Shalamar Hospital

ABSTRACT OBJECTIVES To evaluate and compare the efficacy of xylocaine–propofol admixture and local tapping in reducing the incidence and severity of propofol injection pain. METHODOLOGY This quasi-experimental comparative study was conducted at Shalamar Hospital, Lahore, from August 2025 to December 2025, involving 120 adult patients undergoing elective surgery under general anesthesia. Group A received propofol mixed with 0.5 ml of 2% xylocaine, while Group B received standardized local tapping for five seconds before propofol administration. Pain severity was assessed using a four-point verbal rating scale after the first 5 ml of propofol. RESULTS Pain incidence and severity were significantly lower in the xylocaine group. No pain was reported by 63.3% of patients in Group A compared to 20.0% in Group B, while severe pain occurred in only 1.7% versus 16.7%, respectively (p < 0.001). The mean pain score was significantly lower in Group A (0.50 ± 0.73) than in Group B (1.47 ± 1.04) (p < 0.001). Hemodynamic changes were also smaller in the xylocaine group, with heart rate and systolic blood pressure increasing by +2.7 bpm and +2.1 mmHg, compared to +6.7 bpm and +6.2 mmHg in the tapping group (p < 0.05). Adverse events were minimal, with only one mild irritation case in Group A. Patient satisfaction was higher in Group A, with 66.7% reporting being very satisfied compared to 30.0% in Group B. CONCLUSION It is concluded that xylocaine admixture is significantly more effective than local tapping in reducing propofol injection pain, stabilizing hemodynamic responses, and improving patient satisfaction. Local tapping may offer partial benefit but should not replace xylocaine as the preferred technique for minimizing discomfort during propofol administration.

INTRODUCTION:Chronic heart failure (CHF) remains a leading cause of global morbidity and mortality, frequently resulting in hospitalizations and diminished quality of life. Sacubitril/ Valsartan, the first angiotensin receptor-neprilysin inhibitor (ARNI) approved by the FDA, has shown promising effects in reducing mortality and improving clinical outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Sacubitril/ Valsartan compared with conventional therapies in patients with CHF. METHODS:A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched up to April 18, 2024, using predefined terms. Eligible studies included randomized controlled trials comparing Sacubitril/Valsartan with standard therapies in adult CHF patients. Data extraction was performed independently by multiple reviewers, and study quality was assessed using the JBI checklist. Meta-analyses were conducted to estimate pooled outcomes. RESULTS:Ten randomized controlled trials, including 15,650 patients, were analyzed. The mean age across studies was 68.4 years, with males comprising 59.4% of the Sacubitril/Valsartan group and 63.3% of the control group. Sacubitril/Valsartan significantly reduced NT-proBNP levels (SMD = -0.30, 95% CI: -0.58 to -0.03; p = 0.03) and disease-related events (OR = 0.82, 95% CI: 0.76-0.89; p < 0.00001). Hypotension was the most frequently reported adverse event (OR = 1.57, 95% CI: 1.28-1.93; p < 0.0001), whereas hyperkalemia and renal dysfunction did not differ significantly from control groups. DISCUSSION:The findings indicate that Sacubitril/Valsartan improves outcomes in patients with CHF and exhibits an acceptable safety profile, although clinicians should monitor for hypotension. CONCLUSION:Sacubitril/Valsartan represents an effective therapeutic option for CHF, providing significant benefits in reducing mortality and morbidity compared with standard therapy.

