Resident Journal of Rawalpindi Medical University

The Evaluating Compliance with NICE Guidelines for Diagnosis and Management of Gallstone Disease: An Audit from a Tertiary Care Hospital in Pakistan

admin admin; Usman Hanif

Background: Gallstone disease (GSD) is a prevalent gastrointestinal disorder globally, often requiring surgical intervention. Adherence to standardized management guidelines such as NICE CG188 is essential to optimize patient outcomes. This clinical audit evaluated compliance with these guidelines in a public-sector tertiary care hospital in Pakistan.

Objectives: This Audit was conducted to assess adherence to NICE CG188 for the diagnosis and management of Gallstones disease in order to identify areas for clinical improvement to highlight the deviations from evidence-based standards. The audit sought to uncover system-level barriers and inform targeted quality improvement strategies within a resource-constrained clinical environment.

Methods: A prospective audit of 43 patients diagnosed with gallstone disease between 14^th May and 15^th July 2025 was conducted. Data were collected using a structured proforma and analyzed using SPSS v26. Standards assessed included diagnostic testing, timing and modality of cholecystectomy, management of common bile duct stones, and patient education. Results were compared to NICE CG188 benchmarks.

Results: Adherence to initial diagnostics (LFTs and ultrasound) and offering laparoscopic cholecystectomy (LC) to symptomatic patients was 100%. Bile duct clearance in choledocholithiasis was also fully compliant. However, MRCP use in indicated cases was only 50%, and no patients with acute cholecystitis received LC within one week (0%). No day-case surgeries were performed, and only 25% of asymptomatic patients were appropriately managed conservatively.

Conclusions: While diagnostic and interventional standards were largely met, substantial deficits were found in timely surgical management, use of imaging, and adherence to conservative indications. The audit highlights critical resource and system-level barriers that must be addressed to improve compliance with international standards

The Frequency of Bronchospasm in patients administered General Anesthesia and its Associated Complications: a Cross-Sectional study

Aqsa AL Muqadas, Abeera Zareen; admin admin

Background: Bronchospasm is a serious complication that can pose a significant threat to life during general anesthesia, especially among individual with underlying respiratory comorbidities; such as asthma or Chronic obstructive pulmonary disease (COPD). It may result in significant morbidity if not promptly recognized and managed. The aim of this study was to determine the frequency of intraoperative bronchospasm and assess its associated complications in patients receiving general anesthesia.

Method: A cross-sectional study employing convenience sampling was conducted on all eligible adults undergoing general anesthesia at Benazir Bhutto Hospital, Rawalpindi, April- June 2024 (n=40). Occurrence of bronchospasm during general anesthesia were reviewed through clinical records. Demographic characteristics, comorbidities, anesthetic techniques, and perioperative complications were analyzed using descriptive statistics.

Results: In total, 40 patients were included in the study, 25 men (63%) and 15 women (37%), with a mean age of 37.5 years (SD ± 9.4). Bronchospasm exhibited in 12.5 % of patients (n=5) during general anesthesia. Every patient who experienced bronchospasm also developed intraoperative hypoxemia 100 % (n= 5). Other complications observed were bradycardia 67% (n=4), hypercapnia in 33% (n=2), and delayed recovery in 16% (n=1).

Conclusion: Bronchospasm is found to be an uncommon but clinically important complications of general anesthesia, affecting 12.5% of patient. All affected individuals developed intraoperative hypoxemia, and some also experienced bradycardia, hypercapnia, and delayed recovery. These findings emphasize the importance of careful preoperative evaluation, close intraoperative monitoring, and prompt management to reduce risk of anesthetic morbidity

The Least You Should Know, a Descriptive Cross-Sectional Study Regarding Red Zone of Medical Emergency Department of Holy Family Hospital

Introduction: In environments with inadequate resources, emergency departments (EDs) deal with high patient perceptiveness and mortality rates. Clinicians frequently deal with limited access to intensive care, overcrowding, and cryptic diagnoses. The knowledge that junior practitioners need to recognize life-threatening circumstances in a tertiary care emergency department is emphasized in this study.

Aim: To ascertain the tendency in poisoning and disease patterns and how they relate to mortality in the medical red zone at Holy Family Hospital's Emergency Department.

