Divisional Headquarters Teaching Hospital Mirpur

Excessive crying is one of the most common problems in the first three months of life, accounting for nearly 20% of pediatric consultations. Objectives: To evaluate the effectiveness of Lactobacillus reuteri in infants with infantile colic compared with standard care alone. Methods: A prospective quasi-experimental study was used to enroll 172 infants (<13 weeks of age) with clinically diagnosed infantile colic who were enrolled. Group A received probiotic L. reuteri in addition to standard care, while Group B received standard care alone. Outcomes included mean daily crying time, crying episodes/week, and daily sleep duration, measured at baseline, days 7, 14, 21, and 28. Between-group comparisons were performed using the Mann–Whitney U test, and within-group changes were analyzed using the Friedman test. Results: Over 28 days, Group A showed greater improvement than Group B in reducing crying and increasing sleep. Daily crying decreased by −3.53 ± 1.05 hours in Group A vs. −1.79 ± 1.19 hours in Group B (p<0.001), weekly crying episodes by −3.60 ± 0.69 vs. −3.36 ± 0.97 (p=0.041), and daily sleep increased by 5.38 ± 2.08 hours vs. 2.80 ± 3.52 hours (p<0.001). Conclusions: L. reuteri supplementation in addition to standard care significantly reduced crying time and episodes, and improved sleep-in infants with colic compared to standard care alone.

This study aimed to investigate the surgical management of cerebral arteriovenous malformations (AVMs) by analyzing clinical outcomes and complications in 600 patients (100%) who underwent surgery. The mean age of the cohort was 36.7 years (SD = 12.3), with a majority being female (n = 315, 52.5%). Patients were classified by AVM size: small (35.5%, n = 213), medium (31.5%, n = 189), and large (33%, n = 198). Surgical approaches included microsurgery (31.3%, n = 188), endovascular embolization (33.5%, n = 201), and radiosurgery (35.2%, n = 211). Surgical outcomes revealed that 33.8% (n = 203) achieved complete resection, 32.7% (n = 196) had partial resection, and 33.5% (n = 201) underwent no resection. Post-surgical complications were experienced by 51.5% (n = 309) of patients, with the most common being postoperative hemorrhage (15.2%, n = 91), infection (14.8%, n = 89), and seizures (9.8%, n = 59). Logistic regression identified AVM size (OR = 2.3, p = 0.01), hypertension (OR = 1.8, p = 0.03), and seizure history (OR = 1.7, p = 0.04) as significant predictors of complications. Kaplan-Meier analysis revealed that patients with complete resection had the highest one-year recovery rate (78%), compared to partial (48%) and no resection (38%). Hospital stay was significantly longer for large AVMs (mean = 18.5 days) versus small AVMs (mean = 12.3 days; p = 0.001). These findings underscore the importance of AVM size and patient comorbidities in predicting surgical outcomes and complications, highlighting the need for tailored treatment approaches.

Background: Congenital hypothyroidism (CH) is one of the most common preventable endocrine disorders in neonates, associated with irreversible neurodevelopmental impairment if undiagnosed. While most affected infants are asymptomatic at birth, early biochemical screening enables timely treatment. Global prevalence is approximately 1 in 3,000–4,000 live births, but higher rates have been reported in South Asia, where systematic newborn screening remains limited. Objective: To determine the frequency of congenital hypothyroidism in term neonates at a tertiary care hospital in Islamabad and to characterize clinical and biochemical features of affected infants. Methods: This descriptive cross-sectional study was conducted at Dr. Akbar Niazi Teaching Hospital, Islamabad, between November 2024 and April 2025. A total of 125 term neonates were consecutively enrolled. Venous blood samples collected between days 5–7 of life were analyzed for thyroid-stimulating hormone (TSH) and total thyroxine (T4) using chemiluminescence immunoassay. Neonates with TSH >10 µU/mL underwent confirmatory testing. Data were analyzed using descriptive statistics, chi-square, t-tests, and odds ratios with 95% confidence intervals. Results: The mean gestational age was 38.7 ± 1.4 weeks, with 52.8% males. Initial screening identified 13 neonates (10.4%) with elevated TSH. After confirmatory testing, 7 neonates (5.6%) were diagnosed with CH, 4 (3.2%) with transient hypothyroidism, and 2 (1.6%) remained suspicious. Affected neonates had significantly higher TSH (22.9 ± 8.6 µU/mL) and lower T4 (4.1 ± 0.9 µg/dL) compared to normal infants (p<0.001). More than half of CH cases (57.1%) were asymptomatic. Conclusion: The prevalence of CH among term neonates in this setting exceeded global averages, with most cases clinically silent. These findings underscore the urgent need for nationwide newborn screening programs in Pakistan.

