VOL 11. Issue 3

Deranged Level of Liver and Renal Function Tests in Snake Bite Patients

Kumari Hina*, Muhammad Inam Khan, Muhammad Omer Sultan, Muhammad Ghufran, Anjli Tara, Mahnoor Jamal

Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

Abstract: Background: Snake venoms typically contain hemotoxic, nephrotoxic, and hepatotoxic components, resulting in systemic symptoms such as coagulopathy, compromised liver function, and acute renal failure.

Objective: To determine the frequency of abnormal liver function tests, and renal function tests, and their impact on clinical outcomes among patients presenting with snake bite.

Materials and Methods: This prospective cohort study was conducted at the Department of Medicine, National Poisoning Control Centre, Jinnah Postgraduate Medical Centre, Karachi, from 15th December 2025 to 30th April 2026 (No.F.2-81/2025-GENL/784/JPMC, dated: 13th December 2025. Renal dysfunction was assessed using KDIGO criteria, while abnormal liver function tests were defined as ALT >40 U/L, AST >40 U/L, or total bilirubin >1.2 mg/dL. Envenomation severity and final outcomes were documented during hospital stay.

Result: Among 98 snakebite patients, the median age was 33.0 years (IQR=25.0–42.0), 63 (64.3%) were males. Venomous bite was identified in 68 (69.4%) patients. Acute kidney injury (AKI) was identified in 19 (19.4%), abnormal liver function tests in 33 (33.7%), and combined renal and abnormal liver function tests in 14 (14.3%) patients. abnormal liver function tests was significantly associated with longer presentation time (p<0.001), venomous bite (p<0.001), swelling (p=0.001), vomiting (p<0.001), bleeding manifestations (p=0.001), oliguria (p<0.001), renal dysfunction (p<0.001), greater envenomation severity (p<0.001), longer hospital stay (p<0.001), and poorer outcome (p<0.001). Renal dysfunction was associated with longer presentation time (p<0.001), venomous bite in 19 (100%) vs 49 (62.0%) patients (p=0.001), swelling (p=0.017), vomiting (p<0.001), bleeding manifestations (p<0.001), oliguria (p<0.001), hepatic dysfunction (p<0.001), greater envenomation severity (p<0.001), longer hospital stay (p<0.001), and poorer outcome (p<0.001).

Conclusion: Liver, and renal dysfunction are frequent in admitted snakebite patients and are closely linked with delayed presentation, venomous bite, severe envenomation, and adverse hospital outcomes.

Keywords: Liver, Oliguria, Renal, Snakebite, Venomous.

doi.org/10.21089/njhs.113.0179

Received: July 17, 2026
Revised: August 17, 2026
Accepted: August 25, 2026

Association between Serum Vitamin D Status and Gingival Bleeding among School-Aged Children: A Cross-Sectional Study

Arooj ul Hassan^1,*, Asif Hanif², Muhammad Hassan³, Obaid Bajwa⁴, Muhammad Zaeem Ihsan¹

¹Department of Community and Preventive Dentistry, University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan.
²Department of Biostatistics, Faculty of Medicine Institute: Sakarya University, Sakarya-Türkiye.
³Department of Science of Dental Materials, University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan.
⁴Department of Periodontology, University College of Medicine and Dentistry, The University of Lahore, Lahore, Pakistan.

Abstract: Background: Vitamin D (VD) has immunomodulatory and anti-inflammatory effects that may influence the health of gingiva. Current pediatric evidence, however, remains limited, particularly in South Asia where deficiency is common.

Objective: To examine the association between serum vitamin D status and gingival inflammation, measured by bleeding on probing percentage (BOP%), among school-aged children in Lahore, Pakistan.