Methods: From March to April 2025, 631 patient data were analyzed as part of an analytical, realistic cross-sectional study. Records were documented on demographics, diagnosis, poisoning types, rotating schedules, and outcomes. R Statistical language (version 4.5.0, 2025) was used for statistical analysis.

Findings The most recurrent poisonings were aluminum phosphide (17.91%), rodenticide (18.91%), and unknown (29.35%). The highest poisoning-related mortality rate (8/36 instances) was adhered to aluminum phosphide. Cerebrovascular accidents were the most common non-toxicological disorder (22.66%), while sepsis, liver dysfunction, and shock states were the most fatal. There was a statistically substantial correlation (p < 0.001) between the pinpoint diagnosis and death.

Conclusion: The study's closure emphasized how important it is for junior practitioners to identify exposure of patient diseases, categories, grades and solutions. In Pakistan's emergency care contexts, poisonings and structural disorders continue to be substantial causes of death, demanding better diagnosis, procedures and training diagnosis.

The Sociodemographic Profile and Lifestyle Factors Associated with Acne among patients presenting in Dermatology Out-Patient Department Benazir Bhutto Hospital: A Cross-Sectional Study

Background: Acne vulgaris is one of the most prevalent dermatological conditions worldwide, affecting individuals across age groups and contributing to significant physical and psychosocial burden. Its etiology is multifactorial, with evidence suggesting important roles for both genetic predisposition and modifiable lifestyle factors.

Objective: To assess the sociodemographic profile and lifestyle factors associated with acne.

Methods: A cross-sectional study was conducted among 150 patients clinically diagnosed with acne. Data were collected using a structured questionnaire covering sociodemographic characteristics and lifestyle factors. Data was analyzed using SPSS version 26.0.

Results: Among 150 participants, 103 (68.7%) were male and 47 (31.3%) female. The majority were unmarried (115, 76.7%), urban residents (102, 68.0%), and belonged to nuclear families (123, 82.0%). Only 11 (7.3%) were smokers, and 15 (10.0%) reported chronic medical conditions. Regular physical exercise was practiced by 55 (36.7%), while 126 (84.0%) experienced frequent or occasional stress. Regarding sleep, 79 (52.7%) reported 5–6 hours per night, 67 (44.7%) had 8–9 hours, and 4 (2.7%) reported more than 10 hours. Mobile phone use exceeded 5 hours daily in 66 (44.0%). Family history of acne was positive in 70 (46.7%), most frequently among siblings (42, 28.0%).

Conclusion: The study demonstrates that acne patients commonly present with urban residence, unmarried status, high stress levels, short sleep duration, and prolonged mobile phone use, alongside a strong family history of the condition. These findings underscore the importance of addressing modifiable lifestyle factors in acne management and highlight the need for larger community-based studies to confirm causal relationships.

The Efficacy and Comparative Effectiveness of Bacterial and Fungal Probiotics in Pediatric Acute Gastroenteritis: A Review Article

Ambreen Badar, Aftab Raheem, Sarah Rafi, Aamir Afzal; admin admin

Background: Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children worldwide, particularly in low- and middle-income countries, contributing significantly to healthcare utilization and burden on already crushing economies. While rehydration therapy is the mainstay of management, adjunctive therapies are also used increasingly nowadays. Of these adjunctive therapies, zinc and probiotics are also used with consistently positive results. Probiotics are live microorganisms that confer a health benefit to the host. They have two types fungal and bacterial. Specifically, bacterial strains such as Lactobacillus rhamnosus GG (LGG) and fungal agents like Saccharomyces boulardii have demonstrated efficacy in reducing the duration and severity of diarrheal episodes in pediatric populations.

Objective: This review systematically evaluates the clinical effectiveness of bacterial (Lactobacillus rhamnosus GG) and fungal (Saccharomyces boulardii) probiotics in the management of acute gastroenteritis in pediatric populations.

