Pakistan Journal of Medical & Health Sciences

Postoperative Complications and Survival Outcomes in Neonates with Congenital Diaphragmatic Hernia

SHARIF UR RAHMAN — 2026-04-30

Background: Congenital diaphragmatic hernia (CDH) is a severe neonatal developmental anomaly, which is linked to pulmonary hypoplasia, persistent pulmonary hypertension, respiratory failure, and is a major cause of morbidity and mortality in the immediate postoperative period. Efforts to improve the survival of infants with surgical repair of congenital heart defects have continued but still have detrimental effects on outcome, especially in less developed health care systems, because of postoperative complications.

Objective: To assess the complications and survival rates of neonates who are surgically repaired for congenital diaphragmatic hernia.

Methods: This prospective observational study was conducted at the Departments of Pediatric Surgery and Neonatal Intensive Care Units of Rashid Latif Medical College/RIHS and Nishtar Medical University, Pakistan, from June 2024 to June 2025. A total of 80 neonates diagnosed with congenital diaphragmatic hernia who underwent surgical repair were enrolled through non-probability consecutive sampling. Demographic data, peri- and postoperative data, and outcome measures were collected and analyzed with SPSS 26.0. A p-value <0.05 was considered statistically significant.

Results: Among 80 neonates, 47 (58.8%) were males and 33 (41.2%) were females. Sixty-one (76.3%) neonates had left-sided CDH, and 21 (26.3%) neonates had liver herniation. Thirty-eight (47.5%) neonates had postoperative complications. The most prevalent complication was found in 16 (20.0%) neonates, persistent pulmonary hypertension, followed by respiratory failure in 12 (15.0%) and pneumothorax in 9 (11.3%) patients. The average mechanical ventilator duration in our patients was 8.9 ± 4.6 days and the average NICU stay was 18.7 ± 8.4 days. Overall survival to discharge was 57 (71.3%) and the remaining 23 neonates (28.7%) died in hospital. Prematurity, low birth weight, liver herniation, PHTN and long periods of ventilator support were significantly associated with mortality (p<0.05).

Conclusion: Surgical repair of congenital diaphragmatic hernia is associated with a high incidence of post-operative complications that affect neonatal survival. In order to achieve better postoperative outcomes and mortality in affected neonates, prompt management of pulmonary and infectious complications, early diagnosis, and aggressive periopertative stabilization and optimized ventilatory support are paramount.

Functional Outcome and Complication Rates of External Fixation Versus Internal Fixation in Open Fractures

IMRANA TANVIR — 2026-04-30

Background: Open fractures are severe orthopedic injuries that result in substantial soft tissue trauma, increased risk of infection, prolonged healing time, and poor long-term function. Whether to use external fixation or internal fixation is still controversial, especially in terms of complications and restoration of limb function.

Objective: To assess the functional and complications rates of external fixation and internal fixation in patients with open fractures.

Methods: This prospective comparative clinical study was carried out in the Department of Orthopedic Surgery of a tertiary care teaching hospital between February 2024 and February 2025. Seventy adult patients with radiologically diagnosed open fracture of long bones were enrolled by non-probability consecutive sampling. The participants were divided into two groups of 35 each based on the type of fixation: external fixation and internal fixation. Demographic and injury characteristics were documented and fracture type was assessed using the Gustilo-Anderson classification. At follow-up, functional assessment was performed using the Lower Extremity Functional Scale (LEFS), Disability of the Arm, Shoulder and Hand (DASH) score and clinical grading. The two groups were compared for complications such as infection, delayed union, non-union, malunion, implant or fixation failure, and joint stiffness.

Results: Internal fixation demonstrated better overall functional recovery, with a greater proportion of patients achieving excellent or good outcomes compared with external fixation. Functional outcome scores were better in the internal fixation group. The external fixation group had a higher incidence of superficial infection, pin tract infection, delayed union and joint stiffness, while the incidence of deep infection was higher in the internal fixation group. Both groups experienced non-union and implant failure with a slight difference.

Conclusion: Internal fixation had better functional results, while external fixation was still a safe and effective treatment for more severe open fractures with poor soft tissue conditions.

Comparison of Intramedullary Nailing Versus Plate Fixation in Tibial Shaft Fractures: A Clinical Study

FIZA ARIF — 2026-04-30

Background: Tibial shaft fractures are one of the most common long-bone fractures and can lead to substantial morbidity and disability. Operative fixation is the standard of care for the majority of displaced fractures, and two of the most common methods are intramedullary nailing and plate fixation. But the best method of fixation is still controversial.

Objective: To compare the clinical and radiological outcomes of intramedullary nailing versus plate fixation in the management of tibial shaft fractures.

Methods: This comparative clinical study was performed over a period of one year from March 2024 to March 2025 on 60 adult patients with tibial shaft fractures. The patients were equally divided into two groups: 30 patients were treated with intramedullary interlocking nailing, and 30 with plate fixation. We gathered information on patient demographics, surgical parameters, union time, functional outcome and complications, which were analyzed using SPSS version 26. We used the Johner and Wruhs criteria to evaluate the functional outcome, with a p-value of <0.05 as statistically significant.

Results: Intramedullary nailing demonstrated significantly shorter operative time, reduced hospital stay, and earlier weight-bearing compared to plate fixation (p<0.05). Radiological union also occurred earlier in the nailing group (17.2 ± 3.1 weeks) than in the plating group (20.4 ± 3.8 weeks). Intramedullary nailing was associated with a greater rate of excellent to good functional outcome. Superficial infection and irritation were more frequent in the plating group, while anterior knee pain was more frequent in the nailing group.

Conclusion: Intramedullary nailing and plate fixation are both effective treatments for tibial shaft fractures, but intramedullary nailing is associated with better outcomes in terms of early weight bearing, time to fracture union, and wound complications. It should be the method of choice when possible.

