VOL 10. Issue 4

Association of E-Cigarette Use and Oral Health Complications: A Cross Sectional Study in Punjab, Pakistan

Muhammad Taaha¹, Naila Umer², Hafiz Danish Altaf³, Rabia Anjum⁴, Hammad Hassan⁵,Safi Ullah Khan⁶

¹Department of Science of Dental Materials, Azra Naheed Dental College, Superior University, Lahore, Pakistan.
²Department of Oral Pathology, Azra Naheed Dental College, Superior University, Lahore, Pakistan.
³Department of Prosthodontics, University College of Dentistry, University of Lahore, Lahore, Pakistan.
⁴Department of Oral Pathology, University of Health Sciences, Lahore, Pakistan.
⁵Department of Science of Dental Materials, Azra Naheed Dental College, Superior University, Lahore, Pakistan.
⁶Department of Oral Biology, Azra Naheed Dental College, Superior University, Lahore, Pakistan.

Abstract: Background: E-cigarettes, an alternative to regular cigarettes, can cause oral health issues due to their chemical composition.

Objective: To assess the occurrence oral health complications among users of e-cigarette and association with the duration of use and nicotine concentration in e-cigarette; and to identify predictors of oral health complications.

Materials and Methods: This cross-sectional study was done after the IRB approval (Ref: 20/RE, Dated 19th February 2024) from Faryal Dental College, from 26th February 2024 to 20th June 2025, on a sample of 385 e-cigarette users who were aged 18 years or above. The data was collected through an interview administered survey tool, and the oral checkup. The data was analyzed and using SPSSv20, the Chi-square test was used for associations and logistic regression analysis determined predictors of oral complications.

Result: Out of 385, 189 (49.1%) were males and 195 (50.9%) were females. The mean age of the participants was 26.8±6.2years. Mucosal ulceration was present in 154 (40%), pigmentation of lips in 175 (45.5%), and caries in 213 (55.3%) participants. The oral conditions like ulcers, lip pigmentation and gingivitis (p<0.001) was significantly associated with longer duration of e-cigarettes usage. A higher nicotine use was related to ulceration of mucosa and caries (p<0.05). The age (p<0.001), extent of use (p<0.001), and nicotine concentration (p=0.004) were predictors of poor oral health.

Conclusion: The use of e-cigarettes is significantly related to ulceration of mucosa, caries, and gingivitis. The duration of use and concentration of nicotine are key aggravating factors in females and younger participants. Public health interventions should be encouraged for e-cigarette users.

Keywords: Dental caries, Electronic cigarettes, Nicotine, Oral health, Ulceration of mucosa, Gingivitis.

Received: June 26, 2025
Revised: October 26, 2025
Accepted: October 29, 2025

doi.org/10.21089/njhs.104.0222

Is Obesity Associated with a Higher Risk of Differentiated Thyroid Cancer in a Cytologically Proven Series of Thyroid Nodules?

Irfan Ahmed Shaikh, Danish Ur Rehman, Sidra Bano, Rajesh Kumar, Ramsha Khalid, Raheem Bakhsh

Department of ENT-Head & Neck Surgery, Dr. Ruth K. M. Pfau Civil Hospital, DUHS, Karachi, Pakistan.

Abstract: Background: Obesity and thyroid nodules have increased in frequency globally in recent years. Researchers are still exploring the complex relationship between obesity and cancer risk.

Objective: To determine the association between obesity with differentiated thyroid cancer (DTC) in patients presenting with thyroid nodules.

Materials and Methods: This cross-sectional study was performed in outpatient clinics of ENT department of Ruth K.M. Civil Pfau Hospital Karachi during 1st April, 2025 till 15th July, 2025. Thyroid ultrasound was performed by an experienced radiologist to confirm the presence of nodules, and patients meeting the criteria proceeded to cytological evaluation. The Bethesda classification was used to interpret Fine Needle Aspiration Cytology (FNAC) findings. Bethesda V and VI were interpreted as suspicious for malignancy and malignancy respectively.

