JBUMDC

Sensitivity and Specificity of the Neutrophil Lymphocyte Ratio (NLR) in Diagnosing Late Onset Neonatal Sepsis in NICU Patients

Wed, 01 Jan 2025 00:00:00 GMT

Sensitivity and Specificity of the Neutrophil Lymphocyte Ratio (NLR) in Diagnosing Late Onset Neonatal Sepsis in NICU Patients Zunaira Zulfiqar; Unaiza Syed; Syed Arsalan Hassan; Nabeera Hayat; Hamza Khursheed; Abu Bakar Khan Objective: To compare the sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset neonatal sepsis in NICU patients at a tertiary care center Study Design and Setting: Prospective observational study at Department of Pediatrics, Combined Military Hospital, Lahore from February 2024-July 2024 Methodology: After admission into the NICU for suspected late onset neonatal sepsis, complete blood count, C-reactive protein and blood cultures were sent before changing or starting broad spectrum anti-biotic therapy for 350 patients included in the study. Primary variables observed were sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset sepsis once co-related with the culture results. Results: Blood panel parameters showed mean absolute neutrophil count to be 5928.19796.05/mm3 versus 7032.80166.02/mm3 between the suspected and confirmed patients’ groups (p<0.001). Similarly, mean absolute lymphocyte count was 2745.32394.53/mm3 versus 3223.60278.90/mm3 between both groups (p<0.001). Median value for NLR was 1.70 (1.00) versus 2.20 (1.00) between the suspected and confirmed culture groups (p<0.001). Assessment of receiver operating characteristics (ROC) for NLR when compared with suspected and confirmed sepsis showed area under the curve being 0.644 (CI=95%) with sensitivity of 74.6%, specificity of 55.6%, positive predictive value being 57.3% and negative predictive value being 73.3% with a cut-off value for NLR being 2.05. Conclusion: We conclude that neutrophil lymphocyte ratio with a cut-off value of 2.05 is a reliable method to diagnose late onset neonatal sepsis with good sensitivity

Analyzing trends in Cesarean Section by Action Oriented Classification (Robson Criteria) at Creek General Hospital, Karachi

Wed, 01 Jan 2025 00:00:00 GMT

Analyzing trends in Cesarean Section by Action Oriented Classification (Robson Criteria) at Creek General Hospital, Karachi Saba Pario; Shaista Bashir Anwar; Kaweeta Kumari; Uzair Ahmed; Muhammad Muhib; Ghania Naeem Objectives: The objective of this study is to analyze Cesarean section trends using the Robson classification system and identify the cause of cesarean section in each group, in a tertiary care hospital located in Karachi, Pakistan. Study Design and Settings: This cross-sectional study was conducted in the obstetric department of Creek General Hospital Karachi, from 1 Jan 2021 to 31 Dec 2022. Methodology: Data collection utilized a non-probability consecutive sampling method. This study examined the sociodemographic characteristics, indications for cesarean section, and the Robson classification system in the women who underwent cesarean section in the hospital during specified duration. Inclusion criteria of study were all women who underwent for C-section procedure during the study timeline. Data was analyzed using IBM SPSS Statistics version 26. The study adhered to the Helsinki Declaration and ethical approval. Results: The Robson classification system was analyzed in this study, and group 5 was shown to be the primary contributor followed by group 2 and then group 1. Most frequently noted indication was previous CS (43.2%), followed by non-progress of labor (15.1%), and fetal distress (11.6%). Conclusion: Cesarean section rate can be reduced by encouraging vaginal birth after cesarean section in multiparous women who had one cesarean section, under supervision of senior obstetrician. Meanwhile, the Non-progress of labor can be targeted by improving antenatal and intrapartum care, birth preparation classes and presence of companion during labor. Through CTG interpretation and their standardized management protocols will be effective in preventing and curbing the rising cesarean rate due to fetal distress

Frequency and Association of Perforated Appendix with Patient’s Characteristics in Acute Appendicitis

Wed, 01 Jan 2025 00:00:00 GMT

Frequency and Association of Perforated Appendix with Patient’s Characteristics in Acute Appendicitis Muhammad Zeb; Rafia Ahmad; Abdul Wadood; Ishtiaq Ahmed; Malak Maaz Hassan; Muhammad Moazzam Farooq Objective: To determine the frequency of perforated acute appendicitis in patients with acute appendicitis and its association with patients clinic demographic characteristics. Study design and setting: This cross sectional study was conducted in general surgery unit from 1st January 2022 to 31st December 2022. Methodology: 171 patients were included. Patients who were provisionally diagnosed as acute appendicitis were included in the study. Sampling technique was nonprobability consecutive sampling. Statistical analysis was done through SPSS Version 23. Results: The study included 171 patients, with 58.5% male and 41.5% female. The majority of patients were aged between 25-35 years and had a normal weight. Grossly inflamed appendix was the most common finding (69.6%), followed by perforated appendix (19.3%), normal appendix (8.2%), and gangrenous appendicitis (2.9%). There was no statistically significant difference between gender and intraoperative findings. Age categories and duration of symptoms were significantly associated with intraoperative findings. Conclusion: In conclusion, 19.3% of patients with acute appendicitis presented with perforation. Age and duration of symptoms were found to be significantly associated with intraoperative findings, highlighting the importance of early diagnosis and timely surgical intervention

Development, Implementation and Initial Evaluation of the Blueprint for MBBS Theory Exams in a Private Medical College of Pakistan

Wed, 01 Jan 2025 00:00:00 GMT

Development, Implementation and Initial Evaluation of the Blueprint for MBBS Theory Exams in a Private Medical College of Pakistan Yusra Nasir; Sobia Ali; Muhammad Ahsan Naseer; Sana Farooq Shah Objective: This study aimed to enhance the validity of the exam bank at Liaquat National Medical College (LNMC), Karachi, through the development and evaluation of the exam blueprinting process as part of an ongoing quality assurance initiative. Study design and setting: This study was conducted at Liaquat National Medical College (LNMC), Karachi. Participants included key stakeholders i. faculty members, ii-officials from the examination department (involved in the development of the fourth-year MBBS neuroscience exam blueprint), and iii-students. Methodology: Ethical approval for this study was taken by the LNMC Ethics Review Committee. For the ease of understanding, this article was divided into two sections: In first section, the stepwise approach of blueprint development was discussed whereas the second section dealt with feedback from 105 4th Year MBBS students, feedback from faculty involved in this process and the experiences of examination unit personnel. Results: Following the Calgary model by Coderre et al., a blueprint for undergraduate MBBS theory exam was developed. Students (85%) agreed that the exam accurately assessed the taught content. Faculty expressed satisfaction with the blueprinting process, noting improvements in exam quality, topic representation, and the elimination of redundant questions. Examination unit personnel reported better time management and improved alignment with curricular objectives. Initial challenges, such as faculty’s lack of training and resistance were also identified. Conclusion: The blueprinting process significantly enhanced alignment of theory exam with educational objectives thereby ensuring the content validity. Continued training and institutional support are vital in overcoming initial challenges and ensuring the long-term success of blueprinting.