Behman Hospital

In recent years, there has been a significant increase in screen time among young people, accompanied by a rise in ophthalmological complaints related to visual strain, dry eye syndrome, and accommodation disorders. At the same time, the elderly population continues to show a high prevalence of age-related eye diseases such as cataract, glaucoma, and age-related macular degeneration. Under these circumstances, a comparative assessment of ophthalmological status across different age groups becomes particularly relevant for the early identification of risk factors and the prevention of vision impairment. Since 2021, the Medical Clinic of Osh State University has conducted regular ophthalmological examinations of two cohorts — elderly inpatients (≥65 years) and young individuals (schoolchildren and students) as part of preventive screening programs. The aim of this study is to compare the ophthalmological status of elderly and young participants and to determine the relationship between screen time and the occurrence of ophthalmological complaints or diagnoses among the younger group. The findings will help to clarify age-related differences in the impact of digital technologies on the visual system and contribute to the development of effective preventive recommendations for different age categories.

AimsFollowing resection of a primary bone tumour, reconstruction is commonly performed using either a megaprosthesis or biological reconstruction. Periprosthetic joint infection (PJI) remains one of the most frequent complications. Various treatment strategies exist for PJI, including debridement, antibiotics, and implant retention (DAIR), and single- and two-stage revision, although consensus on optimal management remains elusive. This study aimed to investigate the global practices regarding DAIR in tumour cases through an electronic survey among orthopaedic oncology surgeons.MethodsA global cross-sectional observational survey study was distributed to 272 orthopaedic oncology surgeons who attended the BOOM Consensus Meeting in January 2024. The survey contained 19 multiple choice questions focusing on DAIR practices. Responses were collected anonymously and analyzed using descriptive statistics.ResultsThe survey was completed by 173/272 surgeons (64%) from 44 countries. While 62% (169/272) routinely performed radical soft-tissue debridement in DAIR, only 39% exchanged all modular components, indicating variability in surgical approaches. DAIR was more commonly performed in acute rather than chronic infections, with 55% finding it very useful in acute cases. The use of local antibiotic delivery was supported by 56%, although only 49% found antibiotic cement coatings beneficial. Systemic antibiotic duration post-DAIR varied, with 39% favouring six weeks and 35% preferring three months.ConclusionThe study highlights global inconsistencies in DAIR practices for PJI in orthopaedic oncology, with financial disparities impacting modular component exchange. Standardized definitions are lacking, and we propose that if only polyethylene is changed, then the procedure is referred to as ‘poly exchange’; we recommend defining the procedure as DAIR when extensive debridement, lavage, and removal, wash, and reimplanting of all modular components is done while retaining stable stems, followed by suppressive antibiotic therapy; and finally, we recommend that if all the modular components are changed for new ones, the procedure is referred to as ‘DAIR plus’.Cite this article: Bone Jt Open 2025;6(11):1495–1503.

Heart failure remains a leading global health burden affecting over 64 million individuals worldwide, with limited effective acute management strategies. Carperitide, a recombinant form of human atrial natriuretic peptide, has been primarily used in Japan for acute heart failure treatment, but its clinical efficacy remains controversial. This systematic review and meta-analysis aimed to evaluate the clinical outcomes of carperitide in heart failure patients. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 2025, using terms related to carperitide and heart failure. Studies involving adult heart failure patients receiving carperitide that reported cardiovascular mortality, all-cause mortality, or heart failure-related hospitalization were included. Six studies met inclusion criteria, comprising three observational studies, two randomized controlled trials, and one secondary analysis, published between 2008 and 2025. Meta-analysis was performed using RevMan 4.5.1 (The Cochrane Collaboration) with random-effects models. The pooled analysis of four studies examining all-cause mortality demonstrated no significant difference between carperitide and control groups (risk ratio (RR): 1.02, 95% confidence interval (CI): 0.63-1.66), with substantial heterogeneity (I² = 66%). Similarly, hospitalization due to heart failure showed no significant difference (RR: 0.98, 95% CI: 0.85-1.14) with no heterogeneity (I² = 0%). Composite outcomes of hospitalization and death also revealed no significant benefit (RR: 0.98, 95% CI: 0.85-1.14). This meta-analysis provides evidence that carperitide does not significantly improve clinical outcomes in heart failure patients, challenging its widespread use and supporting the need for evidence-based therapeutic alternatives in heart failure management.

