Pakistan Journal of Medical & Health Sciences

Imagine! Motor Imagery as an Adjunct to Conventional Neuro Rehabilitation after Stroke

2024-06-04T14:56:42+00:00

Stroke occurs due to obstructed blood flow in the brain that eventually leads to cell death. More than 13.7 million episodes of stroke occur each year in the world. The three main types of stroke are Transient Ischemic Attack (TIA), ischemic stroke, and hemorrhagic stroke. In TIA the interruption is temporary and there are no permanent neurological deficits. Ischemic stroke is the commonest (about 87%) and occurs due to obstructed blood supply of the brain. Hemorrhagic stroke is caused by ruptured blood vessel. Stroke is broadly divided into total anterior circulation stroke (TACS), partial anterior circulation stroke (PACS), lacunar stroke (LACS) and posterior circulation stroke (POCS) with symptoms including hemiparesis, sensory changes, visuospatial problems, cognitive impairments etc. The deficits depend upon the area of brain affected. Motor impairment effects about 80% of patients¹. Recovery from stroke requires physical therapy or rehabilitation².

Metabesity: The sword with two edges

2024-03-09T08:11:40+00:00

Pakistan is positioned among the top ten countries in terms of the prevalence of obesity, which exposes its citizens to a heightened risk of developing metabolic disorders and metabolic conditions. Metabolic disorders, such as diabetes, manifest concurrently with obesity and other metabolic disorders. Weight gain is additionally correlated with cardiovascular and neurovascular diseases, as well as accelerated ageing, in addition to the aforementioned complications¹. Metabolic conditions are distinguished by an intricate interplay of genetic, behavioural, and metabolic elements; thus, comprehensive management protocols are especially crucial, especially for the population of Pakistan. For this purpose, standardized guidelines and literature that had undergone rigorous evaluation were consulted, including those established by the American Society of Clinical Endocrinology (AACE). Regular examinations for diabetes, dyslipidemia, and cardiovascular diseases, a uniform set of diagnostic criteria, are advised by established protocols for the management of metabesity. Risk assessment involves the evaluation of several physiological parameters, including fasting blood sugar levels (>99mg/dL), high blood pressure (>135/85mmHg), and waist circumference (>90cm in men and >80cm in women in accordance with Asian-based guidelines). The lipid profile (HDL <40mg/dl in men and <50mg/dl in women) is also assessed^2,3.

Assessment of Portal Vein Thrombosis in Cirrhotic Liver Patients

2024-03-09T08:26:32+00:00

Background: PVT has a number of frequent causes, including cirrhosis of the liver, abdominal inflammation, tumour invasion, and thrombophilic disorders.

Aim: To find out how frequently liver cirrhosis patients get portal vein thrombosis.

Study Design: Cross-sectional study, Department of Medicine, Liaquat University Hospital Hyderabad, Sindh, Pakistan's from 1^st April 2021 to 30^th September 2021.One hundred and twenty eight patients were enrolled. The demographic information like age, sex, and body mass index were noted. Hepatocellular carcinoma patients and history of thromboembolism propensity were excluded. Both male and female patients with hepatic cirrhosis and age ranged from 20 to 50 were included. The monitoring of portal vein thrombosis, Doppler ultrasonography was performed on all patients.

Results: There were 40(34.4%) female patients and 84(65.6%) male patients with average age was 51.95 7.54 years and BMI was 31.87 2.64 kg/m2. Seventy nine patients (61.7%) had hepatitis C, 50 patients (39.3%) had hepatitis B, 66 patients (51.6%) had diabetes mellitus, 81 patients (63.3%) had hyperlipidaemia, and 69 patients (57.9%) had hypertension. The prevalence of portal vein thrombosis (PVT) was 81(63.3%), with 48(59.3%) of the cases involving men and 33 (40.7%) involving females. Of them, 25 patients (50%) had hepatitis B and 44 (55.7%) had hepatitis C.

Conclusion: Patients with liver cirrhosis experienced portal vein thrombosis often, and hepatitis C patients made up the majority of those afflicted.

Keywords: Thrombosis, Portal vein, Liver cirrhosis, thrombophilic disorders

Crisis Management in Professional Basketball Organizations

2024-03-09T08:29:03+00:00

Background: The importance of the crisis concept in sports and the hardly reversible nature of the crises prove the importance of the topic.

Aim: To examine the crisis management skills of professional basketball team managers. The crisis management skills of the team managers were also analyzed based on several demographic variables.

Methods: The sample group for the study consists of 56 team managers who worked in Turkish basketball leagues in the 2021–2022 season. "Crisis Management Scale" developed by Sayın (2008) was used as the data collection tool.

Results: As a result of normality analyses (Kolmogorov, Smirnov), to analyze the data, in addition to the arithmetic mean (x̅) and frequency (f), in independent paired comparisons, the Independent Sample t-Test, and the Mann-Whitney U-test, having non-parametric equivalents, were employed, and in the analyses of group means greater than two, one-way variance analysis (ANOVA) was used.

Conclusion: It was found that there were significant differences in crisis management in terms of sex and professional experience, but no significant difference was found in terms of other variables.

Keywords: Basketball team managers, the crisis in basketball, the crisis in sports, sports organizations

Frequency of Neonatal Hypothermia in Preterm Infants Wrapped with and without Plastic Bag after delivery

2024-03-09T08:31:28+00:00

Background: Preterm birth accompanies many complications including hypothermia that worsens neonatal health and may result in fatality if left untreated. Globally, plastic wraps are being used as a low-cost and effective method to maintain temperature.

Aim: To compare frequency of neonatal hypothermia in preterm infants wrapped with and without plastic bag after delivery.

Study design: This was randomized control trial.

Methodology: This study was conducted using at Pediatrics department of SIMS hospital, Lahore, during 6 months. Data was collected using non-probability, consecutive sampling from a sample of 92 (46 newborns in each group). Infants randomized to group-B (no bag group) received standard hospital care based on WHO thermoregulation of the newborn protocol. The data was entered and analyzed in SPSS 23.

Results: In plastic wrap group there were 32(69.57%) male and 14(30.43%) female cases while in no wrap group there were 27(58.70%) male and 19(41.30%) female cases, p-value >0.05. The median temperature after one hour was higher in plastic wrap and no wrap group was 37.6±0.7 and 36.85±1.8⁰c respectively, p-value < 0.05. There were 3(6.5%) cases in plastic wrap group and 15(32.6%) of the cases in no wrap group who developed hypothermia, the frequency of hypothermia was statistically less in wrap group when compared with no wrap group, p-value <0.05.

Practical Implication: However, there is limited literature in Pakistan that compares temperature maintenance among neonates wrapped and unwrapped with plastic bags. This investigation will help find better answers to this problem.

Conclusion: It is concluded that the preterm infants wrapped with plastic bag after delivery had less frequency of neonatal hypothermia after 1 hour. Plastic wraps are effective, low cost and low resource friendly method that should be opted for temperature maintenance of preterm babies.

Keywords: Hypothermia, Preterm Birth, Hyperthermia, plastic wraps, Neonates and Temperature

Comparison of Aerobic and Pilates Exercises on Depression and Sleep Quality in Primigravida Females

2024-03-09T08:35:46+00:00

Aim: To compare effects of Aerobics and Pilates exercises on depression and sleep quality in primigravida females.

Methods: The study was randomized clinical trial and was conducted in children hospital and Mehmooda Hospital Sheikhupura. This study completed in 10 months and convenience sampling technique was used. Total thirty-eight subjects were assigned randomly by using lottery method into two groups. Group A and B received Aerobics and Pilate exercises respectively. Data was collected from all participants at baseline and after 8 weeks of treatment by using CES-D and PSQI questionnaire. After checking the normality of data as p value was greater than 0.05 it was analyzed by using parametric test (independent T test and paired sample T-test) by using SPSS-25.

Results: The result of the study showed that in group analysis, improvement in CES-D scale and PSQI were observed in both groups as p value was significant p<0.05.But between the groups significant improvement was seen in CES-D and Quality of Sleep in Pilates training group as p<0.05.

Implication: Research on incorporating aerobic exercises during antenatal periods for pregnant women is recommended, with proper follow-up and long-term groupings to ensure treatment efficacy preservation.

Conclusion: It was concluded that Aerobics and Pilates exercise training both had significant effects in treating the symptoms of depression and in improving the quality of sleep in antenatal primigravida females.

Keywords: Aerobic exercises, Antenatal depression, Pilates exercises, Primigravida females, Sleep quality.

Association of Social Media use with Sleep among Physiotherapy Students of Islamabad

2024-03-09T08:38:32+00:00

Background: Social media use is quick and hard to resist nowadays. Social media continue to play a significant role in an individual's life in spite of all of the technological advancements. One of the main reasons why people have insomnia in the modern society is the media.

Aim: To ascertain whether University of Ibadat International University Islamabad physiotherapy students' use of social media and the quality of their sleep are related.

Methodology: A descriptive cross-sectional survey was conducted from October 2022 to February 2023 among students of Ibadat International University Islamabad. Sample was raised through non-probability convenient sampling techniques. 231 participants were selected according to inclusion and exclusion criteria. Data was analyzed by SPSS 25.

Result: Total participants were 112. Out of which 15(13.4%) were males and 97(86.6%) were females, 70(62.5%) were in the age group 18-20 years, 28(25%) were in the age group 21-23 years, 14(12.5%) were in the age group 24-26 years, 88 participants have low addiction; 4 with good sleep and 84 with poor sleep. Whereas 24 participants have high addiction; 1 with good sleep and 23 with poor sleep. Usage of social media 31-60 minutes per day was 2(1.8%), 61-120 minutes per day 35(31.3%) and more than 120 minutes per day was 75(67%). The study population's chi square association (p-value) was 0.709, suggesting that there was no significant correlation between social media disruption and sleep quality.

Practical Implication: Smartphone use for work-related communication at night can reduce efficiency and disrupt sleep hygiene. Accessing social media on smartphones can prolong sleep onset latency, reducing overall sleep duration, and resulting in poor sleep quality and problematic patterns.

Conclusion: There is no association found between social media usage and sleep among physiotherapy students and health care professionals of Ibadat International University.

Keywords: sleep, social media, PSQI, BSMAS, work-related communication, prolong sleep

Frequency of Anterior Inferior Cerebellar Artery Vascular Loops Using CISS Sequence on 3.0T MRI in the Otologic Symptomized Patients

2024-03-09T08:44:38+00:00

Aim: To estimate the frequency of vascular loops in the anterior inferior cerebellar artery in the otologic symptomized patients using CISS sequence on 3.0 Tesla MRI” in Pakistani populations.

Methodology: Cross sectional descriptive study was conducted in Armed Forces Institute of Radiology and Imaging, Military Hospital Rawalpindi from 12^th April 2019 to 11^th October 2019. One hundred patients of both genders between age of 20-60 years were presented with otologic symptoms i.e. tinnitus, dizziness and hearing loss (unilateral/bilateral) and advised MRI brain. Patients with any diagnosed arterial, venous and arterio-venous cause of otologic symptoms, severe claustrophobia and with internal cardiac pacemakers or any other metallic foreign body were excluded. Patients were undergone MRI brain on 3.0 Tesla. TIWS, T2WS and CISS sequences were taken along with post-contrast T1WS images.

Results: There was 20 to 60 years of patients range of age having mean age of 38.38±12.05 years and majority of patients 65% between 20-40 years. There were 53(53%) males and 47(47%) females and having 1.2:1 ratio of male to female. Frequency of anterior inferior cerebellar artery vascular loops in the otologic symptomized patients using CISS sequence on 3.0 Tesla MRI was seen in 59(59%) patients.

Conclusion: The frequency of anterior inferior cerebellar artery vascular loops in the otologic symptomized patients using CISS sequence on 3.0 Tesla MRI is very high.

Keywords: Anterior inferior cerebellar artery vascular loops, Magnetic resonance imaging, Otologic symptoms

Effectiveness of Symbiotic in Treatment of Chronic Spontaneous Urticaria: RCT

2024-03-09T08:47:59+00:00

Background: A challenging health issue nowadays is chronic spontaneous urticaria, which affects almost 2% of the normal population, with half of its sufferers failing to respond to standard treatment therapy.

Aim: To determine the efficacy and safety of a symbiotic in the treatment of chronic spontaneous urticaria.

Method: This was a randomized trial. This experiment at the Lahore General Hospital involved 204 participants with chronic spontaneous urticaria. Participants were randomized into two groups: oral antihistamines plus an oral probiotic sachet (1.5g) twice daily or oral antihistamines alone for eight weeks. The Urticaria Activity Score was used to evaluate efficacy and safety, while the validated Dermatology Life Quality Index assessed quality of life. An independent sample t-test and a Mann-Whitney test were used to compare the age, UAS7, and DLQI score between the two groups. A p-value ≤0.05 was considered significant.

Results: Both treatments significantly improved the UAS7 and DLQI scores from baseline; however, the experimental group produced a significantly greater reduction in the UAS7 and DLQI scores compared to the control group. There was no significant difference in the mean baseline score between both groups. A Wilcoxon signed rank test was used to compare the mean DLQI score before and after treatment in both groups. The results revealed that there was a significant reduction in score from the baseline in both groups.

Practical Implication: Due to a lack of clinical data regarding the effective treatment of this health issue, we planned the current project. The results of this study helped us assess the efficacy of probiotics as adjuvant therapy in our local population and added to our local literature.

Conclusion: It was concluded that the combination of probiotics and antihistamines showed better efficacy than the antihistamine alone, based on the UAS7 and DLQI scores; hence, they can be used as treatment options among patients. Although further research must be done to validate these findings.

Keywords: Efficacy, Safety, Probiotics, DLQI scores, Chronic Urticaria.

Comparison of NEWS2 and CURB65 Score in Predicting Mortality of Hospitalized patients with AECOPD

2024-03-09T08:50:07+00:00

Aim: To determine the diagnostic accuracy of the NEWS2 and CURB-65 scores in predicting in-hospital mortality in patients with acute exacerbations of COPD, mortality during hospital stays is considered the gold standard.

Study Design: Cross-sectional study-design.

Place and duration of study: Department of Chest Medicine, JPMC, Karachi, from September 25, 2020, to January 25, 2021. Two hundred and twelve patients of both genders were included who were admitted because of acute COPD exacerbations. The National Early Warning Score 2 (NEWS2) and CURB-65 Score in the estimation and evaluation of hospital-related mortality were noted.

Results: NEWS2 predicted 156(73.6%), CURB-65 predicted 72(34%) as high-risk patients, and in-hospital mortality was 39(18.4%). NEWS2 had shown sensitivity of 100%, specificity of 32.4%, diagnostic accuracy of 45%, PPV of 25.1%, and NPV of 100% as a prediction value of in-hospital mortality. CURB-65 had shown sensitivity of 76.9%, specificity of 75.7%, and diagnostic accuracy of 76%, PPV of 41.7%, and NPV of 93.6% as a prediction value of in-hospital mortality.

Implication: It is recommended that individual analyses of these associated factors be performed in future studies for the formulation of novel, efficient scores that may be better predictors of mortality in AECOPD patients.

Conclusion: Both of the scoring systems can be used for the purpose of AECOPD patients risk stratification as per clinicians’ preference and as the basic tools of assessment in a resource-poor country.

Keywords: Acute exacerbation of COPD, NEWS2, CURB-65, In-hospital mortality

Impact of Montelukast on Allergic Rhinitis and Asthma as Emerging New Treatment Option

2024-03-09T08:52:25+00:00

Background: AR (allergic rhinitis) is a condition that causes chronic nasal mucosal inflammation. Among the regional signs of AR are sneezing, rhinorrhea, nasal discomfort, and nasal congestion. AR places a considerable financial and social impact on both the person with AR and society. There is mounting evidence that AR may elevate inflammatory mediators throughout the body and raise the chance of developing asthma.

Aim: To determine the degree to which Montelukast altered the symptoms and signs of allergic rhinitis (AR) and asthma, as well as to estimate the proportion of participants who were adversely affected. The absolute eosinophil count and five essential asthma and allergic rhinitis symptoms were assessed before and after therapy.

Method: This was a randomized trial. This experiment at the Lahore General Hospital involved 204 participants with asthma and allergic rhinitis. Participants received either (budesonide) BD (256 mg) with (montelukast) MNT (10mg) + MNT for two weeks, or BD alone (256 mg). The data was entered and analysed in SPSS 23.

Results:However, when compared to BD alone, BD + MNT demonstrated noticeably greater improvements in nasal blockage and itching. Both treatments greatly lessened the five primary symptoms as compared to the baseline. After two weeks of treatment, absolute eosinophil counts in BD + MNT significantly surpassed BD.

Practical Implication: Asthma and allergic rhinitis are major problems nowadays. This investigation will help find better answers to this problem. BD+ MNT is a more successful treatment for this illness. Conclusion:BD + MNT therapy may be more efficient overall than BD monotherapy for those with asthma and allergic rhinitis, especially in lowering nasal obstruction, itching, and subclinical lower airway inflammation. The absolute eosinophil count can also be used to monitor a patient's response to treatment for allergic rhinitis. Keywords: Asthama, budesonide, montelukast, and allergic rhinitis.

