Objective: To compare outcomes of hospital stay, infection rates, reoperation rates and success rates in pediatric patients between ETV and VPS. Study Design: Quasi-experimental study. Setting: Lady Reading Hospital, Pakistan. Period: 17 September 2025 to 17 March 2026. Methods: A total of 226 patients (aged 1 month to 16 years) with obstructive hydrocephalus participated in the study. Clinical judgement was used to divide patients into the ETV (n=113) and VPS (n=113) groups. 3 months after surgery, such parameters as hospital stay (days), infection (surgical site or CSF), re-operation rate and success rate (clinical and radiological improvement without revision) were recorded. Multivariable logistic regression identified factors that predicted unfavorable outcomes. T-tests, chi-square tests, and 95% confidence intervals (CIs) were used for comparative analyses. Results: Mean hospital stay in the ETV group (3.1 ± 1.2 days) was significantly shorter than that of VPS (6.9 ± 1.4 days; p<0.001, mean difference 3.8 days, 95% CI 35 to 35-1). Infection rates were lower in ETV (4.4%, 5/113) versus VPS (13.3%, 15/113; p=-0.018, OR 0.30, 95% CI 0.10-0.89). Re-operation rate was 8.8% (10/113) in ETV but 22.1% (25/113) in VPS (p=0.005, OR 0.34, 95% CI 0.15-0.75). Success rate was higher with ETV (70.8%, 80/113) than with VPS (50.4%, 57/113; p < 0.001, OR 2.42, 95% CI 1.46-4.02). In multivariable regression, VPS (OR 3.12, 95% CI 1.72-5.66, p<0.001) and young age (<1 year; OR 2.45, 95% CI 1.28-4.69, p=0.007) were both independent of re-operation. Stratified analysis confirmed that, despite the age and social standing of a child s parents, the benefits from ETV were consistent (p < 0.05 on all primary outcomes). Conclusion: Among children with obstructive hydrocephalus who underwent VPS, ETV achieved a better outcome, with shorter hospital stays, fewer infections and reoperations, a greater success rate. However, given that the study is non-randomized, it should be interpreted cautiously. These findings support ETV as the preferred option in LMICs, suggesting the need to develop better training procedures and allocate resources more rationally to address all surrounding complications with shunt placement.
Objective: Compare twelve-month functional recovery, complication profiles and long-term revision rates between endoscopic third ventriculostomy and ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus. Study Design: Retrospective Cohort study. Period: January to December 2025. Setting: Department of Neurosurgery, Nishtar Hospital Multan. Methods: Sixty-two adults aged fifty or older with radiologically confirmed ventriculomegaly and positive high-volume tap tests underwent either endoscopic third ventriculostomy or programmable ventriculoperitoneal shunting. Baseline characteristics were rigorously matched. Primary endpoints assessed functional restoration via standardized mobility and cognitive instruments. Secondary metrics evaluated procedure-related adverse events, secondary surgical interventions, hospitalization duration, and validated quality-of-life indices. Multivariate logistic regression and Kaplan-Meier survival analysis controlled for demographic and clinical confounders. Results: Meaningful functional improvement occurred in 77.4% of the endoscopic cohort versus 83.9% in the shunt group, confirming statistical non-inferiority. Gait parameters improved comparably across both interventions. No perioperative mortality was recorded in either cohort. The endoscopic approach demonstrated substantially lower complication frequencies (12.9% versus 48.4%), fewer reoperations (6.5% versus 29.0%), and reduced median hospital stays. Multivariate modeling identified positive tap test responsiveness and preserved cortical architecture as independent predictors of recovery, whereas procedural selection failed to independently influence outcomes. Conclusion: Endoscopic third ventriculostomy provides equivalent functional restoration to mechanical shunting while significantly minimizing hardware-related complications and revision burdens. Preoperative physiological profiling, rather than surgical tradition, must dictate therapeutic strategies in carefully selected candidates.
