Rawalpindi Medical University

Background: Sepsis is a life-threatening complication among trauma patients admitted to intensive care units, and early diagnosis remains challenging due to overlap between post-traumatic systemic inflammation and infection-related immune responses. Interleukin-6 (IL-6), a pro-inflammatory cytokine released rapidly after tissue injury or infection, has been proposed as a potential early biomarker for identifying sepsis in critically injured patients. Objective: To evaluate the diagnostic performance of serum IL-6 measured within 24 hours of ICU admission for early identification of sepsis among trauma ICU patients. Methods: A prospective observational diagnostic accuracy study was conducted in a tertiary care trauma ICU between March and December 2025. A total of 150 adult trauma patients were enrolled using consecutive sampling. Serum IL-6 levels were measured within 24 hours of admission using chemiluminescent immunoassay. Sepsis diagnosis was established according to Sepsis-3 criteria using clinical evaluation, microbiological findings, and organ dysfunction assessment. Receiver operating characteristic analysis was performed to determine the optimal IL-6 threshold and diagnostic accuracy parameters. Results: Among the 150 patients, 144 (96.0%) exhibited elevated IL-6 levels (>50 pg/mL), with a mean concentration of 125 ± 40 pg/mL. ROC analysis demonstrated excellent discriminative ability with an area under the curve of 0.91 (95% CI: 0.85–0.96). The optimal IL-6 cut-off value of 52 pg/mL yielded sensitivity of 93.2%, specificity of 81.4%, positive predictive value of 89.6%, and negative predictive value of 87.5%. Elevated IL-6 levels were consistently observed across age groups and genders. Conclusion: Serum IL-6 measured early after ICU admission demonstrates high diagnostic accuracy for identifying sepsis in trauma patients and may serve as a valuable biomarker for early detection and clinical decision-making in trauma ICU settings. Keywords: Interleukin-6, Sepsis, Trauma ICU, Biomarker, Inflammation, Early detection, ROC analysis.

Complete congenital atrioventricular heart block (CHB) is a rare but serious, life-threatening condition in neonates, most often associated with maternal autoimmune connective tissue disease. Definitive management typically requires epicardial pacing; however, in cases of life-threatening bradycardia and hemodynamic compromise, temporary transvenous pacing may be lifesaving. Securing vascular access in premature or low-birth-weight infants often makes vascular access technically challenging, and conventional routes may not always be feasible. In such situations, the umbilical vein offers a rapid, bedside, and less invasive alternative. We present the case of a premature neonate born at 35 + 1 weeks with congenital third-degree heart block, in whom emergency temporary pacing was successfully performed via the umbilical vein after failed femoral access, subsequently serving as a bridge to permanent pacemaker implantation.

This study explores the stylistic features of legal discourse in Pakistani criminal law, specifically through a register analysis of Supreme Court verdicts. The use of special vocabulary, sentence constructions and style of writing has been seen to make the legal language complex, rigid and closed-ended. Such complications in Pakistan impact transparency and accessibility since most of the English-written legal texts in the country are dominated by the Islamic and British traditions of law. The paper analyses the role of language in the formation of legal authority, the impartiality of the court, and the clarity of interpretation in Supreme Court of Pakistan decisions. The theoretical framework is premised on the stylistic and register analysis model by Halliday (1978) and Fairclough (1995), which aids in explaining how the social context and legal role influence language. The qualitative analysis focuses on the review of 12 verdicts of the English Supreme Court that can be regarded as the best examples of formal legal language in Pakistan because of their judicial authority and thoroughness. The selection of these judgements was due to the reason that they represent the most institutionalised and formal legal language in Pakistan. The results indicate that epistemic certainties, depersonalised agents, and integrations of verdicts into a network of intertextual precedents can be predicted by stylistic choices as a means of supporting the validity of judicial rulings. The research paper adds to the analysis of legal discourse through illustrating the use of register as an authority-making mechanism in postcolonial legal settings. The paper finds that the stylistic devices used are no longer ornamental but functional: they convey legal meaning, organise judicial reasoning, and promote the interpretation clarity of complex legal terms.

Introduction: Acute eosinophilic pneumonia (AEP) is a rare, rapidly progressive pulmonary disorder that can lead to acute respiratory failure requiring ICU-level support and invasive mechanical ventilation (IMV). Although case reports and small series have described its clinical course, national-level data on hospitalization patterns, illness severity, and resource utilization remain limited. We aimed to fill this research gap. Methods: We analyzed adult hospitalizations with a primary diagnosis of AEP(ICD-10 codes) from the 2022 Nationwide Readmissions Database. Survey weights were applied to generate nationally representative estimates. Illness severity was categorized into three mutually exclusive groups: floor admission, ICU admission without intubation, and ICU admission with intubation. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges. Seasonal variation and the prevalence of comorbid asthma and gastroesophageal reflux disease (GERD) were also assessed. Descriptive statistics and survey-weighted subgroup comparisons were performed. Results: A total of 10,035 weighted hospitalizations (n = 3,912 unweighted) were identified. The median age was 60 years (IQR: 45–72), and 61.2% of the participants were female. Asthma and GERD were significantly more prevalent in AEP hospitalizations compared to non-AEP hospitalizations (58.9% vs. 7.0% and 30.8% vs. 16.2%, respectively; p < 0.001). AEP discharges peaked in November (18.5%), with seasonal clustering from June to October and less frequent from January to March. ICU admission occurred in 42%, and 14.1% required IMV. LOS ranged from 4.8 to 8.0 days, and charges from $59,198 to $170,057, increasing with severity. Mortality was 0.24% (floor), 0.26% (ICU without IMV), and 4.18% (ICU with IMV). Conclusions: In our study, AEP hospitalizations show a clear severity-outcome gradient, with higher ICU use, ventilation need, mortality, and cost as illness advances. These findings highlight AEP as a resource-intensive condition with a substantial impact on survival in severe cases. Although asthma and GERD were common, their impact on outcomes was not assessed, and treatment data were not available. Early recognition and triage based on severity may reduce resource burden and improve outcomes.

The management of perforated diverticulitis (PD) has shifted over the last decade, moving from aggressive surgery toward non-operative strategies for hemodynamically stable patients. However, the safety of non-operative treatment in cases with extraluminal air, particularly Hinchey Ia-II disease, remains debated. This systematic review evaluates the efficacy, safety, and long-term outcomes of non-operative management for PD and identifies radiologic predictors of treatment failure. A systematic review was conducted per PRISMA 2020 guidelines. PubMed/MEDLINE, Europe PMC, Science Direct, EBSCO Open Dissertations, ClinicalTrials.Gov, and Cochrane Library were searched for cohort studies published between 2015 and 2025. Inclusion criteria were adults with CT-confirmed PD (Hinchey I-II) treated non-operatively. The primary outcome was treatment success (survival without emergency surgery); secondary outcomes included recurrence, readmission, and mortality. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Twelve cohort studies comprising 25 064 patients were included. Success rates ranged from 76% to 96% for contained perforations. Distant extraluminal air (DA) was a key predictor of failure, with success falling to 10%-37% compared to > 85% for isolated pericolic air. Other risk factors included abscess diameter > 4 cm, free fluid, and age > 75 years. Mortality declined over time (from 18.6% to < 5%), coinciding with increased colorectal subspecialist involvement. Recurrence rates remained notable (16.5%-37.5%), with most occurring after one year. Non-operative management is a safe, effective first-line option for stable patients with PD, especially those with isolated pericolic air. Patients with DA or large abscesses are at higher risk of failure and require close monitoring or early intervention.