Pakistan Journal of Medical & Health Sciences

Risk Factors for Wound Infection after Open Appendectomy in Acute Appendicitis Patients - A Cross-Sectional Clinical Study

MUHAMMAD RASHID — 2025-03-05

Background: Open appendectomy is one of the most common surgical procedures, and surgical site infections (SSIs) are among the most common complications after open appendectomy, especially in resource constrained settings. The key predisposing factors could be identified to improve clinical outcomes and decrease postoperative morbidity.

Aim: To identify the clinical, demographic, and intraoperative risk factors predictive for surgical site infections among patients undergoing open appendectomy.

Methodology: A prospective clinical study was performed on 25 patients who were emergently operated for acute appendicitis through open appendectomy in the patients attending Jinnah Hospital Lahore. Demographics, comorbidities, presentation time, operative details and antibiotic administration were recorded. Incidence of SSIs in patients were followed for 30 days after the operation. Data were analyzed using SPSS version 26, p < 0.05 was regarded as significant.

Results: Out of 25 patients, 7 (28%) developed surgical site infections. Delaying to presentation beyond 48 hours (p = 0.019), presence of a perforated appendix (p = 0.021), a BMI > 25 kg/m² (p = 0.041), diabetes mellitus (p = 0.029), operative time > 60 minutes (p = 0.010), and inadequate antibiotic prophylaxis timing (p = 0.035) were significant risk factors for SSIs. However, smoking was present in a higher proportion in the infected group and did not reach statistical significance (p = 0.280).

Conclusion: The results of this study illustrate that the risk of SSIs after open appendectomy is elevated by the presence of clinical comorbidities, especially diabetes and the presence of obesity, late surgical intervention, perforation, and inadequate perioperative antibiotic management. Prophylactic antibiotics, early diagnosis, optimal timing of surgery are critical in minimizing postoperative wounds complications.

Impact of Preoperative and Postoperative Antibiotic Use on Surgical Site Infection Rates in General Surgery Patients - A Clinical Study

MUHAMMAD TAIMOOR SHAH — 2025-03-05

Background: Despite significant advances in surgical practice, Surgical Site Infections (SSIs) continue to be one of the most common postoperative complications and remain the leading cause of patient morbidity, prolonged hospital stay, and increased healthcare costs. Preoperative and postoperative use of antibiotics is a key strategy to reduce the incidence of SSIs, especially in surgeries.

Aim: To evaluate the effect of preoperative and postoperative antibiotic usage on the risk of surgical site infections in general surgical patients in two tertiary care hospitals of Lahore, Pakistan.

Methodology: A prospective clinical study was carried out from October 2024 to December in Jinnah Hospital and Lahore General Hospital Lahore Pakistan. Non probability consecutive sampling was used to enroll a total of 100 patients who were scheduled or undergoing elective or emergency general surgical procedures. Two groups (A, n=50, received preoperative prophylactic antibiotics; B, n=50, received both preoperative and postoperative antibiotics) were formed according to antibiotic timing. Incidence of SSIs within 30 days post-surgery, clinically and/or microbiologically, was the primary outcome. Demographic, comorbidities, type of surgery and duration of hospital stay data were also collected.

Results: Out of 100 patients, 18 developed SSIs. The infection rate for Group A was 14% (7 of 50) and for Group B, it was 11% (6 of 50). Nevertheless, this difference was not statistically significant (p > 0.05). Notably, the SSI prevalence was higher in patients with diabetes and in those undergoing emergency surgery, regardless of antibiotic strategy. In addition, 5 patients had SSIs despite extended postoperative antibiotic coverage, implying limited added benefit and possibly antibiotic overuse.

Conclusion: Preoperative prophylactic antibiotics did not reduce surgical site infection rates, compared to given postoperatively. More emphasis should be placed on appropriate timing and antibiotic stewardship than on extended antibiotic use.

Evaluation of Outcomes in Patients Undergoing Surgery for Brain Tumors A Prospective Clinical Study

SAUD AHMED — 2025-03-05

Background: Local data are still needed to optimize surgical practices, despite surgical resection being the first line of treatment for many brain tumors, as outcome variability dictates.

Aim: To evaluate postoperative outcomes including neurological function, survival and quality of life in a cohort of 25 patients undergoing brain tumor surgery in a tertiary center.

Methodology: It was a prospective observational study of 25 adult patients who underwent elective craniotomy for brain tumor removal during 6 months. Clinical presentation, imaging, histopathology, extent of resection, complications and 3 month functional outcomes were collected.

Results: Fifteen patients were male and 10 female (mean age: 47.6 ± 11.2 years, out of 25 patients). The most common tumor types were meningioma (9 cases) and glioblastoma multiform (7 cases). Patients achieved gross total resection (GTR) in 64%. Sixty percent improved, 24 percent were stable, and 20 percent deteriorated postoperatively. In benign tumor cases, three month survival was 100%, and in malignant cases, the survival was 71.4%. Complications occurred in 4 patients (16%).