Materials and Methods: This comparative cross-sectional study was conducted from 1st Feb 2023 to April 30th 2024, after approval from the ERB of the University of Lahore (REC-UOL-/577/11/23), dated: 27th January 2023. Two hundred children aged 8 to 16 years were recruited using consecutive sampling and grouped by serum 25-hydroxyvitamin D [25(OH)D] as sufficient (30–100 ng/mL; n=100) or deficient (<30 ng/mL; n=100). BOP was recorded using a WHO probe at six sites per tooth for erupted permanent teeth; the primary outcome was BOP%. Group differences were evaluated using an independent samples t-test. A univariate general linear model assessed whether the association persisted after adjusting for covariates.

Results: BOP% was significantly lower in the VD sufficient group (22.25±1.16) than the deficient group (24.96±1.16), with a mean difference of -2.71 percentage points (95% CI: -3.03 to -2.38; p<0.001). In the adjusted model, VD status showed a strong association with BOP% (F=251.12, p<0.001; partial η²=0.567; adjusted R²=0.569).

Conclusion: VD deficiency was independently associated with increased gingival bleeding in school-aged children, suggesting VD status contributes to early gingival inflammatory burden in this population.

Keywords: Gingiva, Pediatrics, Micronutrients, Deficiency, Inflammation.

doi.org/10.21089/njhs.113.0187

Received: February 21, 2026
Revised: July 28, 2026
Accepted: August 08, 2026

A Prospective Evaluation of Modified Hand Injury Severity Score in Predicting Hand Function and Return to Work in Thresher Machine Hand Injuries

Hiba Khan1*, Faisal Akhlaq Ali Khan1, Asma Ishtiaq1, Saba Asif2, Ali Ekram1, Waqas Sami1

¹Department of Plastic & Reconstructive Surgery, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan.
²Department of Plastic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.

Abstract: Background: Agriculture-related is a cause of complex occupational injuries, particularly in settings where mechanical equipment such as thresher machines are used. Prediction of functionality status is necessary for patients’ counselling.

Objective: To evaluate the role of the modified hand injury severity score (mHISS) in predicting return to work following an injury from a thresher machine. The study also aimed to predict hand function in this cohort of patients.

Materials and Methods: A prospective longitudinal study was conducted at the Department of Plastic Surgery at Ruth Pfau Civil Hospital during 8th November 2024 to 25th February 2026 (Ref. No. IRB-3677DUHS/Approval/2024/343, dated: 6th November 2024). We used mHISS score to assess hand injury severity. Patients were assessed for their hand function (TAM) prior to returning to work. The outcomes were evaluated at the sixth month follow-up.

Result: Data from 110 patients were analyzed, whose mean age was 35.0 ±9.8 years. Median mHISS score was 35. The majority returned to work within 6 months (84.5%) with a median time of 50 days and TAM was 185. The mHISS was significantly associated with return to work (HR=0.98, 95% CI: 0.97-0.98) and TAM (β=-0.88, 95% CI: -0.99 –-0.77).

Conclusion: mHISS is a strong predictor of return to work, not only as it relates to time to return to work, but also relates to hand function at six months after the initial injury, as increasing mHISS indicating an extended time to return to work and a deterioration in hand function.

Keywords: Agricultural injury, Hand function, Hand trauma, Occupational injuries, Predictive scoring system.

doi.org/10.21089/njhs.113.0194

Received: July 01, 2026
Revised: August 12, 2026
Accepted: August 17, 2026

Pattern of Presentation and Outcomes of Pediatric Blunt Abdominal Trauma: A Cross-Sectional Single Centre Study

Zuha Zafar*, Batool Fatima, Muhammad Kashif Bashir, Muhammad Rehman Waheed, Syed Salman Hussain Zaidi, Mahwish Noor ul Haq

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

Abstract: Background: Blunt abdominal trauma (BAT) is a major reason of morbidity and mortality worldwide in pediatric age group. Injury patterns, mechanisms, and outcomes vary across regions, necessitating local data to guide management strategies.