Mental health challenges among youth have emerged as a pressing public health issue globally, especially in low- and middle-income countries like Pakistan. Despite the growing burden, awareness and access to mental health services remain limited due to stigma, cultural misconceptions, and inadequate institutional support. Bahawalpur, being a semi-urban region in Southern Punjab, lacks localized data on the awareness and barriers faced by its youth in seeking mental health care. The purpose of this study was to assess the level of awareness, attitudes, and perceived barriers toward mental health among youth residing in Bahawalpur, Pakistan. This descriptive cross-sectional study was conducted among 70 young individuals aged between 15 and above 30 years from both rural and urban areas of Bahawalpur. A non-probability purposive sampling technique was used. A convenient sampling technique was used to choose the participants, and IBM SPSS Statistics 27.0.1 was used for analysis after a close ended questionnaire was used to gather data. Among the 70 participants, 52.9% were female and 47.1% were male. The majority of respondents (55.7%) were aged 19–22 years, with 64.3% having completed bachelor’s level education. Most participants (81.4%) lived in urban areas, and 80% identified as students. An overwhelming 97.1% reported having heard the term “mental health,” and 57.1% had received mental health information at school, college, or work. However, only 35.7% knew of any local mental health services. Attitudinally, 77.2% agreed or strongly agreed that people with mental illness are dangerous, while 71.4% agreed that mental health issues should be treated like physical conditions. Common barriers identified included stigma, lack of awareness, and religious misconceptions. Notably, 68.6% believed mental health issues were a sign of personal weakness. This study highlights both promising levels of awareness and persistent barriers surrounding mental health among youth in Bahawalpur. While most participants recognize the importance of mental health, misconceptions and lack of service accessibility limit help-seeking behavior. These findings underscore the urgent need for community-based awareness campaigns, school-level mental health education, and culturally appropriate interventions to reduce stigma and improve access to youth mental health services.

Hepatic encephalopathy (HE) is a serious neurocognitive complication of liver cirrhosis, contributing substantially to morbidity, hospitalizations, and mortality. Antibiotics such as rifaximin and metronidazole are widely used to reduce gut-derived ammonia; however, evidence regarding their comparative efficacy in acute HE remains inconsistent, particularly in South Asian populations. This study evaluated and compared the effectiveness of rifaximin and metronidazole in patients with hepatic encephalopathy admitted to a tertiary care hospital in Pakistan. Objective: To compare the efficacy of rifaximin versus metronidazole in patients with hepatic encephalopathy using the West Haven criteria. Methods: A randomized controlled trial was conducted in the Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Ninety patients aged 20–70 years presenting within 48 hours of the onset of hepatic encephalopathy were enrolled and randomly allocated into two groups: Group A received intravenous metronidazole 500 mg every eight hours, while Group B received rifaximin 550 mg twice daily. Both treatments were administered for seven days. Efficacy was defined as an improvement of at least one grade on the West Haven scale. Demographic variables, comorbidities, and baseline HE grades were recorded. Data were analyzed using SPSS version 25, with the Chi-square test used to compare efficacy between groups. Results: The cohort's mean age was 54.2 ± 9.8 years, with males accounting for 67.8%. Baseline characteristics, including comorbidities and HE grades, were comparable between groups. After 7 days of treatment, efficacy was significantly higher in the metronidazole group, with 75.6% of patients demonstrating improvement, compared with 42.2% in the rifaximin group (p = 0.002). Stratified analysis showed consistent superiority of metronidazole across gender, diabetes, hypertension, and HE Grades II and III. No significant adverse effects were reported in either treatment group. Conclusion: Metronidazole was significantly more effective than rifaximin in improving hepatic encephalopathy over a seven-day treatment period. These findings support the preferential use of metronidazole for acute HE management in resource-limited settings such as Pakistan, where cost-effective and rapidly acting treatment options are essential.