Material and Methods: In this meta-analysis we drew evidence from randomized controlled trials (RCTs) published between January 2019 and June 2024, by searching Cochrane database and PubMed. A total of 12 studies are included in this metanalyses

Inclusion criteria: Randomized control trials only, Children aged 0-18 years with acute gastroenteritis, Published in the last five years {from 2019 till 2025}, probiotics clearly defined as either fugal (Saccharomyces boulardii) or bacterial (Lactobacillus, Bifidobacterium) and Orally administered probiotics only Exclusion criteria as follow; Studies on adults (aged greater than 18 years), Non-RCT designs, Animal or in vitro studies, Non-oral probiotics e.g. topical rectal etc. Probiotics combined with prebiotics(symbiotic)

Results: Current evidence from high-quality RCTs indicates that both probiotic categories offer significant clinical benefits. LGG consistently reduces diarrhea duration by approximately 1 to 1.5 days across multiple studies. S. boulardii events.

Conclusion: Probiotics represent a safe and effective adjunct therapy for pediatric acute gastroenteritis. While both LGG and S. boulardii are beneficial, emerging comparative evidence from RCTs suggests that strain-specific selection, guided by factors such as the severity of illness, suspected etiology (e.g., rotavirus), and patient age, may optimize clinical outcomes. Further head-to-head RCTs are warranted to refine these recommendations and explore optimal dosing and combination strategies.

The Outcomes of Trial of Labor After Cesarean Section: A Study of Single-Scar Patients

Sibgha Aziz, Ismat Batool, Nighat Naheed, Rehana Kousar; admin admin

Objective: To evaluate maternal outcomes in pregnant patients with one previous cesarean section to determine the optimal delivery method, and develop recommendations to reduce the increasing cesarean section rate.

Methodology: This retrospective observational study was conducted from June 1, 2024, to june 30, 2025. A specially designed proforma was completed for all patients with one previous cesarean scar admitted to the Department of Obstetrics and Gynecology at Benazir Bhutto Hospital, Rawalpindi. Data collected included patient condition at admission, comprehensive obstetrical history, delivery mode decisions, intrapartum and postpartum complications, and maternal and fetal outcomes.

Results: During the one-year period, 9,958 patients delivered, of whom 1,215 (12.21%) had one previous cesarean scar. Among these patients, 480 (39.49%) were offered a trial of labor after cesarean section (TOLAC). A total of 735 patients (60.51%) were not offered TOLAC and underwent planned repeat cesarean section. The overall VBAC rate among all patients with one previous scar was 32.3%. The successful TOLAC rate was 80.5%.

Conclusion: Women with previous cesarean sections constitute a significant proportion of obstetrical admissions. Trial of labor in carefully selected patients within tertiary care hospital obstetrical units is safe when adequate resources are available for labor monitoring.

The Feedback of the Postgraduate Trainees about Computer & IT skills workshops organized at Rawalpindi Medical University Pakistan

Rizwana Shahid; admin admin

Background: Feedback about workshops and educational sessions are substantially significant for gauging the effectiveness of content delivery and collaborative educational environment. Constructive feedback promotes the culture of continuous improvement. Hence, the objective of this study is to get the feedback of the postgraduate residents about Computer & IT skills workshop organized at Rawalpindi Medical University (RMU).

Methods: A cross-sectional descriptive study was carried out to review the feedback of 37 postgraduate trainees about various aspects of Computer & IT skills workshop that was organized for a period of 3 days at RMU during October 2024. The data was gathered from the trainees pertaining to the objectives of the workshop, educational climate, facilitator’s competency, fulfilment of educational needs, provision of reading material, opportunities for interaction, clarification of queries and summarization of key points. Data was analyzed by using SPSS software version 27.0 and Microsoft Excel 2019. Descriptive statistics were applied.

Results: Of the total 37 trainees participating in the workshop, 43.2% strongly agreed with the achievement of the intended learning outcomes. All trainees agreed with the relevancy of the learning experience to the learning objectives of the workshop, command of the facilitators over subject matter and availability of sufficient opportunities for interaction during the session. About 94.6% of the trainees were satisfied with clarification of the queries in workshop while 86.4% agreed with clarification of their queries. Most (91.8%) of the trainees found educational environment conducive to learning. Overall 97.2% of the trainees perceived that computer and IT skills workshop was relevant to their educational needs.

Conclusion: Feedback of the postgraduate trainees was quite optimistic with respect to overall learning experience and adequacy of learning environment.