Result: The number of studied patients were 314. Mean age was 43.6 ± 11.4 years. 69.7% of people were overweight or obese. 22.9% of cases fell under Bethesda categories 5 or 6. On univariate analysis, risk of Bethesda 5/6 finding was significantly lower in patients who were having normal weight and overweight as compared to obese patients. On multivariable analysis, risk Bethesda 5/6 finding was lower in overweight patients than obese patients but there no significance of lower risk in patients with normal body mass index (BMI) levels than obese patients.

Conclusion: While obesity was found to have a greater risk of differentiated thyroid cancer in univariate analysis, this was not consistently significant in all BMI categories in multivariable analysis. Therefore, the current study did not demonstrate a clear association of BMI and DTC cancer.

Keywords: Body mass index, Obesity, Thyroid nodules, Differentiated thyroid cancer, Fine needle aspiration cytology, Follicular neoplasm.

Received: July 14, 2025
Revised: October 19, 2025
Accepted: November 04, 2025

doi.org/10.21089/njhs.104.0230

Diagnostic Accuracy of Ultrasound in Detecting Axillary Lymph Nodes in Patients with Early Breast Cancer Taking Histopathology as a Gold Standard

Ambreen Shaikh, Saleha Anwar, Hasnain Ali, Raisa Altaf Malik, Humaira Erum, Bisma Rizwan

Department of Diagnostic Radiology, Liaquat National Hospital Karachi, Pakistan.

Abstract: Background: Axillary Ultrasound plays an essential role in assessment of axillary lymph nodes metastasis in early breast cancer. It is considered as important prognostic factor in the recurrence of the disease and survival of the patient.

Objective: The study was aimed to determine ultrasonography’s diagnostic accuracy taking histopathology as a Gold Standard in finding axillary lymph nodes in early CA breast patients.

Materials and Methods: Study was designed as cross-sectional, conducted at Department of radiology, Liaquat National Postgraduate Medical Center, Karachi. The sample size calculated for the study was 271. Patients of age between 18-65 years were included in the study. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated.

Result: The mean age of the participants was 46.28 ± 9.76 years. The age range from 25 years to 78 years. The study has yield a sensitivity of 76.9% whereas specificity was reported 68.2%. The overall diagnostic accuracy of AUS was observed as 74%. A positive predictive value and negative predictive value was 88.8% and 52.7% respectively.

Conclusion: The findings of this study provides information related to the diagnostic accuracy of AUS as a detection tool for early breast cancer. The findings of this study are consistent with the existing literature showing high sensitivity and accuracy of the tool pointing out that AUS can serve as a reliable means of identification of patients who have axillary metastasis.

Keywords: Axillary ultrasound, Histopathology of breast cancer, Diagnostic tools, Axillary lymph nodes, Metastasis, Human Papilloma Virus.

Received: September 01, 2025
Revised: November 11, 2025
Accepted: November 13, 2025

doi.org/10.21089/njhs.104.0238

Role of Heparin to Prevent Hypertrophic Scarring in Donor Area of Split Thickness Skin Graft

Asma Ishtiaq, Faisal Akhlaq Ali Khan, Farhan Zahid, Iqra Muhammad Tasleem, Asra Zahid, Nasreen Bano Khatri

Department of Plastic & Reconstructive Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan.

Abstract: Background: It is normal to experience hypertrophic scarring after skin harvesting at donor site. Topical heparin treatment has been suggested to have particular significance in the treatment of hypertrophic scars.

Objective: to determine the effect of topical heparin for prevention of hypertrophic scars and pain status following split thickness skin graft donor site.

Materials and Methods: This open label randomized control trial (NCT07196358) was performed at Plastic & Reconstructive Surgery Department, Ruth K.M. Pfau Civil Hospital, Dow University of Health Sciences during 1st August, 2024 to 31st July, 2025. Group H was assigned to heparin group whereas Group C was assigned to control group. Study outcomes included pain status, additional postoperative analgesic requirement and hypertrophic scarring. Patients were assessed at 14 days, 4 weeks, 6 weeks, 2 months and 3 months following the procedure.

