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Objective: This study aims to determine the diagnostic utility of IL-18 for early diagnosis of AKI by comparing it with the routinely used marker serum creatinine. Material and Methods: This validation study was carried out in the Department of Pathology, Khyber Medical College, Peshawar from September 2021 to February'2022. A total of 156 patients with Acute Kidney Injury were recruited from the intensive care units of three Peshawar tertiary care hospitals. Serum and urinary samples were taken at the time of admission and 48 hours after admission to estimate Serum creatinine level and urinary IL-18. Comparisons were made between the diagnostic utility of Urinary IL-18, and serum creatinine using the paired t-test. Sensitivity, specificity, positive predictive value, and negative predictive values were calculated. Results: This study included 156 acute kidney injury (AKI) patients. The mean creatinine level on admission was 0.90 ± 0.26 mg/dl; after 48 hours of admission, it was 1.38 ± 0.70 mg/dl. Similarly, IL-18 on admission was 130.14 ± 61.31 pg/ml while after 48 hours it was 290.32 ± 136.50 pg/ml. IL-18 levels of =75 pg/ml with a positive predictive value of 100% and a negative predictive value of 29% can be used as a cutoff in the diagnosis of AKI in patients after 48 hours of admission. Conclusion: Due to high sensitivity and specificity, Urinary IL-18 can predict AKI 24-48 hours before the onset of renal injury and can be used as an early marker for this purpose. [ABSTRACT FROM AUTHOR]

Objectives: Measles is one of the most familiar contagious diseases in children associated with numerous systemic complications. The aim of this study is to find the frequency of Myocarditis in children suffering from measles. Materials and Methods: This cross-sectional study was conducted in the department of pediatrics, MTI Lady Reading Hospital Peshawar from 6th December 2019 to 5th June 2020. Ninety-six patients of both genders and ages ranging from 1-12 years having measles for more than one week were enrolled in the study after informed consent. Ethical approval for the study was obtained from the Ethical Review Board. Patient demographic data were collected on a structured proforma and the frequency of children having clinical presentation of myocarditis was recorded. Data were entered and analyzed using SPSS 22. Results: The frequency of Myocarditis was 7.3% in children presented with Measles. The mean age was 6.6± 3.06 years. There were 47.9% males and 52.1% females. Most patients belonged to middle socioeconomic status i.e. 61.5%. Maternal education was 49% in the 6-10 age group. In sampled population, 46.9% belonged to urban areas and 5.1% belonged to rural areas. There were 18.8% vaccinated children and 81.3% were not vaccinated for measles. Myocarditis was significantly associated with the younger age group (p-value 0.028), however, there was no difference in gender (p-value 0.781). Children with low socioeconomic status had significantly higher frequency (p-value 0.05) of myocarditis. Conclusion: Myocarditis is commonly presented in children having measles especially patients in younger age groups and belonging to poor socioeconomic status. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the frequency and drug resistance of Salmonella typhi in district Buner, Khyber Pakhtunkhwa. Material & Methods: This cross-section study was conducted at District Head Quarter Hospital Buner and private diagnostic centers from Jan 2020 to May 2021. A total of 460 blood samples were collected from OPD patients reported with signs and symptoms of Typhoid fever. Samples were cultured on blood and MacConkey agar, incubated at 37° for 24 hours. Bacterial identification was done on colony morphology, gram staining, and polyvalent antisera for strain identification. Finally, antibiotic susceptibility testing was done for the isolated bacteria. All commonly prescribed first-line and second option antibiotics were tested on Mueller Hinton agar by Kirby Bauer disk diffusion method following CLSI guidelines 2020. Result: A total of 240 out of 460 samples showed bacterial growth where Salmonella typhi was found in 98 (40.8%) cases. Among them, 28(28.6%) were reported as MDR while 1 (17.4%) were XDR. Out of the XDR, 4 strains were found resistant to Vancomycin and clarithromycin as well. The isolated S. typhi was 100% sensitive to Meropenem, and Azithromycin, however showed 100% resistance to Aztreonam, Ampicillin, and Cotrimoxazole. Prevalence of S. typhi was more (50%) in females while resistance was reported more in age group 20-40 years. Conclusion: The frequency of Salmonella typhi at district Buner was 41% in patients reported with high grade fever where 28% of the strains reported were multidrug resistant. Some extended spectrum drug-resistant S. typhi and Vancomycin and Clarithromycin resistant strains were also reported which is alarming. Meropenem, and Azithromycin were the only drugs effective against most of the strains. However, resistance to these drugs may develop soon if we do not stop empirical excessive use of antibiotics. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore the frequency of biochemical factors in children presenting with severe acute malnutrition. Materials and methods: Children having an age range of 6-59 months with severe acute malnutrition of more than six weeks' duration, admitted at Pediatric Unit, Leady Reading Hospital Peshawar were included in the study. The study was conducted for 6 months (October 13, 2018, to April 13, 2019). The child's age, weight, mother's gestational age, mode of delivery, birth weight, maternal education, and parity were recorded on a proforma. Blood samples were sent to the hospital laboratory for serum electrolytes, hemoglobin, serum calcium, serum albumin, random blood sugar and the frequencies of these biochemical profile were calculated. Data were analyzed in SPSS-20. Results: Out of 161 children, 48% were 1-3 years old, followed by 33% 3-5 years old. The majority of children were females (62%). Low birth weight children were 60%. Maternal illiteracy was 58%. Multiparty of mothers was reported in 59% and 67% of children were born by spontaneous vaginal delivery. Anemia was the most common (98%) finding followed by hypokalemia (68%), hypocalcemia (35%), Hypochloremia (16%), and Hyponatremia (14%). Serum albumin was low in 7% of children. Hypoglycemia was found in 15% of children. Conclusion: Anemia followed by hypokalemia was the commonest biochemical findings in acute severe malnutrition. Similarly, hypocalcemia and hypoglycemia were also common life-threatening conditions found in these patients. [ABSTRACT FROM AUTHOR]