Conclusion: Postoperatively, this cohort showed significant improvement in neurological function in benign tumors. Repetition of the need for surgical precision and early intervention is supported by the finding that extent of resection remains a critical determinant of outcome.

Comparative Evaluation of Dietary Patterns and Nutrient Intake in Obese and Non-Obese Adults of Lahore

MUHAMMAD NASIR SHAHBAZ SHAHBAZ — 2025-03-05

Background: Obesity is a major public health problem worldwide and especially in an urban setting such as Lahore where dietary transition is driving health outcome. Sometimes, the development of obesity is attributed to nutritional imbalances. Nevertheless, there are limited comparative data on dietary patterns of obese and non-obese adults in Pakistan.

Aim: To assess and compare dietary patterns, nutrient intake and caloric distribution between obese and non- obese adults living in Lahore to identify dietary risk factors which are modifiable in order to reduce the risk of obesity.

Methodology: Comparative study was carried out on 100 adult participants (50 obese and 50 non-obese) aged 20 to 50 years from urban health clinics and community centers in Lahore. Records were made of anthropometric measurements (BMI, waist circumference). The daily nutrient intake, macronutrient distribution, and adherence to balanced diet were assessed by a validated food frequency questionnaire and 24 hour dietary recall. Fasting glucose and lipid profile were also studied.

Results: Mean ± SD daily calories consumed were significantly greater for obese (2,630 ± 340 kcal) than non-obese (1,980 ± 290 kcal, p < 0.001). The obese group had excessively high saturated fat and sugar intakes and very low fiber and vegetable intakes. Furthermore, the non-obese group had a higher adherence to balanced dietary guidelines, higher whole grain, fruit and lean protein intake. Also, there was a positive correlation between total caloric intake and BMI (r = 0.72).

Conclusion: Significant differences in dietary pattern and intake of nutrients are shown in obese and non-obese adults in Lahore. Obesity is defined by poor dietary habits such as high caloric intake, low fiber consumption, imbalanced macronutrient ratios. These findings emphasize the importance of implementing community based nutritional interventions and public health strategies on dietary education and lifestyle modification.

Morphological Analysis of the Aortic Arch Branching Patterns in Different Populations - A cross-section study

MUHAMMAD UMAR — 2025-03-05

Background: There is a considerable anatomical variability in the aortic arch branching pattern within the same population and across populations with important clinical and surgical implications. This is important to understand variation in vascular surgeries, endovascular interventions and diagnostic imaging procedures.

Aim: To evaluate and classify the morphological patterns of aortic arch branching in a sample of 100 patients of different ethnic background to determine the frequency of common and variant configurations.

Methodology: Contrast-enhanced computed tomography (CT) angiograms of 100 patients were utilized in a cross sectional study using contrast enhanced CT angiograms from a tertiary care hospital. People with congenital heart disease or who had had previous vascular surgery were excluded. Standard classifications of branching patterns were used to classify the branching patterns according to the classical three branch pattern, the bovine arch variant, and other less commonly reported types.

Results: Of 100 patients, 68% showed the classical branching pattern of the brachiocephalic trunk, left common carotid artery and left subclavian artery. Most common among subjects of African descent, 22% of patients had the bovine arch configuration. 6% had a rare aberrant right subclavian artery, 4% had other atypical branching patterns, such as double aortic arch, or common origin of carotid and subclavian arteries.

Conclusion: Significant population related variations of aortic arch branching is highlighted by the study. However, the classical pattern continues to prevail over the field, but there are significant variations such as bovine arch and aberrant right subclavian artery which should be taken into consideration during pre-surgical planning as well as diagnostic evaluation. Future studies on more diverse populations and larger populations will better illuminate the embryological and clinical significance of these patterns.

Examining Legal Recourse and Rehabilitation for Burnt Survivors of Domestic Violence: A Study of Section 337-L (1) in Pakistan

ZULFIQAR ALI BUZDAR — 2025-03-05

Background: The section 337-L (1) of the Pakistan Penal Code serves as a pivotal legal instrument, providing a framework for addressing injuries for disturbing normal pursuits of life for about 20 days or more. In this context burns inflicted within the realm of domestic violence surfaces as the most notorious mode of injury to be evaluated in light of this particular section of law.

Aim: To identify the correlation between physiological outcomes and the length of hospital stay of survivors of unfortunate victims of burns.

Methodology: Data were collected from Accident and Emergency Department of May Hospital Lahore from December 2023 to December 2024. Physiological outcomes were assessed including scar, movement limitation, disfigurement, loss of feeling of sensation and permanent pain or discomfort; participants were categorized based on gender and age group. Statistical analysis was carried out to find the relation between the return to normal physiology when compared with the one of longer hospital stay.