Key words: Montelukast, allergic rhinitis, Asthma, Emerging New Treatment Option

Disease-Related Stigma, Emotional Regulation and Depression in Patients with HIV

2024-03-09T08:54:39+00:00

Background: HIV/AIDS has become one of the major global health burdens. Self-stigma and emotion dysregulation in people living with HIV (PLWH) have become urgent issues and have attracted the attention of both physicians and epidemiologists.

Aim: To examine the relationship between disease-related stigma, emotional regulation, and depression in patients with HIV.

Method: A cross-sectional study was conducted. A purposive sample of 100 patients—70 male and 30 female diagnosed with HIV/AIDS was collected from two public hospitals in southern Punjab. Patients who had been diagnosed as being HIV positive for at least three months were included in the study. The age range of participants was 18 to 50 years. Patients with other medical issues were excluded from the study. Measures for data collection were the Discrimination and Stigma Scale (DISC), Difficulties in Emotional Regulation Scale (DERS), and Hamilton Depression Scale. The data was evaluated using SPSS version 24. Pearson’s correlation was applied.

Results: There is an inverse relationship (-.34**) obtained between disease-related stigma and emotional regulation, whereas a significant positive relationship (r =.41**) is found between disease-related stigma and depression. A negative relationship
(r=-.59**) is also examined between emotional regulation and depression. Emotional regulation is a mediator between disease-related stigma and depression in patients with HIV. There is a significant gender difference in depression. The mean score of depression is high among females as compared to males.

Practical Implication: It improved the psychological health of HIV-positive patients by categorizing the issues they face.

Conclusion: It was concluded that disease-related stigma is positively related to depression while emotional regulation is inversely related to depression. Emotional regulation also plays a mediating role between self-stigma and depression in patients with HIV positive. Women scored higher on depression as compared to men.

Keywords: HIV Patients, Psychological Impact, Psychological Distress and Social Stigma.

Outcome of Olecranon Fracture Treated with Tension Band Wiring Versus Anatomical Locking Plate Fixation

2024-03-09T08:56:53+00:00

Aim: Up to 10% of all upper limb fractures involve the olecranon, and this type of fracture is the most common osseous injury of the elbow joint. These show a bimodal distribution occurring in younger patients due to high-energy trauma and in elderly cohorts with low bone quality after low-energy falls.
Objective: To compare functional outcome of tension band wiring versus anatomical locking plate fixation for reduction of olecranon fracture
Materials and Methods: This randomized controlled trial study was conducted in the Department of Orthopedic, Lady Reading Hospital, Medical Teaching Institute Peshawar from December 2022 to June 2023. Non-probability consecutive sampling technique was used in this study. Sample size was calculated using WHO calculator keeping 95% confidence interval 80 % power of study, 10% absolute precision, mean Mayo elbow score was 84.0±9.3 in the TBW group and 88.3±9.1 in the locking plate fixation group (4). Expected sample size is 32 patients in each group, total 72 patients. Patients of both genders have age range from 20 to 70 year with Mayo type 2A olecranon fractures, more than 2 mm of joint displacement determined on X-ray elbow, and elbow extension loss determined on physical examination presented within 7 days of the injury were included in the study while Patients with open fracture and revision surgery were excluded from the study.
Results: In this study age distribution among 72 patients was analyzed as n= 20-30 Years 17(27.4%) 31-40 Years 14(22.6%) 41-50.Years 11(17.7%) 51-70 Years 20(32.3%). Mean age was 47.1 Years with SD ± 2.87. Gender wise Distribution among 72 Patients was analyzed as Male were 31(50.0%) and female were 31(50.0%). Distribution of duration of disease among 72 patients were analysed as n= 1-2 weeks were 47(75.8%) and 3-4 weeks were 15(24.2%)
Practical Implication: There are no established guidelines for the treatment of olecranon fracture in our institution. Most olecranon fractures are treated according to surgeon preferences and surgical experience of the surgeon. Previous studies showed variables results with no consensus. We will provide rationale basis for universal use of standard treatment of olecranon fracture.
Conclusion: Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group.
Keywords: Anatomical locking plate; complications; eyelet wire; olecranon fracture; tension band wiring.

Evaluation Techniques in Medical Education: An Opinion

2024-06-04T14:51:42+00:00

Evaluation techniques play a crucial role in medical education at the undergraduate level. Medical educators have been exploring various evaluation techniques to ensure the comprehensive assessment of undergraduate medical students. In this article, we will delve into a comprehensive review and analysis of the existing evaluation methods used in medical education at the undergraduate level. By understanding the strengths and limitations of these techniques, educators and administrators can make informed decisions about the most effective evaluation methods for their institutions. Moreover, this review will provide valuable insights for future research and development in the field of medical education evaluation. To conduct a comprehensive review and analysis of evaluation techniques in medical education at the undergraduate level, a thorough literature review was conducted. The review included a wide range of sources such as academic journals, textbooks, and reports from reputable medical education organizations. Key evaluation methods were identified and analyzed based on their usage, effectiveness, and applicability to the undergraduate medical curriculum. Additionally, specific criteria such as validity, reliability, feasibility, and acceptability were considered in evaluating the effectiveness of these techniques. Furthermore, a comparative analysis of the identified evaluation techniques was performed, considering factors such as validity, reliability, feasibility, and acceptability among educators and students. This allowed for a deeper understanding of the strengths and limitations of each method, providing valuable insights into their practical implementation and impact on student learning outcomes.

Keywords: Evaluation techniques, medical education, applications, multiple choice question.

Role of Healthcare Staff in Promoting Mental Health & Wellbeing in Community

2024-07-10T16:40:49+00:00

Background: In many low- and middle-income nations, including Pakistan, where data on the frequency of mental health disorders is lacking, mental health is an underappreciated field. This issue is made worse by the unequal distribution of mental health service providers as well as the general public's pervasive ignorance and stigma about mental illness.
Objective: The purpose of the study conducted in Larkana, Sindh, Pakistan, was to evaluate community members' and healthcare professionals' knowledge, attitudes, and practices around mental health.
Methods: 540 people of the community and 110 healthcare professionals participated in the descriptive cross-sectional survey, which included qualitative and quantitative approaches. Key informant interviews, focus groups, and household surveys were used to gather data, which was then analyzed using thematic analysis, descriptive statistics, and univariate frequencies.
Results: According to the survey, 68% of healthcare workers had been diagnosed with mental health disorders, whilst 39% of community members had a family member with a mental health issue. Substance misuse, heredity, spiritual origins, and socioeconomic pressures were frequently cited as reasons for mental disease. Just 29.4% of HCWs reported that counseling services were available at health facilities, indicating a large gap in this regard. Between health care workers and members of the community, opinions on how accessible and affordable mental health services are varied significantly. Furthermore, although healthcare workers indicated that free medication was available, community members reported shortages. The study also emphasized the usage of traditional healers and religious leaders for mental health issues and observed differences in attitudes toward patients with mental illness in terms of respect and dignity.
Conclusion: With its emphasis on the high prevalence of mental illness, the scarcity of resources, and the pervasive myths and misconceptions, this study offers insightful information about the state of mental health in Larkana, Pakistan. In order to effectively treat mental health issues in Pakistan and other comparable rural contexts, it emphasizes the need for stronger health systems, increased public awareness, and better training for healthcare workers.

Frequency, Causes and Pattern of Presentation of Impacted Maxillary Canine, A Clinical and Radiographic Study

2024-07-10T17:09:13+00:00

Aim: Toassess frequency, causes and pattern of presentation of maxillary canine impaction.
Method: This cross-sectional study was conducted from August 2022 to July 2023 at Oral & Maxillofacial Surgery Department and Orthodontic Department of Nishtar Institute of Dentistry, Multan. A total of 84 patients with 96 impacted maxillary canines matching inclusion and exclusion criteria were included in the study. Patient demographic data, clinical and radiographic findings were recorded and all the data were collected on a specially designed proforma. Data were analyzed using SPSS version 22 and frequencies, percentages, ratios, means ± SD were calculated.
Results: Overall frequency of canine impaction in all patients presenting was 3.5%. A male to female ratio of (30%:70%) 1:2.5 with female predominance was found. There was more occurrence of unilateral impacted maxillary canine than bilateral with a ratio of 6:1 and more palatally impacted canines than buccal once (75%:25%).
Conclusion: Overall frequency of canine impaction in local population was low. The most common cause of maxillary canine impaction was a mismatch in jaw size and tooth size followed by wrong line and long path of eruption.Frequency of odontogenic pathology associated with maxillary impacted canine was low. The most common type of canine impaction was palatal followed by buccal one. The most common clinical diagnostic indicator for impacted canine was presence of palatal or buccal buldge. Radiologically, most of the canine impactions fall in Sector III grade and type II in relation to root of adjacent lateral incisor

The Socio-cultural Variables Influencing Pakistan’s Perception of the COVID-19 Vaccine

2024-07-10T17:20:26+00:00

Aim: The present study investigates the perceptions of students and the general public about COVID-19 vaccination in Pakistan. Socio-cultural variables such as lifestyle, buying habits, education, age, gender, religion, beliefs, values, demographics, social classes, sexuality, and attitudes affect people's perceptions and lead them to think differently. The survey aims to create a discourse around the socio-cultural variables of COVID-19 vaccination and inform future policies and practices to promote more vaccination.
Methodology: A survey was conducted at the public and private universities in Pakistan using a Google Form questionnaire. The responses of 304 participants were analyzed to assess their perception of the COVID-19 vaccination. The findings indicate that a significant proportion of students and the general public in Pakistan hold positive opinions regarding the COVID-19 vaccination.
Results: The results of the university students show that more than half of the respondents (66%) were confident in the COVID- 19 vaccine, and 11.2% of the respondents were not confident in the COVID-19 vaccine. And 22.9% of respondents were hesitant about getting the vaccination. At the same time, the results from the general public show that more than half (53%) of respondents were confident, but that is less than the university student’s confident percent. About 23.8% of the general public were not confident.
Practical implication: The study suggests that public health campaigns should target different demographics, particularly women, and age-specific strategies like vaccine education, social media, and community outreach programs to boost vaccine acceptance and public health.
Conclusion: Through this, it is proven that socio-cultural variables like education and more have influenced people’s perceptions of the COVID-19 vaccination because university students were more confident as compared to the general public. In this way, all socio-cultural variables influence the perceptions of people. As a result, governments and commercial groups all over the world have introduced policies to encourage or coerce vaccination.

An Evaluation of the Effectiveness of Pain Management Interventions in the Postoperative Setting

2024-07-10T17:55:39+00:00

Objective: The objective of this research is to evaluate the effectiveness of various pain management interventions in the postoperative setting and assess their impact on pain relief, patient satisfaction, and recovery outcomes
Material and Methods: This prospective observational study was conducted at CMC Hospital Larkana for a period of 6 months from January 2021 to June 2021 after approval from the institutional ethics review committee. Patients aged 18 years or above, with different surgical interventions, and experiencing postoperative pain was eligible for inclusion. Patients with pre-existing chronic pain conditions or those unable to provide informed consent were excluded.
Results: A total of 96 participants were selected for this study. Out of them majority of the participants were male, accounting for 63 individuals or 60.4% of the total population. Females made up 33 individuals, representing 31.6%. When examining the types of surgical procedures, the most common were urological surgeries with 25 cases (24%), followed by abdominal surgeries with 34 cases (32.6%). The least common were thoracic surgeries with only 2 cases (1.9%). The mean age of the group is 42.3 years, with a standard deviation of 10.5 years. The mean weight is 71.2 kg, with a standard deviation of 13.8 kg. The average height is 154.8 cm, with a standard deviation of 4.7 cm. The mean BMI (Body Mass Index) is 27.2 kg/m2, with a standard deviation of 4.6 kg/m2. The experience of pain is a sign that the illness has gotten worse" had a mean score of 3.2±1.4, indicating a moderate level of agreement but with more variability.
Practical Implication: Effective postoperative pain management is crucial for improving patient outcomes, reducing recovery times, and enhancing overall quality of life. This research provides evidence-based insights that can inform clinical practices, ensuring that patients receive the most effective pain relief with minimal side effects. Furthermore, by identifying the most effective interventions, the study can help reduce the burden on healthcare systems through decreased hospital stays and readmissions, as well as lower the risk of chronic pain development. The findings can also guide policy makers in developing standardized pain management protocols, ultimately leading to improved patient satisfaction and healthcare efficiency. By addressing the community’s need for effective pain management, this study contributes to the well-being of postoperative patients and supports the broader goal of enhancing public health.
Conclusion: We found that the implementation of various interventions significantly improved pain relief, increased patient satisfaction, and positively impacted recovery outcomes

Frequency of Union in Intramedullary Solid Nailing (SIGN nailing) Via Open Reduction for the Treatment of Fracture Shaft of Tibia

2024-07-10T18:01:01+00:00

Introduction: Fractures involving the shaft of long bones are common worldwide and tibial fractures are among the most common lower limb injuries to be treated by an orthopedic surgeon.
Objective: The objective of this study was to find frequency of union in intramedullary solid nailing (SIGN nailing) via open reduction for the treatment of fracture shaft of tibia.
Study Design: This Randomized controlled trial was conducted in Department of Orthopedic Surgery, Allied Hospital, Faisalabad from July 1st 2014 to December 31st 2014. After taking approval from hospital ethical committee, patients coming through emergency fulfilling the inclusion criteria were enrolled and informed consent was taken. After initial treatment following ATLS protocol, x-ray was taken from hospital radiology department and then patients were treated with intramedullary nailing. Both the procedures were performed by consultant orthopedic surgeon. Union of bone was assessed on x-ray (as in operational definition) at 6th month.
Results: A total of 130 cases fulfilling the inclusion/exclusion criteria were enrolled to compare the frequency of union in intramedullary solid nailing (SIGN nailing) via open reduction for the treatment of fracture shaft of tibia. Mean age of the patients was calculated as 35.38+12.49 years. Frequency of union in intramedullary solid nailing (SIGN nailing) via open reduction for the treatment of fracture shaft of tibia was done which shows union in 78.46%. P value was calculated as 0.05 which shows a significant difference.
Conclusion: It is concluded that that the frequency of union was significantly lower in intramedullary solid nailing (SIGN nailing) for the treatment of fracture shaft of tibia as compared to cannulated nailing.

Risk of Hypertension and Diabetes in Patients with Cholecystectomy

2025-01-08T14:23:48+00:00

Background: Although cholecystectomy is often considered a straightforward and harmless surgery with minimal long-term impact on a patient's health, it can result in significant increase in metabolic diseases.

Objective: To determine the risk of hypertension and diabetes in patients with cholecystectomy.

Study Design: Retrospective cohort study

Place and Duration of Study: Medical unit 2, Department of General Medicine, Bolan Medical Complex Hospital, Quetta, from 1^st January 2016 to 31^st December 2020.

Methodology: One hundred cases that underwent cholecystectomy within last 5 years were compared with 100 controls. All patients who had undergone cholecystectomy and were ≥35 years of age, were included. The patients in the control group were compared with cholecystectomy group patients in terms of their demographics, body mass index, systolic and diastolic blood pressure, blood glucose levels, cholesterol level, extent of physical activity and mortality index.

Results: The value of systolic blood pressure and cholesterol tends to increase in the further mean 3.21 (95% confidence interval 0.21 to 6.21), mean8.92 (95% confidence interval 15.09to 2.73) in control group when compared with cholecystectomy group patients mean 1.52 (95% confidence interval 1.51 to 4.52) and mean 14.15 (95% confidence of interval 20.32 to 7.97) while body mass index showed a greater increase in cholecystectomy patients mean 1.52(95% confidence interval 1.51 to 4.52)as compared to control as mean 0.01 (95% confidence interval 0.25 to 0.24).

Conclusion: There is a slight risk of rise in fasting blood glucose levels in patients who have undergone cholecystectomy.

Keywords: Cholecystectomy, Gallbladder, Hypertension, Diabetes mellitus.

Gynaecological Interventions to Improve Outcomes of Preterm Infants

2025-01-08T14:26:05+00:00

Background: Preterm infants are at higher risk of health and mental issues and conditions in comparison with full term delivered infants. Specialist follow-up care, involving a multidisciplinary approach, is essential for identifying potential issues early, which can help reduce associated risks.

Objective: To assess the outcomes of gyanecological interventions in reducing preterm births.

Study Design: Prospective study

Place and Duration of Study: Department of Obstetrics & Gynaecology, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat from 1^st January 2023 to 30^th June 2023.

Methodology: Two hundred preterm pregnant women based on clinical diagnosis of the pregnant women were enrolled. Preterm pregnant women within the age group of 21 to 44 years were included in this study. Various gynaecological interventions including aspirin usage in 16 weeks, magnesium sulfate and delayed clamping at peripartum, vaginal progesterone, cervical cerclage, cardiotocograph monitoring, caesarean section, antennal corticosteroid, tocolysis as well as continuous positive airway pressure. Kangaroo Mother Care was also provided to the majority of the preterm delivered newborns.

Results: Mean age of 30.3±3.5 years and vaginal progesterone and cardiotocograph as well as caesarean section and application of antenatal corticosteroid to bring positive outcomes in the preterm delivery. The interventions of cervical cerclage and tocolysis had more likely to bring negatives outcomes as positive outcomes. The relative risk for Kangaroo Mother Care was 0.95 (0.82 to 0.99).

Conclusion: The gynaecological interventions of antenatal corticosteroids, caesarean section, cardiotocograph as well as vaginal progesterone in addition to kangaroo mother care and continuous positive airway pressure usage are associated with significant positive outcomes for preterm infants followed by magnesium sulfate usage as well as delayed clamping.