Objectives: Assessment drives learning and improving the quality of assessment has a remarkable impact on the quality of learning. Objective Structured Clinical Examination is termed more reliable and valid as compared to conventional practical examination. Objective: The objective of this study was to find the perception of postgraduate family medicine trainees about the OSCE assessment method and compare those having previous experience with those having no previous experience. Material & Mothods: This was a cross-section study conducted at the end of exit examination of diploma in family medicine at the Family Medicine Department. Khyber Medical University Peshawar. Data were collected on an eleven items questionnaire on a five-point Likert Scale. Study participants were categorized based on their previous experience of the OSCE. and were grouped into two categories. Data were analyzed by using Fisher's Exact test and a p-value of < 0.05 was considered statistically significant. Results: Out of 60. 56 candidates returned completed questionnaires. The response rate was 93.33% where the majority were males 52(92.9%). Participants with experience of the OSCE were 22 (39.3%) while 34 (60.7%) were having no experience of the assessment method. There was a significant difference (p= 0.001) in the perception about the OSCE with the simulated patient than real patient, fairness and reliability of the OSCE. stress and length of the OSCE and reduction of bias in the OSCE. The perception about weightage to be given to the OSCE in any examination was significantly different (p=0.004) between the two groups. Conclusion: Participants of both groups (experienced vs non-experienced) agreed on some aspects of the OSCE. Their opinion differed about the fairness, validity and stress related to the OSCE assessment method. This difference is probably explained by the inadequacy of an experience to form an opinion. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of pulmonary Tuberculosis (TB) among severely malnourished children and its association with inappropriate feeding practices. Materials and Methods: This cross-sectional study was conducted at the Nutritional Rehabilitation Unit/Stabilization Center (NRU/SC), Pediatric ward, Lady reading hospital Peshawar. A total of 222 (118 male and 104 females) severely malnourished In-patients, aged 2-59 months were enrolled and their demographics like age, gender, parent's literacy rate, family income and family type were studied. All enrolled patients were screened for TB using the National TB control Program and Pakistan Pediatric Association scoring chart. Socio-demographic characteristics, nutritional status, immunization status, and feeding practices of all the enrolled subjects were determined and analyzed. Results: Amongst 222 patients, 82(36.9%) were diagnosed with TB. Among these, 58 patients (70.7%) were severely malnourished, indicating that malnutrition may be a risk factor for TB. Among these, only 2.4% were breastfed. Lower rate of breast feeding was significantly (p<0.05) associated with greater occurrence of TB. Majority (63.4%) of TB cases started complimentary feeding late as compared to the recommended age (p<0.05). Other characteristics like family type, illiteracy, poverty and lack of immunization had insignificant association with increased risk of TB Conclusion: Malnutrition and inappropriate feeding practices increased the risk of developing Pulmonary Tuberculosis. [ABSTRACT FROM AUTHOR]

Objectives: To determine the gender, age distribution, and pattern of blood disorders on bone marrow aspirate examination. Material & Methods: This study was conducted at Bacha Khan Medical College Diagnostic Laboratory, Mardan, Pakistan from April 2013 to September 2015. All patients referred for bone marrow aspirations were included in this study. Patients with known history of bleeding disorders were excluded. Patients with inconclusive bone marrow report were dropped. The demographic variables included gender, age and pattern of the disorder on bone marrow aspirate examination. Data retrieved was analyzed by calculating percentage and frequencies. Results: Over a period of 30 months a total of 133 bone-marrow aspirations were performed. Out of these, 17(12.78%) cases were dropped (diluted marrow), 74 (55.64%) had non-malignant hematological disorders while 40 (30.07%) had hematological malignancies. Out of all 133 cases, 10 patients had single lineage cytopenia, 37 had bicytopenias while 47 presented with pancytopenia. Conclusion: Reactive marrow is the most common finding among non-malignant hematological disorders followed by megaloblastic anemia. Acute leukemia is the most common hematological malignancy. Bone marrow aspiration is very helpful in ascertaining the cause of the disease. [ABSTRACT FROM AUTHOR]

Objective: To determine the etiological pattern of pancytopenia in pediatric age group patients presenting to a tertiary care hospital at Peshawar. Material and Methods: This descriptive study was conducted from January 2016 to December 2017. During this twoyear duration, 100 pediatric patients with clinical diagnosis of pancytopenia were enrolled in the study fulfilling the inclusion and exclusion criteria. Non-probability consecutive sampling technique was used. A detailed clinical evaluation was done in all diagnosed cases of pancytopenia. Hematological profile included hemoglobin, red cell indices, total and differential leukocyte counts, platelet count, peripheral blood smear, bone marrow aspirate and trephine biopsy were carried out. Results: In this study 66% were male and 34% were female with male to female ratio of 1.94: 1. The mean age of patients enrolled was 07.173 years+3.7702 SD where 35% of all cases were in the age range of 01-05 years. Mean hemoglobin level was 6.631gm%+ 2.0273 mean total leucocyte count was 2910.21 (SD + 1399.452)X 103/µl, and platelet count was 57750.00 (SD + 40776.646) X103/µl. Majority of the patients (51%) had acute lymphoblastic leukemia, followed by aplastic aneamia(20%) and hypoplasia (12%). Conclusion: Acute lymphoblastic leukemia is the commonest cause of pancytopenia followed by aplastic aneamia and bone marrow hypoplasia as per this study findings. [ABSTRACT FROM AUTHOR]