Results: The results showed strong correlations between burns and some physiological outcomes, such as scarring, motion impairment and permanent pain or discomfort in survivors. Physiological outcomes were correlated with the severity of prolonged hospitalization, reflecting the limitations of survivors in receiving timely and comprehensive healthcare services. The p value 0.009 found the association defined to be statistically grossly significant.

Conclusion: present study demonstrated the urgency to tackle burns through holistic and survivor centered approaches of early detection, trauma informed care, and integrated support services. When healthcare systems prioritize the well-being of survivors and encourage interdisciplinary collaboration, they can contribute to mitigating the ravages of burns and help survivors heal and recover.

Use of Quranotherapy among patients with Epilepsy

HÜSEYIN ÇAKSEN — 2025-03-05

Millions of people worldwide live with epilepsy and need long-term medication. Recently, the use of complementary and alternative medicine (CAM) has increased in epilepsy. Approximately half of epilepsy patients use at least one CAM. Mind-body medicine incorporates a practices that take advantage of the interactions among the mind, brain, body, and behavior to affect body functions. Mind-body practices use the mind to affect physical functioning and promote health. Mind-body medicine such as meditation, mindfulness, cognitive behavioral therapy, biofeedback, music, yoga, etc., is one of the most common used of CAMs for treatment of epilepsy.

The Quran is the instructor, true wisdom, guide, and leader of the world of humanity; it is both a book of wisdom and law, a book of prayer and worship, a book of command and summons, and a book of invocation and Divine knowledge – it is a book for all spiritual needs; and it is a sacred library offering books appropriate to the ways of all the saints and veracious, the purified and the scholars, whose ways and paths are all different¹. The Quranotherapy (or Quranic therapy), a modality of transcendental meditation, involves reciting, reading and listening to the Quran to improve physical, social, mental, spiritual and/or religious health. Herein, we discussed use of the Quran as a cure and remedy in patients with epilepsy to emphasize that the Quranotherapy is a meditation modality.

Meditation and religious therapies are commonly used in patients with epilepsy in many cultures around the world. In the series of McConnell et al², overall CAM use was 70%, with the use of prayer/spirituality in 31% and meditation in 19%. Of the patients, 44% reported improved seizure control with CAM. Stress management accounted for perceived seizure reduction in 74%, followed by marijuana (54%), prayer (49%), and yoga (42%)². Asadi-Pooya et al³ found that 72.3% of physicians believed that CAM

might be helpful in patients with epilepsy. They also noted that 22.3% of participants used/prescribed CAM to patients with epilepsy; among them, 46.5% of people found CAM to be safer than conventional antiseizure medications. The most common endorsed CAM included meditation (41%), and the ratio of prayers was 15%³. Al-Rumayyan et al⁴ reported that the prevalence of CAM usage was 42% among pediatric neurology patients (40% of patients had epilepsy), and the most common (66%) type of CAM was the Quranotherapy. In another series, 56% of parents had used CAM for their child’s neurological illness (28% of patients had epilepsy). The most common modality (77%) was prayer/ Quranotherapy⁵. Two most popular therapeutic modalities were drug treatment alone (85.3%) and associated with the Quranotherapy (35.3%) among people with epilepsy⁶.

Quranotherapy has been commonly used among patients with epilepsy and their caregivers and most of them believed that Quranotherapy helped in coping with epilepsy^7-10. Quranotherapy was constantly used by all the participants with epilepsy in the study of Kissani et al⁹ In another series, 90% patients with epilepsy believed that Quranotherapy helped in coping with epilepsy¹⁰. In a large series, 31.5% of individuals among general population believed that epilepsy could be treated by the Quranotherapy¹¹. Hijazeen et al¹² noted that the most common (71.4%) reported treatment method in epilepsy was the Quranotherapy among university students. In another study, 34.6% of medical students thought the Quranotherapy was an appropriate treatment for epilepsy¹³.

In conclusion, we would like to emphasize that the Quranotherapy is one of the meditation modalities. Secondly, Quranotherapy has been frequently used among patients with epilepsy and their caregivers for treatment of epilepsy in many parts of the world because they believe the following ayat of the Quran: “We send down (stage by stage) in the Quran that which is a shifa (healing) and a mercy to those who believe¹⁴. Based on the interpretation of shifa from mufassirun (interpreters), the outline of shifa concept is as follows: (a) Allah has absolute authority to spread and shifa all diseases to mankind; (b) The Quran is a divine revelation from Allah as shifa for human disease, especially spiritual disease; (c) Allah had created natural resources as medication for physical disease¹⁵. Thirdly, further studies using neurobiochemical and neurohormonal analyses and electrophysiological and neuroimaging techniques should be conducted to determine how effective Quranotherapy is in patients with epilepsy. Finally, we recommend that randomized controlled studies should be conducted about use of the Quranotherapy in epileptic patients in societies with different cultures and religious beliefs.