Nishtar Hospital is a teaching hospital of Nishtar Medical University, located in Multan, Pakistan. It is a tertiary care hospital, serving a large population of South Punjab, adjoining areas of Baluchistan and [Bharat India Pakhtunkhwa]] provinces.
Background: Preeclampsia is a major contributor to maternal and perinatal morbidity and mortality worldwide, with a particularly high burden in low- and middle-income countries like Pakistan. Emerging evidence suggests that vitamin D deficiency may play a contributory role in the development of preeclampsia through its effects on immune modulation, placental function, and vascular regulation. Aim: This study aimed to evaluate the association between maternal serum vitamin D levels and the risk of developing preeclampsia among pregnant women in Pakistan. Methodology: A hospital-based case-control study was conducted over 13 months at Combined Military Hospital, Multan, including 180 pregnant women—90 with preeclampsia (cases) and 90 normotensive pregnant women (controls). Participants had singleton term pregnancies and were not on vitamin D supplementation. Serum 25 hydroxyvitamin D [25(OH)D] levels were measured, and statistical analyses including chi-square tests and binary logistic regression were performed to assess associations, with significance set at p < 0.05. Results: Women with preeclampsia had significantly lower mean vitamin D levels (13.27 ± 1.53 ng/mL) compared to healthy controls (21.83 ± 5.93 ng/mL, p = 0.001). Vitamin D deficiency (<10 ng/mL) was more prevalent among cases (22%) than controls (5%, p = 0.001). Logistic regression revealed that vitamin D deficiency was independently associated with increased odds of preeclampsia (adjusted OR = 4.66, 95% CI: 1.41–9.65, p = 0.01). Additionally, maternal age between 30–35 years and a BMI of 25-30.1 kg/m² were also significant risk factors. Conclusion: The study found a strong and independent association between maternal vitamin D deficiency and preeclampsia, suggesting that vitamin D status may serve as a modifiable risk factor. Routine screening and early correction of hypovitaminosis D in antenatal care may aid in reducing the burden of preeclampsia in high-risk populations.
Pulmonary alveolar microlithiasis is an autosomal recessive disease caused by a mutation in the SLC34A2 gene often misdiagnosed as pulmonary tuberculosis due to nonspecific clinical features and radiological overlap. Diagnosis is confirmed on a histopathological basis; however, no definitive treatment strategy exists. A 20-year-old female presented to us with progressive shortness of breath for 1 year. Physical examination revealed clubbing of fingers with diffuse lung crepitations. Imaging revealed a 'sandstorm-like' appearance and diffuse reticulonodular pattern. Transbronchial biopsy confirmed pulmonary alveolar microlithiasis. This case underscores the importance of identifying characteristic radiological and histopathological features of pulmonary alveolar microlithiasis to avoid misdiagnosis and timely management of the disease.
Aims: To assess compliance with recommended standards for completion and documentation of risk assessment on admission and discharge in the psychiatry inpatient unit, and to evaluate the effect of targeted interventions on improving patient safety and continuity of care. ET AL AUTHORS: 6. Dr. Ali Abbas Zahid - Internal Medicine PGR- aliabbaszahid004@gmail.com - Aleem Medical Collge / Gulab Devi Teaching Hospital, Lahore, Pakistan 7. Dr. Muhammad Zubair - General Practitioner- muhammadzubair1103@gmail.com Methods: A closed-loop quality improvement audit with a repeated cross-sectional design was conducted over two months. Twenty-five consecutive patients were reviewed in each cycle (total n=50). Baseline data were collected retrospectively from clinical records, followed by implementation of interventions including staff education, display of risk-assessment checklists in the ward, and reminders during ward rounds to complete admission and discharge risk documentation. A prospective re-audit was then performed using identical standards. Criteria assessed included completion of risk assessment within 24 hours of admission, documentation in clinical notes, coverage of risk domains (risk to self, risk to others, risk from others, risk of absconding), documentation of a risk management plan, and review and update of risk assessment prior to discharge. Results: Admission risk assessment within 24 hours improved from 64% to 92% (absolute improvement +28%). Documentation in clinical notes increased from 84% to 96% (+12%). Assessment of risk to self improved from 84% to 96% (+12%), risk to others from 80% to 92% (+12%), risk from others from 68% to 88% (+20%), and risk of absconding from 80% to 92% (+12%). Documentation of a risk management plan increased from 72% to 88% (+16%). Discharge-related safety showed the greatest improvement. Review of risk assessment prior to discharge improved from 40% to 84% (+44%), and updating of risk assessment before discharge improved from 40% to 80% (+40%). Overall, post-intervention compliance was high across all admission and discharge standards, with the largest absolute gains seen in safeguarding assessments and discharge safety processes. Conclusion: This closed-loop audit demonstrates that simple, low-cost interventions led to substantial absolute improvements (12–44 percentage points) in multiple components of risk assessment, particularly in safeguarding domains and discharge risk review, which are critical for preventing post-discharge adverse events. Although post-intervention compliance was high, gaps remain in achieving universal documentation of risk management plans and discharge updates. Embedding standardized admission and discharge proformas and continued staff reinforcement are recommended to sustain and further improve patient safety practices.