Objective: To evaluate the association between serum magnesium concentration and clinically significant arrhythmias in patients with heart failure with reduced ejection fraction. Study Design: Analytical Cross Sectional. Setting: Department of Biochemistry, Shahida Islam Medical and Dental College, Lodhran. Period: October 2025 to February 2026. Methods: Total of 185 adults with confirmed systolic dysfunction (left ventricular ejection fraction ≤40%). Hypomagnesemia was defined as fasting serum magnesium <0.70 mmol/L. Arrhythmia burden was ascertained using standardized electrocardiography and ambulatory rhythm monitoring. Multivariable logistic regression quantified independent associations after rigorous adjustment for demographic, renal, electrolyte, and guideline-directed pharmacological confounders. Statistical significance was considered at p value <0.05. Results: Hypomagnesemia affected 15.7% of participants, while 36.8% exhibited clinically significant arrhythmias, predominantly atrial fibrillation and frequent ventricular ectopy. Unadjusted analysis revealed markedly elevated arrhythmia prevalence (odds ratio: 2.89; p=0.009). Following comprehensive covariate adjustment, low serum magnesium remained independently associated with arrhythmia occurrence (adjusted odds ratio: 2.14; 95% confidence interval: 1.03–4.45; p=0.041). Concomitant reductions in estimated glomerular filtration rate and serum potassium emerged as additional independent predictors. Model diagnostics demonstrated acceptable discriminatory capacity and calibration. Subgroup evaluations confirmed consistent effect modification across renal and diuretic exposure categories. Conclusion: Hypomagnesemia independently predicts a substantially higher arrhythmia burden in systolic heart failure. Systematic magnesium surveillance and targeted repletion constitute pragmatic, cost-effective strategies for arrhythmia risk mitigation.
Objective: To determine the distribution spectrum and frequency of testicular and para-testicular lesions, including both neoplastic and non-neoplastic types from one of the diagnostic centres of Pakistan. Study Design: Cross-sectional study. Setting: Chughtai Institute of Pathology, Lahore. Period: August 2025 to February 2026. Methods: A total of 396 cases of testicular and paratesticular lesions, including 204 orchidectomy specimens and 192 testicular biopsies received over a period of 1 year were studied retrospectively. Results: Overall, non-neoplastic conditions were predominant. The most frequent non-neoplastic diagnosis was non-granulomatous epididymo-orchitis (40 cases, 19.60%), followed closely by atrophic testes (34 cases, 16.66%). Undescended testis (cryptorchidism) was identified in 12 specimens (5.88%). Among the neoplastic lesions from the 204 surgical cases, mixed germ cell tumors were the most common tumor type (35 cases, 17.15%), followed by seminoma (21 cases, 10.29%). Yolk sac tumors were observed in 9 cases (4.41%), predominantly in the pediatric age group (6 cases in the 0-10-year age bracket). Histopathological findings of the 192 testicular biopsies varied from normal spermatogenesis and maturation arrest to Sertoli-cell-only syndrome and hyposermatogenesis, providing critical diagnostic information for managing male infertility. Conclusion: The study shows that the non-neoplastic lesions predominate among the testicular and para-testicular pathologies with epididymo-orchitis and testicular atrophy being the most common findings. Within the malignant lesions, germ cell tumors are most frequently followed by mixed germ cell tumors and seminoma.
Objective: To evaluate the frequency and nature of complications associated with ultrasound-guided omental biopsies and to assess the effectiveness of immediate on-table management strategies using a co-axial biopsy technique. Study Design: Prospective Observational Clinical Cohort study. Setting: Department of Interventional Radiology, Tertiary Care Hospital, Lady Reading Hospital, Peshawar. Period: June 2025 to June 2026. Methods: Included 115 consecutive patients undergoing ultrasound-guided omental biopsy using a co-axial core biopsy system. Demographic data, lesion characteristics, procedural details, complication rates, bleeding severity, and management strategies were recorded prospectively. Minor bleeding was managed using autologous clotted blood injection through the same c o-axial tract, whereas major bleeding was treated using Gel Foam slurry embolization followed by manual compression. Post-procedural ultrasound follow-up was performed to assess residual hematoma formation and delayed complications. Results: Among the 115 patients included in the study, 81 (70.4%) were female and 34 (29.6%) were male. Bleeding complications occurred in 12 patients (10.4%). Minor bleeding occurred in 9 patients (7.8%) and was successfully managed with autologous clot injection through the existing co-axial needle tract. Major bleeding occurred in 3 patients (2.6%) and was managed successfully using Gel Foam slurry embolization through the same tract followed by manual compression for 15 minutes. Technical success of hemostasis was achieved in 100% of complicated cases. No patient required surgical intervention, angiographic embolization, blood transfusion, or intensive care admission. Follow-up ultrasound demonstrated no residual hematoma or delayed bleeding complications. Conclusion: Ultrasound-guided omental biopsy using the co-axial technique is a safe, effective, and minimally invasive diagnostic procedure. Immediate management of bleeding complications through the same access tract significantly enhances procedural safety, minimizes patient morbidity, reduces resource utilization, and eliminates the need for additional invasive interventions.