Materials and Methods: This prospective descriptive cross sectional study was conducted in the Department of Pediatric Surgery, Mayo Hospital Lahore, from 1st December 2024 to 30th June 2025 (Ref. No. 764/RC/KEMU), dated: 20th November 2024. Children aged 0–13 years presenting with blunt abdominal trauma were included. Data regarding demographics, mechanism of injury, solid organ and hollow viscus injuries, management strategies, associated injuries, intensive care unit (ICU) admissions, blood transfusion requirements, length of hospital stay and outcomes were collected and analysis was done using SPSS version 26.

Result: Seventy-three patients were included in the study. The most affected age group was 6–9 years (54.8%), and males constituted 76.7% of the cohort. Falls were the leading mechanism of injury (57.5%), followed by road traffic accidents (37.0%). Liver injuries were the most common solid organ injury (39.7%), followed by splenic injuries (23.3%), renal injuries (13.7%) and hollow viscus injuries (8.2%). Blood transfusion was required in 53.4% of patients, while 42.5% required ICU admission. Non-operative management was successful in most patients, with only 15.1% requiring surgical intervention. The median hospital stay was 7 days. Overall recovery was achieved in 94.5% of patients, while mortality was 5.5%.

Conclusion: Pediatric blunt abdominal trauma predominantly affects school-aged boys. Fall was the most noted mechanism of injury in our setting. Most cases were successfully managed non-operatively, with favorable outcomes. Strengthening injury-prevention programs and ensuring timely multidisciplinary trauma care may further improve outcomes.

Keywords: Pediatric trauma, Abdominal trauma, Liver injury, Splenic injury, Non-operative management, Outcomes.

doi.org/10.21089/njhs.113.0201

Received: June 30, 2026
Revised: August 20, 2026
Accepted: August 20, 2026

Dermatological Manifestation in Malnourished Children under 5 Years of Age in a Tertiary Care Hospital

Romana Nisar*, Shabbir Ahmed Mallick, Faiqa Qureshi, Ameera Shabbir

Department of Pediatric Medicine, Liaquat National Hospital, Karachi, Pakistan.

Abstract: Background: The replenishment of macronutrients and micronutrients is essential for normal function of cutaneous tissues, making cutaneous manifestations a good indicator of nutritional status.

Objective: To evaluate dermatological manifestation in malnourished children under 5 years of age presenting in pediatric outpatient clinic in a tertiary care hospital.

Materials and Methods: This cross-sectional study was performed in Pediatric outpatient clinics at Liaquat National Hospital during 1st August 2024 to 1st August 2025 bearing IRB no App#1067-2024-LNH-ERC, dated: 24th July 2024. Children under five-years of age having malnutrition were included. Assessment of malnutrition was done using anthropometric measurements (weight and length/height) to calculate Z-scores using the WHO reference standards. A dermatological examination was carried out by a consultant dermatologist to evaluate skin manifestations. Recorded data included patients’ age, gender, WHO-z scores, term status, feeding type, immunization status, monthly income, maternal education and dermatological complaints.

Result: A total of 196 patients were studied with an average age of 27.3 ± 11.6 months. The acute malnutrition based on WHZ-Score demonstrated that 54.1% children having moderate acute malnutrition and 45.9% children having severe acute malnutrition. The most frequent manifestation was angular cheilitis (89.8%) followed by lusterless hair (84.7%) and xeroderma (82.1%), pigmentary change (66.8%) of patients, lost subcutaneous fat 63.8%), and excessive lanugo lashes (25.5%), ichthyosis skin changes and lichenoid skin changes (9.2%).

Conclusion: This study shows that malnourished children exhibit cutaneous and adnexal related disorders. Regardless of clinical spectrum, these dermatological manifestations frequently seen in malnourished children with angular cheilitis, lusterless hairs and xeroderma being the most common features.

Keyword: Severe Acute Malnutrition, Child Nutrition Disorders, Skin Diseases, Cheilitis, Child, Preschool, Xerodermia, Ichthyotic, Ichenoid.

doi.org/10.21089/njhs.113.0208
 

Received: July 14, 2026
Revised: August 19, 2026
Accepted: August 20, 2026

Linezolid resistant Enterococci: An Emerging Threat to Infection Control

Sana Anwar^1,*, Uzma Saad¹, Sana Muslim¹, Shaheen Sharafat², Fizza Faisal³

¹Department of Microbiology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
²Department of Pathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
³Ziauddin Hospital, Karachi, Pakistan.