Background Variceal upper gastrointestinal bleeding (UGIB) is a life-threatening complication of portal hypertension and cirrhosis, associated with high morbidity and mortality. The objective of this study was to evaluate the clinical outcomes and identify independent predictors of six-week mortality in patients presenting with variceal UGIB at a tertiary care center, while providing locally representative data from a large cohort in a low- to middle-income country to strengthen region-specific evidence. Methodology This retrospective observational study was conducted at Shalamar Hospital, Lahore, Pakistan, from June 2020 to June 2025. It included 355 patients admitted with endoscopically confirmed variceal UGIB. Data regarding demographics, clinical presentation, laboratory parameters, endoscopic findings, treatment modalities, and outcomes were collected from hospital records. Results The mean age of patients was 52.3 ± 12.8 years, with 59.7% male patients. Most patients (83.9%) had known cirrhosis, and hematemesis was the most frequent presentation (69.0%). Endoscopic variceal ligation was the commonest intervention (76.3%). Initial hemostasis was achieved in 86.5% of patients. Rebleeding occurred in 20.8%, while the mean hospital stay was 6.9 ± 3.4 days. The overall six-week mortality was 21.1%. Independent predictors of mortality included rebleeding (AOR: 3.91; 95% CI: 2.10-7.30; p < 0.001), Child-Pugh class C (AOR: 2.84; 95% CI: 1.52-5.30; p = 0.001), and hemodynamic instability at admission (AOR: 2.76; 95% CI: 1.44-5.28; p = 0.002). Conclusion Variceal UGIB continues to pose a major clinical challenge, with significant mortality despite effective endoscopic and pharmacological interventions. Advanced liver dysfunction, rebleeding, and shock at presentation strongly predict poor outcomes.

Background: Enteric fever is a frequent cause of acute febrile illness in children living in endemic areas. Pakistan carries one of the highest burdens worldwide, but recent culture-confirmed estimates from routine hospital practice that could guide testing in febrile children are limited. Objective: To determine the frequency of blood culture–positive enteric fever in children presenting with acute febrile illness. Method: This is a Cross-sectional study. Department of Paediatrics, Punjab Rangers Teaching Hospital, Lahore, from 1 March 2025 to 30 September 2025. After institutional ethical approval, 121 children with acute febrile illness of more than 48 hours’ duration were enrolled and assessed for enteric fever by blood culture. Data were analysed in SPSS version 25. Effect modifiers were addressed by stratification, and the chi-square test was used to test associations, with a p-value of ?0.05 taken as significant. Results: The mean age was 6.60 ± 3.53 years, and 68 children (56.2%) were male. The mean duration of fever at presentation was 5.45 ± 2.18 days, and the mean axillary temperature was 39.03 ± 0.60 °C. Blood culture was positive in 23 children (19.0%) and negative in 98 (81.0%). Among the positive cultures, S. Typhi accounted for 14 (60.9%) and S. Paratyphi for 9 (39.1%). On stratification, children with a temperature above 39 °C had a significantly higher rate of culture positivity (p = 0.041). Conclusion: Culture-confirmed enteric fever was common (19.0%) in this group of febrile children and was associated with high-grade fever. The single-centre design and modest sample size limit wider application, and larger multicentre studies with susceptibility testing are needed.

Introduction Vesicovaginal fistula (VVF) is an abnormal communication between the urinary bladder and vagina, resulting in continuous urinary incontinence. Common causes include iatrogenic injuries during obstetric and gynecological surgeries, pelvic malignancies, and radiotherapy. Objective To compare the success rate of transabdominal VVF repair performed with and without interposition of a pedicled omental flap. Methodology This retrospective study was conducted at Sir Ganga Ram Hospital, Lahore, Pakistan, by reviewing medical records from August 2023 to August 2025. A total of 60 patients with VVF were included. Patients were divided into two groups based on the surgical technique performed: those who underwent repair with an interposition omental flap (Group A, n=30) and those who underwent repair without an interposition omental flap (Group B, n=30). Treatment success was defined as complete fistula closure without urinary leakage, assessed at three months postoperatively. Results Successful closure was achieved in 29/30 (96.7%) patients in the Group A compared to 22/30 (73.3%) in the Group B (χ²=6.38, p=0.011). Age did not significantly influence treatment outcomes. However, fistula size and operative duration were significantly associated with surgical success. Large-sized fistulae in the Group B were associated with lower success rates (χ²=16.20, p=0.001), and procedures lasting >120 minutes had reduced success in the Group B (χ²=6.44, p=0.011). Conclusion The use of an interposition omental flap significantly improves the success rate of transabdominal VVF repair. Incorporating a vascularized omental graft enhances surgical outcomes and reduces failure rates.