Civil Hospital Karachi

Background: Bowel rupture associated with pelvic fractures is a rare but life-threatening complication of high-energy trauma. Its diagnosis is often delayed due to nonspecific clinical presentation and competing injuries, resulting in increased morbidity and mortality. Objective: To systematically review the current evidence on epidemiology, diagnostic approaches, surgical management, and outcomes of bowel injury in patients with pelvic fractures. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched for studies published between 2004 and 2026. Eligible studies included adult patients with pelvic fractures and associated bowel injury, reporting diagnostic methods, surgical interventions, or outcomes. Study selection was performed independently by two reviewers. Methodological quality was assessed using the Newcastle-Ottawa Scale and AMSTAR-2 criteria. Due to heterogeneity, findings were synthesized narratively. Results: Thirty studies were included in the qualitative synthesis. Bowel injury was most commonly associated with high-energy blunt trauma, particularly road traffic accidents. Contrast-enhanced CT was identified as the primary diagnostic modality, although early injuries may be missed. Early exploratory laparotomy significantly reduced morbidity and mortality, while delayed diagnosis was associated with increased rates of sepsis and peritonitis. Damage control surgery was beneficial in hemodynamically unstable patients. Multidisciplinary trauma care and early pelvic stabilization improved overall outcomes. Reported mortality rates ranged from 20% to 50%, particularly in cases with delayed intervention. Conclusion: Early recognition, prompt surgical intervention, and coordinated multidisciplinary management are essential in improving outcomes in patients with bowel rupture associated with pelvic fractures. Advances in imaging and trauma protocols have improved survival; however, further research is needed to enhance early diagnostic accuracy and standardize management strategies.

Objective: To evaluate the diagnostic accuracy of 1.5 Tesla Magnetic Resonance Imaging (MRI) in assessing meso-rectal fascia (MRF) invasion in patients with anorectal carcinoma as compared to histopathology, serving as the gold slandered.Methods: This was a cross-sectional study at the Department of Radiology, Ziauddin University Hospital, Karachi, conducted between July 2019 and January 2020. One hundred and fifty-four (154) patients underwent preoperative MRI patients with suspected anorectal carcinoma. MRI was done in a 1.5T Siemens Magnetom Harmony with a dedicated pelvic coil and normal T1W, T2W and contrastenhanced sequences. The involvement of MRF was evaluated using the blinded senior radiologist, who was not aware of the histopathology outcomes, with histopathology being used as a reference standard. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined.Results : The mean age of the study subjects was 47.4 + 7.05 years with 55.8% and 44.2% male and females respectively. In 95 (61.7%) cases, MRF was confirmed by histopathology. The MRI had an overall diagnostic accuracy of 44.2% (95% CI: 36.3–52.0%). The sensitivity was 26.3% (95% CI:17.5–35.2%), specificity was 72.9% (95% CI: 61.5–84.2%), PPV was 61.0% (95% CI: 46.0–75.9%), and NPV was 38.1% (95% CI: 29.1–47.0%).Conclusion: In this study, 1.5T MRI demonstrated suboptimal sensitivity and specificity for the preoperative assessment of MRF involvement in patients with anorectal carcinoma, resulting in limited overall diagnostic accuracy. This emphasizes that, while MRI provides valuable anatomical information and aids surgical planning, it cannot reliably replace histopathological evaluation for definitive staging. Factors such as MRI field strength, imaging protocol limitations, and the absence of adjunct sequences may have contributed to these findings. Consequently, careful interpretation of MRI results is essential, and correlation with histopathology remains crucial to ensure accurate staging, optimal surgical decision-making, and appropriate oncological management

Accidental hypothermia (AH) in hospitalized adults is an under-recognized condition associated with increased morbidity, mortality, and prolonged hospital stays. Unlike primary AH caused by environmental exposure, inpatient hypothermia is often secondary to acute illness, comorbidities, iatrogenic factors, or medications that impair thermoregulation. We systematically reviewed studies reporting risk factors, management strategies, and clinical outcomes of AH in adults (≥18 years). Five studies, including 1,698 patients, met the inclusion criteria. Common risk factors were advanced age, male sex, alcohol use, reduced functional status, sepsis, endocrine or neurological disorders, and hospital-related exposures such as cool environments or unwarmed intravenous fluids. Management strategies comprised passive external, active external, and active internal rewarming, with ICU monitoring for moderate-to-severe cases. In-hospital mortality ranged from 13% to 26%, with complications including arrhythmias, coagulopathy, infection, and prolonged length of stay; trauma-specific populations had significantly higher mortality (OR ~5.18). These findings highlight the need for early recognition, targeted rewarming, and preventive measures in high-risk inpatients. Future multicenter prospective studies with standardized definitions and predictive models are required to optimize detection, management, and outcomes of AH in hospitalized adults.

