Journal of the Dow University of Health Sciences (JDUHS)

Correlation of Oxford Classification Score with Early Response to Treatment in IgA Nephropathy: A Cross-Sectional Study

2025-02-10T00:29:52-07:00

Objective: To evaluate the correlation between the Oxford classification score and early response to treatment in Immunoglobulin A nephropathy (IgAN) in a single-center study in northern Pakistan.
Methods: This cross-sectional study was conducted at the Department of Nephrology, Shifa International Hospital, Islamabad, from July 2024 to January 2025. Patients aged 18 to 65 years with biopsy-proven primary IgAN were included. Baseline demographic, clinical, and laboratory data, including serum creatinine, eGFR, and proteinuria, were recorded. Renal biopsies were assessed using Oxford classification, evaluating mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C). Early treatment response was defined as a ≥50% reduction in proteinuria after three months.
Results: Of total 30 patients, the median age was 30.5 (24.5 – 43.5) years. The Oxford classification revealed that 19 (63.3%) patients had M1 and S1 lesions, 16 (53.3%) had E0 lesions, and 12 (40.0%) exhibited T0 lesions. A significant reduction in proteinuria was observed after treatment (p-value < 0.001), with eGFR and serum albumin levels improving significantly (p-value 0.003 and p-value 0.023) respectively. T1-2 lesions demonstrated a strong negative correlation with eGFR (ρ = -0.760, p-value < 0.001), and E1 lesions were moderately correlated with proteinuria (ρ = 0.378, p-value 0.039). Treatment response was observed in 12 (40%) patients, but no significant associations were found with individual Oxford classification scores.
Conclusion: A significant reduction in proteinuria and improvement in eGFR and albumin were observed post-treatment. Histopathological features correlated with renal outcomes, emphasizing their significance in predicting early treatment outcomes.

Achieving Large-Scale Remission in Type 2 Diabetes Mellitus: The Role of Diet and Lifestyle Interventions

2024-11-20T02:05:36-07:00

Type 2 diabetes mellitus (T2DM) is a major global public health challenge, with over 382 million adults affected in 2013, a figure projected to rise to 592 million by 2035. Pakistan ranks third globally in diabetes prevalence, with 33 million adults currently living with T2DM, a number expected to nearly double by 2045. This rapid increase places immense financial pressure on the healthcare system, with complications like dialysis and cardiovascular diseases consuming substantial 3 resources. Urban areas in Pakistan show a higher prevalence of diabetes compared to rural areas. For instance, the prevalence of diabetes in urban areas is reported to be 28.3% compared to 25.3% in rural areas, highlighting the role of lifestyle, socioeconomic factors, and healthcare access.This editorial explores the drivers of T2DM in Pakistan, its challenges, and the potential for large-scale remission through culturally tailored diet and lifestyle interventions.

Prevalence and Associated Risk Factors of Retinopathy of Prematurity in Preterm Infants: A Cross-Sectional Study

2024-11-13T01:42:52-07:00

Objective: To determine the prevalence of Retinopathy of Prematurity (ROP) and its associated risk factors in preterm infants at the National Institute of Child Health (NICH), Karachi, Pakistan.
Methods: This cross-sectional study was conducted in the neonatal intensive care unit (NICU) department of NICH, Karachi, Pakistan from October 2020 to March 2021. The study included preterm infants with a gestational age under 32 weeks, admitted to the NICU at the NICH, Karachi. ROP was diagnosed by indirect ophthalmoscopy following pupil dilation, performed by a trained ophthalmologist. Risk factors were assessed based on preterm infants' age, gestational age, residence, gender, maternal education, sepsis, respiratory distress syndrome (RDS), anemia, oxygen dependency duration, and mechanical ventilation.
Results: Of total 310 preterm infants, the mean age was 5.73 ±1.49 days. There were 184 (59.3%) males and 126 (40.6%) females. ROP was observed in 139 (44.8%) preterm infants. Binary logistic regression indicated significantly increased ROP risk in infants of illiterate mothers (aOR 3.31, 95% CI 1.08 to 10.17, p-value 0.036), those with family income ≤ 45,000 rupees (aOR 3.70, 95% CI 1.40 to 9.76, p-value 0.008), and reduced risk in female infants (aOR 0.12, 95% CI 0.04 to 0.31, p-value <0.001), infants on oxygen ≤ 4 days (aOR 0.04, 95% CI 0.01 to 0.12, p-value <0.001), and NICU stay ≤ 12 days (aOR 0.02, 95% CI 0.01 to 0.08, p-value <0.001).
Conclusion: Nearly half of the preterm neonates were affected by ROP, with contributing factors including maternal illiteracy, low family income, prolonged oxygen dependency, and extended NICU stays.