Result: A total 50 patients were studied in each group. Post-operative analgesic consumption was significantly lower in patients managed with heparin than control group (p<0.001). Throughout the study period pain was significantly lower in heparin group than control group. At second month and third month, occurrence of hypertrophic scarring frequency was significantly higher in control group than heparin group. The mean VSS score was significantly lower in heparin group than control group.

Conclusion: The findings suggests that heparin was found to be superior in comparison to the conventional approach of sterile paraffin dressing soaked with normal saline in terms of pain control and prevention of hypertrophic scarring.

Keywords: Donor site, Hypertrophic scarring, Heparin, Numeric rating scale, Vancouver scar scale, Split thickness skin graft.

Received: October  31, 2025
Revised: November 18, 2025
Accepted: November 24, 2025

doi.org/10.21089/njhs.104.0244

Outcomes of Intestinal Anastomosis with or without Platelet Rich Plasma Application

Syeda Wajiha Mustafa, Malik Asad Munir, Atika Tahir, Batool Fatima, Muhammad Azam Mirza, Muhammad Kashif Bashir

Department of Pediatric Surgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan.

Abstract: Background: Intestinal anastomotic leakage remains a significant clinical challenge. PRP has gained increasing attention in recent years due to its potential therapeutic benefits in various medical applications.

Objective: To evaluate the effect of PRP application on outcomes of intestinal anastomosis among pediatric patients in a tertiary care hospital.

Materials and Methods: This prospective cohort study was performed at Department of Pediatric Surgery, Mayo Hospital, Lahore, Pakistan, during 1st December 2024 to 30th September 2025, after obtaining ethical approval bearing number 841/RC/KEMU. After through assessment of underlying pathology intraoperatively, the surgeon decided either for conventional approach or PRP. Group P received PRP was administered between the two layers of the anastomosis whole Group C did not receive PRP application.

Result: A total of 160 patients were studied with equal allocation in both of the cohorts (i.e. 80 in each cohort). Anastomosis time was significantly higher in Group P than Group C (35 versus 30, p<0.001). Anastomosis leakage (5% versus 15%, p=0.261) and adhesion related obstruction (7.5% versus 15%, p=0.480), duration of nasogastric tube (4.7±1.1 versus 5.2±1.9, p=0.090), length of hospital stay (13.1±3.4 versus 14.5±2.7, p=0.070) were lower in Group P than Group C but it did not reach statistical significance.

Conclusion: The findings of the present study suggested a consistent trend towards better outcomes in the PRP group than control group in terms of anastomosis specific outcomes including anastomotic leakage and adhesions related obstruction and recovery parameters including shorter duration of nasogastric tube and length of hospital stay. The findings should be verified in a large scale, multicenter study for establishing the superiority of PRP than conventional approach.

Keywords: Anastomosis leakage, Intestinal anastomosis, Platelet-rich plasma therapy, Pediatric surgery, Hyperthermia, Inflammatory disease.

Received: November 06, 2025
Revised: November 24, 2025
Accepted: November 30, 2025

doi.org/10.21089/njhs.104.0251

Risk Assessment of Venous Thromboembolism in Pregnancy and Adequate Prophylaxis: An Observational Study

Aliya Nasim¹, Sagheera Anjum Manaver², Naima Shah³, Humaira Tahir⁴, Mehvish Kanval¹

¹Department of Obstetrics & Gynecology, Liaquat College of Medicine and Dentistry, Karachi, Pakistan.
²Department of Obstetrics & Gynecology, Fazaia Ruth Pfau Medical College, Karachi, Pakistan.
³Department of Obstetrics & Gynecology, Darul Sehat Hospital, Karachi, Pakistan.
⁴SESSI Landhi Hospital and Liaquat College of Medicine and Dentistry, Karachi, Pakistan.