Chronic liver disease (CLD) is a major health burden in Pakistan, commonly due to viral hepatitis. Cirrhotic cardiomyopathy (CCM) is an underdiagnosed complication that may impact prognosis and management. Objectives: To determine the frequency and spectrum of echocardiographic abnormalities in CLD patients and assess their correlation with disease severity based on the Child-Pugh classification. Methods: A cross-sectional study of 187 adult CLD patients was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, between September 2024 and February 2025. Echocardiographic parameters, including pulmonary artery pressure, ejection fraction, systolic, and diastolic function, were evaluated using a Philips EPIQ 7 (Philips Healthcare, Andover, MA, USA) system. Patients were categorized according to Child-Pugh class (B or C). Associations between echocardiographic findings and Child-Pugh class were analyzed using chi-square and logistic regression tests, with p < 0.05 considered significant. Results: Mean age was 55.6 ± 13.4 years; 51.9 % were men. The leading etiologies were hepatitis C (46 %) and B (26 %). Diastolic dysfunction was the most frequent abnormality (53.5 %), while systolic dysfunction occurred in 23.5 %—significantly more common in women (p < 0.001) and in advanced disease (Child-Pugh C: 67 % vs B: 38 %; OR ≈ 3.4, p=0.0001). Pulmonary hypertension (23.5%) and reduced ejection fraction (10.2%) showed no correlation with Child-Pugh class. Conclusions: Echocardiographic abnormalities are common in CLD, particularly diastolic dysfunction. Systolic dysfunction increases with worsening hepatic severity, emphasizing the need for routine cardiac assessment in cirrhotic patients for better risk stratification and management.

Background: Knee osteoarthritis (OA) is a progressive degenerative joint disease in which early cartilage loss determines long-term functional trajectory. Vitamin D, beyond its classical skeletal role, modulates chondrocyte metabolism and joint inflammatory signaling through vitamin D receptor pathways; however, its cross-sectional association with radiographic cartilage preservation in early knee OA remains incompletely characterized. Objective: To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] sufficiency and medial tibiofemoral joint space width (JSW) as a radiographic marker of cartilage integrity in adults with early knee osteoarthritis. Methods: A cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, enrolling 135 adults aged 40–65 years with Kellgren–Lawrence grade I–II knee OA. Serum 25(OH)D was measured by chemiluminescent immunoassay and categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL) per Endocrine Society guidelines. Standardized weight-bearing JSW was measured digitally by two blinded musculoskeletal radiologists (ICC = 0.91). WOMAC pain and function subscales provided secondary clinical outcomes. ANOVA with Tukey post-hoc testing, Pearson correlation with 95% CIs, and multivariable linear regression adjusting for age, sex, BMI, and symptom duration were applied. Results: Mean serum 25(OH)D was 26.7 ± 8.4 ng/mL. Sufficient participants demonstrated significantly greater JSW than deficient individuals (3.89 ± 0.57 mm vs. 3.11 ± 0.54 mm; mean difference 0.78 mm, 95% CI 0.51–1.05, p < 0.001). Serum 25(OH)D correlated positively with JSW (r = 0.41, 95% CI 0.26–0.54, p < 0.001) and inversely with WOMAC pain (r = -0.36, p = 0.002) and function (r = -0.33, p = 0.004). Associations remained significant after confounder adjustment (β = 0.023 mm/ng/mL, 95% CI 0.011–0.035, p < 0.001). Conclusion: Vitamin D sufficiency was independently associated with greater radiographic joint space width and reduced symptomatic burden in early knee OA, supporting its evaluation as a modifiable nutritional target in early OA prevention.