Acinetobacter baumannii (A. baumannii) represents a major threat because of its multidrug resistance, achieved through its ability to control virulence, and its mechanisms of drug efflux resistance. In this study, we used a combined experimental-computational approach to create and evaluate antimicrobial peptides that targeted the two essential pathogenic proteins, BfmR and AbaQ. The genomic analysis of a clinical isolate showed an extensive resistome and virulence profile, which matched high-risk global lineages. This study conducted molecular docking of an experimental AMP (cathelicidin KR-12 screened from the literature) and a rationally designed synthetic AMP (modified KR-12 analog) with pathogenic proteins, followed by 200 ns molecular dynamics simulations to evaluate both the binding stability and inhibitory potential of the compounds. The disk diffusion assay and microdilution assay were performed against A. baumannii. The study used comparative trajectory analyses, including RMSD, RMSF, radius of gyration, solvent-accessible surface area, principal component analysis, and MM-PBSA free energy calculations, to show that the synthetic AMP created stable electrostatic and hydrogen-bond networks, which caused conformational locking, and reached lower energy states than the experimental peptide. The synthetic AMP showed significant inhibition in validation in vitro. Contrastingly, the experimental AMP had transient interactions and no specificity. The study demonstrates that rationally designed AMPs have therapeutic potential, while the results create a reliable in silico framework to combat multidrug-resistant A. baumannii.
Background: Palliative care integration is increasingly recommended for patients with advanced cancer, yet implementation remains limited in low- and middle-income settings, including Pakistan. Objective: To evaluate whether nurse-led integrated palliative care was associated with reduced symptom burden and improved patient satisfaction among oncology patients at Nishtar Hospital, Multan. Methods: A quasi-experimental non-equivalent control group study was conducted among 120 adults with stage III or IV solid malignancies, including 60 patients receiving nurse-led integrated palliative care plus standard oncology care and 60 patients receiving standard oncology care alone. The intervention included structured symptom assessment, patient and family education, psychosocial support, care coordination, and repeated follow-up over five months. Symptom burden was measured using the Edmonton Symptom Assessment System, and patient satisfaction was measured using the Patient Satisfaction Questionnaire Short Form at baseline, one month, three months, and five months. Longitudinal outcomes were analyzed using adjusted linear mixed-effects models with missing outcome data handled through multiple imputation. Results: ESAS scores decreased from 52.4 ± 11.8 to 28.6 ± 9.4 in the intervention group and from 51.9 ± 12.1 to 45.3 ± 10.8 in the control group, with a month-5 between-group difference of -16.7 points. PSQ-18 scores increased from 58.3 ± 10.2 to 85.6 ± 8.7 in the intervention group and from 59.1 ± 9.8 to 65.4 ± 10.1 in the control group, with a month-5 between-group difference of 20.2 points. Conclusion: Nurse-led palliative care integration was associated with lower symptom burden and higher patient satisfaction among advanced oncology patients, supporting further multicenter evaluation of this model in resource-constrained settings.
