Mayo Hospital is one of the oldest and biggest hospitals in Lahore, Punjab, Pakistan. King Edward Medical University, one of the oldest and most prestigious medical institutions in South Asia, is attached to Mayo Hospital. Mayo Hospital is located in the heart of Old Lahore, and provides free treatment to almost all admitted patients as part of a government policy. It also has many different ward's mainly centered around the Syed A route location.
Objectives: Heart failure is a major global health problem frequently encountered in medical emergencies, pulmonology, and cardiology units. The burden of heart failure continues to rise worldwide, including in low-and middle-income countries such as Pakistan. Thyroid dysfunction, a common endocrine disorder, has well-recognized effects on cardiovascular structure and function and may influence the clinical course of heart failure. This study aimed to determine the frequency and pattern of thyroid dysfunction among patients with heart failure and reduced ejection fraction. Methodology: A hospital-based cross-sectional study was conducted in the Cardiology Department of Bahria International Hospital from May 18, 2025, to September 30, 2025. A total of 163 patients with heart failure and reduced ejection fraction were enrolled using non-probability consecutive sampling. Thyroid function was assessed by measuring serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Data were analyzed using SPSS version 28. Results: The mean age of participants was 51.45 +/- 11.67 years, and the mean ejection fraction was 32.25 +/- 4.41%. Thyroid dysfunction was identified in 48 patients (29.4%). Hypothyroidism was the most prevalent abnormality, observed in 31 patients (19%), while 17 patients (10.4%) had hyperthyroidism. No statistically significant association was found between thyroid dysfunction and age or gender. Conclusion: Thyroid dysfunction is common among patients with heart failure and reduced ejection fraction, with hypothyroidism being the most frequent abnormality. Routine assessment of thyroid function may be beneficial in patients with heart failure. Further studies are warranted to evaluate the clinical outcomes following correction of thyroid dysfunction.
Inflammatory myofibroblastic tumour (IMT) is an uncommon and enigmatic neoplasm that can imitate a range of other medical conditions, frequently making it difficult to reach an accurate diagnosis. It primarily affects children, though there is a shortage of documented cases in the medical literature. The lungs are the most common location for this tumour to develop and intra-abdominal lesions are rare. Tumours arising from the small intestine and mesentery are exceptionally uncommon. This report highlights a rare case involving a 10-year-old child who presented to the emergency department exhibiting signs and imaging features that closely resembled acute appendicitis. However, surgical exploration revealed acutely inflamed appendix attached to a mass originating from the ileal wall, six feet proximal to the ileocaecal junction, covered by necrotic omentum and another mass in the ileal mesentery just proximal to the ileocaecal junction. The child underwent surgical removal of the appendix along with both the abdominal masses. The excised tissues were analysed through histopathology, confirming the diagnosis of an inflammatory myofibroblastic tumour. The post-operative period was uneventful, and follow-up evaluations revealed no evidence of the recurrence of the tumour.
BACKGROUND:Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is one of the important procedure-related complications of ERCP. Periprocedural intravenous hydration with lactated Ringer's solution has been considered a simple and feasible measure for reducing this complication. The present trial was designed to assess whether aggressive hydration with lactated Ringer's solution was more effective than standard hydration in preventing post-ERCP pancreatitis (PEP). METHODS:This randomized controlled trial was performed at two tertiary care hospitals. A total of 126 patients undergoing first-time ERCP were included and randomly distributed into two equal treatment groups. Patients in group A were managed with standard hydration, whereas patients in group B received aggressive hydration using lactated Ringer's solution. The main outcome measure was the development of PEP. Other recorded outcomes were post-ERCP hyperamylasemia, isolated hyperamylasemia, serial pain scores on the visual analog scale, serum amylase levels, duration of hospital stay, and fluid-related adverse effects. RESULTS:All 126 randomized patients completed the 24-hour assessment. PEP developed in 14 patients in the standard hydration arm and four patients in the aggressive hydration arm (22.2% versus 6.3%; p = 0.020; RR = 0.29, 95% CI = 0.10-0.82). Total post-ERCP hyperamylasemia was less frequent after aggressive hydration than standard hydration (14.3% versus 41.3%; p = 0.001). Isolated hyperamylasemia was recorded in 7.9% and 19.0% of patients, respectively (p = 0.116). Pain scores remained lower with aggressive hydration at 4, 12, and 24 hours (all p < 0.001). Hospital stay was also reduced (1.8 versus 3.0 days; p < 0.001). CONCLUSIONS:Aggressive hydration with lactated Ringer's solution significantly reduced PEP, post-procedure hyperamylasemia, pain scores, and hospital stay compared with standard hydration. The regimen was well tolerated in selected patients without fluid-overload risk.
Premature ejaculation (PE) is a common type of male sexual dysfunction. The Premature Ejaculation Diagnostic Tool (PEDT) was developed as a standardized tool to correctly diagnose PE and has been translated into many languages. However, a valid, culturally adapted Urdu version of the PEDT (PEDT-U) for northern Punjab does not exist. This study aimed to develop the Urdu version of the PEDT-U and evaluate its psychometric properties in a sample of Pakistani men with PE compared with healthy controls. PEDT-U was translated by two blinded translators and further refined using the forward-backward translation method. A total of 168 bilingual participants, 87 (51.79%) of them clinically diagnosed with PE (PE group) and 81 (48.21%) controls, completed both PEDT and PEDT-U questionnaires. Response time for PEDT-U was significantly less (p < 0.001). Receiver operating characteristic curve analysis showed that the area under the curve (AUC) for the PEDT-U was 0.987 (95% CI: 0.974-1.0), with a sensitivity of 0.736 and a specificity of 0.988. For the PEDT, the AUC was also 0.987 (95% CI: 0.976-0.999), with a sensitivity of 0.747 and a specificity of 0.990. Cronbach's alpha scores for PEDT (0.938) and PEDT-U (0.939) showed adequate internal consistency in both questionnaires. Cohen's kappa statistic showed good agreement in the responses of the participants; the median intravaginal ejaculatory latency time (IELT) for the 28 PE patients was 45 s, with a minimum IELT of 12 s and a maximum of 71 s. PEDT-U has shown a significant correlation between the original English and the translated PEDT-U. It has shown good internal consistency, test-retest reliability, degree of agreement, and discriminant validity relative to the original English version of the PEDT. It takes less time, and patients felt more comfortable with it. Hence, this tool is recommended for the diagnosis of PE among the Pakistani population.