BACKGROUND: Gliomas represent a significant global health burden due to their high morbidity, infiltrative nature and often limited therapeutic options. MRI is pivotal in their diagnosis, providing detailed structural and functional assessments that refines tumor characterization. Accurate MRI driven evaluation carries strong prognostic implications, guiding personalized treatment and improving outcome prediction. OBJECTIVES: To evaluate diagnostic accuracy of T2/FLAIR mismatch sign in predicting IDH mutations in low grade gliomas. METHODOLOGY: This cross-sectional study analyzed 52 histologically confirmed glioma patients from 2022 to 2024 at AKUH. Preoperative 1.5T (GE) and 3T (Toshiba) MRI were reviewed by two neuroradiologists for T2/FLAIR mismatch and additional imaging features and compared with molecular profiling i.e. IDH1/2 following WHO 2021 criteria. Statistical analysis was done with Fisher’s exact test. RESULTS: IDH mutant gliomas exhibited frequent T2/FLAIR mismatch i.e. 58.3% vs 10.7% in wildtype, which highlights the utility of conventional MRI techniques as a reliable, non-invasive tool for predicting IDH status. CONCLUSIONS: T2/FLAIR mismatch sign along with conventional MRI features, may serve as a useful non-invasive adjunct, particularly where molecular testing is unavailable.

Objective: To determine the prevalence and trimester-specific trends of neuro-otological manifestations among pregnant women attending antenatal care in tertiary care hospitals at Karachi, Pakistan.Methodology: A prospective, multicenter observational study was conducted from January 2020 to December 2024 at two tertiary hospitals in Karachi. A total of 1,230 pregnant women aged 18-45 years were enrolled through non-probability consecutive sampling. Data were collected using a validated three-part assessment tool encompassing demographic characteristics, otological symptoms, and neurological/vestibular presentations. Statistical analysis was performed using SPSS software version 26 (IBM Corp., Armonk, NY). Chi-square and Fisher’s exact tests were applied, with significance defined as P < 0.05.Results: Neuro-otological symptoms were highly prevalent. Otological complaints were reported in 874 (71%) participants, most commonly tinnitus in 390 (31.7%) and ear fullness in 310 (25.2% ). Neurological and vestibular manifestations were observed in 847 (69%), with vertigo (304, 24.7%), headache (260, 21.1%), and dizziness (215, 17.5%) being the most frequent. A significant increase in the frequency of symptoms was noted with advancing gestational age, with the third trimester demonstrating the highest burden across most manifestations (P < 0.001).Conclusions: Neuro-otological manifestations are common during pregnancy and exhibit a trimester-dependent rise, peaking in late gestation. Routine screening and early recognition within antenatal care may help prevent misdiagnosis, reduce patient distress, and improve maternal quality of life.

Background and Objectives:Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. Nerinetide, a neuroprotective peptide, has shown potential in limiting neuronal damage when administered early after stroke onset. This study aimed to evaluate the efficacy and safety of nerinetide compared with placebo in patients with AIS.Methods:A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA and AMSTAR 2 guidelines. Electronic databases, including PubMed, MEDLINE, Cochrane Library, ScienceDirect, and ClinicalTrials.gov, were searched up to February 2025. The primary outcome assessed was mortality, while secondary outcomes included functional recovery (modified Rankin Scale, Barthel Index), infarct volume, and adverse events.Results:Three RCTs encompassing 2462 patients met the inclusion criteria. Nerinetide treatment demonstrated a modest yet statistically significant reduction in mortality risk (risk ratio = 0.86; P = 0.05). However, no significant improvement was observed in functional recovery or infarct size. The frequency of adverse events was comparable between the nerinetide and placebo groups, with minimal variability.Conclusion:Nerinetide may slightly reduce mortality in AIS, particularly among patients not treated with alteplase. Although functional outcomes did not significantly improve, its favorable safety profile and potential neuroprotective effect support further investigation in larger clinical trials.

Fever is a prevalent clinical manifestation in pediatrics, representing a significant proportion of emergency department (ED) visits worldwide. While fever is often benign and self-limiting, it can also indicate life-threatening infections requiring immediate intervention, particularly in neonates and immunocompromised children. This comprehensive review delves into the intricate pathophysiology of fever, exploring its dual role as a protective immune mechanism and a potential physiological risk. It critically examines diagnostic challenges, evidence-based management strategies, and global disparities in fever treatment. Special emphasis is placed on parental perceptions, the overuse of antipyretics, and the emerging role of artificial intelligence in fever diagnosis. Future directions include refining diagnostic biomarkers, implementing digital health tools, and advancing antimicrobial stewardship to curb antibiotic resistance. By improving clinical decision-making and public awareness, this review aims to optimize the management of febrile children worldwide and enhance patient outcomes.