Abstract: Background: Globally, Venous Thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a major cause of maternal morbidity and mortality. A hypercoagulable state is brought on by pregnancy, and risk is further increased by obesity, cesarean sections, and thrombophilia.

Objective: The purpose of this study was to determine the risk factors for VTE in pregnant women and the effectiveness of thromboprophylaxis in accordance with the recommendations of the Royal College of Obstetricians and Gynecologists (RCOG)

Materials and Methods: A prospective observational study was conducted over nine month period started from November 20, 2023 to August 20, 2024 in the Department of Obstetrics and Gynaecology, LCMD/DSH Hospital, Karachi. Non-probability convenience sampling was used to recruit 246 first-trimester pregnant women. Each participant was given a VTE risk score using the RCOG method after clinical, obstetric, and demographic information was gathered. To find predictors of prophylactic use, chi-square and logistic regression tests were used in statistical analyses

Result: The mean age of participants was 28.9 ± 5 years. Cesarean section was the most frequent mode of delivery (69.8%), and obesity (BMI > 30 kg/m²) was present in 13.2%. Based on RCOG scoring, 34.3% were high-risk, 44.9% moderate-risk, and 20.4% low-risk for VTE. Only 28.2% received thromboprophylaxis. Obesity (OR = 6.56; p < 0.001), high-risk score (OR = 8.41; p < 0.001), and cesarean delivery (OR = 2.58; p = 0.01) were significant predictors of prophylaxis use.

Conclusion: A substantial proportion of pregnant women were at moderate to high risk for VTE, yet prophylaxis use was suboptimal. Incorporating structured RCOG-based risk assessment and improving adherence to thromboprophylaxis guidelines could significantly reduce VTE-related maternal morbidity and mortality.

Keywords: Venous thromboembolism, Pregnancy, Thromboprophylaxis, Risk assessment, Cesarean section, Obesity.

Received: November 07, 2025
Revised: December 03, 2025
Accepted: December 03, 2025

doi.org/10.21089/njhs.104.0258

Experience in Pediatric Bleeding Disorders in Tertiary Care Health Services from Southern Region of Saudi Arabia: Single Center Retrospective Study

Badriah Gharamah Al Asmari¹, Ali Mujtaba Tahir¹, Mohammed Alpakra¹,  Mohaned Mustafa

Ahmed Mohammad¹, Sara Saeed Mahamoud Hassanien¹, Mahnoor Saeed², Manea Abdullah Alqarni³, Sami Saleh Alamri³

¹Pediatric Department, Armed Forces Hospital Southern Region, Khamis Mushait, KSA.
²Pediatric Department, Azra Naheed Medical College, Lahore, Pakistan.
³Department of Pathology, Armed Forces Hospital Southern Region, Khamis Mushait, KSA.

 Abstract: Background: Bleeding disorders are commonly encountered in clinical practice worldwide. In Saudi Arabia, such disorders are witnessed as a notable entity in clinical practice. They encompass a variable group of disorders – categorized into acquired and congenital. Notable among them are hemophilia, von Willebrand disease (vWD), platelet-function defects, clotting factor deficiencies and immune thrombocytopenia (ITP).

Objective: To describe the various bleeding disorders among Pediatric population and its related clinical features, diagnostics and management modalities adhered to.

Materials and Methods: Retrospective cross-sectional study was carried out in Pediatric Medicine Department, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushait, Kingdom of Saudi Arabia. The data was gathered for last five years – 1st May 2020 to 30th April 2025, as pediatric patients were included who were diagnosed with a bleeding disorder while aged up till fourteen years. Pertinent details subject to relevant history, clinical course and laboratory investigations like blood indices, prothrombin time (PT), activated partial thromboplastin time (PTTK) and accordingly relevant investigations notably factor assay and platelet-function tests were recorded.

