Good Hope Hospital

Abstract Aim The objective of this study is to evaluate Neutrophil-Lymphocyte ratio in foreseeing the severe pancreatitis in the severe acute and early diagnostic phase, keeping the CTSI as standard. Method Validation (cross sectional) study from 20th July 2023 to 19th July 2024 at General surgery ward (1 and 2). A total of 107 patients diagnosed with acute pancreatitis, aged 18-70 years of either gender were included. Patients with diseases such as chronic pancreatitis, diabetes, cardiovascular diseases, trauma, ERCP (iatrogenic), hypertriglyceridemia, alcohol, and end-stage renal and hepatic diseases were excluded. Laboratory investigations included CBC, LFT, serum amylase, serum lipase and ultrasound abdomen. Amylase lipase levels greater than three times normal, and ultrasonographic evidence of cholelithiasis, was reviewed by a surgical specialist; to confirm the diagnosis of acute biliary pancreatitis. All patients underwent CT severity index (CTSI) at 72 hours. Results 41 (38.31%) and 7 (6.54%) came out to be true and false positives respectively in the positive NLR group. Out of 59 (55.14%) who were NLR below cut-off, 55 (55.40%) and 4 (3.73%) were true and false negative respectively. The positive predictive value was 85.42% whereas, the negative predictive value was 93.22%. Sensitivity and specificity were 91.11% and 88.71% respectively. Conclusions It is concluded that NLR remains a highly effective minimally invasive and reproducible method in predicting the outcome of acute pancreatitis, especially in the first few hours of presentation.

Lyme disease, caused by Borrelia burgdorferi and transmitted by Ixodes ticks, is rare in South America and is often misdiagnosed in returning travelers. We report the case of a 19-year-old Peruvian male who presented with pruritic erythematous maculopapular lesions and abdominal pain after travel to Maryland, United State of America. His atypical cutaneous findings, including a crusted lesion with ill-defined borders and a maculopapular rash, were initially misinterpreted as bacterial cellulitis, resulting in multiple unsuccessful courses of antibiotics. Further evaluation, guided by his travel history, led to the diagnosis of Lyme disease through serological testing and histopathology. Treatment with doxycycline achieved complete resolution. This case illustrates the diagnostic challenges posed by atypical presentations of Lyme disease in nonendemic regions. Greater awareness among clinicians in South America is essential to recognize imported cases, facilitate early diagnosis, and prevent complications associated with delayed treatment.

Three-dimensional (3D) reconstruction is necessary for visualizing complex anatomy and supporting clinical decision-making in radiology. However, traditional techniques often struggle with limitations in scalability, speed, and reproducibility. The recent emergence of artificial intelligence (AI) has enabled a new generation of reconstruction tools that offer greater automation and new clinical capabilities. Motivated by the demand for efficient imaging, researchers have applied deep learning to overcome longstanding barriers, with impacts spanning diagnosis, surgical planning, and disease monitoring. This review included peer-reviewed studies published within the last 10 years, focusing exclusively on adult human imaging published in the English language, as anatomical development, imaging protocols, and clinical decision pathways differ significantly in pediatric populations. While this improved applicability to adult radiology, it limited insight into emerging pediatric and preclinical research. Searches focused on AI-driven 3D reconstruction across different radiologic modalities. Articles were selected based on the following predefined inclusion criteria: adult human participants, AI-based 3D reconstruction, clinical validation, and relevance to radiologic practice. Studies including pediatric or animal subjects, preclinical-only experimentation, non-English-language text, or without applied clinical evaluation were excluded. Our results showed that AI has improved the accuracy, speed, and clinical utility of 3D reconstruction in multiple specialties. Deep learning models such as U-Net, V-Net, DenseVNet, and generative adversarial networks have achieved high segmentation accuracy, often reporting Dice scores >0.90. These models have also been used for tumor detection, surgical planning, and reducing radiation exposure. However, challenges such as high computational requirements, lack of standardized datasets, limited real-world validation, and ethical concerns remain. In conclusion, 3D reconstruction is transforming radiology with more accurate patient-specific images for improved clinical decision-making. While it is rapidly being integrated into practice, these technologies still have limitations that need to be addressed. Nonetheless, with improved and ongoing innovation, AI has the potential to become a catalyst for precise imaging and patient care.

Background: During pregnancy, balanced and healthy diet is very essential for both mother and the proper growth and development of fetus. The purpose of the study is to evaluate the dietary status and related health risk factors of pregnant mother living in slummy areas of Faisalabad. Methods: Various methods can be used for the dietary assessment of mother including the easiest method 24-hour dietary recall, the most preferred semi quantitative food frequency questionnaire, food diary, online questionnaire, cross sectional survey, anthropometric measurement, score method, consecutive days dietary record etc. Result: Maternal malnutrition is the major public health problem in both developed and under developed countries Malnutrition during gestation does not cause complications only during and after pregnancy but it also effects new born physically and mentally for remaining whole life. Food practices during pregnancy are not according to the mark and it is further stressed by poor socioeconomic status. Pre term and low birth weight are the popular poor pregnancy outcomes. Low-income mothers are mostly deficient in iron, folate, fruits and vegetables. Stress and depression because of poor socioeconomic status is further deteriorating dietary habits and food practices. Conclusions: This study suggested that pregnant women need dietary counselling and particularly women belong to slummy areas are also in need of dietary supplementation.