Background: Unexplained infertility is the absence of identifiable cause for infertility and the female's inability to get pregnant after at least 12 months of unprotected sexual intercourse for whom all the standard evaluations are normal.Objective: Our study aims to assess the effectiveness of adding Cabergoline to Clomiphene citrate in management of women complaining of unexplained infertility.Materials & Methods: 120 Patients diagnosed with unexplained infertility were randomized to Clomiphene citrate plus cabergoline or Clomiphene citrate alone.All Patients were followed up for three cycles by transvaginal ultrasound folliculometry to document the number and size of mature graffian follicles and ovulation.The primary outcome of the study was the number and size of mature follicles.The secondary outcomes included the occurrence of ovulation, pregnancy rate, abortion rate, endometrial thickness, and the rate of adverse effects of the study medications.Results: There is a statistically significant difference regarding to the number (P<0.001), size of follicles (P<0.001),occurrence of ovulation (P=0.04,0.006, 0.016) and endometrial thickness (P=0.000) between the two groups in the favor of adding Cabergoline to Clomiphene citrate.Conclusion: Adding Cabergoline to Clomiphene citrate in induction of ovulation in euprolactinemic infertile women with unexplained infertility results in high ovulation rate, better endometrial thickness and high pregnancy rate compared to use of Clomiphene citrate alone.

The gut microbiota (GM) represents an intricate, dynamic, and complex ecosystem. It plays a key role in health and disease. The GM interacts with the host and modulates various physiological functions, including metabolism, immune regulation, and neurological function. This narrative review comprehensively analyses the role of the GM in the development and progression of three major chronic conditions, namely diabetes, autoimmune disorders, and cancer. Using a structured literature search strategy across databases such as Google Scholar, PubMed, Scopus, and Web of Science, relevant studies published between 2000 and 2025 were identified and analysed. This review highlights that dysbiosis contributes significantly to the pathogenesis of these chronic conditions. In type 2 diabetes mellitus (T2DM), alterations in the GM are associated with systemic inflammation, insulin resistance, and decreased microbial diversity. Similarly, in autoimmune disorders such as rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD), dysbiosis disrupts immune homeostasis, which in turn causes sustained inflammation and aberrant immune responses. Lastly, dysbiosis has been linked to the onset and progression of various gastrointestinal cancers through mechanisms including chronic inflammation and the production of carcinogenic metabolites. Fecal microbiota transplantation (FMT), probiotics, prebiotics, and dietary modifications are being explored for their potential to restore microbial balance and improve clinical outcomes. In conclusion, this review highlights the GM’s pivotal role in the pathogenesis of chronic diseases and its potential as a therapeutic target.

Acute aluminum phosphide (ALP) poisoning presents a significant global medical challenge, particularly in regions where it is commonly used as a pesticide. Despite medical advancements, mortality rates from ALP poisoning remain high. Glucose-insulin-potassium (GIK) infusion therapy has emerged as a potential treatment for ALP poisoning due to its ability to counteract its toxic effects on metabolism and heart function. However, there is limited institutional data on the effectiveness of GIK therapy in treating ALP poisoning. Hence, this study aims to evaluate the therapeutic impact of GIK infusion therapy in managing acute ALP poisoning within our institution. The research aims to provide valuable insights into the efficacy of GIK therapy, with the potential to enhance patient outcomes and guide clinical practices in ALP poisoning management. This cross-sectional study was conducted at the Resuscitation Unit of the Emergency Department of Lady Reading Hospital (LRH), Peshawar, from February 1, 2021, to May 31, 2021, using convenient sampling of all patients with aluminum phosphide (ALP) poisoning meeting the inclusion criteria. The study group included 15 ALP poisoning cases treated with GIKinfusion therapy combined with standard supportive measures and examined individuals with ALP poisoning admitted to the Resuscitation Unit during a specific period, comparing their outcomes to those observed before the introduction of GIK therapy. Randomization was based on time span, as GIK therapy was introduced in October 2020. Inclusion criteria encompassed a confirmed history of ALP poisoning with at least one deranged vital parameter, including patients of all genders and age groups. At the same time, we excluded patients with normal blood pressure on arrival, no deterioration four hours post-presentation, or those who expired before arrival. Data on hospital registration number, gender, age, arrival date, serial blood pressures, supportive measures, GIK infusion usage, and outcomes were analyzed using SPSS version 20.0 to assess the therapeutic impact of GIK infusion therapy. Among 15 ALP poisoning cases, 20% resulted in fatalities, with 80% either transferred to acute units (40%). Mortality was highest (66%) in the 20-29 age group, contrasting with no deaths in the 1-19 age group. Additionally, 33% mortality occurred in the 30-39 age group. Only 25% of patients with blood pressure below 91/61 succumbed. GIK therapy led to hemodynamic stability, prolonged unit stays, and increased transfers. Patients in acute units had longer stays compared to discharged or expired cases, reflecting the nuanced dynamics of ALP poisoning management. This research aimed to systematically examine the effect of GIK infusion therapy on ALP poisoning cases at LRH, Peshawar, offering insights into its effectiveness compared to previous cases and reducing mortality by enhancing cardiac function.