Abstract: Background: Enterococci cause healthcare-associated infections and can develop resistance to multiple antimicrobial agents. Linezolid is used to treat infections caused by multidrug-resistant and Vancomycin-resistant Enterococci. However, the emergence of linezolid-resistant Enterococci limits treatment options and complicates infection control and antimicrobial stewardship.

Objective: This study evaluated the prevalence of Linezolid resistant Enterococci isolated from various clinical samples at a tertiary care hospital in Karachi.

Materials and Methods: A retrospective analysis was conducted in the Microbiology laboratory of Liaquat National Hospital from 1^st September 2021 – 31^st December 2023 after taking approval from the Institutional Review Board & Ethical Review Committee (Ref: 1026-2024-LNH-ERC), dated: 04-04-2024. The study determined the prevalence of Linezolid resistant Enterococci in clinical samples. All consecutive samples from which Linezolid resistant Enterococci were isolated were included in the study. Duplicate samples from the same patient were excluded. Identification of the isolates was performed using standard Microbiological techniques. Antibiotic susceptibility testing used the Kirby–Bauer disk diffusion method, on Muller- Hinton agar (MHA) and Minimum inhibitory concentration (MIC) on Vitek 2 system. Susceptibilities were interpreted according to recommended CLSI (Clinical and Laboratory Standards institute) guidelines, M100, 32nd edition.

Result: During the study period a total of 2891 Enterococcus species were isolated from various clinical samples. Out of these twenty-four-linezolid resistant Enterococcus faceium were isolated from fourteen male and ten female patients. Majority of the isolates were from urinary samples (n= 14), followed by blood (n=6), Pus (n=2) and one each from tissue and pleural fluid. In addition to being resistant to Linezolid all the isolates were also resistant to Vancomycin (VRE), Ampicillin, Amoxicillin + Clavulanate. The urinary isolates although being resistant to Linezolid and Vancomycin showed good sensitivity to Nitrofurantoin and Fosfomycin  (85.7 % ,12 out of 14 were sensitive).

Conclusion: The emergence of linezolid – resistant Enterococci in clinical samples presents a significant threat to public health. Understanding the local burden is critical for guiding effective infection control and antibiotic stewardship strategies to preserve the efficacy of this vital therapeutic agent.

Keywords: Enterococcus species, Linezolid, Vancomycin resistance, Antimicrobial resistance, Nosocomial.

doi.org/10.21089/njhs.113.0216

Received: May 04, 2026
Revised: August 21, 2026
Accepted: August 30, 2026

Comparison of Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy with and without Transversus Abdominis Plane (TAP) Block: A Prospective Comparative Study

Sarah Rauf*, Asif Qureshi, Yabinda Sahrish, Muhammad Sajid Naseem Khan

Department of Surgery, Liaquat College of Medicine & Dentistry, Karachi, Pakistan.
 

Abstract: Background: Effective pain management in early postoperative period improves outcomes. TAP block is an adjunctive procedure for postoperative analgesia.

Objective: To compare the outcomes of TAP vs Non-TAP Block in patients undergoing laparoscopic cholecystectomy.