Keywords: Outcome, Preterm infants, Gynaecological intervention.

Frequency of post operative complications after functional and selective next dissection in patients with squamous cell carcinoma oral cavity

2025-01-08T14:33:03+00:00

Background: Regarding those afflicted with cancer of the head and neck who have cervical neck metastases, neck dissection is a surgical treatment. In order to maximize the cancer's cure rate, neck dissection aims to establish loco-regional control. This procedure may result in a number of problems.

Objective: To find the frequency of post-operative complications after neck dissection in patients with confirmed diagnosis of squamous cell carcinoma of oral cavity.

Study Design: Prospective interventional study.

Place and duration of study: Faryal Dental College's Department of Oral and Maxillofacial Surgery, Lahore from 8^th March 2022 to 8^th September 2022.

Methodology: One hundred and twenty three patients who were eligible to participate were enrolled. Functional and selective neck dissection was carried. Complications were noted at 30^th post-operative day.

Results: The mean age of the 123 patients was 42.40±10.95 years, with 28.5% (n=35) being between the ages of 18 and 35 and 71.5% (n=88) being between the ages of 36 and 65. There were 47.2% (n=58) females and 52.8% (n=65) men. Frequency of wound dehiscence, marginal mandibular nerve weakness and accessory nerve weakness was 11.14%, 8.9% and 9.8% respectively.

Conclusion: After neck dissection, a number of problems might arise. The likelihood of problems after this operation might be reduced by being aware of these potential issues.

Keywords: Neck dissertation, Squamous cell carcinoma, Wound dehiscence.

Objective: To find the frequency of post-operative complications after neck dissection in patients with confirmed diagnosis of squamous cell carcinoma of oral cavity.

Study Design: Prospective interventional study.

Place and duration of study: Faryal Dental College's Department of Oral and Maxillofacial Surgery, Lahore from 8^th March 2022 to 8^th September 2022.

Conclusion: After neck dissection, a number of problems might arise. The likelihood of problems after this operation might be reduced by being aware of these potential issues.

Keywords: Neck dissertation, Squamous cell carcinoma, Wound dehiscence.

Comparative Efficacy of Diclofenac Sodium and Gabapentin against Post-Operative Pain as Pre-Emptive Analgesia in Laparotomy

2025-01-21T08:51:46+00:00

Background: To assess the relative effectiveness of diclofenac sodium and gabapentin as preventive analgesics for post-operative pain management in patients having laparotomy.

Study Design: Present study was a comparative controlled trial conducted at random.

Methodology: Current comparative controlled trial was conducted at random fashion in different surgical and pharmacology departments of Pakistan from December 2022 to June 2023. There were a total of 100 individuals having laparotomy therefore 600 mg capsule of Gabapentin and 100 mg sustain released combination therapy was given to the every patient one hour before to going into the procedure room under doctors direct supervision. All patients were put to sleep using the conventional general anesthetic approach. The patient was moved to the recovery area next to the operating theater once the procedure and extraction were finished and their pain was measured 1to 31 minutes. Finally, all patients were shifted to the ward where the intensity of their pain were measured 60, 121, 241 and 361 minutes respectively. The intermediate time of admission and operation were noted regularly. The bio-statistic version SPSS 2020 were applied for the description of raw data.

Results: The mean standard deviation levels of age, gender, BMI, surgery duration and average anesthesia time in both Group-X and Group-Y individuals with gabapentin and diclofenac sodium were (57.18±18.04, 58.21±1.03), (67.11±01.02, 67.11±01.01), (33.10±01.04, 33.10±01.04), (28.10 ± 1.01), (27.11 ±1.01), (118.01±01.01), (128.01±02.02) showed a significant (P≤ 0.05) change. The pain ratings for gabapentin was (9.01±04.01) and diclofenac sodium was (15.25±02.03) for the 361-minute interval. 12-hour period or 721 minutes Compared to Diclofenac sodium, which exhibits a pain intensity of (14.61±04.05), gabapentin showed a considerable decline in pain.

Conclusion: The study's findings showed that administering a single oral dosage of gabapentin as a preventive analgesic to patients having major abdominal operations is beneficial for managing post-operative pain since the medication's effects linger longer and decrease the need for rescue analgesics.

Keywords: Gabapentin, Laparotomy, Anticonvulsants, glycopyrrolate, analgesics, surgery, abdominal, gynecological.

Evaluation of Efficacy of Arginine Calcium Carbonate Versus Potassium Nitrate Paste in the treatment of Dentinal Hypersensitivity

2025-01-21T08:54:26+00:00

Background and Aim: Dentin hypersensitivity (DH) is a frequent oral health condition that affects one or more teeth in many adults characterized by a severe pain of exposed dentin to an external stimulation. The present study aimed to assess the efficacy of arginine calcium carbonate versus potassium nitrate paste in the dental hypersensitivity treatment.

Materials and Methods: This randomized controlled trial was carried out on 56 subjects in the Department of Dentistry of a Tertiary Care Hospital from January 2021 to December 2022. All the subjects were divided into two groups: Group-I as test group (toothpaste containing 8% arginine and calcium carbonate and toothpaste containing 5% potassium nitrate) and Group-II as control group. Schiff Cold Air Sensitivity scale was used for recording the air blast stimuli at baseline and DH scores were used for tactile stimuli on visual analog scale immediately post scaling after desensitizing paste application. Subjects were followed-up for 1 month. SPSS version 27 was used for data analysis.

Results: The subjects in test-group had decreased sensitivity values 2.52± 0.31 at baseline to post scaling after desensitizing paste application value of 1.87 ± 0.28. The sensitivity further reduced to 1.12 ± 0.39 after paste use for one month and 1.07± 0.42 after one month cessation of its use. Both tooth pastes significantly alleviated dental hypersensitivity. The arginine and calcium carbonate presented better clinical response than potassium nitrate paste after 1 month assessment.

Conclusion: The arginine and calcium carbonate showed better clinical response than potassium nitrate paste in terms of long-term reduction in dentinal hypersensitivity symptoms.

Keywords: Dentinal hypersensitivity, Arginine and calcium carbonate, Potassium nitrate, Efficacy, Dental Pulp.

Epidemiological Patterns and Clinical Consequences of Organophosphorus Poisoning

2025-01-21T08:58:19+00:00

Background: Organophosphates (OPs) are widely used chemicals with known harmful effects on human health, leading to Organophosphate poisoning (OPP). This study assesses the epidemiology and clinical outcomes of OPP in a developing country. The primary aim is to describe the characteristics and short-term outcomes of OP poisoning, including recovery and development of complications.

Methods: This descriptive cross-sectional study was conducted over ten months periods at DHQ Nowshehra, involving 50 adult patients with OPP repeated over a period of 10 months. Data regarding age, gender, socioeconomic status, and hospital stay was collected. Outcomes such as coma, circulatory failure, respiratory failure, and death were monitored.

Results: The study included 50 patients, predominantly young adults, with a slight male majority. Most patients recovered from poisoning effects, with a minority experiencing complications such as respiratory and circulatory failure. Mortality was recorded in 12% of cases.

Conclusion: The study highlights the significant impact of OPP, particularly among young adults in rural areas. Early hospital presentation and adequate emergency care are crucial for recovery. However, the accessibility and unregulated sale of OPs pose a continued risk, especially for intentional ingestions.

Keywords: Organophosphate Poisoning, Epidemiology, Clinical Outcomes, Developing Country, Emergency Care, Mortality.

Outcome of Spine Fixation for Unstable Fractures at Dorsolumbar Junction including Fractured Vertebrae in Pedicular Screw Fixation

2025-01-29T08:52:58+00:00

Background: The most serious injury that may change a person's life is a spinal cord injury that results in loss of neurological function. Many people in Pakistan suffer from spinal injuries every year. Although research on spinal injuries has been published in Pakistan, it is still unclear how often spinal injuries are there.

Objective: To assess the radiological and clinical outcomes of transpedicular screw fixation for fractures of the spine, including vertebral fractures

Methodology: This prospective research carried out by the Department of Orthopaedics and Spine Surgery, PIMS, Islamabad and Health Net Hospital Phase 5, Hayatabad Peshawar between November 2022 and April, 2023. This research comprised 130 individuals with single-level fractures ranging from D11 to L2. In every patient, a dorso-lumbar MRI and a full spine X-ray were performed. Clinical criteria included back pain measured by the Visual Analogue Score (VAS) and disability measured by the Oswestry Disability Index (ODI). Version 23 of the SPSS software was used to analyze the data.

Results: A total of 130 patients were included in this study. The mean age (SD) of the enrolled patients was 32.8 (±2.11) years. There were 97 (74.62%) males patients while the female patients were 33 (25.38%). A statistical significant improvement was observed post-operatively in posterior vertebral height, anterior vertebral height, Cobb angle and sagittal index. (p<0.05). Statistical significant improvement in Oswestry disability index (ODI) and reduction in VAS was observed in our study. (p<0.05). The post-operative complications were observed in only 12 (9.24%) Patients.

Conclusion: Excellent radiological and clinical results were obtained in our investigation using transpedicular screw fixation that included the fractured vertebrae. By providing an additional pedicle for fixation, it shortened the fixation segment and enhanced biomechanical stability while also aiding in reduction and repair of deformities. Therefore, in the case of dorso-lumbar spine fractures, we highly advise transpedicular screw stabilization of the fractured vertebra.

Keywords: Spine fixation; Unstable fractures; Dorsolumbar junction.

Indications and Outcomes of Emergency Obstetric Hysterectomy at Tertiary Care Hospital

2025-01-29T09:04:52+00:00

To analyze the indications and outcomes of the emergency obstetric hysterectomy at tertiary care hospital.

Materials and Method: The current descriptive cross-sectional study was conducted for the period of six months from December 2021 to May 2022, at the Department of Obstetrics and Gynecology, Ayub Teaching Hospital Abbottabad. A total of 88 females were selected through a purposive sampling technique and the females were from 20- 40 years of age. Informed consent was obtained from each participant who was willing, in addition, they were assured that their privacy and confidentiality will be maintained. The data was collected through a well-structured questionnaire from each participant. All the data were analyzed properly by using the latest version of SPSS 24.

Results: There were 88 female’s patients who underwent emergency obstetric hysterectomy. 23.86 % and 30.68 % of the patients were aged 31-35 and 36-40 years, and most of them were multiparous. 26. 13 % of the cases were with uterus rupture, while 21.59 % of the patients were presented with adhered placenta, which was mainly associated with a previous history of cesarean section. In addition, 19.31 % of the cases were presented with atonic postpartum hemorrhage. 14.7 % of the individual have uterine atony. 39.77 % of the patients had developed anemia after the surgery, while 21.59 % of patients needed a vasopressor, along with that, 7.95 % of the patients were admitted to the intensive care unit, and 3.40 % were reopened (repeated laparotomy).

Conclusion: The present study concluded that cesarean sections were the main contributing factors to emergency obstetric hysterectomy that leads to placental abnormalities, moreover, uterine rupture and adherent placenta as the main causes of EOH. Therefore, the frequency of cesarean sections needs to be reduced and more care is needed for the patients during and after the surgeries to minimize the complications.

Keywords: Laparotomy, placental abnormality, anemia, cesarean section.

Outcomes of Propofol or Thiopental Sodium and Oral Midazolam as an Induction Agent for Day Care Surgery

2025-02-05T08:05:26+00:00

Background: Acceptance of day surgery has been steadily rising for over a decade. Day surgery is essential in developing countries since it allows for quick healing and lower overall costs. Day surgeries have been on the rise in recent years. Induction agents like propofol and thiopentone are frequently utilized during outpatient procedures. This study aimed to compare ASA grade I and II patients undergoing day surgery, the compass reading time, hemodynamic comeback, respiratory upshots, and the postoperative resurgence of the two medications.

Objective: Oral midazolam, thiopental sodium, and propofol were all used for induction before day surgery. The goal was to determine which method was most cost-effective and resulted in the quickest recovery.

Methodology: The study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan from February, 2023 to July, 2023. A total of sixty patients were selected, practically thirty from one of ASA's top two health tiers. In group A, patients were given 2.0 mg/kg of propofol for compass reading, while in group B, patients were given 0.250 mg/kg of oral midazolam 30 minutes prior they were prearranged 2.50 mg/kg of thiopental sodium for induction. During the operation, doctors kept tabs on the patient's vital signs, BP, recuperation score, and ability to return home. For both groups, we calculated the typical price of induction.

Result: After 30 minutes of reverse, group A scored 8.8± 1.75, and group B scored 8.01± 1.03. Group B's costs (BDT 37.88±1.37) were considerably lower than A's (BDT 142.00±6.00), with a P value of< 0.05.

Conclusion: For outpatient surgeries, using vocal midazolam and low- a prescribed amount of thiopental sodium orientation is more cost- effectual than propofol induction.

Keywords: Day care surgery, Oral midazolam, thiopental sodium, propofol.

Prevalence of Pneumonia Associated with Measles among Infants and Children Hospitalized in Healthcare setups of Pakistan

2025-02-05T08:07:24+00:00

Background: Pneumonia in children is the primary cause of morbidity in developing countries and one of the risk factor for Pneumonia is measles.

Objective: The aim of this study was to find out the Prevalence of pneumonia associated with measles among infants and children hospitalized in Pakistan.

Materials and method: The contemporary cross-sectional study was carried out at the pediatric department of Sifwat Ghayour Shaheed Memorial Hospital, Peshawar and HBS General Hospital, Islamabad from November 2022 to April, 2023, after taking the permission from the ethical boards of the institutes. A total of 154 individuals, infants and children of less than 5 years of both genders hospitalized and diagnosed with measles were enrolled in this study. After obtaining informed written consent, the patients' comprehensive demographic information was documented. Detailed demographic information about the patients, including height and weight, was recorded following the authorities' informed written consent. The prevalence of pneumonia and its symptoms in each patient were evaluated. The SPSS 22.0 version was used to analyze the data. Frequencies and percentages were used to evaluate categorical variables.

Results: A total of 154 individuals were enrolled in this study out of which 62(40.2%) were infants and 92 (59.7%) were children. 32 (20.7%) individuals had a high socioeconomic position, 50 (32.4%) had an average socioeconomic status, and 72 (46.75%) had a poor socioeconomic status. 87 56.4% participants resided in a rural area. On the basis of severity 36 (23.3%) of the patients had mild measles, 46 (20.8%) had moderate measles, and 72 (46.7%) had severe measles. Pneumonia was found to be prevalent in 97 (65%) participants. 42 individuals (27.3%) had received a measles vaccine.

Conclusion: In this study, we came to the conclusion that children with measles had a noticeably high rate of pneumonia(65%).

Keywords: Children; Measle; Pneumonia.

Frequency of Iron Deficiency Anemia in patients with Helicobacter Pylori Gastritis

2025-02-20T11:22:10+00:00

Objective: Helicobacter pylori (H. pylori) causes worldwide infection that leads to chronic gastritis alongside multiple gastrointestinal disorders. The research shows that H. pylori increases the risk of developing iron deficiency anemia (IDA). Scientific research will determine the frequency of iron deficiency anemia (IDA) among patients suffering from H. pylori gastritis.

Methods: This study was done at the Department of Medicine at Federal Govt Polyclinic Hospital Islamabad over a period of six months. Material included 228 confirmed H. pylori infection patients via stool antigen testing. Hemoglobin levels (men < 13 g/dL, women < 12 g/dL;); serum ferritin concentrations (men < 20 ng/mL, women < 10 ng/mL); diagnosis IDA. We performed statistical analyses, consisting of chi-square tests, to determine the association of IDA with patient demographics.

Results: We identified 56 (24.6%) of 228 H. pylori infected patients with IDA. Hemoglobin mean 13.2 ± 1.9 g/dL and serum ferritin mean 24.2 ± 10.4 ng/dL. There was no statistically significant difference in IDA prevalence between males (26.6%) and females (22.1%; p = 0.432). IDA prevalence showed no significant effect by age stratification (p = 0.910).

Conclusion: In fact, around one-fourth of patients with H. pylori infection had been observed to have IDA, which hinted at an association of the infection with iron metabolism disturbances. H. pylori infected individuals should receive routine screening for IDA to enable early intervention and better clinical outcomes. Work needs to be done to advance causal understanding and explore mechanisms.

Keywords: Helicobacter pylori infection, Iron deficiency anemia, Gastritis, Hemoglobin, Serum ferritin.

Surgical Outcome of Spine Tumor Surgery

2025-02-20T11:25:38+00:00

Aim and objective: The aim of the study was to assess the outcome of spinal tumor surgery.

Materials and Method: The current prospective study was conducted from June 2022 to July 2023 at Jinnah Teaching Hospital after approval from the institutional review board. A total of 72 patients were selected through a convenient sampling technique including both male and female. Every patient has had an MRI as well as an X-ray taken. The posterior midline technique was used in all surgical procedures. All the data were collected from physical records, histopathology, and lab reports and then analyzed by using the latest version of SPSS 24.

