Military Hospital Rawalpindi

Background. Autoimmune hepatitis (AIH) is increasingly seen in children worldwide and it is more severe in children compared to adults. This study highlights the biochemical and clinical aspect, treatment given and outcome of the disease including pediatric liver transplantation. Study. Retrospective review (2012-2022) was done in Shifa International Hospital, Islamabad. Patients under 18 years diagnosed with AIH were included. Data related to age, gender, clinical features, laboratory investigations including liver function test, liver biopsy findings and imaging modalities were included. Results. Fifteen patients were included 7 (47%) were males and 8 (53%) females. AIH type 1 was the most common type seen in 7 (46%), AIH type 2 in 5 (33%) and seronegative in 3 (20%). Jaundice was the most common symptom. Liver biopsy showed findings characteristic of AIH. Liver transplant performed in 3 patients. Conclusion. The study highlights the varied clinical presentation of AIH in Pakistani children.

Background Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage. Methods We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as less than 70 g/L. Hospitals in each country where anaemia in pregnancy is common were identified from a network established during previous obstetric trials. Women who were younger than 18 years without permission provided by a guardian, had a known tranexamic acid allergy, or developed postpartum haemorrhage before the umbilical cord was cut or clamped were excluded from the study. Prebirth haemoglobin, the exposure, was measured after hospital arrival and just before giving birth. Postpartum haemorrhage, the outcome, was defined in three ways: (1) clinical postpartum haemorrhage (estimated blood loss >= 500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) WHO-defined postpartum haemorrhage (estimated blood loss of at least 500 mL); and (3) calculated postpartum haemorrhage (calculated estimated blood loss of >= 1000 mL). Calculated postpartum haemorrhage was estimated from the peripartum change in haemoglobin concentration and bodyweight. We used multivariable logistic regression to examine the association between haemoglobin and postpartum haemorrhage, adjusting for confounding factors. Findings Of the 10 620 women recruited to the WOMAN-2 trial between Aug 24, 2019, and Nov 1, 2022, 10 561 (99.4%) had complete outcome data. 8751 (82.9%) of 10 561 women were recruited from hospitals in Pakistan, 837 (7.9%) from hospitals in Nigeria, 525 (5.0%) from hospitals in Tanzania, and 448 (4.2%) from hospitals in Zambia. The mean age was 27.1 years (SD 5.5) and mean prebirth haemoglobin was 80.7 g/L (11.8). Mean estimated blood loss was 301 mL (SD 183) for the 8791 (83.2%) women with moderate anaemia and 340 mL (288) for the 1770 (16.8%) women with severe anaemia. 742 (7.0%) women had clinical postpartum haemorrhage. The risk of clinical postpartum haemorrhage was 6.2% in women with moderate anaemia and 11.2% in women with severe anaemia. A 10 g/L reduction in prebirth haemoglobin increased the odds of clinical postpartum haemorrhage (adjusted odds ratio [aOR] 1.29 [95% CI 1.21-1.38]), WHO-defined postpartum haemorrhage (aOR 1.25 [1.16-1.36]), and calculated postpartum haemorrhage (aOR 1.23 [1.14-1.32]). 14 women died and 68 either died or had a near miss. Severe anaemia was associated with seven times higher odds of death or near miss (OR 7.25 [95% CI 4.45-11.80]) than was moderate anaemia. Interpretation Anaemia is strongly associated with postpartum haemorrhage and the risk of death or near miss. Attention should be given to the prevention and treatment of anaemia in women of reproductive age. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.

Abstract: Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications. Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI <25kg/m2. Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients. In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c <7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17. Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c. Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medications

Background: Sleep is an essential event that effects quality of life and hormonal balance in human body. The association between sleep and diabetes is bi-directional. Methods: This study was conducted with a case control design in the Department of Medicine of Combined Military Hospital Peshawar between June 2022 to November 2022. Results: . Mean age of study population was 51.1±12.94 years with 46% females and 54% males. Majority population was educated up to matriculation with BMI in normal (18.5-24.9 kg/m2) range. There was no statistical difference in demographic data amongst diabetic and control group . Avg HbA1c was 8.546% ± 1.57% in the diabetic group and 5.712% ± 0.49% in control group. As per PSQI questionnaire 47 (47%) participants were good sleeper across the study population, which included 17 out 50 (34%) individuals in the diabetic and 30 out of 50 (60%) in control group. This equated to statistically significant difference amongst two group with a p value 0.007. A statistically significant difference (p = 0.001) was also seen in PSQI score between diabetic and control groups (9.40 ± 5.82 vs 5.98 ± 4.85 respectively). Diabetics had 2.9 times odds (95% confidence interval 1.29-6.57, p = 0.01) of having bad quality sleep as compared to controls. In the diabetic group majority were males educated up to matriculate having medium adherence treated with both oral hypoglycemic drugs and insulin having 3 or more comorbid condition with hypertension being most prevalent single comorbid disease. Conclusion: By strict glycemic control in diabetics we can imove their quality of sleep Interventions to improve sleep hygiene can be suggested to patients by diabetes educators as part of diabetes self-management education programs.

Objective: To determine the effect of moderate exercise training on vitals i-e., Blood pressure (Systolic and diastolic), Pulse Rate(PR), Respiratory Rate(RR) and Peak VO2 in different age categories of adults during COVID-19 pandemic. Study Design: Descriptive cross-sectional study. Place and Duration of Study: This study was carried out at a tertiary cardiac care center from Feb 2021 to May 2021. Methodology: It was a descriptive cross sectional study conducted generally for 6 months in tertiary care center. A total of 104 participants were included and divided into three groups i-e., Young adults (17-30 years), Middle age adults (31-45 years) and Old age (>45 years) Participants were selected through non-probability convenient sampling technique and allocated in groups based on their age. Participant, after meeting inclusion criteria were supervised during moderate exercise training which includes walking for 23 minutes, cycling for 23 minutes and stepping for 5 minutes. Participants were assessed Pre and Post through Manual sphygmomanometer for BP, NMQ for muscle discomfort. Borg scale was used to assess exertional level and 6 Minute Walk test to assess Peak VO2. Results: Post intervention between the groups showed the significant effect on all three assessment factors of VO2,Borg Scale and SBP with Kruskal Wallis test (p<0.05). Post intervention within the group showed significant effect on all three assessment factors of SBP,DBP,PR,RR,VO2 and Borg RPE scale with Friedman test (p<0.05). Post assessment of muscle discomfort shows highest frequency i-e 13.8(4%) in shoulder, thigh, upper and lower back region. Conclusion: This study reported that disturbed vitals and reduced VO2 due to inactivity because of COVID-19 pandemic. Post COVID-19 affects can be recovered through 6 weeks of moderate training. Furthermore, this study reported that participants belonging to old age showed maximum improvement in vitals in response to training while showed maximum muscle discomfort frequency in shoulder, thigh, lower and upper back