Materials and Methods: It is a prospective observational comparative cohort study of two patient groups undergoing laparoscopic cholecystectomy. The study was conducted at the Department of Surgery, Liaquat College of Medicine & Dentistry, Karachi, from 5th August 2025 to 4th February 2026, after the approval from institutional review board (Ref. No. IRB/M-000133-25), dated: 4th August 2025. The sample size was calculated using a power analysis for comparing two independent means (TAP Block vs. Non-TAP Block). Inclusion criteria had patients aged 18–60 years & exclusion criteria consisted of patients with acute cholecystitis, empyema, perforated gall bladder ASA of ≥ 3.  All the LC were performed by same surgeon. Patients’ postoperative pain was

Results: The mean age among patients in this study was 46.15 ± 8.92 years.73.3% patients were female while 26.7% patients were male. The groups showed similar outcomes like age, gender distribution, duration of symptoms and BMI. Mean VAS score in TAP block group 12 hours after surgery was 2.80 ± 1.54 while in non-TAP block group was 6.13 ± 1.73 (p < 0.0001). Mean time rescue analgesia in TAP block group was 13.92 ± 6.74 hours vs non-TAP block group was 4.77 ± 2.79 hours (p < 0.0001).

Conclusion: The study concludes that administration of TAP block following LC is associated with significantly reduced postoperative VAS Scores and prolonged time to rescue analgesia.

Keywords: Laparoscopic Cholecystectomy, Post-operative pain, TAP block, Gallbladder, Post-operative opioid consumption, Visual analog scale, ERAS.

doi.org/10.21089/njhs.113.0222

Received: February 25, 2026
Revised: August 30, 2026
Accepted: September 06, 2026

Obesity Profile among Doctors in a Tertiary Care Hospital of Karachi, Pakistan

Samar Abbas^*,1, Tooba Sardar², Vijay Kumar³, Syeda Rida e Zehra⁴

¹Department of Internal Medicine, National Medical Centre, Karachi, Pakistan.
²Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan.
³Department of Internal Medicine, Ziauddin University and Hospital, Karachi, Pakistan.
⁴Department of Rheumatology, Liaquat National Hospital and Medical College, Karachi, Pakistan.

Abstract: Background: Obesity increases the risk of non-communicable diseases worldwide. Obesity also affects populations in Pakistan, and South Asian populations can develop cardiometabolic risk at lower body mass index levels. Young doctors face several challenges which can lead to weight gain. However, local data on obesity among young doctors remain limited.

Objective: To determine the profile of obesity and explore associated factors among doctors in a tertiary care hospital of Karachi, Pakistan.

Materials and Methods: This cross-sectional study was conducted at National Medical Centre, Karachi, Pakistan, from 16th January 2026 to 31st March 2026. Ethical approval was obtained from the institutional ethical review committee (ERC Number: 005/2026 NMC, dated: 15th January, 2026) before commencement of the study. Doctors were recruited through non-probability consecutive sampling. Height and weight were measured and BMI was classified using Asian BMI criteria. Of 142 participants initially enrolled, 99 remained in the final cleaned analytic cohort after exclusion of incomplete records. Categorical comparisons, logistic regression, false discovery rate adjustment, and Firth penalized logistic regression were used as appropriate.

Results: Among 99 participants, 63 (63.6%) were females. The median BMI was 23.1 kg/m² (IQR 20.6-27.7), while 38 (38.4%) participants were obese and 54 (54.5%) were overweight or obese. In comparisons between normal-weight and obese participants, irregular eating was significantly more common among obese participants (50.0% vs. 25.0%, p=0.039), and immediate family history of obesity was also significantly more frequent (44.7% vs. 17.5%, p=0.009). Previous obesity diagnosis, self-perception of being overweight, current weight-loss attempts, and dietary modification were more frequent among obese participants. In univariable logistic regression, male sex, married status, and immediate family history of obesity showed nominal associations, although none remained significant after false discovery rate correction. In multivariable analysis, male sex remained independently associated with obesity (aOR 3.29, 95% CI 1.27-8.83, p=0.015).

Conclusion: Obesity and excess weight were common among young doctors in this hospital. Male sex was the only statistically significant independent factor associated with obesity in the final multivariable model, while family history showed a clinically important but borderline association. This stresses the importance of conducting larger studies to better understand the factors leading to obesity in this population.

Keywords: Body mass index, Obesity, Physicians, Lifestyle, Stress.

doi.org/10.21089/njhs.113.0228

Received: August 21, 2026