Results: A total of 72 clients were selected for the current study aged from 10-75 years of age. 44.44 % of them were from 46-60 years and 40.27 % of them were from 61-75 years of age. 58.33 % of them were males and 41.66 % of them were females. 70.83 5% had pain and 15.27 % had motor impairments. 9.71 % had sensory and 4.16 % of them had sphincter impairments. 26.38 % had a muscular weakness. 33.33 % had schwannoma, 12.5 % had lipoma, 9.71 % had an arachnoid cyst and 23.61 % had a meningioma. 6.94 % had instant improvement, 27.77 % had improved after a week, 44.44 % had after a month, and 12.5 % of them had no improvements, furthermore, the rate of mortality was 2.7 %. The post-op complications like infection and leakage of CSF were 11.11 % and 4.16 % respectively.

Conclusion: The current study concluded that early surgical interventions are necessary for the patients in order to or the best chance of a full and speedy recovery from both physiological and anatomical handicap caused by a spinal tumor, prompt surgical intervention and complete removal of the tumor are essential. Schwannoma 33.33 % was the most common histopathological finding.

Keywords: Schwannoma, Spinal tumor, Cervicothoracic, CSF.

Opting Biological and Targeted Synthetic Disease-modifying Antirheumatic drugs: Willingness to Pay, Perceptions and barriers among Pakistani Rheumatoid Arthritis Patients

2025-02-21T13:46:34+00:00

Background: Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) have revolutionized the treatment of rheumatoid arthritis (RA). These novel agents have costs, perceptions, barriers and misconceptions.

Objective: To determine the factors associated with limited use of b/tsDMARDs among RA patients.

Study design: Analytical cross-sectional study.

Place and duration of study: Gulab Devi Teaching Hospital, Lahore and Gujranwala Medical College Teaching Hospital, Gujranwala from 1^st January 2023 to 30^th June 2023.

Methodology: One hundred and sixteen patients with rheumatoid arthritis and willingness to pay to pay, perceptions regarding b/tsDMARDs and barriers rendering suboptimal use of standard treatment were included.

Results: Fifty (45%) patients preferred biological and targeted synthetic disease-modifying antirheumatic drugs. Regarding perceptions and challenges, we found that patients prefer two to three tablets (56%) instead of injection-based therapy. 27% patients among sampled population perceived that injection being the last treatment should be avoided. 13% patients had needle phobia. 14% patients were willing to pay for b/tsDMARDs while 86% patients were not willing to pay because of financial constraints,

Conclusion: Financial constraints are the major barrier to optimal utilization of the newer biological and targeted synthetic disease-modifying antirheumatic drugs among Pakistani patients with rheumatoid arthritis.

Keywords: Conventional versus non-conventional DMARDs, Arthritis.

Abnormal Lipid Profile and its Association with the Type of Disease Modifying Antirheumatic drugs among Rheumatoid Arthritis Patients

2025-02-21T13:48:35+00:00

Background: Patients suffering from rheumatoid arthritis (RA) may have abnormal lipid profile increasing the likelihood of cardiovascular diseases. Biological or targeted synthetic disease modifying antirheumatic drugs (DMARDs) have different mechanism of action than conventional DMARDs.

Objective: To determine the effects of type of disease modifying antirheumatic drugs on prevalence of abnormal lipid profile among RA patients.

Study design: Cross-sectional study

Place and duration of study: Al-Aleem Medical College Lahore and Gujranwala Medical College Gujranwala from 1^st December 2022 to 30^th May 2023.

Methodology: One hundred and sixteen rheumatoid arthritis patients were recruited from medical outpatient departments. Fasting lipid profile was assessed. Non obese patients of both genders, with diagnosis of rheumatoid arthritis were included. Smokers and obese patients were excluded.

Results: 44.8% patients had abnormal lipid profile. 53% were on conventional DMARDs while 46% were using biological or targeted synthetic DMARDs. Abnormal lipid profile was associated with the duration of the disease greater than 5 years. It was not associated with type of DMARDs or severity of disease.

Conclusion: The abnormal lipid profile is not associated with type of disease modifying antirheumatic drugs i.e. conventional or biological or targeted synthetic DMARDs.

Keywords: Cardiovascular diseases, Conventional versus non-conventional DMARDs, Abnormal lipid profile, Arthritis.

A Multimodal Diagnostic Approach to Liver Mass, Including Clinical, Radiological and Pathological Parameters

2025-02-22T21:45:23+00:00

Liver masses encompass a wide spectrum of benign and malignant lesions, posing significant diagnostic and therapeutic challenges in clinical practice.

Place of Study: This study aimed to evaluate the clinical, radiological, and pathological characteristics of liver masses in University College of Medicine & Dentistry Lahore emphasizing the importance of a multidisciplinary approach for accurate diagnosis and management.

Study Duration: January 2021-December 2022

Methodology: A retrospective analysis was conducted on 200 patients with liver masses referred between 2020 and 2023. Data on clinical history, imaging findings, histopathology, and serum biomarkers were collected and analyzed.

Result: Hepatocellular carcinoma (HCC) was the most common malignant lesion (45%), followed by metastatic tumors (30%), while benign lesions such as hemangiomas (20%) and focal nodular hyperplasia (FNH) (15%) were also prevalent. Radiological imaging, including ultrasound, CT, and MRI, played a pivotal role in lesion characterization, with MRI demonstrating superior diagnostic accuracy.

Discussion: Histopathological examination confirmed diagnoses, with immunohistochemistry aiding in differentiating malignant lesions. Serum biomarkers, such as alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9), provided additional diagnostic value. The study underscores the necessity of integrating clinical, radiological, and pathological data to optimize patient outcomes. Early detection, accurate diagnosis, and tailored treatment strategies are critical for improving prognosis, particularly in malignant liver masses.

Conclusion: The findings advocate for a multidisciplinary approach involving gastroenterologists, radiologists, pathologists, oncologists, and surgeons to address the complexities of liver mass evaluation and management. This integrated framework not only enhances diagnostic precision but also guides personalized therapeutic interventions, ultimately improving patient care.

Keywords: Hepatocellular carcinoma (HCC), Metastatic tumors, Hemangiomas, Focal nodular hyperplasia (FNH), Radiological imaging (ultrasound, CT, MRI), MRI diagnostic accuracy

Assessment of Liver Steatosis and Fibrosis in Newly Diagnosed Acromegaly: An Integrated Approach Utilizing Quantitative Ultrasound, Histological Analysis and Biochemical Markers"

2025-02-22T21:56:13+00:00

Aim of Study: Acromegaly, a disorder characterized by excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1) release, is associated with systemic consequences, including hepatic steatosis and fibrosis. Early identification of liver involvement is crucial for optimal therapy.

Place of Study: Punjab Medical College, Faisalabad Medical University, Faisalabad Pakistan

Study Duration: February 2021 until January 2023

Material and Methods: This study investigates the efficiency of quantitative ultrasonography (QUS) techniques and biochemical markers in detecting liver steatosis and fibrosis in newly diagnosed acromegaly patients. Fifty acromegaly patients and 30 healthy controls performed QUS imaging (shear wave elastography [SWE] and controlled attenuation parameter [CAP]) and serum biomarker analysis (FIB-4, APRI, and ELF scores). Liver biopsies were performed in a subgroup of patients for validation.

Results: demonstrated substantial relationships between QUS parameters, biochemical markers, and histological findings. QUS revealed great sensitivity and specificity for detecting steatosis and fibrosis, while biochemical markers provided complementing diagnostic value.

Conclusion: This work demonstrates the promise of non-invasive approaches for early liver screening in acromegaly, enabling timely intervention and improved outcomes.

Keywords: Quantitative ultrasound (QUS), Controlled attenuation parameter (CAP), Biochemical markers, FIB-4 score, APRI score, ELF score, Liver biopsy

Frequency and Histopathological Characteristics of Malignant Tumors Reported at Tertiary Care Hospital

2025-02-27T11:15:20+00:00

Background: Cancer is a very important cause of worldwide mortality, and therefore, a continuous updated research is always needed regarding types of cancers in a particular area, histopathological grades and prevalence of cancer .Only a limited research work is available in our country in the field of cancer and histopathology.

Objective: To express the prevalence of cancers and types of carcinoma with age, gender, site, and histopathological type, histopathological grades.

Study Design: Descriptive study

Place and Duration of Study: Department of Pathology, Pak Red Crescent Medical & Dental College, Dina Nath from 1^st July 2018 to 30^th June 2023.

Methodology: One hundred and ninety four male and female patients were enrolled. Patients >12 years and with malignancy were included.

Results: The average age of patients was 51 years and most of the patients were females. Predominant cancers were of breast and cervix. Around 88% of patients had carcinoma, of which mostly were females. Sarcoma was also more common in females whereas lymphoma was seen mainly in male patients .(P<0.05) also shows the maximum percentage of female had cancer as compared to male patients. The highest percentage of patient of carcinoma and sarcoma were of grade-2 and Lymphoma seen was of high grade.

Conclusion: Most of the findings in prevalence and cancer subtypes were similar to other studies in Pakistan with a few differences, which are due to difference in facilities provided. Most patients had advanced grades of cancer, when prognosis is no longer favourable.

Keywords: Cancer, Prevalence, Breast cancer, Stage, Grade, Histopathology

Analgesia after Lower Abdominal Surgery in Children Treated with Caudal Bupivacaine Versus a Bupivacaine-Tramadol Combination

2025-02-27T15:26:17+00:00

Background: Postoperative pain management in pediatric patients is essential in controlling pain and in improving recovery results. The technique of caudal epidural analgesia is widely used in pediatric lower abdominal surgeries and adding tramadol to bupivacine has been effective in producing increased analgesic effect.

Objective: To evaluate the efficacy of tramadol as an adjuvant to bupivacaine for caudal analgesia in pediatric patients undergoing lower abdominal surgeries.

Material and Methods: This randomized controlled trial was performed at the Fatima Hospital Baqai Medical University Karachi, from January 2023 to June 2023. Total 64 pediatric patients aged 2–12 years undergoing elective lower abdominal surgeries were randomly assigned into two groups of 32 patients each. In Group A, caudal bupivacaine (0.25 %, 1 mL/kg,) was administered while in Group B bupivacaine (0.25 %, 1 mL/kg) and tramadol (1 mg/kg.) in combination with each other. Evaluation of postoperative pain was performed using the FLACC scale at 1, 2, 4, 6, and 12, and 24 hours in the postoperative period. The primary result was the duration of analgesia, secondary results included the pain scores, requirements for rescue analgesia and adverse effects. The statistical analysis was done using SPSS version 24.

Results: Mean pain scores were significantly lower for the bupivacaine-tramadol group at all time points (p < 0.001) and the duration of analgesia in this group was longer (11.99 ± 2.00 hours versus 5.68 ± 0.95 hours, p < 0.001). The bupivacaine-tramadol group also had lower rescue analgesia requirements (0.56 ± 0.50 doses vs 2.78 ± 0.83 doses; p < 0.001). There was no significant increase in adverse effects.

Conclusion: For pediatric patients requiring caudal analgesia, the addition of tramadol to bupivacaine provides prolonged analgesia with a favorable safety profile, and results in improved postoperative pain management.

Keywords: Bupivacaine, Tramadol, Caudal analgesia, Pediatric surgery, Postoperative pain.

Analyzing the Biochemical Alterations and Histopathological changes in Oxidative Stress-Induced Tissue Damage. A Study on Antioxidant Therapeutic Interventions

2025-03-03T19:57:24+00:00

Background: Hexavalent chromium [Cr (VI)] is a toxic industrial chemical that produces oxidative stress, disrupts biochemical pathways, and causes severe organ damage.

Objectives: The study aimed to assess the dose and time-dependent biochemical and histopathological effects of hexavalent chromium [Cr (VI)] exposure, including oxidative stress, hepatotoxicity, and nephrotoxicity.

Methodology: The effects of hexavalent chromium (Cr (VI)) were evaluated on albino rats over 30, 60, and 90 days, at dose and time-dependent conditions. Control and treatment groups (2, 5, and 10 mg/kg [Cr (VI)] were given daily orally to rats. The analysis of oxidative stress markers (MDA, GSH, SOD), liver enzymes (ALT, AST), and renal parameters (creatinine, BUN) was carried out. For formalin fixation and staining, liver and kidney tissues were subjected to histopathological examination. One-way ANOVA (p < 0.05) significance was used in statistical analysis, adhering to ethical and international guidelines.

Results: Dose and time dependence of oxidative stress and organ damage were produced after exposure to hexavalent chromium [Cr (VI)]. Decreased glutathione (GSH) and superoxide dismutase (SOD) activity, increased blood levels of lipid peroxidation products, and higher malondialdehyde (MDA), a sign of lipid peroxidation, were demonstrated. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and blood urea nitrogen (BUN) were high, indicating hepatocellular damage and renal impairment, respectively, and suggesting systemic toxicity and increasing oxidative damage.

Conclusion: Dose and time-dependent oxidative stress (increased lipid peroxidation and decreased antioxidant defenses), causing hepatocellular and renal dysfunction, results from exposure to hexavalent chromium [Cr (VI)]. These results also serve to further demonstrate the cumulative toxicity of [Cr (VI)] and its ability to disrupt biochemical and histopathological homeostasis.

Keywords: Hexavalent chromium, malondialdehyde, glutathione, superoxide dismutase, alanine aminotransferase, aspartate aminotransferase.

Efficacy of Antibiotic Prophlaxis in Preventing Surgical Site Infections: A Review of Current Practices and Emerging Alternatives in General and Plastic Surgery

2025-03-06T02:08:09+00:00

Background: Effective preventive measures are necessary to reduce the incidence of surgical site infections (SSIs), which continue to be a leading cause of postoperative morbidity.

Objective: This study aimed to evaluate the efficacy of antibiotic prophylaxis in preventing SSIs in general and plastic surgery, compare different antibiotic regimens, and analyze factors influencing infection rates.

Methodology: A prospective observational study was conducted from at the department of Surgery, Mardan Medical Complex, Mardan from January 2022 to December 2022. There were 116 patients in all having either general or plastic surgery. Based on surgical indications, cefazolin, cefuroxime, or clindamycin-gentamicin were used in antibiotic prophylaxis in accordance with FDA recommendations. To evaluate the incidence of SSI, patients were monitored for 30 days after surgery. SPSS version 25 was used to gather and analyze data on patient demographics, comorbidities, wound categorization, surgery specifics, and preventative measures. Chi-square tests were used for categorical variables.

Results: General surgery had a greater infection rate than plastic surgery, with an overall SSI incidence of 14.66%. With the lowest infection incidence, cefazolin was the most effective antibiotic; SSI rates were greater for cefuroxime and clindamycin-gentamicin. While the difference in SSI rates between general and plastic surgery was not statistically significant, wound classification and the presence of drains were strongly linked with infection risk (p < 0.05).

Conclusion: The most effective drug cefazolin proves to significantly reduce the possibility of surgical site infection according to research. Perioperative infection control methods must be optimized because of this requirement.

Keywords: Surgical site infection, antibiotic prophylaxis, general surgery, plastic surgery, cefazolin, infection control

Maternal and Fetal Outcome in Cardiac Patients a Cross-Sectional Study at Tertiary Care Setting

2025-03-06T02:10:28+00:00

Background: In low-resource settings, when specialist treatment is unavailable, cardiovascular disease during pregnancy presents severe hazards to the health of both the mother and the fetus.
Objective: To assess maternal and fetal outcomes in pregnant women with cardiac disease admitted to a tertiary care hospital, identifying common cardiac conditions, associated complications, and predictors of adverse outcomes.
Methodology: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Saidu Group of Teaching Hospitals, Swat and North West General Hospital, Peshawar over one year (June, 2022 to May 2023). In all, 164 pregnant women who had a history of heart problems were considered. Information on the patient's demographics, heart condition (type and severity), pregnancy, challenges throughout pregnancy, foetal outcomes, and neonatal health were culled from clinical records. Data was summarized using descriptive statistics, and relationships between maternal cardiac problems and fetal outcomes were analyzed using t-tests, with a p-value less than 0.05 being deemed statistically significant.
Results: Out of all cardiac conditions, rheumatic heart disease accounted for 37.80% of cases, congenital heart disease for 29.27%, cardiomyopathies for 19.51%, and ischemic heart disease for 13.41%. Heart failure (25.61%), arrhythmias (21.95%), thromboembolic events (10.98%), and pulmonary edema (12.20%) were among the maternal problems that contributed to the 4.88% maternal death rate. Preterm delivery (45.12%), intrauterine growth restriction (23.17%), and stillbirth (8.54%) were all notable fetal problems; 25.61% of these babies needed to be admitted to the neonatal intensive care unit (NICU). The rates of preterm delivery (53.13%, p = 0.03), NICU hospitalizations (34.38%, p = 0.02), and stillbirth (15.63%, p = 0.01) were greatest among cardiomyopathies, indicating a substantial connection between the severity of the maternal condition and bad newborn outcomes.
Conclusion: Early risk assessment and multidisciplinary care are necessary to enhance maternal and newborn outcomes when maternal heart illness is present, since it is linked with major pregnancy problems.
Keywords: Maternal cardiac disease, pregnancy outcomes, rheumatic heart disease, congenital heart disease.

Assessment of Cognitive Function among Pregnant Women with Anemia in the Early and Late Trimester of Pregnancy

2025-03-12T23:44:43+00:00

Background: Anemia during pregnancy is a common condition that has been associated with various adverse maternal and fetal outcomes. While its physiological effects are well-documented, its impact on cognitive function remains understudied.

Objective: This study aimed to assess and compare cognitive function among pregnant women with anemia in the early and late trimesters of pregnancy.