ABSTRACTParaesthesia can be due to many causes, including entrapment, nerve injury and snapping. We describe a rare case of snapping of the infrapatellar branch of the saphenous nerve (IPBSN) causing paraesthesia in a 40‐year‐old male that was managed successfully with ultrasound (US)‐guided hydrodissection and review the literature.

Despite osimertinib being the standard therapy for advanced EGFR T790M mutation positive NSCLC, in many Latin American countries, access to molecular testing and targeted therapies is limited, directly impacting patient outcomes. This study describes the real-world management and outcomes of Peruvian patients with advanced EGFR-mutated NSCLC who develop the T790M mutation. We conducted a multicenter retrospective study including patients from nine Peruvian institutions, both public and private, who progressed to first-line EGFR TKI and developed T790M mutation, detected between January 2018 and December 2023. We evaluated demographic, clinico-pathological features and treatment data, including diagnostic pathway, treatment patterns, and survival outcomes. Seventy-eight patients were included; T790M was detected by liquid biopsy in 52.6 % of cases. Median time from progression to T790M detection was 59.5 days (7-244). Osimertinib was administered to 62.8 % of patients after detection, with a median initiation time of 42 days (1-104). Median overall survival (OS) from first-line treatment was 46.6 months for patients who received osimertinib, 23.9 months for those receiving other therapies, and 16.1 months for those without treatment (p = 0.001). Among osimertinib-treated patients, the objective response rate (ORR) was 59.2 %, with a median progression-free survival (PFS) of 15.8 months. Median OS from osimertinib initiation was 16.3 months, significantly longer than for patients receiving other treatments after T790M detection (9.7 months; p = 0.002). This study confirms the real-world effectiveness of osimertinib in Peruvian patients with advanced EGFR T790M positive NSCLC and highlights the importance of timely detection and access to targeted therapies.

IntroductionCardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations. The aim of this study was to investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope.MethodsA retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation.ResultsThe mean age of patients who underwent an ILR implantation was 65 +/- 19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p < 0.001), male sex (p = 0.006), impaired left ventricular function (p = 0.04) and presence of hypertension (p = 0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see table 1). 97 Table 1Linear regression analysis of predictors of CIED implantationVariable Beta (95% confidence interval) p value Univariate Age 0.007 (0.005 – 0.008) <0.001 Sex -0.104 (-0.165 – -0.044) 0.001 Presence of CAD 0.102 (0.025 – 0.179) 0.01 LV Function -0.151 (-0.237 – -0.064) 0.001 Presence of hypertension 0.166 (0.106 – 0.227) <0.001 Presence of valvular heart disease 0.103 (0.028 – 0.178) 0.007 History of previous stroke/TIA 0.063 (-0.032 – 0.159) 0.20 Presence of CKD 0.148 (0.055 – 0.241) 0.002 Multivariate Age 0.006 (0.004 – 0.007) <0.001 Sex -0.081 (-0.139 – -0.023) 0.006 LV Function -0.089 (-0.173 – -0.006) 0.04 Presence of hypertension 0.068 (0.004 – 0.132) 0.04 ConclusionOld age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age >75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see figure 1).Conflict of InterestNone

No touch' vaginoscopy should be the standard technique for outpatient hysteroscopy, especially where successful insertion of a vaginal speculum is anticipated to be difficult and where blind endometrial biopsy is not required Using this 'no touch' approach and not using a speculum is considered to partly reduce the uncomfortable or painful aspect of the procedure. However, traditionally at the end of the vaginoscopy and removal of the scope, a speculum is passed to allow the passage of an endometrial sampling device under direct visualisation through the external os and blindly into the uterine cavity [2]. This activity would appear to be at odds with the claims to a 'no touch' procedure.

Objectives/HypothesisTo understand the effect of the COVID‐19 pandemic on the volume, quality, and impact of otolaryngology publications.Study DesignRetrospective analysis.MethodsFifteen of the top peer‐reviewed otolaryngology journals were queried on PubMed for COVID and non‐COVID‐related articles from April 1, 2020 to March 31, 2021 (pandemic period) and pre‐COVID articles from the year prior. Information on total number of submissions and rate of acceptance were collected from seven top‐ranked journals.ResultsOur PubMed query returned 759 COVID articles, 4,885 non‐COVID articles, and 4,200 pre‐COVID articles, corresponding to a 34% increase in otolaryngology publications during the pandemic period. Meta‐analysis/reviews and miscellaneous publication types made up a larger portion of COVID publications than that of non‐COVID and pre‐COVID publications. Compared to pre‐COVID articles, citations per article 120 days after publication and Altmetric Attention Score were higher in both COVID articles (citations/article: 2.75 ± 0.45, P < .001; Altmetric Attention Score: 2.05 ± 0.60, P = .001) and non‐COVID articles (citations/article: 0.03 ± 0.01, P = .002; Altmetric Attention Score: 0.67 ± 0.28, P = .016). COVID manuscripts were associated with a 1.65 times higher acceptance rate compared to non‐COVID articles (P < .001).ConclusionsCOVID‐19 was associated with an increase in volume, citations, and attention for both COVID and non‐COVID articles compared to pre‐COVID articles. However, COVID articles were associated with lower evidence levels than non‐COVID and pre‐COVID articles.Level of Evidence3 Laryngoscope, 132:1364–1373, 2022