Result: During the last five years, 205 patients were evaluated by Pediatric Hematology team in regards to suspicion for a bleeding disorder. Out of these, 21% cases (44 patients) were confirmed with a definite bleeding disorder. Among these 44 patients, 24 (54%) patients being male and 20 (46%) female, all with Saudi ethnicity with their average age of 8 years 4 months. They were diagnosed with a bleeding disorder at average age of 4 years 10 months. 18 (41%) were having an acquired disorder while 26 (59%) were diagnosed with congenital disorder. Chronic ITP was observed in 9 cases while 5 cases were witnessed for each of acute ITP, vWD and factor VII deficiency. The most frequent presenting symptom was petechiae (25% patients) followed by epistaxis in 16% and ecchymosis in 11%, with no significant variation observed in congenital vs acquired disorders. Each patient had an average of one admission during the course of the disease. Thrombocytopenia was the most common laboratory abnormality identified (52% cases). This was followed by abnormal clotting factor levels (27% patients), raised PTTK in 25% and high INR in 14%. Furthermore, WES (whole exome sequencing) was performed in selected cases and genetic mutations were found in 41%. IVIG (intravenous immunoglobulin) was the most common intervention adopted.

Conclusion: We were able to identify a specific bleeding disorder in 21% of cases who were worked up for a suspected bleeding disorder. Among the pediatric population from southern region of Saudi Arabia, chronic ITP was most frequent (20%), followed by 11% cases each for acute ITP, vWD and factor VII deficiency. Awareness strategies aimed towards bleeding disorders accompanied by swift diagnosis, appropriate therapeutics and genetic counseling is indispensable in averting morbidity.

Keywords: Bleeding disorders, Clotting factor, Coagulation profile, Hemophilia, Platelets, von Willebrand disease.

Received: July 08, 2025
Revised: October 27, 2025
Accepted: October 27, 2025

doi.org/10.21089/njhs.104.0264

Prevalence of Depression and Anxiety in Patients with Obstructive Lung Disease and Correlation with Spirometry

Ehab Nabeel¹, Sohail Akhtar¹, Ahmed Ali¹, Syed Wajahat Hussain², Mujahid Hussain¹

¹Department of Pulmonology, Indus Hospital and Health Network, Karachi, Pakistan.
²Department of Research Innovation & Commercialization, Indus Hospital and Health Network, Karachi, Pakistan.

Abstract: Background: Occurrence of respiratory symptoms with everyday life, including simple home chores or even walking, causing depression and anxiety. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic lung diseases in Pakistan. However, local literature is scarce regarding depression and anxiety prevalence.

Objective: To determine depression and anxiety prevalence in obstructive lung diseases, including asthma and COPD, and explore its correlation with spirometry.

Materials and Methods: This cross-sectional study was conducted at the outpatient clinics of Pulmonology, Indus Hospital & Health Network Karachi, from January 2025 to May 2025. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety, respectively. Spirometry evaluation included forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio.

Result: A total of 118 participants were included with a mean age of 50.6 ± 6.8 years. Most of the patients were females (54.4%). Asthma and COPD were seen in 64.4% and 35.6%, respectively. Prevalence of depression and anxiety in COPD patients was 90.5% and 62%, respectively. While the prevalence of depression and anxiety in asthma patients was 85.5% and 59%, respectively. Asthma and COPD patients did not differ on the basis of depression and anxiety prevalence. For asthma patients, there was no significant correlation of depression and anxiety score with lung function. For the COPD cohort, no significant correlation was found between lung function and anxiety score. In COPD patients, a significant weak negative correlation was seen for depression score and FEV1% (r=-0.319, p=0.040), FVC (r=-0.411, p=0.007), and FEV1/FVC ratio (r=-0.345, p=0.025).

Conclusion: Anxiety and depression are common in people with obstructive lung disease who also have asthma or COPD. This result emphasizes the necessity of routinely screening for anxiety and depression in order to alleviate the psychological burden among patients with COPD and asthma. Furthermore, a strong inverse link between depression and lung function measures highlights the need for continuous treatment plans to take psychological factors into account in order to enhance COPD therapy.