Methods: This observational study was conducted at DHQ hospital KDA Kohat during May 2022 to May 2023. A total of 85 pregnant women were added in the study. They were divided into two groups: 43 women in the early trimester (1st to 2nd month) and 42 women in the late trimester (7th to 9th month) of pregnancy.

Results: Cognitive function was significantly lower in the late trimester group compared to the early trimester group, with MMSE scores showing a decline from 23.6 ± 2.8 to 22.3 ± 3.1 (p = 0.03). Attention and working memory, assessed through DST, were also significantly lower in the late trimester (p = 0.02 and p = 0.05). TMT scores indicated slower processing speed in the late trimester (p = 0.003). Fatigue was significantly higher in the late trimester (18.5 ± 4.1 vs. 14.2 ± 3.2, p < 0.001) and was more strongly correlated with cognitive decline than depression. Hemoglobin levels were not significantly different between the groups (p = 0.26), suggesting that factors beyond anemia contribute to cognitive changes in pregnancy.

Conclusion: It is concluded that cognitive function declines as pregnancy progresses, with the late trimester group showing greater impairments in attention, memory, and executive function.

Keywords: Anemia, Cognitive Function, Pregnancy, Fatigue, Attention, Memory, Executive Function.

Short-Term Effects on Tear Film Following Cosmetic Botulinum Toxin Injections in Healthy Individuals

2025-03-12T23:46:33+00:00

Introduction: The cosmetic treatment Botox relies on the paralysis of facial muscles in order to minimize wrinkles. Research now focuses on investigating how Botox treatment influences the tear film at the same time it reduces facial wrinkles.

Objective: To evaluate the short-term effects of cosmetic botulinum toxin injections on the tear film in healthy individuals, with a focus on tear production, stability, and overall ocular health.

Methodology: This prospective cohort study was conducted at Burn and Plastic Surgery Center Hayatabad, Peshawar during March 2022 to June 2023 involving 85 healthy individuals who were selected based on their decision to undergo cosmetic botulinum toxin injections for aesthetic purposes.

Results: A total of 85 participants were added with mean age 30.5 ± 5.7 years. 47% males (40 participants) and 53% females (45 participants). The mean tear production was 12.4 ± 3.5 mm, and the mean tear breakup time (TBUT) was 10.3 ± 2.1 seconds. Only 8% of participants reported any discomfort at baseline. At baseline, only 8% of participants reported ocular discomfort, but this increased significantly to 23% 1-week post-injection (p < 0.05). By 1-month post-injection, the discomfort decreased to 9%, which was not statistically significant (p > 0.05).

Conclusion: Cosmetic botulinum toxin injections have a short-term impact on tear film stability and tear production, with a gradual recovery within a month. These findings highlight the need for careful assessment of ocular health in individuals undergoing botulinum toxin treatments, especially those with underlying dry eye conditions or concerns about tear production.

Keywords: Botulinum toxin, tear film, tear production, Schirmer’s test, tear breakup time, ocular discomfort, visual disturbances.

Molecular Detection of T. Gondii DNA by Polymerase Chain Reaction in Blood Samples of Pregnant Women Attending Tertiary Care Unit in Islamabad, Pakistan

2025-03-12T23:48:47+00:00

Background and Purpose: Toxoplasmosis is caused by Toxoplasma gondii and is mainly diagnosed through serological methods, but the sensitivity is insufficient. When it fails, one must rely on direct detection of parasites or DNA testing via polymerase chain reaction (PCR). Our goal is to establish a molecular tool for domestic toxoplasmosis research through PCR technology targeting the B1 gene and compare it with ELISA results.

Design and Setting: This study was conducted at the Rawal Institute of Health Sciences, Islamabad between May 2023 and July 2023 on pregnant women attending Rawal General Hospital, Islamabad.

Patients and Methods: Peripheral blood samples were collected from patients (n=137). DNA was extracted and the B1 Toxoplasma gondii gene was amplified by PCR. Amplicons were visualized and sequenced, and the results analyzed. For comparison, anti-T. gondii IgG and IgM in serum were measured by enzyme-linked immunosorbent assay (ELISA).

Results: Among the 137 samples tested, 56 (41%) had B1 gene amplification detected by PCR. DNA sequencing confirmed these results. The IgM-ELISA test detected 9 of these cases (6.5%). Immunoglobulin G test results were positive in 53 patients (38.6%).

Conclusion: This study demonstrates the need for PCR as a confirmatory test in addition to serological testing to detect recent infection. We recommend nationwide implementation of these molecular diagnostic tools.

Keywords: T. Gondii DNA, Polymerase Chain Reaction, Pregnant Women, PCR.

Socioeconomic, Genetic, and Dietary Risk Factors of Ischemic Heart Disease in Pakistan. A Multicenter Case-Control Study

2025-03-13T21:44:27+00:00

Background: Ischemic heart disease (IHD) is a leading cause of mortality in the world and has an overt contribution in low- and middle-income countries such as Pakistan. Traditional risk factors (hypertension, diabetes, dyslipidemia) are well known; however, the socioeconomic, dietary, and genetic determinants have not been fully explored.

Aims and Objectives: This study aimed to investigate the association between socioeconomic factors, dietary habits, and genetic predisposition in the development of IHD risk in Pakistan. It was specifically designed to find out if adverse socioeconomic conditions, unfavourable dietary patterns, and the presence of the APOE ε4 allele, on their own or in combination, would independently and individually increase the likelihood of IHD.

Methods: A Multicenter Case Control Study was conducted on n=250 participants (130 IHD patients and 130 controls) from the Punjab Institute of Cardiology (Lahore) and Chaudhry Pervaiz Elahi Institute of Cardiology (Wazirabad) from June 2022 to June 2023. Blood pressure, body mass index, lipid profile, and fasting blood glucose were measured, and comprehensive clinical evaluations were performed. Structured questionnaires were used to collect socioeconomic and dietary data, and a validated food frequency questionnaire was used to collect dietary data. Fasting blood samples were used for genomic DNA extraction, and PCR-RFLP analysis was used to genotype the APOE gene. Bivariate and multivariate logistic regression was done to determine independent predictors of IHD.

Results: They were older IHD patients who were known to have higher BMI, blood pressure, and adverse lipid profiles. IHD patients had lower income and educational levels, higher saturated fat intake, and lower fruit and vegetable consumption. The IHD group had a significantly higher frequency of the APOE ε4 allele.

Conclusion: The multifactorial interplay of clinical, socioeconomic, dietary, and genetic factors promptly in this context plays a pivotal role, and hence, an integrated preventive strategy is warranted.

Keywords: ischemic heart disease, socioeconomic factors, dietary habits, APOE ε4, genetic predisposition, Pakistan.

A Comparative Study of Obstetric Outcome of Patients with Pregnancy Induced Hypertension

2025-03-18T23:24:10+00:00

Background: Pregnancy-induced hypertension (PIH) is a common complication that affects maternal and fetal health.

Objective: To assess and compare the obstetric outcomes in patients diagnosed with pregnancy-induced hypertension, including maternal complications, fetal health, and delivery outcomes.

Methodology: This comparative study was conducted at Department of Gynaecology & Obstetrics, Gujranwala Medical College, Gujranwala from 1^st January 2023 to 30^th June 2023. A total of 320 patients were added in the study. Data were collected from hospital records, structured questionnaire and follow-up visits. The demographic and clinical data included patient age, parity, gestational age at diagnosis, obstetric history, and comorbid conditions.

Results: Women with severe PIH had a higher incidence of complications such as preeclampsia (45% vs. 25%), placental abruption (15% vs. 5%), and stroke/acute renal failure (3% vs. 1%), and were more likely to undergo cesarean delivery (45% vs. 20%), with an average hospitalization duration of 6 days compared to 3 days for the mild PIH group. Fetal outcomes were also worse in the severe PIH group, with higher rates of intrauterine growth restriction (IUGR) (25% vs. 10%), preterm birth (18% vs. 8%), and lower average birth weight (2.7 kg vs. 3.1 kg). Neonates in the severe PIH group had lower Apgar scores, with 85% achieving a score of 7+ at 1 minute (compared to 95% in the mild PIH group), more frequent NICU admissions (20% vs. 6%), and higher rates of neonatal complications (25% vs. 7%).

Conclusion: Severe pregnancy-induced hypertension is associated with higher maternal and fetal morbidity compared to mild PIH. Early diagnosis, close monitoring, and appropriate management are essential to reduce complications and improve obstetric outcomes in PIH patients.

Keywords: Pregnancy-induced hypertension, maternal outcomes, fetal outcomes, preeclampsia, cesarean section, birth weight, preterm birth, NICU admissions.

Association of Omega-3 Fatty Acid Levels with Cardiovascular Disease Risk Factors and Metabolic Syndrome among Adults

2025-03-18T23:32:06+00:00

Background: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Omega-3 fatty acids (ω-3 FAs) have been suggested to have a beneficial effect on CVD risk factors and metabolic syndrome (MetS), but their role in adults remains unclear.

Objective: To investigate the association of omega-3 fatty acid levels with cardiovascular disease risk factors and the prevalence of metabolic syndrome among a cohort of 243 adults.

Methodology: This cross-sectional study was conducted at Shaikh Zayed Hospital, Lahore during January 2023 till August 2023. A total of 243 patients were added in the study. Data were collected using a combination of clinical assessments, laboratory tests, and self-reported questionnaires. Data collection for this study involved clinical assessments, laboratory tests, and self-reported questionnaires.

Results: The mean age of 45 years ranging from 18 to 65 years. There were 55% females and 45% males. The mean body mass index was 27.5±4.2 kg/m², indicating that the majority were overweight or obese, with a range of 18.5 to 38.0 kg/m². Waist circumference measurements revealed an average of 94 cm for men and 88 cm for women, reflecting central obesity. The relationship between Omega-3 Index (O3I) levels and insulin resistance, as measured by HOMA-IR, revealed that participants with an O3I of less than 4% had a higher mean HOMA-IR of 2.2±1.1, with 35% of them exhibiting insulin resistance (HOMA-IR ≥2.5). In contrast, participants with O3I levels between 4-6% showed a mean HOMA-IR of 1.9±0.9, with 25% demonstrating insulin resistance. Those with an O3I of 6% or higher had the lowest mean HOMA-IR of 1.5±0.7, and only 15% had insulin resistance.

Conclusion: Higher omega-3 fatty acid levels are inversely associated with cardiovascular disease risk factors and the prevalence of metabolic syndrome among adults. Omega-3 supplementation or dietary intake could be beneficial in mitigating cardiovascular and metabolic risks in the adult population.

Keywords: Patients, Omega-3 Fatty acids, CVD, Metabolic, Syndrome

Clinical Spectrum and Radiological Evaluation of Urinary Tract Infections in Children

2025-03-18T23:34:20+00:00

Objective: To evaluate clinical spectrum and radiological findings in pediatric patients presenting with urinary tract infection.

Study Design: Cross sectional study

Place and Duration of Study: Radiology and Pediatric Departments, Niazi Medical & Dental College, Niazi Welfare Teaching Hospital Sargodha from 1^st January 2023 to 31^st July 2023.

Methodology: One hundred and fourteen children were enrolled. Urine samples of patients under three months of age were collected by suprapubic aspiration, while in the older children urine was collected by clean catch method or via catheter in catheterized children. All children and neonates having urine routine examination proven urinary tract infections were enrolled in the study. The radiological investigations included ultrasound of the renal tract, intravenous pyelography and micturating cystourethrogram. Clinical signs and symptoms of urinary tract infections, radiological findings, and the history of recurrent urinary tract infections, as well as any complications arising from this infection, were documented using separate questionnaires.

Results: There were 52.6% males and 47.4% females. Fever was a prevalent clinical symptom, observed in 57.0% of cases, while vomiting was documented in 16.7% of patients. Failure to thrive was reported in a minority of cases (12.3%), while abdominal pain was relatively common (31.6%). Edema, dysuria, hematuria, urinary urgency, urinary incontinence, and urinary retention were generally rare symptoms in this population.

Conclusion: The diagnosis and management of pediatric urinary tract infections, underscoring the importance of early detection, individualized treatment, and evidence-based guidelines. It contributes valuable insights to the field, while also recognizing the need for further research to enhance our understanding of this prevalent pediatric condition.

Keywords: Urinary tract infection, pediatric population, ultrasound, IVU, MCUG

A Systematic Review on the Impact of Helicobacter Pylori Eradication on Gastrointestinal and Extra-Gastrointestinal Diseases

2025-03-22T01:55:59+00:00

Background: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and gastric cancer, with emerging associations with metabolic, cardiovascular, neurological, and autoimmune diseases. This systematic review evaluates the impact of H. pylori infection and its eradication on these conditions.

Methods: A systematic search was conducted across different databases from January 2000 to June 2023. Eligible studies included clinical trials, cohort studies, and meta-analyses that assessed disease progression or symptom improvement post-eradication.

Results: Eradication significantly reduces PUD recurrence (from 85.3% to 6.8%) and lowers gastric cancer risk by 36%, though its effect on intestinal metaplasia remains unclear. The impact on GERD is inconclusive. H. pylori increases insulin resistance by 54% and metabolic syndrome risk by 31%, with eradication improving lipid profiles and glucose metabolism. The infection is linked to atherosclerosis, hypertension, and systemic inflammation, with eradication reducing CIMT and inflammatory markers. H. pylori is also associated with Alzheimer’s and Parkinson’s diseases, likely via gut-brain axis disruption, and may impair levodopa absorption in Parkinson’s disease. Autoimmune links include rheumatoid arthritis and Hashimoto’s thyroiditis through molecular mimicry and immune activation.

Conclusion: While eradication is essential for GI diseases, its role in extra-GI conditions remains under investigation. Targeted eradication in high-risk populations may offer therapeutic benefits, but broad eradication requires further study.

Keywords: Helicobacter pylori, peptic ulcer, gastric cancer, metabolic syndrome, cardiovascular disease, neurodegenerative disorders, autoimmune diseases, eradication therapy.

Salivary Biomarkers CYFRA 21-1 and MMP9: Predictive Indicators of Disease Progression in Oral Squamous Cell Carcinoma

2025-03-22T01:58:10+00:00

Background: Oral squamous cell carcinoma (OSCC) is a prevalent cancer with high mortality rates. Identifying non-invasive biomarkers for early diagnosis and monitoring the disease's progression is crucial.

Objective: This study aims to assess the salivary levels of CYFRA 21-1 and MMP-9 in OSCC patients and their correlation with clinicopathological characteristics and histological grades.

Methods: A total of 90 participants, including 45 healthy controls and 45 OSCC patients, were enrolled. Demographic and clinicopathological data were collected, including gender, habits (smoking, gutkha, betel nut, pan/naswar), habit duration, and tumor site. Salivary levels of CYFRA 21-1 and MMP-9 were measured using enzyme-linked immunosorbent assay (ELISA). The OSCC patients were categorized into well-differentiated, moderately differentiated, and poorly differentiated histological grades.

Results: Among OSCC patients, males (78%) were predominant. Smoking and gutkha use were the most common habits. The highest percentage of patients reported habit durations >16 years. CYFRA 21-1 and MMP-9 levels were significantly higher in poorly differentiated OSCC compared to moderately and well-differentiated cases (p = 0.01 and p = 0.002, respectively). MMP-9 levels showed a significant increase with longer habit durations (p = 0.002). The tumor site predominantly involved the tongue, especially in poorly differentiated cases (46.6%).

Conclusion: Salivary CYFRA 21-1 and MMP-9 are promising biomarkers for OSCC, with elevated levels correlating with histological grade and habit duration. These biomarkers may aid in early diagnosis and monitoring the progression of OSCC.

Keywords: CYFRA 21-1, MMP-9, Oral Squamous Cell Carcinoma, Saliva, Histological Grade.

Sexual Function after Staged Penile Urethroplasty with Oral Mucosal Graft: A Single-Center Prospective Analysis

2025-03-23T02:01:45+00:00

Objective: The current study aims to assess erectile, ejaculatory and anatomical changes following staged penile urethroplasty with oral mucosal graft including outcomes re-evaluation after a set period of time in men with complex urethral strictures.

Methods: This study was a prospective cohort study of 33 men who underwent staged penile urethroplasty with oral mucosal graft in Khyber Teaching Hospital Peshawar from July 2023-August 2024. Patients completed their sexual function assessment prior to and after the surgery using the Sexual Health Inventory for men (SHIM) and the Male Sexual Health Questionnaire Ejaculatory Short Form (MSHQ-EjD). Penile curvature, length, and sensitivity were assessed subjectively using a non-validated questionnaire. Changes in scores were analyzed using linear regression and descriptive statistics were used to summarize patient-reported outcomes.

Results: The cohort had mean age 45years (SD: 11.2) and BMI 27.6kg/m^2(SD: 4.1). Stricture causes included failed hypospadias repair (52%), lichen sclerosus (27%) and previous urethroplasty (52%). Median follow up after the second stage was 6.3 months (IQR: 3.5–13.3). No clinical significance change was found in SHIM (Δ = −0.64, 95% CI: –3.00–1.72) or MSHQ-EjD score (Δ = 1.55, 95% CI: – 1.53–4.63). Subjectively 23% reported new penile curvature, 55% reported decreased length and 45% reported altered sensitivity. Satisfaction with intercourse increased in 32% (SHAM Q5) while 40% reported decreased bother by ejaculation (MSHQ-EjD Q4). Only 1 patient was on post-operative erectile dysfunction medication.