Background: The quality of life of people with rheumatoid arthritis (RA), a chronic inflammatory illness, is greatly impacted by sleep disturbances that are often experienced in conjunction with the condition.Objective: The purpose of this research was to ascertain the prevalence of sleep problems in RA patients as well as their relationship to patient demographics and disease severity.Methodology: A cross-sectional study was conducted from January to December 2023. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate sleep disturbances and structured questionnaires were used to gather data. Demographic characteristics and the severity of the RA condition were also assessed. using a significance threshold set at p<0.05, Chi-square tests were used to evaluate the relationship between sleep problems and the severity of RA illness in the statistical studies carried out using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA).Results: A total of 385 RA patients were included in the study. Among them, 38.96% (n=150) reported insomnia, 18.18% (n=70) suffered from sleep apnea, and 15.58% (n=60) experienced restless legs syndrome. Poor sleep quality was prevalent in 75.32% (n=290) of participants, as assessed by the PSQI. Notably, a significant association was found between insomnia and moderate disease activity (n=55; p<0.001), while sleep apnea was most frequently observed in patients with low disease activity (n=27; p=0.003). Additionally, restless legs syndrome was predominantly seen in those with moderate disease activity (n=26; p=0.002), highlighting the complex relationship between RA severity and sleep disturbances.Conclusion: The high prevalence of sleep disorders in RA patients, particularly insomnia and sleep apnea, is significantly associated with disease severity, highlighting the need for targeted management strategies.

Objective: To determine the frequency of clinico-hematological features and JAK 2 status of young adults presenting with Polycythemia Vera at the department of hematology. Study Design: Cross-sectional study. Setting: Department of Hematology, RMI Hospital, Peshawar. Period: 25th November 2023 to 25th May 2024. Methods: A total of 190 patients aging between 18-45 years and presented as suffering from Polycythemia Vera as per diagnosis of consultant hematopathologists, were included in this study. Samples with clear evidence of hemolysis, coagulation, or clots were excluded. Patient’s demographics, details of physical appearance, clinical findings and history of adverse events were recorded. Hematological and pathological investigations were done and analysis of JAK2 V617F mutation was conducted using polymerase chain reaction from the diagnostic lab of the institute. The primary outcome of the study was to determine the frequency of clinico-hematological features and JAK 2 status. Results: The Mean±SD of age in our study was 36.81±6.11 years with an age range of 21-45 years. Out of total patients, 49 (25.79%) patients were asymptomatic. The major symptoms affecting the daily life activities were headache 65 (34.21), abdominal discomfort 41 (21.58%), blurred vision 27 (14.21%) and fatigue 27 (14.21%). These patients had plethoric face 61 (32.11%), splenomegaly 64 (33.68%) and budd-chiari syndrome 8 (4.21%). The results of hematopathological findings showed abnormal hemoglobin (17±3.92 gm/dL), hematocrit (52.94±4.8 g %), platelet (579.63±227.68 103/μL) and leukocyte (10.32±2.6, 103/μL) levels while 177 (93.16 %) patients had mutated JAK2 levels. Conclusion: Plethoric face and splenomegaly are the commonly found clinical findings in patients with Polycythemia Vera while these patients also have abnormal levels of hemoglobin, hematocrit, platelet and leukocyte. JAK 2 status serves conclusive role in the diagnosis of Polycythemia Vera.