Keywords: Asthma, Anxiety, Chronic obstructive lung disease, Depression, Mental Health, Pulmonary disease.

Received: September 26, 2025
Revised: November 19, 2025
Accepted: December 08, 2025

doi.org/10.21089/njhs.104.0271

In-Hospital Outcomes of Early Extubation in Post CABG Patients: A Retrospective Study from a Tertiary Care Hospital in Karachi, Pakistan

Qaiser Aziz Khan¹, Latifa Haidari¹, Imran Khan Sandeelo², Marium Nastaeen Sarhandi¹, Sarib Bin Yasir¹, Mariam Amir¹

¹Department of Cardiac Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
²Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan.

Abstract: Background: The Society of Thoracic Surgeons established extubation within six hours of surgery as a standard quality of care supported by clear national registry information on positive effects. This is evident that clinical profile of patients undergoing coronary artery bypass grafting (CABG) is changing over the time and there is paucity of such data from Pakistan.

Objective: To determine in-hospital outcomes of early extubation among CABG patients in a tertiary care hospital.

Materials and Methods: This retrospective chart review was performed by Cardiac Surgery Department at Liaquat National Hospital during March to August, 2025. Data was retrospectively retrieved and reviewed for year 2023 and 2024. Early extubation was defined as extubation within six hours of surgery. Data was retrieved for patients’ demographics, clinical features and in-hospital outcomes from patients’ medical record files.

Result: A total of 206 records were reviewed. Mean age of patients was 58.8 ± 8.5 years. Early extubation was seen in 36.4% patients. Intubation time (hours) (5.3 ± 0.3 versus 9.8 ± 3.7, p<0.001), ICU stay (days) (26.8 ± 1.8 versus 35.7 ± 6.9, p<0.001) and overall hospital stay (days) (6.5 ± 0.5 versus 7.4 ± 0.5, p<0.001) were significantly lower among patients who underwent early extubation. Reintubation rate (1.3% versus 3.8%, p=0.420), respiratory complication rate (2.7% versus 8.4%, p=0.140) and death rate (2.3% versus 5.3%, p=0.260) were not significantly different among early and late extubated patients.

Conclusion: The findings of the present study support that the practice of early extubation was safe and beneficial in post CABG patients with lower ICU days and overall hospital stay in contrast to the patients with prolonged intubation.

Keywords: Cardiac surgery, Coronary artery bypass grafting, Fast-track cardiac care, Intubation, Extubation, Anesthesia.

Received: October 01, 2025
Revised: November 27, 2025
Accepted: November 30, 2025

doi.org/10.21089/njhs.104.0279

Knowledge, Attitudes & Perceptions towards Premenstrual Syndrome among Low Socioeconomic School-Going Adolescent Girls in Karachi, Pakistan

Shaikh Ali Masood¹, Shabbir Ahmed Mallick¹, Hamna Jamal², Maria Murtaza¹, Manahil Nadeem¹, Ameera Shabbir³

¹Department of Pediatric Medicine, Liaquat National Hospital & Medical College, Karachi, Pakistan.
²Department of Pharmacology, Liaquat National Hospital & Medical College, Karachi, Pakistan.
³Department of Child Health Department, Aga Khan University Hospital, Karachi, Pakistan.

Abstract: Background: A girl’s reaction to menstruation is determined by their knowledge and understanding of the process. Education about menstruation and associated changes may influence their experience of menarche.

Objective: To assess knowledge, attitudes & perceptions towards premenstrual syndrome (PMS) among adolescent girls in Karachi, Pakistan.

Materials and Methods: This is a descriptive cross-sectional study which was conducted by Pediatric Department, Liaquat National Hospital and Medical College, Karachi, from January 2024 to April 2024. Adolescent girls between the age of 12 and 19 years, attending schools in low socioeconomic regions of Karachi, and having undergone menarche were eligible for inclusion in the study. Structured, self-developed questionnaire was employed as the main data collection instrument for this study.