Assessment of Neuroinflammatory Markers (IL-6, TNF-α) and Cognitive Decline in Early Alzheimer’s Disease Patients

FEHMIDA BIBI — 2026-04-30

Background: Alzheimer disease is a progressive neurodegenerative disorder characterized by premature deterioration of the brain and progressive memory impairment. Emerging evidence suggests that neuroinflammation plays a central role in the pathogenesis of the disease, with pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) contributing to neuronal dysfunction and cognitive decline.

Objective: To measure serum IL-6 and TNF-α levels in patients with early-stage Alzheimer disease and to determine their association with cognitive deterioration.

Methods: This cross-sectional comparative study was conducted at a tertiary care hospital from March 2023 to February 2025. A total of 70 participants were enrolled, including 40 patients with early Alzheimer disease and 30 cognitively healthy controls. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Serum IL-6 and TNF-α levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using SPSS version 26, and correlations were assessed using Pearson’s correlation coefficient.

Results: Patients with early Alzheimer disease had significantly lower cognitive scores than controls (MMSE: 21.48 ± 2.86 vs 28.27 ± 1.41; MoCA: 18.94 ± 3.17 vs 26.31 ± 1.84; p = 0.001). Serum IL-6 and TNF-α levels were significantly elevated in the Alzheimer group (IL-6: 8.61 ± 2.49 pg/mL vs 4.29 ± 1.47 pg/mL; TNF-α: 14.87 ± 4.12 pg/mL vs 8.64 ± 2.31 pg/mL; p < 0.001). Both cytokines demonstrated significant negative correlations with MMSE and MoCA scores, indicating that higher inflammatory marker levels were associated with poorer cognitive performance.

Conclusion: Elevated serum IL-6 and TNF-α levels in early Alzheimer disease are significantly associated with cognitive decline. These findings support the role of neuroinflammation in Alzheimer disease progression and suggest that these inflammatory markers may serve as accessible biomarkers for early disease monitoring and prognostic evaluation.

Obesity and Metabolic Syndrome in Adolescents: A Growing Clinical Challenge

NAVEED SHUJA — 2026-04-30

Nowadays, adolescent obesity has emerged as one of the major clinical and public health problems¹. Obesity, once viewed primarily as a cosmetic or lifestyle issue, is now understood as a complex medical condition linked to insulin resistance, hypertension, dyslipidaemia, fatty liver disease, psychological stress and early cardiovascular risk². In 2022, the World Health Organization (WHO) reported that over 390 million children and adolescents aged 5-19 years were overweight, with overweight prevalence rising from 8% in 1990 to 20% in 2022³. This quick increase reflects that obesity is no longer confined to adulthood but is starting to take root in childhood and adolescence⁴.

Metabolic syndrome in adolescents represents a clustering of cardiometabolic abnormalities, including central obesity, raised blood pressure, impaired glucose regulation, high triglycerides, and low high-density lipoprotein cholesterol⁵. The significance of its importance is that these abnormalities are frequently subclinical in the early years and slowly contribute to the increased risk of type 2 diabetes mellitus, cardiovascular disease, chronic kidney disease, and non-alcoholic fatty liver disease (NAFLD)⁶. The risk of metabolic syndrome is significantly higher for adolescents with overweight and obesity than for normal-weight adolescents, and research indicates that the risk for overweight adolescents is several-fold higher⁷.

Changing social and environmental patterns compound the clinical challenge. Increased consumption of calorie-dense processed foods, sugar-sweetened beverages, sedentary screen-based behavior, reduced outdoor activity, poor sleep, academic stress, and family history of metabolic disease all contribute to the problem⁹. However, obesity is also commonly overlooked in many communities, with overweight in teens sometimes being confused as a natural part of growth or “a healthy look.” This late recognition permits the metabolic complications to develop in a silent way¹⁰.

The consequences of adolescent obesity extend beyond physical health¹¹. Affected adolescents often have low self-esteem, are anxious, depressed, socially isolated, bullied and have decreased involvement in school and sports activities¹². These psychological effects can even exacerbate eating habits and physical inactivity, which can further perpetuate a negative cycle of effects.¹³ Thus, it is important that management should not be limited to weight loss, but that the emotional health, the family support and the sustainable behavioral change as well should be taken into account¹⁴.

Early screening is of critical importance¹⁵. Body mass index percentile, waist circumference, blood pressure, fasting glucose, lipid profile, liver enzymes, and family history should be assessed in adolescents with obesity or rapid weight gain¹⁶. Additional work-up for insulin resistance, fatty liver disease, sleep apnea, and endocrine diseases may be warranted in high-risk patients¹. The goal should be to achieve early detection, before irreversible cardiometabolic damage occurs,².

Prevention is the best approach³. It is important for schools, families, health care providers and policy makers to collaborate to encourage healthy eating, physical activity, limiting screen time, good sleep hygiene, and early counseling⁴. Treatment should be tailored to the person and not stigmatizing. Adolescents should not be blamed for obesity; instead, they should be supported within their family and social environment⁶. Lifestyle modification remains the foundation of treatment, but multidisciplinary care involving pediatricians, nutritionists, psychologists, endocrinologists, and physical activity specialists is often needed for sustained improvement⁷.

In conclusion, obesity and metabolic syndrome in adolescents represent a growing clinical challenge with lifelong consequences⁸. The adolescent period provides a critical window for prevention, early diagnosis, and intervention⁹. Taking action early can minimise the risk of diabetes, cardiovascular disease and other metabolic problems in adulthood¹⁰. Addressing this problem requires not only medical treatment but also a broader public health approach that reshapes diet, activity, education, and community awareness¹¹.