The Evaluating Patient Satisfaction with Care and Services in the Dialysis Unit of Holy Family Hospital, Rawalpindi: A Clinical Audit

Aminullah Betanai, Asmara Asrar, Haq Nawaz; admin admin — Thu, 23 Apr 2026 00:00:00 +0000

Background Chronic kidney disease (CKD) is a major global health challenge, affecting over 850 million people worldwide. More than 4 million individuals depend on dialysis for survival. In Pakistan, nearly 20 million people are estimated to have CKD, yet only a small proportion receive regular haemodialysis due to limited facilities and financial constraints. Despite the disease burden, few local studies have assessed patient satisfaction with dialysis services.

Methods: A descriptive, cross-sectional clinical audit was conducted from November to December 2024. Thirty-four patients undergoing maintenance haemodialysis for at least three months completed a structured questionnaire based on a five-point Likert scale (1 = very dissatisfied, 5 = very satisfied). Data were analysed using SPSS version 25. Descriptive statistics were expressed as mean ± standard deviation for continuous variables and frequencies with percentages for categorical variables.

Results: The highest satisfaction was reported for staff behaviour (mean = 4.73 ± 0.45), cleanliness (4.61 ± 0.49), and nephrologist availability (4.59 ± 0.50). Relatively lower scores were noted for dietary counselling (4.28 ± 0.62) and emotional support (3.91 ± 0.71). Overall, 70.6% of patients were very satisfied, 26.5% were satisfied, and 2.9% were neutral. None were dissatisfied.

Conclusion: Patients demonstrated high satisfaction with most aspects of care, particularly staff conduct and cleanliness. Areas requiring improvement include emotional support and dietary counselling. Regular patient feedback and periodic audits are recommended to ensure continuous quality improvement and enhance patient-centred dialysis care.

The Correlation of CRP and OGTT in 2nd Trimester of pregnancy in GDM patients

Background: Gestational diabetes mellitus is rising public health issue linked with both maternal and fetal problems. In etiology of GDM, chronic low-grade inflammation has been increasingly acknowledged; C-reactive protein is becoming a possible indicator. This study examined the link between CRP levels and Glucose tolerance test outcomes during the 24-28 week gestational period in pregnant women.

Methods: Under the auspices of Rawalpindi Medical University, a cross-sectional research was conducted within the obstetrics and gynecology department at Benazir Bhutto Hospital in Rawalpindi. Through continuous sampling, a total of 100 pregnant participants were recruited during their 24-28 week gestational period following Dean’s Review Committee authorization. CPR testing and standard 75g OGTT were done on the subject. Diagnosis of GDM complied WHO 2013 standards. High-sensitivity immune radiometric assay was used to estimated CPR. Using SPSS v25, data were examined; Pearson correlation and t-test were used as needed..

Results: Among the participants, 32% received GDM diagnosis. Non-GM subjects had significantly lower CRP levels (3. 18 ± 1. 4 mg/L, p < 0. 001) than the GDM group (5. 72 ± 2. 1 mg/L,p <0.001). OGTT values were also dramatically higher throughout all time points in the GDM group. CRP levels had moderate positive correlations with 1-hour (r = 0. 47), 2-hour (r = 0. 52) and fasting (r = 0. 41) glucose levels (all p < 0. 01).

Conclusion: High CRP levels are strongly linked in mid-pregnancy to glucose intolerance and GDM. These results indicate that sub-clinical inflammation plays a part in GDM development and suggest that CRP may be a helpful adjuvant biomarker in early risk stratification. Further extensive studies are advised to confirm these results and investigate inclusion into clinical screening systems.

The Refractive Changes After Vitrectomy with Silicone Oil Tamponade in Phakic, Pseudophakic and Aphakic Eyes

Azeen Razzaq; admin admin

Objective: To evaluate the refractive changes after Vitrectomy with Silicone oil Tamponade in Phakic, Pseudophakic and Aphakic eyes.

Material and Methods: It was a Descriptive Cross-sectional study. The research was carried out at Rawalpindi's Holy Family Hospital from April to September 2024. 25 patients of all ages attended Allied Hospitals Rawalpindi's outside patient department, and they were all part of my study. A variety of diagnostic techniques were used on the patients in order to confirm vitreoretinal disorders.