Result: A total of 384 school-aged adolescent girls participated in the study (mean age 14.36±1.68 years). Among them, 68.8% were aware of PMS, 35.2% associated symptoms with premenstrual, and 36.4% thought PMS is curable. Almost 45.1% considered it a health issue of serious concern. Around 63% perceived PMS as normal, 53% preferred open talking, 59% agreed on seeking medical attention, and 56% supported menstrual leave in the workplace.

Conclusion: The findings of this study identify significant gaps in knowledge and ambivalent opinions regarding PMS among low socioeconomic school-going adolescent girls in Karachi. Although numerous acknowledge PMS as a legitimate health condition, myths and stigmatization persist. Targeted school-based education on menstrual health is vital for enhancing awareness and empowering adolescent girls to better manage symptoms.

Keywords: Premenstrual syndrome, Gynecological illness, Breast tenderness, Fatigue, Restlessness, Mood swings, Crying spells.

Received: September 09, 2025
Revised: November 11, 2025
Accepted: December 08, 2025

doi.org/10.21089/njhs.104.0285

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Timing of Surgical Intervention and its Impact on Short-term Outcomes in Pediatric Hydrocephalus

Shakeel Ahmed¹, Shoaib Saleem Khan², Syed Zahid Hussain Shah³, Muhammad Ali Waqas¹, Ubaid Ullah⁴, Zeeshan Karim⁴

¹Department of Pediatric Neurosurgery, The Children’s Hospital and Institute of Child Health, Multan, Pakistan.
²Department of Neurosurgery, Ibne Sienna Hospital and Research Institute, Multan, Pakistan.
³Department of Neurosurgery, Tertiary Care Hospital Nishtar-II, Multan, Pakistan.
⁴Department of Neurology, Ibne Sienna Hospital and Research Institute, Multan, Pakistan.

Abstract: Background: Hydrocephalus is a common pediatric neurosurgical condition. Timely surgical intervention is critical to prevent permanent neurological damage. Available research highlights the importance of optimal surgical timing. However, global data is limited, and local populations remain understudied.

Objective: To determine the impact of timing of surgical intervention on short-term postoperative outcomes in pediatric patients with hydrocephalus.

Materials and Methods: This retrospective observational study was conducted at the Pediatric Neurosurgery Department of the Children’s Hospital and the Institute of Child Health, Multan, from January 2024 to March 2025. From the hospital record, data of 83 children aged 1 month to 12 years diagnosed with hydrocephalus and who underwent surgical intervention were analyzed using non-probability consecutive sampling. Children were categorized into early (≤7 days) and delayed (>7 days) intervention groups based on timing from diagnosis to surgery. Short-term outcomes like post-intervention complications, length of hospital stay, readmission, and mortality, were evaluated. Data analysis was performed using SPSS version 26.0. Descriptive and inferential statistics were applied, taking p<0.05 as statistically significant.

Result: Of the 87 patients, 48 (55.2%) were female. The median age was 5.42 (IQR: 3.00–8.67) years. Early intervention was performed in 47 (54.0%) and delayed in 40 (46.0%) patients. Enlarged head (46.8% vs. 25.0%, p=0.036) and poor feeding (55.3% vs. 32.5%, p=0.033) were more common in early group, while seizures were more prevalent in delayed group (6.4% vs. 25.0%, p=0.015). Median hospital stay was significantly shorter in early group (5.00 vs. 8.00 days, p<0.001). Readmission was significantly lower in early group (4.3% vs. 17.5%, p=0.043). Although shunt malfunction, infection, and day-30 mortality were lower in early group, differences were not statistically significant.

Conclusion: Early surgical intervention in pediatric hydrocephalus was significantly associated with shorter hospitalization and relatively lower early readmission rates, and potentially associated with fewer complications and mortality.

Keywords: Children, hydrocephalus, mortality, readmission, seizures, Etiology.

Received: September 29, 2025
Revised: November 25, 2025
Accepted: December 01, 2025

doi.org/10.21089/njhs.104.0292