Objective: To assess frequency and severity of thrombocytopenia and evaluate prevalence and severity of dengue hepatitis among patients with DF and DHF. Study Design: Comparative Cross-Sectional Study. Setting: Department of Medicine, Rawalpindi Teaching Hospital (RTH), affiliated with Rawalpindi Medical University, Rawalpindi, Pakistan. Period: One Year from September 2024 to September 2025. Methods: A comparative cross-sectional study involving 200 serologically confirmed dengue patients (100 DF, 100 DHF) admitted to a Rawalpindi Medical University Teaching Hospital. Platelet counts were classified as per severity and dengue hepatitis was confirmed from noted elevations in ALT and AST. Chi-square tests and correlation were used to ascertain associations between fever type and laboratory variables. Statistical significance was robust at p<0.05. Results: Thrombocytopenia was common among all patients and severe thrombocytopenia (<40×10³/µL) was slightly more frequent among DHF. However, the association between fever type and platelet levels did not show significant correlation (p>0.05). On the other hand, Dengue Hepatitis Was Higher In Prevalence And Severity Among DHF Patients With Increased ALT Levels (P=0.011). Higher AST elevations were seen in most patients. A significant negative correlation was identified between hepatic enzyme levels and disease severity (Spearman r = –0.232, p=0.001), suggesting transaminase levels progressively rise then fall during the course of ill clinical status. Conclusion: Although thrombocytopenia occurred frequently in both DF and DHF without a significant difference, dengue hepatitis was substantially more common and severe in DHF. Elevated liver enzymes, particularly ALT and AST, serve as reliable indicators of Severe Dengue and may aid in early risk stratification.
Objective: To analyze the risk factors, clinical characteristics, management, and outcome of liver abscess in pediatric patients. Study Design: Retrospective Observational study. Setting: Department of Pediatric Surgery, Liaquat University Hospital, Hyderabad. Period: January 2018 to October 2025. Methods: Inclusion criteria included all children aged 14 years or younger who had a diagnosis of liver abscess. Results: A total of 72 patients with liver abscess were analyzed. The mean age was 6.8 ± 3.4 years. Males were predominant (Male : Female = 1.4:1). The most common symptoms were fever (95.8%), abdominal pain (84.7%), and hepatomegaly (69.4%). Nutritional deficiencies were observed in 31.9% of patients. There was predominant involvement of the right lobe in 70.8% patients. Solitary abscess was found in 68.1%. There was 62.5% of pyogenic origins. Amebical (30.6%) and mixed (6.9%) were the next most common origins. K. pneumoniae was the predominant organism (34.7%). The treatment methods were conservative (23.6%), needle aspiration (27.8%), percutaneous catheter drainage (41.7%), and open surgery (6.9%). Success rates were 94.4% overall. Mortality was 2.8%. Multiloculated abscess and complications of the disease were significant. Conclusion: Pediatric liver abscesses can be managed well using a protocol-based approach such as antibiotics and image-guided drainage. Early identification of high-risk signs helps implement proper management, and this leads to a favorable outcome.
Objective: To assess the clinicohematological characteristics and treatment outcome in Diffuse Large B-cell Lymphoma (DLBCL) patients. Study Design: Cross Sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD-BMT). Period: January 2024 to March 2025. Methods: This study included DLBCL patients who were treated at NIBD-BMT. The disease staging was done according to Ann Arbor staging. The IPI and Revised IPI (R-IPI) were employed for prognostic evaluation. All treatment naïve patients received 6 cycles of R-CHOP. Relapse/refractory patients were offered salvage regimen (R-ICE/R-DHAP/R-Lenalidomide/DHAP). The clinical and laboratory findings were evaluated on follow-up visits every 3 months. The statistical analysis was done by using SPSS version 25. Results: A total of 21 DLBCL patients were included and 57.1% were males. The median age of participants was 52 years; ranging from 32 to 58 years. Among the total, 52.4% of patients had hemoglobin levels <10.5 g/dl,81% had low TLC of <11 × 10⁹/L and platelet counts >100 × 10⁹/L in 71.4%.The R-IPI indicated that 82.4% of patients had a poor prognosis. The Ann Arbor staging system revealed that 52.9% had stage 4B.The 57 months overall survival (OS) was 62.5% for the entire cohort. In primary patients, the OS was 69% and in patients with relapsed lymphoma at the initial presentation OS was 50% with log rank test p-value 0.89. Conclusion: The study revealed the clinical characteristics, risk stratification and treatment outcomes in DLBCL in resource limited country. Furthermore, multicenter studies with large sample size are needed to validate the outcome of treatment in DLBCL patients.