Results: Among the 25 patients, hyperopic refractive error was observed in 22 patients and myopic error in 3. Of the hyperopic group, 8 were phakic, 11 pseudophakic, and 3 aphakic. In the myopic group, 2 were phakic and 1 pseudophakic. A weak correlation coefficient (r = 0.189) was observed between lens status and postoperative refractive changes, suggesting other contributing factors such as silicone oil viscosity and the presence of scleral buckles.

Conclusion: The weak correlation between lens status and refractive changes suggests that not only lens status is valuable predictor of refractive outcomes after vitrectomy. However, there are some other factors that contribute to refractive changes such as belt buckle, silicone oil viscosity etc. Furthermore, the refraction is mostly altered by the insertion and removal of silicone oil, regardless of the condition of the crystalline lens. After surgery, some patients had a notable improvement in their visual acuity, while others experienced stable eyesight

The Assessment of Six-month Postoperative Mortality in Elderly Patients with Femoral Neck Fractures: A Single-Center Study from Rawalpindi

M Awais Iqbal , Talha Farooq, Saad Ahmed, Faisal Javed; admin admin

Objective:
To determine the six-month mortality rate in elderly patients who underwent surgery for neck of femur fractures at Rawalpindi Teaching Hospital.

Methods:
This descriptive study was conducted in the Orthopedic Surgery Department of Rawalpindi Teaching Hospital from November 8, 2023, to February 28, 2025. Patients aged ≥55 years with neck of femur fractures who met the inclusion criteria and underwent surgical management were included. Postoperative follow-up was maintained for six months. The chi-square test was used to assess associations..

Results:
A total of 113 patients were included (mean age 69 ± 10 years); 72 (64%) were male and 41 (36%) female. The most common fracture type was subcapital (52.2%), followed by basicervical (29.2%) and transcervical (18.5%). Surgical procedures included hemiarthroplasty (62.8%), proximal femoral nail (17.6%), dynamic hip screw (11.5%), and total hip replacement (7.9%). The overall six-month mortality rate was 17.6% (n=20), with the highest mortality in patients aged ≥80 years (55% of deaths). Female patients had a higher mortality rate (60%) compared to males (40%).

Conclusion:
Elderly female patients aged 80 years and above demonstrated a higher six-month mortality rate following neck of femur fracture surgery.

The Histopathology of EUS-Guided Needle Aspiration of Liver and Lymphnode

Muhammad Umar; admin admin

Abdominal lymphadenopathy of unknown etiology presents a significant diagnostic challenge, often occurring in asymptomatic individuals or patients presenting with constitutional symptoms such as weight loss, low-grade fever, and abdominal pain. Despite comprehensive history taking, physical examination, and laboratory testing, establishing a definitive diagnosis remains difficult. While cross-sectional imaging, specifically computed tomography (CT), evaluates predictive parameters such as anatomical site, distribution, enhancement patterns, and nodal morphology imaging alone lacks the specificity to definitively distinguish between malignant and benign etiologies. Generally, normal nodes are oval or "cigar-shaped" and <1 cm, while rounded nodes >1 cm are highly suspicious for malignancy. Given these limitations, tissue diagnosis is essential. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has become a primary modality for obtaining core tissue samples from lesions adjacent to the gastrointestinal tract, offering high diagnostic yields and preserved tissue architecture in over 90% of cases

A Navigating Diagnostic Quagmire Encephalitis Camouflaged by Postpartum Psychosis Presentation- A Case Report

Neurological complications are associated with the puerperium. Pregnancy and puerperium have high incidence of cerebral neurological complication. Postnatal encephalitis is the most common neurological disease to occur in immunosuppressed population i.e., women in puerperium period. The most severe infection is herpes simplex virus central nervous system infection¹. Certain physiological changes result in neurological and psychiatric syndrome that require multidisciplinary approach². We report the case of a postpartum woman, who presented with behavioral disturbances, she also had spikes of fever. Her CT Brain showed mild meningeal enhancement and cerebrospinal fluid routine examination showed lymphocytes. The patient was shifted to the medical ward for the management of encephalitis. This case is being reported to emphasize the importance of unusual presentation of encephalitis. This also highlights the importance of early diagnosis of the patient on the basis of history and examination and early management can lead to better prognosis. The prognosis of encephalitis depends on the early diagnosis and management. The mortality can be reduced by the early pharmacological treatment of encephalitis by antiviral agents, if there is suspicion of encephalitis⁴.