Conclusion: As assessed with validated instruments, staged penile urethroplasty with oral mucosal grafting OMG has minimal effects on erectile and ejaculatory functions. On the other hand, subjective anatomical changes (sensitivity, curvatures, length) are commonplace and necessitate proper counseling prior to surgery. These insights are relevant to the expectations of patients and offer suggestions for further research on objective measurements of anatomy of the penis.

Keywords: urethroplasty, sexual dysfunction, penile curvature, oral mucosal graft, erectile function, ejaculatory function.

Early Detection of Primary Open Angle Glaucoma Using Optical Coherence Tomographic Ganglion Cell Layer Thickness

2025-03-13T17:53:26+00:00

Background: POAG is a leading cause of blindness worldwide. Early detection is key to preventing progression, however, traditional diagnostic methods are not able to detect the disease at the early stages. An emerging tool for early diagnosis is optical coherence tomography (OCT) for quantifying the thinning of the retinal ganglion cell layer (GCL) which precedes functional loss.

Methodology: This prospective, observational study was performed for one year in a tertiary eye care center in Faisalabad, Pakistan from January 2022 to January 2023. There was n=50 patients with early POAG and 50 age and sex matched healthy controls enrolled, for a total of n=100 subjects (200 eyes). An ophthalmic examination, including measurement of intraocular pressure (IOP), standard automated perimetry (SAP), and spectral domain OCT imaging, was performed comprehensively. A 6 × 6 mm² macular cube scan centered on the fovea was acquired using OCT, and automated segmentation algorithms calculated the average, superior, and inferior GCL thickness. Clinical parameters and OCT measurements were compared between the groups, and correlations between GCL thickness and visual field indices were assessed using statistical analyses performed using SPSS.

Results: IOP and MD in POAG patients were significantly higher than in healthy controls (p < 0.001). The thickness of the GCL in POAG patients was significantly reduced in the average, superior, and inferior sectors from controls (p < 0.001). Decreased GCL thickness was linearly correlated (r = -0.65, p < 0.001) to worsening MD in the POAG group.

Conclusion: Measurements of the ganglion cell layer by OCT are sensitive and objective biomarkers for the early detection of POAG. POAG patients have significantly smaller GCL thickness and there is strong correlation with functional deficits which makes it an ideal candidate for early glaucoma screening in resource-poor settings such as Pakistan, as OCT can be integrated in early screening protocols.

Keywords: Primary Open-Angle Glaucoma, Optical Coherence Tomography, Ganglion Cell Layer, Early Detection, Visual Field, Faisalabad, Pakistan

Patient Satisfaction in Lumbar Decompression Surgery under Spinal Anesthesia: A Prospective Study

2025-03-27T17:12:00+00:00

Background: Spine surgery, particularly in the lumbar region, is often associated with significant anxiety due to concerns about anesthesia, positioning, and postoperative discomfort. Traditionally performed under general anesthesia, lumbar decompression procedures are increasingly being done under spinal anesthesia to reduce complications and enhance recovery. This study aimed to evaluate patient satisfaction with spinal anesthesia for lumbar decompression surgery and to identify factors influencing their experience.

Methods: This prospective study was conducted at Shamshad Aslam Hospital from July 2020 to June 2023. A total of 152 patients undergoing lumbar decompression under spinal anesthesia were enrolled. Patient demographics, intraoperative experiences, postoperative symptoms, and satisfaction levels were recorded using a structured questionnaire. Data were analyzed using SPSS version 27, with Pearson correlation applied to explore associations between patient variables and satisfaction (p < 0.05).

Results: The majority of patients (91.5%) reported satisfaction with the overall surgical experience, and 94.1% indicated they would recommend spinal anesthesia for similar procedures. Despite comprehensive preoperative counseling, 30.9% experienced moderate to severe pain during needle insertion, 40.1% reported shivering, and 64.5% experienced nausea or vomiting. Chest discomfort in the prone position was noted in 82.9% of patients. Postoperative issues such as spinal headache, numbness, or urinary retention were reported by 11.9%, with most resolving within 48 hours. Older age, higher BMI, and longer surgical duration were negatively associated with satisfaction (p < 0.05).

Conclusion: Spinal anesthesia for lumbar decompression surgery is a safe and well-accepted option, associated with high patient satisfaction and manageable complications. Careful patient selection and preoperative counseling can further improve outcomes.

Keywords: Spinal anesthesia, lumbar decompression, patient satisfaction, prone positioning, postoperative symptoms, minimally invasive spine surgery.

Impact of Standardized Gestational Diabetes Screening on Maternal and Neonatal Health

2025-04-15T07:35:22+00:00

Background: To evaluate the effect of standardized gestational diabetes mellitus (GDM) screening on maternal and neonatal health outcomes among pregnant women receiving antenatal care at public sector hospitals.

Methods: This cross-sectional study was conducted at DHQ Hospital Haripur and Bacha Khan Medical Complex, Swabi during the first half of 2023, from January to June. For the purpose of this study, 101 pregnant women in the 24 to 28 weeks of ‘gestation period were screened for GDM using either one step or two step oral glucose tolerance tests (OGTT)’. Information regarding the demographics and clinical details of the mother, along with the outcome of the pregnancy and the child, were gathered and analyzed. The significance of the results was assessed by means of a chi-square or t-test, considering p-values under 0.05 as statistically significant.

Results: There is an increase in the prevalence of gestational hypertension, preeclampsia and cesarean deliveries in women with GDM. Infants with GDM mothers have increased risk of macrosomia, neonatal hypoglycemia and NICU admissions. Implementation of GDM-specific screening algorithms facilitated early diagnosis and treatment of GDM and enabled better maternal glucose levels thus decreasing the detrimental outcomes.

Conclusion: The implementation of organized antenatal care has been associated with a decrease in the frequency of negative maternal and neonatal pregnancy outcomes. In order to mitigate the risks associated with pregnancy, early detection, accurate diagnosis, and timely intervention is paramount for enhanced nursing outcomes.

Keywords: Gestational diabetes mellitus, standardized screening, maternal outcomes, neonatal complications, macrosomia, NICU admission, cesarean section

Challenges and Innovations in Left Main and Bifurcation Stenting

2025-04-24T21:11:43+00:00

Objective: To evaluate the challenges and innovations in left main and bifurcation stenting in patients undergoing PCI at Hayatabad Medical Complex Peshawar, Pakistan. The objective was to assess the efficacy of single versus dual stenting techniques and their associated clinical outcomes.

Methodology: A total of 150 patients with left main and bifurcation lesions were included in this retrospective study. Data were collected from the hospital’s electronic medical records from January 2023 to June 2023. Patients were classified into two groups: single stenting (76.7%, n = 115) and dual stenting (23.3%, n = 35). Various parameters including comorbidities (hypertension, diabetes, hyperlipidaemia), procedural details, and clinical outcomes (myocardial infarction, stroke, restenosis, MACE, mortality) were analysed.

Results: The most common mode of presentation was NSTEMI (45.3%), followed by STEMI (22.7%). The prevalence of comorbidities included hypertension (38.7%), diabetes (52%), and hyperlipidaemia (45.3%). Complications included myocardial infarction (12%), stroke (4.7%), restenosis (8.7%), and MACE (18.7%). The dual stenting group had higher complication rates (p = 0.018 for MACE).

Conclusion: The study highlights that single stenting remains the preferred treatment method, with dual stenting reserved for complex lesions, though it carries a higher risk of complications. Tailored patient selection and procedural strategies are essential to optimize outcomes.

Keywords: Left main, bifurcation stenting, PCI, complications, dual stenting.

Assessment of the Functional Outcomes Associated with Tension Band Wire (TBW) Treatment for Patella Fractures at Bolan Medical and Teaching Hospital, Quetta

2025-04-24T21:16:12+00:00

Introduction: Patella fractures represent approximately 1% of all types of fractures and are most frequently seen in individuals aged 20 to 50. Various surgical fixation methods for patellar fractures have been documented, including the use of tension bands, plates and screws, cerclage wire, and external fixation, among others. The tension band wire (TBW) technique is particularly prevalent due to its ability to provide stable fixation and facilitate early mobility.

Objective: To assess the effectiveness of tension band wiring (TBW) in the treatment of patellar fractures.

Setting and Study Duration: This Descriptive study was conducted at Bolan Medical and teaching hospital, Quetta, Study extended from 15th December 2022 to 15th June 2023.

Material and Method: After approval by the hospital's ethical board, a total of 142 patients, comprising both males and females, were enrolled in the study during an emergency situation. Informed consent was obtained from all participants. A demographic profile, including age, gender, and place of residence, was recorded. All cases that underwent total patellar replacement were evaluated based on established inclusion and exclusion criteria. Patients were assessed at two weeks, four weeks, and twelve weeks post-surgery. The functional outcomes were evaluated at the twelve-week mark using the Good fellow grading system for motion.

Results: In this study a total of 142 patients who underwent TBW patella were studied. The mean age of the study population was 39.1±16.52 years. Majority if the assessed cases were males that is 81.7% (116 cases). Functional outcome was categorized as per the Good Fellows grading of range of motion. Highest number of cases i-e 60 (42.3%) showed good results. Second commonest category was excellent: 31% (44 cases) demonstrated good results. Whereas 21.1%, 4.2% and 1.4% showed fair, satisfactory and poor results, respectively.

Conclusion: Thus, it is evident that the tension band wiring of patella after anatomic reduction is associated with good to excellent functional recovery. Additionally, incorporating cerclage enhances the strength of the construct, contributing to the attainment of these positive outcomes.

Keywords: Patella fractures, tension band wiring, patella cerclage, knee extension mechanism.

Comparative Evaluation of Immediate Versus Delayed Antibiotic Prescription in Pediatric Acute Otitis Media

2025-03-29T21:05:30+00:00

Background: Acute otitis media (AOM) is one of the most common pediatric infections and a leading cause of antibiotic prescriptions. As a result of concerns about antibiotic resistance and adverse effects, delayed antibiotic prescribing as an alternative to immediate therapy has been of interest. In this study, immediate versus delayed antibiotic treatment in children with uncomplicated AOM was compared in terms of clinical efficacy, inflammatory response and safety.

Methods: This is a prospective, multicenter study in which, from January 2022 to January 2023, the University Medical College, Islamabad, the Children’s Hospital, Taif, and the Children’s Hospital, Lahore, enrolled 150 children aged 6 months to 12 years with a clinically diagnosed AOM. We proceeded with nonrandom patient assignment to receive either immediate (n = 75) or delayed (n = 75) antibiotic therapy. Demographics with baseline age, weight, and sex, and inflammatory biomarkers (C-reactive protein [CRP] and white blood cell [WBC] count) were recorded. The primary end point was complete symptom resolution by day 7, and the secondary end points were total antibiotic usage, adverse events, reconsultation rates, and complications.

Results: Groups were similar on baseline characteristics. On day 7, the immediate group was 89.3% and the delayed group was 80.0%, and achieved complete symptom resolution (p > 0.05). Thus, the antibiotics were given to all patients in the immediate group, but only 36 percent of the delayed group needed treatment. There were 28% of the immediate group and 14.7% of the delayed group with adverse events. CRP and WBC counts were significantly reduced from baseline in both groups, with no significant between-group difference.

Conclusion: Clinical outcomes of delayed antibiotic prescribing for uncomplicated pediatric AOM are equivalent to immediate therapy and provide reductions in antibiotic exposure and adverse events. This approach facilitates the development of improved antimicrobial stewardship in pediatrics.

Keywords: acute otitis media, pediatric, delayed antibiotic, immediate antibiotic, antimicrobial stewardship, CRP, WBC, antibiotic resistance

The Role of Serum Uric Acid as a Biomarker for Early Detection of Metabolic Syndrome in Middle-Aged Pakistani Adults: A Cross-Sectional Study

2025-05-07T08:17:17+00:00

Introduction: Metabolic syndrome (MetS) is the collection of interrelated metabolic abnormalities, including central obesity, hypertension, dyslipidemia, and hyperglycemia, that together increase the risk of cardiovascular disease and type 2 diabetes. The traditional serum uric acid (SUA) marker for gout has recently been implicated in MetS development. However, despite growing international data, no research has been done in the Pakistani population to investigate this association.

Aims and Objectives: The objective of the study was to assess the association between serum uric acid levels and metabolic syndrome in middle aged adults visiting tertiary care hospitals of Pakistan and to determine the gender distribution and correlation of SUA with each component of MetS as well.

Methodology: It was a cross-sectional observational study in Liaquat University Hospital, Hyderabad/Jamshoro, from July 2022 to June 2023. There were 120 adults aged 40–60 years enrolled. Anthropometric measurements, blood pressure, fasting glucose, lipid profiles, and serum uric acid levels were assessed. NCEP ATP III criteria were used to define metabolic syndrome. SPSS version 26 was used to analyze data with the application of t-tests and Pearson correlation analysis.

Results: This was found in 56.7% of the participants. Mean serum uric acid was significantly higher in the MetS group (6.8 ± 1.1 mg/dL) than in non non-MetS group (5.3 ± 1.0 mg/dL, p < 0.001). A positive correlation was seen between serum uric acid and waist circumference, systolic blood pressure, and triglyceride, and a negative correlation with HDL cholesterol. Gender-specific analysis showed consistent associations.

Conclusion: Serum uric acid is strongly associated with metabolic syndrome and the degree of severity. SUA measurement could be used to early identify persons at metabolic risk in Pakistan.

Keywords: serum uric acid, metabolic syndrome, middle-aged adults, Pakistan, hyperuricemia, cardiovascular risk

Association of β-Thalassemia and its Types with ABO and Rh Blood Groups in Pakistan

2025-05-11T13:14:13+00:00

Background: β-Thalassemia is a common inherited blood disorder in Pakistan, with considerable clinical and genetic heterogeneity. Exploring its association with ABO and Rh blood group systems may help uncover patterns that support early identification and management strategies.

Objective: To determine the association between β-thalassemia and its subtypes with ABO and Rh blood group distributions in a cohort of Pakistani patients.

Methodology: This cross-sectional study was conducted at The Children's Hospital Lahore from Feb 2023 to July 2023 and included 85 diagnosed β-thalassemia patients. Demographic details including age and gender, clinical characteristics such as the type of β-thalassemia (major, intermedia, or minor), consanguinity status, and family history of thalassemia were recorded.

Results: Among 85 β-thalassemia patients, blood group B was most common (36.5%), followed by O (30.6%), A (24.7%), and AB (8.2%). Rh-positive status was observed in 91.8% of cases. No statistically significant association was found between ABO or Rh blood groups and thalassemia subtypes (p > 0.05). Consanguinity and family history were significantly higher in β-thalassemia major patients (p < 0.01).

Conclusion: It is concluded that there is no significant correlation between β-thalassemia subtypes and ABO or Rh blood group systems. However, the predominance of blood group B and Rh-positive status among β-thalassemia patients aligns with trends observed in the general population. Further large-scale studies are recommended to validate these findings.

Keywords: β-Thalassemia, patients, Rh distribution, ABO, Blood group

Outcomes Comparison of Direct Stenting versus Pre Dilation in Percutaneous Coronary Intervention

2025-05-14T10:03:25+00:00

Objective: To compare the outcomes of Direct Stenting (DS) versus pre-dilation in Percutaneous Coronary Intervention (PCI) by evaluating procedural time, fluoroscopy time, and clinical outcomes.

Methodology: This retrospective study included 100 patients (50 in each group) who underwent PCI at the Department of Cardiology, Qazi Hussain Ahmed Medical Complex, Nowshera, from January 2022 to December 2022. Data on procedural times, fluoroscopy times, and clinical outcomes swere collected from patient records. Chi-square tests for categorical results and t-tests for continuous variables were used in the statistical study.

Results: The results showed that DS resulted in a significantly shorter procedure time (23.4 ± 11.6 minutes) compared to pre-dilation (33.7 ± 14 minutes), with a p-value of 0.004. Fluoroscopy time was also significantly lower in the DS group (4.1 ± 2.5 minutes) compared to pre-dilation (6.7 ± 3.8 minutes), with a p-value of 0.002. No significant differences were observed in myocardial infarction (6% vs 8%, p = 0.67), revascularization needs (7% vs 9%, p = 0.72), side branch compromise (10% vs 8%, p = 0.72), or slow flow (5% vs 7%, p = 0.68) between the two groups.

Conclusion: DS is a time-efficient and safe alternative to pre-dilation in PCI, offering reduced procedural and fluoroscopy times with similar clinical outcomes. More studies with larger populations are needed to validate these findings and explore long-term outcomes.

Keywords: DS, pre-dilation, PCI, procedure time, fluoroscopy time.

The Management of Lower Ureteric Stones: A Comparison of Silodosin and Extracorporeal Shock Wave Lithotripsy with Regard to Efficacy and Safety

2025-05-17T10:59:45+00:00

Objectives: To compare the efficacy and safety of silodosin versus extracorporeal shock wave lithotripsy for the management of lower ureteric stone.

Study design: Randomized controlled trial

Place & Duration of Study: Conducted at Liaquat University of Medical and Health Sciences Jamshoro during from the period September 2022 to August 2023.

Methods: Total 110 patients of either gender with ureteric stone were included. All the cases were equally divided in to two groups i.e. Group I in which patients received extracorporeal shock wave lithotripsy and group II patients were given 8mg silodosin orally for 3 weeks and advised to discontinue if stone passage.

