 0.012) and stent dwell time > 6 months (adjusted OR 23.39, 95% CI 6.64–82.38, p < 0.001). A strong positive correlation existed between stent duration and complication severity (ρ = 0.62, p < 0.001). Conclusion Forgotten DJ stents caused substantial morbidity, with low educational status and prolonged retention independently predicting encrustation. Gaps in patient education and follow-up systems persist in resource-limited settings. Stent registries, automated reminders, and targeted counselling may help reduce this preventable complication.

OBJECTIVE: This study aimed to compare the outcome of Lichtenstein inguinal hernia repair using stainless steel staples versus polypropylene sutures for mesh anchorage. METHODOLOGY: A Prospective analytical study was conducted at the Surgical Department Lady Reading Hospital, Peshawar, from June to December 2022. Consecutive non-probability sampling was used to assess a total of 100 cases (50 undergoing repair by each method). The study included primary unilateral inguinal hernia cases aged 20 to 70 years. Patients with complicated inguinal hernia, chronic ailments, BMI > 30, or immunocompromised state were excluded to avoid confounders. Outcome was assessed in terms of operative time, postoperative pain, and surgical site infection. RESULTS: Surgical site infections (SSI) were noted in 6% cases of Group A and 16% cases of Group B (with p-value = 0.11). The only parameter that showed a statistically significant difference between the two groups was operative time (Group A: 36.63 +/- 3.14 minutes, Group B: 45.68 +/- 2.69 minutes, p-value <0.001). The differences in postoperative pain between the two groups were not statistically significant (p-value of 0.47). CONCLUSION: Both techniques provide excellent results. However, mesh anchoring using stainless steel staples takes less time than the polypropylene anchoring, which can have essential implications in postoperative recovery.

Abstract Background I’m Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals, particularly those with advanced HIV/AIDS. However, an increasing number of cases are being identified in non-HIV immunocompromised hosts, including patients receiving B-cell-depleting therapies such as Rituximab. Case presentation A 67-year-old male with marginal B-cell lymphoma developed an isolated cryptococcal bloodstream infection shortly after completing Rituximab therapy. Initially, the patient presented with persistent diarrhea and progressive weakness. Subsequently, acute otitis media developed, and Streptococcus pneumoniae bacteremia was diagnosed. During his hospital course, his repeated blood cultures were cleared of bacteria but revealed Cryptococcus neoformans, confirmed by a positive serum cryptococcal antigen (titer 1:40). Given the patient’s severe coagulopathy, a lumbar puncture was not feasible, necessitating an alternative diagnostic approach. Adhering to IDSA guidelines, he received a 2-week induction phase of amphotericin B and flucytosine, followed by consolidation and maintenance therapy with fluconazole. The patient successfully completed his induction therapy as an inpatient without complications and demonstrated clinical recovery at a subsequent follow-up visit. Conclusion This case study highlights the expanding spectrum of cryptococcosis beyond HIV/AIDS and underscores the paramount importance of early recognition and treatment, adhering to established guidelines, in the context of Rituximab-associated immunosuppression. Further research is needed to refine risk stratification of isolated Cryptococcus bloodstream infection and develop tailored management strategies for this emerging at-risk population.

ABSTRACT OBJECTIVES This study aims to determine the frequency of sexual dysfunction among patients undergoing SSRI treatment. METHODOLOGY A cross-sectional study was conducted at the Department of Psychiatry, MTI Lady Reading Hospital, Peshawar, from December 2023 to June 2024. Using non-probability consecutive sampling, 288 patients aged 20-40 years receiving SSRIs for at least 12 weeks for various psychiatric disorders were enrolled. Patients with severe medical illnesses, substance dependence, or pre-existing sexual dysfunction were excluded. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale (ASEX). Data were analyzed using SPSS version 26. Chi-square test was applied, and p≤0.05 was considered statistically significant. RESULTS The mean age of the patients was 27.20±5.40 years. The mean duration of SSRI use was 2.61±1.12years. The p-value >.05 indicated that there is no statistically significant correlation between SSRI duration (1-3 years vs. >3 years) and sexual dysfunction. Among the participants who had sexual dysfunction, 56 (62.2%) were male, while 34 (37.8%) were female and aged 2-30 years, but the association was not statistically significant (χ² = 1.34, p = 0.246, φ = 0.07). The chi-square result shows no statistically significant difference between demographic and clinical variables and sexual dysfunction, and the effect size shows a very small association. CONCLUSION A substantial proportion of patients receiving SSRIs experienced sexual dysfunction, highlighting the need for routine screening and counseling in psychiatric practice.