Prevalence and Risk Factors of Giardiasis in Children with Persistent Watery Diarrhea: A Cross-Sectional Study

2024-10-31T01:13:10-06:00

Objective: This study aimed to examine the prevalence and risk factors of giardiasis in children with persistent watery diarrhea at a tertiary care hospital Karachi, Pakistan.
Methods: This cross-sectional study was conducted at the National Institute of Child Health in Karachi, Sindh, Pakistan, between November 2023 to April 2024. Children aged ≤15 years, with persistent watery diarrhea lasting more than six days were included in the study. The study assessed two primary outcomes, prevalence of giardiasis with persistent watery diarrhea and associated risk factors. Giardia was diagnosed by examining stool samples using fluorescent antibody testing to detect cysts and trophozoites of Entamoeba histolytica and Giardia lamblia. Risk factors were assessed based on children's demographic information and clinical history.
Results: Of total 133 children, the mean age was 6.76 ±4.28 years. Giardiasis was detected in 18 (13.5%) children. The risk of giardiasis was 5 times significantly higher in children whose mothers did not practice handwashing before feeding (aOR 5.04, 95% CI 1.10 to 23.02, p-value 0.037) and had piped drinking water sources (aOR 5.47, 95% CI 1.24 to 24.08, p-value 0.025). While, 92% siginificantly lower in children who had adequate domestic water storage (aOR 0.08, 95% CI 0.01 to 0.48, p-value 0.006) and 93% significantly lower in children had no recent traveling history (aOR 0.07, 95% CI 0.01 to 0.49, p-value 0.007).
Conclusion: This study identified giardiasis as a health concern, with infection risk influenced by maternal handwashing, domestic water storage, piped drinking water, and recent travel history.

Comparison of Aspiration Versus Incision and Drainage in the Treatment of Breast Abscess, in terms of Recurrence: An Analytical Cross-Sectional Study

2024-11-14T01:42:35-07:00

Objective: To assess and compare the treatment outcomes of breast abscess using two different methods aspiration versus incision and drainage.
Methods: This analytical cross-sectional study was conducted at Combined Military Hospital, Karachi, Pakistan, from October 2023 to March 2024. Females age`d 18 to 50 years with ultrasound-diagnosed acute breast abscesses up to 5 cm, presenting with signs and symptoms such as breast pain, localized swelling, erythema, tenderness, and fever, were included. Patients were randomly assigned to receive needle aspiration or incision and drainage. Outcomes were assessed based on recurrence and scarring. Recurrence was defined as the reappearance of similar signs and symptoms after complete resolution. Patients were monitored for one-month post-treatment.
Results: Of total 124 patients, the mean age was 38.10 ±5.21 years. The mean duration of procedure was 26.33 ±10.58 minutes. A significantly longer mean duration of the procedure was observed in the aspiration group as compared to the incision and drainage group i.e., 36.61 ± 2.82 minutes vs. 16.04 ± 1.67 minutes (p-value <0.001). A significant association found between the two groups in terms of parity (p-value <0.001) and site of abscess (p-value 0.001). Treatment outcome showed higher rate of recurrence and scarring in the aspiration group compared to the incision and drainage group i.e., 8 (66.7%) vs. 4 (33.3%) and 5 (100.0%) vs. 0 (0.0%). However, a significant association of scar (p-value 0.022) was observed between groups.
Conclusion: Incision and drainage proved more effective than aspiration for treating breast abscesses, with lower rates of recurrence and scarring.