Results: Majority of patients were male in Group I and II 36 (65.45%) and 37 (67.27%). Mean age in group I was 37.42+7.24 years while in group II, the mean age was 36.55+6.87 years. The success rate in term of clearance of stones, Group I had 72.73% while Group II had 90.91%. The difference was statistically significant p-value 0.012. Complications were more in ESWL group as compared to silodosin group p-value <0.05.

Conclusions: The silodosin is more efficacious and safe than extracorporeal shock wave lithotripsy for elimination of ureteric stones.

Keywords: Ureteric Stone, Silodosin, Extracorporeal shock wave lithotripsy

Assessment of the Characteristics of Domestic Violence Presenting to Emergency Department in a Tertiary Care Hospital in Pakistan

2025-05-21T10:05:44+00:00

Background: Domestic violence is a pervasive global issue and a recognized public health concern in Pakistan. Here we present the characteristics of domestic violence victims presenting to the emergency department.

Methodology: A cross-sectional study was conducted in one of the tertiary care hospitals in Pakistan. The study analyzes the characteristics of domestic violence presented in the hospital's emergency department and also determines the prevalence and the demographics of the victims.

Results: The study with a total of 124 participants, revealed a distressingly high incidence of domestic violence, with 78.2% of participants reporting experiencing Domestic Violence (DV) at some point in their lives. Among various forms of DV, the most prevalent included being slapped (25.8%), pushed (15.3%), and kicked (14.5%). Furthermore, threats (14.5%), weapon use (4.8%), child abuse (10.5%), neglect (2.4%), and shouting (8.9%) were also documented. These findings highlight the diverse and troubling nature of domestic violence, affecting individuals both physically and psychologically.

Conclusion: Despite the study's limitations, including a small sample size and convenient sampling technique, the findings provide valuable insights into the widespread and complex nature of domestic violence in Pakistan, influenced by cultural norms. Collaboration among healthcare providers, policymakers, and the community is vital to address this pressing public health issue and protect vulnerable individuals, especially women who are disproportionately affected.

Keywords: domestic violence, intimate partner violence, abuse, neglect

Comparison of Superficial Surgical-Site Infection Rates between Primary and Delayed Primary Wound Closure in Open Appendectomy for Gangrenous or Perforated Appendicitis

2025-05-21T10:13:26+00:00

Background: Surgical‐site infection (SSI) is a common and costly complication following open appendicectomy for gangrenous or perforated appendicitis. In resource-limited, high-volume settings, the optimal skin-closure strategy immediate primary closure (PC) versus delayed primary closure (DPC) remains unclear.

Objective: To compare the incidence of superficial SSI, length of hospital stay, wound-care burden and patient discomfort between PC and DPC in adults undergoing open appendicectomy for complicated appendicitis.

Methods: In this comparative study at Civil Hospital Quetta and Mayo Hospital Lahore (June 2022–May 2023), eighty consecutive patients (aged 18–65 years) with intra-operative confirmation of gangrenous or perforated appendicitis were alternately allocated to PC (n = 40) or DPC (n = 40). All subjects received the same peri-operative antibiotic regimen and operative technique; DPC patients had skin closure deferred until postoperative day 4. Primary outcome was superficial SSI within 30 days. Secondary outcomes included hospital length of stay, number of dressing changes, and pain during dressing (0–10 scale). Continuous data were compared by Student’s t-test or Mann–Whitney U test; categorical data by chi-square or Fisher’s exact test.

Results: Baseline demographics and operative factors were comparable. SSI occurred in 14/40 (35 %) PC patients versus 6/40 (15 %) DPC patients (absolute risk reduction 20 %, p = 0.02). Mean hospital stay was shorter with DPC (5.3 ± 1.4 days vs 6.2 ± 1.8 days; p = 0.015). DPC required more dressing changes (4.9 ± 0.8 vs 2.1 ± 0.5; p < 0.001) and higher pain during dressing (4.1 ± 1.1 vs 2.3 ± 0.8; p = 0.001), but pain levels equalized after skin closure. No wound dehiscence, deep SSI or mortality occurred.

Conclusion: Delayed primary closure significantly reduces superficial SSI rates and shortens hospital stay at the expense of transiently increased early wound-care demands and discomfort. In similar surgical environments, DPC is a pragmatic approach to enhance postoperative outcomes.

Keywords: Appendectomy, Infection, Closure, Gangrene, Perforation, Wound, Healing

Drug Coated Balloon only Angioplasty Outcomes in Non-diabetic and Diabetic Patients with De Novo Small Coronary Vessels Disease

2025-05-23T11:47:37+00:00

Background: Small artery coronary disease is a known predictor of terrible outcomes after PCI, and it is quite challenging to identify the best course of action for treating coronary disease in small vessels.

Objective: The aim of this study was to explore the Drug-Coated Balloon-Only Angioplasty Outcomes in Non-diabetic and Diabetic patients with De Novo Small Coronary Vessels Disease.

Methodology: This correctional multi-centre study was carried out at the Cardiology Department BMCH Quetta and Cardiology department Al Qasimi hospital Sharjah, UAE from January, 2023-June, 2023 after taking permission from the ethical board of the institute. Over all 1200 participants with vascular disorder cured with Drug-Coated Balloon -Test method were examined. Angiographic and clinical follow-up were scheduled for 12 months. The key outcomes were non-primary large detrimental cardiac activities and target lesion failure. Both the 2-tailed Fisher's actual test and chi-squared test were used to assess express variables, and the unbiased samples t-test (also known as the "Student's t-test") was used to assess non-stop variables. When the bilateral P is less than 0.05, it is deemed statistically significant.

Results: A total of 1200 participants were enrolled in this study out of which 832(69.33%) were male and 368(30.6%) were female. 431(35.9%) were diabetes and 769 (64.0%) were non diabetic. A total of 1352 lesions were treated; 484 were identified within the diabetes treatment group and 869 among the non-diabetic group. In the diabetes and non-diabetic groups, standard artery thickness was comparable (P value 0.366); however, the operating voltage inflation level and period were also comparable (P value 0.416 and 0.474, correspondingly).There have been notable differences in TLF incidence costs between companies, with a higher incidence among the diabetic population (P value0.006). There have been no statistically significant variations of the MACE comparing many of the two firms (P value 0.120).

Conclusion: Our study concluded that the drug-covered balloon alone decreased the incidence of target lesion failure and significant detrimental cardiac events in patients with de novo small coronary artery disease.

Keywords: Drug-Coated Balloon; Angioplasty; Non-diabetic; Diabetic; Coronary Vessels Disease.

Challenging Traditional Fasting Protocols with New Data on Carbohydrate-Loaded Clear Fluids up to 2 Hours before Surgery

2025-05-23T11:51:38+00:00

Introduction: Preoperative fasting in the past only dictates that patients that are undergoing surgery should be nil per os (NPO) for at least 6 hours before the operation commences. However, new evidence suggests that pre-existing clear fluids loaded with carbohydrates up to two hours pre-surgery could provide various advantages such as enhanced glycaemia control and speedy recovery.

Objective: To assess the safety and efficacy of carbohydrate-loaded clear fluids taken no longer than two hours before surgery against the traditional fasting procedures.

Materials and Methods: A prospective, randomized controlled study was carried out at Anesthesia Department, Lady Reading Hospital-MTI Peshawar, Pakistan, from December, 2022 to May, 2023. Patients having elective minor surgeries are randomized to intervention (carbohydrate-loaded fluids) or control (standard NPO) groups. Postoperative complications, level of glycemic control, recovery times, and patient satisfaction were also measured.

Results: The intervention group suffered from fewer complications, better glycemic control, speedier recovery, and greater patient satisfaction than the control group.

Conclusion: Carbohydrate-loaded clear fluids up to two hours before surgery enhance recovery and reduce complications, supporting a shift in preoperative fasting guidelines.

Keywords: Carbohydrate loading, preoperative fasting, surgical recovery, glycemic control, patient satisfaction, enhanced recovery.

Effect of Telemedicine Follow-Up on Neonatal Outcomes: A Pre-Post Intervention Study

2025-05-23T12:12:41+00:00

Background: Neonatal mortality and morbidity remain major public health concerns, especially in low- and middle-income countries.

Objective: To evaluate the effect of a structured telemedicine follow-up program on neonatal outcomes using a pre-post intervention design.

Methods: This pre-post interventional study was conducted at The Children's Hospital Lahore from 1 Jan 2023 to 1 july 2023. A total of 185 neonates were enrolled consecutively. The participants were divided into two groups: a pre-intervention group (n = 92), which received standard post-discharge care, and a post-intervention group (n = 93), which received structured telemedicine follow-up.

Results: Hospital readmissions were significantly lower in the telemedicine group (5.4%) compared to the control group (14.1%, p = 0.038). Emergency visits also declined (9.7% vs. 19.6%, p = 0.041). Mean daily weight gain was higher in the telemedicine group (29.6 ± 6.4 g/day vs. 25.1 ± 7.2 g/day, p = 0.005). Exclusive breastfeeding rates were improved (81.7% vs. 65.2%, p = 0.018), and immunization adherence increased (94.6% vs. 84.8%, p = 0.041). Caregiver satisfaction was significantly higher in the telemedicine group (87.1% vs. 63.0%, p < 0.001).

Conclusion: It is concluded that telemedicine follow-up is effective in improving key neonatal health indicators and caregiver satisfaction. This approach offers a scalable solution for enhancing post-discharge neonatal care, particularly in settings with limited healthcare access.

Keywords: Telemedicine, Neonatal, Outcomes, Intervention, Effect, Patients

Pulmonary Tuberculosis in Dermatological Patients on High-Dose, Long-Term Steroid Therapy

2025-05-23T12:20:13+00:00

Background: Tuberculosis is a dangerous infection that can affect the vital organs of the body. Steroid is the cornerstone of immunosuppressive treatment disorders in dermatology.

Objective: The aim of the study was to find out the frequency of Pulmonary tuberculosis in dermatological patients on high-dose, long-term steroid therapy.

Methodology: The current study was conducted at the Dermatology department, Kuwait teaching hospital Peshawar from January 2022 to November 2022 after taking approval from the ethical committee of the institute. Individuals who presented to the dermatology department, met the inclusion criteria (patients of either sex, in the adult (≥12 years) age range, and needed high dosage, continuous systemic steroid treatment for their skin condition) were enrolled. To assess for pulmonary tuberculosis, patients were checked on every three months, six weeks, and six months following treatment. Sputum smears for acid-fast bacilli (AFB) were performed for three days straight at each appointment. In cases where more than one sputum smears tested positive for AFB, no further testing was done. An X-ray of the chest was taken to look for any anomalies that would be compatible with active pulmonary TB if just one sputum smear tested positive for AFB. The data was imported into the SPSS (Statistical Package for the Social Sciences) version 19 computer software application and examined as necessary. The quantitative variables were shown using the mean, median, and standard deviation. To determine the P value, the McNamara test was used.

Results: A total 54 individuals with skin diseases needing high-dose systemic steroid treatment over an extended period of time participated in this study. Out of which 26(48.1%) were male and 28 (51.85%) were females. The patients' ages ranged from 15 to 75. After a duration of three months, 4 individuals (7.4%) out of 54 receiving high dosage long-term systemic steroid treatment developed pulmonary TB (P=0.0001).

Conclusion: This study evaluated 7.4% pulmonary tuberculosis among individuals receiving large doses of systemic steroid treatment over an extended period of time.

Keywords: Pulmonary tuberculosis; Dermatological patients; High-dose, Steroid therapy

Prevalence, Risk Factors, and Maternal Outcomes of Polycystic Ovary Syndrome (PCOS) in Reproductive-Age Women. A Cross-Sectional Study

2025-05-27T07:41:19+00:00

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age, associated with a spectrum of metabolic, reproductive, and psychological complications. Despite growing recognition of its clinical significance, regional data on its prevalence, associated risk factors, and maternal health outcomes remain limited.

Objective: To determine the prevalence of PCOS, identify associated risk factors, and evaluate its impact on maternal outcomes in reproductive-age women.

Methodology: This cross-sectional study included 100 women aged 18 to 45 years attending tertiary care gynecology clinics. PCOS was diagnosed using the Rotterdam criteria. Data were collected on demographic characteristics, clinical features, biochemical markers, and maternal health parameters including fertility status, gestational complications, and mode of delivery.

Results: The prevalence of PCOS in the study population was 36%. Significant risk factors included obesity (p = 0.003), family history of PCOS (p = 0.001), and insulin resistance (p = 0.004). Women with PCOS had higher incidences of subfertility (48% vs. 21%, p = 0.01), gestational diabetes mellitus (29% vs. 10%, p = 0.02), and cesarean delivery (41% vs. 24%, p = 0.03) compared to non-PCOS women.

Conclusion: PCOS is highly prevalent among reproductive-age women and is significantly associated with adverse maternal outcomes. Early detection and targeted management strategies are essential to reduce reproductive and metabolic complications.

Keywords: Polycystic Ovary Syndrome, Prevalence, Risk Factors, Maternal Outcomes, Cross-Sectional Study, Reproductive Health.

Association Between Early Postpartum Counseling and Breastfeeding Success Rates: A Cross-Sectional Study

2025-05-27T07:50:43+00:00

Background: Early initiation of breastfeeding within the first hour of life and exclusive breastfeeding for six months are essential for optimal infant health and maternal well-being. Despite global recommendations, breastfeeding practices in Pakistan remain suboptimal due to social, cultural, and systemic barriers. Early postpartum counseling may play a critical role in improving these outcomes, yet local evidence is limited.

Objective: To evaluate the impact of early postpartum counseling on breastfeeding initiation, exclusivity, maternal knowledge, and satisfaction.

Methodology: This cross-sectional study was conducted at a tertiary care hospital in Quetta, Pakistan, from November 2022 to June 2023. A total of 100 postpartum women were divided into two equal groups: Group A received structured breastfeeding counseling within six hours of delivery, while Group B received routine care without counseling. Outcomes assessed included time to breastfeeding initiation, exclusivity at six weeks, maternal knowledge score (0–10), satisfaction level (Likert scale), and need for formula supplementation. Data were collected through structured interviews and analyzed using SPSS version 25. Chi-square and t-tests were applied where appropriate.

Results: Early initiation within one hour was significantly higher in Group A (86%) than in Group B (52%) (p = 0.001). Exclusive breastfeeding at six weeks was 76% in Group A versus 44% in Group B (p = 0.002). Maternal knowledge and satisfaction scores were significantly higher in the counseled group (p < 0.001), with lower formula use (18% vs. 48%, p = 0.003).

Conclusion: Early postpartum counseling significantly improves breastfeeding outcomes. Integrating structured counseling into postnatal care is strongly recommended.

Keywords: Breastfeeding, postpartum counseling, exclusive breastfeeding, maternal knowledge, infant nutrition.

A Cadaveric Study of Anatomical Variations in the Course and Branching Pattern of the Median and Ulnar Nerves in the Palm

2025-05-27T07:54:00+00:00

Background: Anatomical variations in the course and branching pattern of the median and ulnar nerves in the palm hold significant clinical importance, particularly in the context of hand surgery, nerve repair, and regional anesthesia. Precise knowledge of these variations helps in minimizing iatrogenic injuries during surgical interventions.

Objective: To examine and document the anatomical variations in the pathway and branching pattern of the median and ulnar nerves in the palm through a cadaveric study.

Materials and Methods: This descriptive cadaveric study was conducted on 10 formalin-fixed adult human hands obtained from preserved cadavers in the anatomy department. Dissection was carefully performed in the palmar region to expose the median and ulnar nerves. Each hand was examined for the course of the nerves, number and pattern of branches, presence of communicating branches, and any unusual anatomical features.

Results: Anatomical variations were identified in 4 out of 10 dissected hands (40%). The median nerve displayed variation in the origin and number of common palmar digital nerves in 2 hands. Ulnar nerve variations included aberrant branching and communicating branches with the median nerve in 2 specimens. No significant asymmetry between left and right hands was observed.

Conclusion: The study demonstrated that anatomical variations in the median and ulnar nerves are relatively common even in a small sample size. These findings underscore the importance of preoperative anatomical awareness and careful dissection in surgical practice. Further large-scale studies are recommended to establish population-based anatomical baselines.

Keywords: Median nerve, ulnar nerve, Hand anatomy, Cadaveric study, palmar nerves, Anatomical variation, Nerve branching

C-Reactive Protein Levels in Preeclampsia Singleton Pregnant Women and Their Outcomes

2025-06-01T11:36:22+00:00

Background: Preeclampsia is a hypertensive disorder that occurs during pregnancy, typically after 20 weeks of gestation and the relationship between C-reactive protein levels and adverse pregnancy outcomes.

Objective: To analyze the C-reactive protein levels in preeclampsia singleton pregnant women and their outcomes.

Methodology: This case control study was performed at District Health Development Centre, Sahiwal from 1^st October 2022 to 31^st March 2023. A total of 100 women including 50 preeclampsia and 50 controls were enrolled after the ethical clearance of the study. The inclusion criteria consisted of women having singleton pregnancy and were clinically diagnosed to be suffering from preeclampsia. Participants were assessed clinically, biochemically, and via ultrasonography to confirm a normal pregnancy or diagnose preeclampsia. The association between C-reactive protein levels and preeclampsia was then evaluated. The outcomes of pregnancy with preeclampsia and high C-reactive proteins were followed upto 3 days in women after delivery.

