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Background The use of antihypertensive medications is common among older adults to manage hypertension and prevent cardiovascular events. However, the potential impact of these medications on bone health and the risk of fractures remains a concern. This study investigates the association between antihypertensive medication use and fracture risk in elderly individuals. Materials and methods A cross-sectional study was conducted from February 2023 to July 2024, including 299 elderly patients (aged ≥65) diagnosed with hypertension and currently using antihypertensive medications. Data were collected from medical records, focusing on demographics, fracture incidence, comorbid conditions, and medication use. Logistic regression models were used to analyze the association between antihypertensive use and fracture risk, adjusting for confounders. Results Among the participants, 110 reported falls, and 88 (29.43%) sustained fractures. Fractures were more prevalent among females (63.6%) and those aged 75-84 years (45.5%). A history of falls, mobility difficulties, osteoporosis, and urinary incontinence were significantly associated with fractures. While most antihypertensive classes did not show a significant association with fracture risk, diuretics were associated with a 2.3-fold increased risk of fractures (OR 2.30, p=0.037). Conclusions This study highlights the need for careful consideration of fracture risk in elderly patients using antihypertensive medications, particularly diuretics. Healthcare providers should balance the benefits of blood pressure control with the potential risk of fractures in this population., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Ethics Committee of the Institute of Public Health Peshawar issued approval IPH&SS-AAA-330. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nadeem et al.)

Pregnancy luteoma (PL) is a rare, non-neoplastic ovarian lesion that can mimic malignant ovarian tumors, posing significant diagnostic challenges. PL typically presents as asymptomatic, unilateral, or bilateral ovarian masses and is often discovered incidentally. Its development is linked to hormonal fluctuations during pregnancy, particularly elevated human chorionic gonadotropin (hCG) levels. While PL generally resolves postpartum, complications such as torsion may necessitate surgical intervention. We report the case of a 23-year-old primigravida presenting with acute abdominal pain, vomiting, and abdominal distention at 13 weeks gestation. Imaging revealed large, bilateral multicystic ovarian masses. Elevated CA-125 levels raised suspicion for malignancy, leading to a laparotomy and bilateral oophorectomy. Histopathological analysis confirmed the diagnosis of pregnancy luteoma., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nawaz et al.)

Background The objective of our investigation was to evaluate the mortality rate and predictor factors that are associated with bloodstream infections (BSIs) in elderly patients who are admitted to the internal medicine ward. Materials and methods A retrospective cross-sectional analysis was conducted at a 550-bed tertiary care hospital in Peshawar, Pakistan, from January 2021 to June 2022. The study involved elderly inpatients aged 65 and older with positive culture results detected within two days of admission. Data collection involved demographic and patient-related risk variables, BSI-related risk factors, and environmental risk factors, with statistical analysis performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). Results Of the total study sample (n=186), 103 (55.4%) survived while 83 (44.6%) did not. The non-survivor group had a higher median Sequential Organ Failure Assessment (SOFA) score (6 vs. 2, p<0.0001) and Charlson Comorbidity Index (5 ± 2 vs. 3 ± 2, p<0.0001), with more frequent immunosuppression (25.3% vs. 8.7%, p=0.001). Additionally, gram-positive bacteria were more common in non-survivors (42% vs. 10%, p<0.0001), while gram-negative bacteria were more prevalent in survivors (73% vs. 36%, p=0.002). Conclusions Our research validates that BSI in older adults is a serious condition that is linked to a substantial death rate during hospitalization. The biggest determinant of death in older patients with BSI is the severity of clinical symptoms evaluated by the SOFA score upon admission. It is imperative to acknowledge that respiratory-induced BSIs are the most fatal, and patients who are hospitalized and admitted to the intensive care unit (ICU) are at an elevated risk., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Ethical Committee of Amaan Medical Institute issued approval reference: AMI-AAA-340. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shah et al.)

Background and objective Chronic kidney disease (CKD) poses a significant global public health challenge, especially among the Asian population who experience higher prevalence and more rapid disease progression. This study aimed to compare the epidemiology and risk factors associated with CKD between rural and urban residents in Peshawar, Pakistan. Materials and methods A cross-sectional study involving adult patients with CKD was conducted at a public tertiary care hospital in Peshawar between July 2023 and January 2024. To collect data, a tool was developed based on existing literature. CKD was defined as follows: a low estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m 2 , albuminuria (urine albumin-creatinine ratio >3 mg/mmol), or a combination of both low eGFR and albuminuria. The prevalence of moderate to severe CKD, adjusted for place of residence, was calculated. Statistical analysis was performed using SPSS Statistics V. 26 (IBM Corp., Armonk, NY). Results Among the study sample, 114 (41.45%) patients hailed from rural areas while 161 (58.55%) resided in urban areas. Urban patients had a higher prevalence of albuminuria levels below 30 mg/g than rural patients (83.2% vs. 76.3%, p=0.00). Additionally, the mean eGFR was slightly higher among rural residents. Rural patients had a higher prevalence of hypertension, and there was a noticeable disparity in the occurrence of kidney stones, with rural residents experiencing a greater incidence. Patients living in urban areas showed a higher level of understanding of risk factors and reported taking preventive measures for CKD. Factors associated with moderate to severe CKD included living in urban areas and having a medical history of diabetes and hypertension (p=0.00). No significant association was observed between behavioral factors and the severity of CKD. Conclusions Urban residents exhibited higher rates of CKD and albuminuria and had a greater awareness of CKD risk factors. In contrast, rural areas had a slightly higher mean eGFR and greater prevalence of hypertension and kidney stones. Diabetes and hypertension were key predictors of moderate to severe CKD., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Ethics Committee, Institute of Public Health, Khyber Medical University issued approval IPH&SS-AAA-325. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)