Background Breastfeeding is recognized as a crucial determinant of child health and development, yet its multifaceted effects remain underexplored in many contexts. This cross-sectional study investigates the association between breastfeeding practices and various health and developmental outcomes in infants and young children, focusing on exclusive breastfeeding, partial breastfeeding, and formula feeding. Done at Khyber Teaching Hospital, Pakistan, the research aims to provide comprehensive insights into the nuanced impacts of breastfeeding on child well-being. Objectives This study aims to assess the association between breastfeeding duration and practices with the incidence of infectious diseases in infants and young children. It investigates the relationship between different breastfeeding practices: exclusive breastfeeding, partial breastfeeding, and formula feeding and cognitive development outcomes in early childhood. Additionally, the study evaluates the role of breastfeeding in the development of motor skills in infants and young children. Methodology A cohort of 390 participants, aged one month to three years, participated in the study. Data collection encompassed parental interviews, clinical assessments using standardized tools such as the Bayley Scales of Infant Development, and reviews of medical records. Statistical analyses, including frequency analysis and chi-square tests, were conducted to elucidate the relationships between breastfeeding practices and health outcomes. Results Exclusive breastfeeding exhibited a significantly lower incidence of infectious diseases compared to partial breastfeeding and formula feeding. Specifically, among exclusively breastfed children, incidences of colds, pneumonia, and diarrhea were 32%, 39.7%, and 40%, respectively. These rates were notably higher in partially breastfed and formula-fed children. Cognitive development outcomes also varied significantly across feeding groups. Exclusively breastfed children demonstrated superior cognitive performance, with 34.2% rated above average, compared to only 6.5% in the formula-fed group. Additionally, the prevalence of developmental delays was lowest among exclusively breastfed children (14.1%), contrasting with 62.8% in the partial breastfeeding group and 77.0% in the formula-feeding group. Conclusions The study underscores the pivotal role of exclusive breastfeeding in promoting optimal child health and development. Exclusive breastfeeding is associated with significantly reduced incidences of infectious diseases, superior cognitive development outcomes, and a lower prevalence of developmental delays. These findings highlight the importance of supportive interventions and policies aimed at encouraging exclusive breastfeeding practices, ultimately enhancing child well-being and developmental trajectories.

OBJECTIVES This study aimed to determine patient satisfaction with the pre-operative anaesthetist visit. METHODOLOGY A cross-sectional study was conducted from March to September 2023. All consecutive elective patients operated under anaesthesia during the study period were interviewed 24 hours after the operation. Data were collected by the Leiden peri-operative patient satisfaction questionnaire (LPPSq) within 24 hours postoperatively. SPSS 26 version was used for data analysis. The chi-square test was used to compare pre-operative visits and patient satisfaction.RESULTS230 elective patients were operated upon under anaesthesia during the study period. Among all sections, the Fear and concern factor has the highest Cronbach alpha, 0.942. almost half of the patients aged 26-35 (42.2%) were female (56.3%), Class I in ASA physical status (50.2%), and living in a rural area (64.9%). For occupation, the majority of respondents were unemployed (89.2%). In addition, more than half of the respondents received general anaesthesia (60.6%). The most frequent procedure type was the gynaecology procedure (38%). Regarding an anaesthetist's visit, most respondents received a pre-operative anaesthetist visit (89.6%) and an anaesthetist approach (73.6%). However, the majority didn't receive adequate information, didn’t have a chance to choose the type of anaesthesia, and didn’t have an opportunity to ask a question, with percentages of 68%, 90%, and 95.2%, respectively. A significant and strong association existed between patient satisfaction and pre-operative anaesthetist visits (P&lt;0.000). CONCLUSION Patient satisfaction with the pre-operative anaesthetic evaluation was the same compared with the Royal College of Anaesthetists standards. There is an association between pre-operative anaesthetist visits and patient satisfaction. Pre-operative anaesthetic evaluation should be emphasized.