Objective: To evaluate excess oxygen incidence and the prognostic value of Cumulative Excess Oxygen Exposure (CEOE), by using non-invasive SpO2, for in-hospital mortality in a Pakistani Pediatric intensive care unit (PICU). Study Design: Prospective observational cohort study. Setting: Department of Pediatrics and Child Health, Liaquat National Hospital, Karachi, Pakistan. Period: May 2024 to April 2025. Methods: Using non-probability consecutive sampling, this study included all children aged 1 month to 15 years admitted in PICU and requiring invasive or non-invasive respiratory support within the first 24 hours of the admission. Children with cyanotic heart diseases and who had a stay of <24hrs were excluded. CEOE was calculated as the mean hourly FiO2 exceeding 0.21, for the hours in which corresponding SpO2 was ≥95%, over the first 24 hours of respiratory support. Primary outcome was CEOE, secondary was in-hospital mortality. Results: Among 197 children for analysis, 98.5% experienced excess oxygen exposure of varying severity. In-hospital mortality was 10.7%. Median CEOE was 29.00 (IQR 19.08-40.87). CEOE of >39.46 showed 71.45 sensitivity and 77.8% specificity. CEOE significantly predicted mortality (AUC 0.754; 95% CI 0.687-0/812; p<0.0001). Higher CEOE was significantly associated with invasive mechanical ventilation (MV), prolonged PICU stay, mortality and Multi-Organ Dysfunction Syndrome (MODS) (all p<0.01). Shorter PICU stay (adjusted OR 0.202; p=0.017) and High-flow nasal cannula (HFNC) (adjusted OR 0.123; p<0.001) use were independently protective against high CEOE. Conclusion: Nearly all critically ill children experienced excess oxygen exposure. CEOE, a potentially modifiable risk factor, predicts in-hospital mortality. This highlights the significance of oxygen titration, practicable in resource-limited settings like ours by using non-invasive SpO2.
Objective: To determine the prevalence of beta thalassemia trait (BTT) among undergraduate medical students using red cell indices in a pilot study. Study Design: Cross-sectional descriptive study. Setting: Rashid Latif Khan University (RLKU) Medical College. Period: Over one year, February 2024 to February 2025. Methods: A total of 100 undergraduate medical students were included. Complete blood count (CBC) was performed for all participants. Anaemia was defined according to World Health Organization criteria (hemoglobin <13 g/dL in males and <12 g/dL in females). Anaemic students were further evaluated using red cell indices (MCV, MCH, RDW, RBC count). Mentzer Index (MCV/RBC) was calculated, and values <13 with elevated RBC count were considered suggestive of BTT. Suspected cases underwent hemoglobin electrophoresis using capillary electrophoresis for confirmation. Results: The mean age was 20 ± 2 years, with 40% males and 60% females. Anaemia was present in 23% students. Four students (17.4% of anaemic group) had a Mentzer Index <13 with raised RBC count. Hemoglobin electrophoresis confirmed BTT in 2 cases, giving a prevalence of 2%. The positive predictive value of Mentzer Index was 50%. The estimated prevalence was 2% (95% CI: 0.24%–7.0%). Conclusion: In this pilot study, red cell indices appear to be a cost-effective screening tool for identifying suspected BTT cases. Larger studies are required to validate these findings.