Objective: The purpose of this study is to investigate the frequency of hypocalcemia in term newborns with neonatal hyperbilirubinemia following phototherapy. Material and Methods: The descriptive case series research was conducted for six months, from August 2020 to February 2021, at the Department of Pediatric Medicine at the Divisional Headquarters Teaching Hospital, Mirpur Azad Kashmir. All patients were enrolled, informed consent was obtained, and they received 48 hours of double surface phototherapy. Routine investigations also included the measurement of serum calcium. Results: The study found a mean age of 14 days, with 63.68% male and 36.32% female cases. Before and after therapy, blood calcium levels averaged 2.41 ± 1.477 mmol/L & 2.5 ± 0.465 mmol/L respectively. Hypocalcemia was seen in 15.79% of patients. The study discovered that the prevalence of hypocalcemia was statistically equal in situations where the baseline blood bilirubin levels before treatment were 85.5-119.7 µmol/L (14.2%) and 121.4-171 µmol/L (16.8%). Conclusion: In conclusion, after 48 hours of phototherapy, 15.79% of the newborns experienced hypocalcemia, indicating that calcium supplementation may be used as a preventative measure to avoid this disease. Keywords: Neonatal jaundice, Calcium supplementation, Phototherapy, Complications.

Introduction: Jaundice is a state of disease in liver function often along with gastrointestinal (GI) complications primarily characterized by hyperbilirubinemia. Other tests regarding liver function are often used besides bilirubin as during any liver complications biomarkers such as alanine aminotransferase (ALT), serum glutamic pyruvic transaminase (SGPT), aspartate aminotransferase (AST), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), and many other biomarkers even total protein metabolism might get disrupted and get released in the blood. However, no comparison or association among those biomarkers was determined in a cohort. Method: In this observational retrospective cohort study, we investigated the levels of different liver biomarkers and tried to compare their differences and correlations in jaundice patients with GI complications. We examined nine different biomarkers where, primarily, the jaundice was confirmed through the total bilirubin test and further categorized and analyzed them.Result: Among the 91 patients of the study cohort after bilirubin (n=91) and conjugated bilirubin (n=88) levels, we found that enhanced globulin (n=79) levels were the most dominant among the cohort followed by unconjugated bilirubin (n=76), albumin (n=72), and total protein (n=71). On the other hand, a high ALP level was determined in the lowest number of the population (n=22). Regarding the category of men and women, similar findings were observed with a slight variation as the number of included female patients was approximately six times higher than that of male patients. In the case of age groups, similar observations were determined with some slight variation, as most of the patients were found to be over 40 years of age.Conclusion: Besides bilirubin, globulin can be a promising biomarker to diagnose jaundice, especially in patients with GI complications. It may also help to indicate the presence of undiagnosed or unsuspected jaundice in patients with gastrointestinal problems.

Warfarin is a notorious drug for drug interactions. Certain situations like severe Mitral Stenosis and Atrial Fibrillation still necessitate the use of warfarin, which increases bleeding risk. Here, we describe a case of warfarin-induced coagulopathy which may have occurred due to unusual interaction with digoxin.