Results: The maternal mean age was almost similar within both groups as 24.32±4.1 years and 25.26±5.63 years respectively. There was a higher body mass index trend in preeclampsia women than controls (p<0.05). The mean systolic blood pressure and diastolic blood pressure was much higher than control with a mean value as 115.33±9.39 vs 72±7.74 respectively. There were 72% of the preeclampsia vs 15% controls having previous history of hypertension. While only 16% preeclampsia and 10% control was already presenting a clinical history of diabetes. The mean preeclampsia C-reactive protein levels was 6.25±2.8 mg/L ad that of controls was 3.1±1.3 mg/L with 70% cases in preeclampsia group having higher that 15.5 mg/L CRP level in comparison to only 30% controls. The 35(70%) women having high C-reactive protein level and were preeclampsia; had adverse outcomes of their pregnancy including low birth weight in 77.1 (n=27) cases while preterm birth in 62.85 (n=22) cases.

Conclusion: Higher levels of C-reactive proteins were linked with preeclampsia in singleton pregnant women leading to adverse outcomes of pregnancy including delivery complications, low birth weight and preterm births in significant number of cases.

Keywords: C-reactive protein, Preeclampsia, Pregnant women, Outcome

Comparative Efficacy & Safety of Intralesional Verapamil versus Intralesional Triamcinolone Acetonide as First-Line Therapy for Treating Hypertrophic Scars & Keloids

2025-06-03T08:29:15+00:00

Background: Hypertrophic scars and keloids are challenging fibroproliferative disorders with high recurrence rates. Intralesional therapies like verapamil and triamcinolone acetonide are widely used, yet their comparative efficacy and safety as first-line treatments remain underexplored.

Objective: To compare the efficacy & safety of Intra lesional Verapamil versus Intra lesional Triamcinolone Acetonide as first-line therapy in treatment of Hypertrophic scars and Keloids.

Study Design & Setting: Randomized clinical trial conducted on patients attending OPD of Plastic and reconstructive department of Sheikh Zayed Medical College, Rahim Yar Khan August 2022 to July 2023.

Methodology: Patients fulfilling inclusion criteria were selected through non probability purposive sampling. After randomization, the study participants were divided into 2 groups, A and B. Group A given Intra lesional Injection of Verapamil, 2.5 mg/ml every 4 weeks and in Group B, Intralesional Injection of Trimcinolone Acetonide at a dose of 40 mg/ml was given at 4 weeks interval. A total of 6 sessions were done or till the flattening of the scar. Follow up was done after 5 months or till the scar was flattened by calculating Vancouver scar scale. VSS of < 3 was taken as success of treatment. After data collection and analysis, frequencies & percentages were calculated. The success rate of treatment with Intra lesional Injection of verapamil was compared to Intra lesional Injection of Triamcinolone Acetonide, Chi square test and t-tests were used as test of significance for qualitative and quantitative variables respectively.

Results: This study conducted on 60 patients showed that most patients having hypertrophic scars and keloids were between ages 12-55 years. 60% affected were males, 45% dark skinned, 55% gave history of burn as most prevalent because whereas most common site of scars was presternal in both the groups (40 and 36.6%). The success of treatment in Group A treated with Intra lesional Injection of Verapamil was 28% versus 72% in patient in Group B this difference was statistically significant.

Clinical Implication: Identifying a more effective and safer first-line intralesional agent can significantly improve scar outcomes, reduce recurrence, and guide evidence-based clinical management of keloids and hypertrophic scars.

Conclusion: Intra lesional Injection of Triamcinolone Acetonide has better efficacy and safety than Intra lesional Verapamil as 1st line therapy in treating hypertrophic scars and keloids.

Keywords: Hypertrophic Scar, Keloid, Intra lesional, First-line therapy, Verapamil,

Evaluation of Postoperative Pain Following Desarda vs. Lichtenstein Mesh Repair in Inguinal Hernia Surgery

2025-06-03T08:36:51+00:00

Background: Inguinal hernia repair is one of the most frequently performed surgical procedures globally. While the Lichtenstein mesh repair is widely accepted as the gold standard due to its low recurrence rate, it is associated with mesh-related complications and significant postoperative pain. The Desarda technique, a tissue-based repair method that avoids mesh use, has emerged as a promising alternative, potentially reducing postoperative discomfort and complications.

Objectives: To evaluate and compare postoperative pain and recovery outcomes following Desarda versus Lichtenstein mesh repair in patients undergoing inguinal hernia surgery.

Study Design & Setting: This comparative study was conducted at Department of General Surgery Fatima Hospital/ABU Amara Medical College Lahore.

Methodology: This study enrolled 120 patients diagnosed with unilateral inguinal hernia. Patients were randomly assigned to either Desarda or Lichtenstein repair groups. Patients aged 18 to 60 years with primary inguinal hernia were included. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 6, 12, 24, and 48 hours. Additional analgesic requirements, operative time, hospital stay, and pain-free mobilization time were recorded and analyzed.

Results: The Desarda group demonstrated significantly lower mean pain scores at all time intervals compared to the Lichtenstein group (p < 0.001). Operative time and hospital stay were shorter in the Desarda group (p < 0.01). A greater proportion of Desarda patients required no additional analgesia (63.3% vs. 35.0%; p = 0.002) and achieved pain-free mobilization earlier (p = 0.004).

Practical Implication: The Desarda technique offers a viable mesh-free option for inguinal hernia repair, associated with reduced postoperative pain and faster recovery, which may improve patient satisfaction and reduce healthcare costs.

Conclusion: Desarda repair is an effective alternative to Lichtenstein mesh repair, providing superior postoperative pain control and quicker mobilization.

Keywords: Desarda repair, inguinal hernia, Lichtenstein repair, postoperative pain, tissue-based repair

A Comparative Assessment of Designs of Hairline Patterns in Patients Undergoing Hair Transplant

2025-06-03T08:58:38+00:00

Background: Hair loss affects millions of people globally by generating psychological distress together with a diminished sense of self-confidence. Modern hair transplant surgery presents patients with an established means to achieve natural hairline recovery. Improper hairline design results in aesthetically displeasing pluggy appearance which leads to psychological distress among patients.

Materials and Methods: A comparative cross-sectional study was conducted from January 2022 to September 2022. In this study, a total of 100 patients was recruited by using random non-convenient sampling method after obtaining prior written informed consent from all the study participants. In this study, all the patients undergoing hair transplant due to androgenic alopecia, age-related alopecia and alopecia due to scarring were included.

Results: A total of 50 patients were recruited for the study with the mean age of 33.82 + 4.99 years of age. Post transplantation, degree of hair fall and hairline pattern was also assessed using Norwood Hamilton scale and it was observed that hairline pattern improved significantly as explained in table 3 and up till grade 4 it was noticed that all the patients reverted back to the type 1.

Conclusion: The research delivers significant information about hairline styles as well as transplantation performance assessment at a tertiary care center located in Balochistan Pakistan. Most patients benefited from their hair transplant procedures by showing substantial development in their hairline patterns according to lower Norwood-Hamilton grade assessments after treatment.

Keywords: hair transplant, alopecia, androgenic, hairline patterns,

Correlation between Estrogen Metabolites and Antioxidant Defense Systems in Premenopausal and Postmenopausal Women. A Clinical Study

2025-06-03T09:01:35+00:00

Background: Estrogens and their metabolites influence systemic oxidative balance by directly scavenging reactive oxygen species and upregulating antioxidant enzymes. Menopause leads to a marked decline in circulating estrogens, potentially diminishing antioxidant defenses.

Objective: To evaluate the correlation between specific estrogen metabolites and key antioxidant defense parameters in premenopausal and postmenopausal women.

Methodology: In this cross‐sectional study conducted from June 2022 to May 2023 at the Gynecology and Obstetrics Department, Unit 3, Civil Hospital, Quetta, seventy women (thirty‐five premenopausal, thirty‐five postmenopausal) were enrolled. After an overnight fast, venous blood was drawn between 08:00 and 10:00 AM. Plasma concentrations of estradiol (E₂), estrone (E₁), 2-hydroxyestrone (2-OHE₁), and 16α-hydroxyestrone (16α-OHE₁) were quantified by high‐performance liquid chromatography. Activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were measured via established spectrophotometric assays, and total antioxidant capacity (TAC) was determined using the ferric reducing antioxidant power method. Group comparisons employed independent t-tests, and Pearson’s correlation assessed relationships between estrogen metabolites and antioxidant markers.

Results: Premenopausal women demonstrated significantly higher mean E₂ (54.1 ± 14.5 pg/mL vs. 12.5 ± 5.9 pg/mL; p < 0.001), E₁ (45.5 ± 12.1 pg/mL vs. 23.0 ± 9.1 pg/mL; p < 0.001), and 2-OHE₁ (19.0 ± 5.3 pg/mL vs. 9.8 ± 3.9 pg/mL; p = 0.002). There was no significant difference in 16α-OHE₁ (12.0 ± 4.6 pg/mL vs. 10.5 ± 4.0 pg/mL; p = 0.15). SOD activity (8.1 ± 1.8 U/mL vs. 5.7 ± 1.5 U/mL; p < 0.001), CAT activity (49.0 ± 9.0 U/mL vs. 34.5 ± 7.8 U/mL; p < 0.001), GPx activity (12.3 ± 3.2 U/mL vs. 7.8 ± 2.9 U/mL; p < 0.001), and TAC (1245 ± 215 µmol Fe²⁺/L vs. 925 ± 185 µmol Fe²⁺/L; p < 0.001) were all significantly greater in premenopausal women. Estradiol correlated strongly with SOD (r = 0.69; p < 0.001), CAT (r = 0.62; p = 0.001), GPx (r = 0.58; p = 0.003), and TAC (r = 0.56; p = 0.005). The metabolite 2-OHE₁ correlated positively with TAC (r = 0.54; p = 0.004) and SOD (r = 0.50; p = 0.006). In contrast, 16α-OHE₁ was weakly and inversely correlated with GPx (r = −0.32; p = 0.045).

Conclusion: Higher levels of estradiol and the antioxidant‐favoring metabolite 2-OHE₁ in premenopausal women are associated with enhanced antioxidant enzyme activities and total antioxidant capacity. After menopause, the decline in these protective estrogens corresponds to reduced antioxidant defenses, potentially increasing susceptibility to oxidative stress–related pathologies.

Keywords: estrogen metabolites; antioxidant defense; premenopausal; postmenopausal; superoxide dismutase; catalase; glutathione peroxidase; total antioxidant capacity

Comparative Outcomes of Intravenous Hydrocortisone Versus Dexamethasone in Pediatric Patients Presenting with Croup

2025-06-04T20:36:39+00:00

Background: Croup is a common upper respiratory illness in children, characterized by stridor, barking cough, and respiratory distress due to subglottic airway inflammation. Corticosteroids are the mainstay of treatment in moderate to severe cases.

Objective: To compare the clinical outcomes of intravenous hydrocortisone versus intravenous dexamethasone in pediatric patients presenting with moderate to severe croup.

Methods: This comparative observational study was conducted at Mayo Hospital Lahore from Jan 2023 to June 2023. A total of 215 pediatric patients presenting with clinical features consistent with croup were enrolled in the study. Children aged 6 months to 6 years with a clinical diagnosis of moderate to severe croup based on the Westley croup score were included in the study. Patients with known hypersensitivity to corticosteroids, pre-existing chronic respiratory illnesses (e.g., asthma, tracheomalacia), or concurrent bacterial infections requiring antibiotics were excluded from the study.

Results: Out of 215 patients, 108 received hydrocortisone and 107 received dexamethasone. The mean time to stridor resolution was significantly shorter in the dexamethasone group (12.7 ± 3.8 hours) compared to the hydrocortisone group (18.4 ± 4.3 hours; p < 0.001). Fewer patients in the dexamethasone group required ≥2 doses of nebulized epinephrine (23.4% vs. 48.1%; p = 0.001). Mean hospital stay was also shorter in the dexamethasone group (2.2 ± 0.5 days) than in the hydrocortisone group (2.9 ± 0.7 days; p < 0.001). ICU admissions were lower in the dexamethasone group (3.7%) compared to the hydrocortisone group (10.2%; p = 0.048).

Conclusion: It is concluded that intravenous dexamethasone is superior to hydrocortisone in achieving faster symptom resolution, reducing hospital stays, and minimizing the need for additional interventions in pediatric patients with croup.

Keywords: Croup, Patients, Efficacy, Outcomes, Edema

Comparative Diagnostic Accuracy of Low-Dose CT Kub and Conventional CT in Detecting Renal and Ureteric Calculi

2025-06-05T17:36:52+00:00

Background: Computed Tomography (CT) KUB is the imaging modality of choice for detecting renal and ureteric calculi due to its high sensitivity and specificity. However, conventional CT involves substantial radiation exposure.

Objective: To compare the diagnostic accuracy of low-dose CT KUB with conventional CT KUB in detecting renal and ureteric calculi, and to evaluate its performance across different patient subgroups.

Methods: This prospective, observational study was conducted at Punjab Rangers Teaching Hospital, Lahore from 5 Feb 2023 to 10 August 2023. A total of 85 patients with clinical suspicion of urolithiasis were recruited for the study. These patients presented with symptoms such as acute flank pain, hematuria, or a known history of renal calculi. All patients provided informed written consent before participation.

Results: Low-dose CT detected renal or ureteric calculi with a sensitivity of 95.6%, specificity of 92.6%, PPV of 97.0%, NPV of 89.3%, and overall diagnostic accuracy of 94.7%. The mean radiation dose was 2.1 mSv for low-dose CT versus 8.9 mSv for standard-dose CT, representing a 76% dose reduction (p < 0.001). Diagnostic performance was highest for stones ≥4 mm and remained acceptable across different BMI categories and stone locations. Interobserver agreement for low-dose CT was strong (κ = 0.88).

Conclusion: Low-dose CT KUB offers comparable diagnostic performance to standard-dose CT while significantly reducing radiation exposure. It is a reliable and safer alternative for the evaluation of suspected urolithiasis, particularly in young patients and those requiring frequent imaging.

Keywords: Low-dose CT, CT KUB, urolithiasis, renal calculi, ureteric stones, diagnosis.

Effectiveness of Rotavirus Vaccine in Reducing Hospital Admissions for Acute Diarrhea in Children Under 5 years of Age

2025-06-11T10:20:32+00:00

Background: Rotavirus is a leading cause of acute diarrhea among children under five, often resulting in hospital admissions and increased healthcare burden.

Objective: To evaluate the effectiveness of the rotavirus vaccine in reducing hospital admissions, disease severity, and clinical complications associated with acute diarrhea in children under five years of age.

Methods: This comparative observational study was conducted at The Children's Hospital Lahore from March 2023 to August 2023. A total of 95 pediatric patients under the age of five were included in this study. Patients with acute diarrhea defined as the sudden onset of three or more loose or watery stools within 24 hours, lasting less than 14 days were included in the study. The sample included both male and female children across various age groups within the under-five population.

Results: Vaccinated children exhibited significantly lower rates of severe dehydration (21.2%) compared to unvaccinated children (44.2%). The average duration of hospital stay was shorter in the vaccinated group (2.3 ± 1.1 days vs. 3.8 ± 1.5 days). Complete recovery within 48 hours was higher among vaccinated children (88.5% vs. 60.5%). The unvaccinated group had a higher need for IV rehydration and accounted for all tertiary care referrals. The relative risk of severe outcomes in unvaccinated children ranged from 1.65 to 3.36 depending on the outcome measured.

Conclusion: It is concluded that the rotavirus vaccine is effective in significantly reducing the severity and hospital burden of acute diarrhea in children under five. These findings support the continued inclusion and timely administration of rotavirus vaccines in national immunization programs.

Keywords: Rotavirus, Acute Diarrhea, Vaccination, Hospitalization, Vaccine Effectiveness

Amniotic Membrane Transplantation (AMT) Success Rate in Non-Healing Corneal Ulcers

2025-06-12T08:42:57+00:00

Introduction: Cornea is the outermost fibrous layer of the eye that is nourished by tears and aqueous humor and lacks blood vessels. One of the main causes of ocular morbidity is corneal ulcers. Non healing corneal ulcers are those that, inspite of appropriate topical medication, do not heal within a period of 2 weeks. These ulcers can result in descemetocele development and perforation. Nowadays, amniotic membrane transplantation (AMT) is regarded as the preferred course of treatment for these ulcers.

Objective: To determine the amniotic membrane transplantation (AMT) success rate in patients of corneal ulcers that do not heal.

Study Design: Descriptive case series

Settings: Ophthalmology Department, Ward No. 15, Nishtar Hospital Multan.

Duration of Study: 6 months, from February 2023 to July 2023.

Patients & Methodology: This study comprised 86 patients, both male and female, aged 20-70 years, who has been diagnosed with non healing corneal ulcers. Age, gender, height, weight, body mass index(BMI), diabetes and duration of corneal ulcer among the baseline demographics recorded. AMT was positioned stromal side down and the procedure success rate was recorded one month following the transplant.

Results: Mean age was 47.23 ± 13.31 years. Mean BMI was 24.96 ± 4.21 kg/m². Mean duration of corneal ulcer was 7.26±3.05 months. Mean corneal ulcer size before treatment was 5.16 ± 1.34 mm and after treatment was 0.68±1.22 mm. Mean pain score before treatment was 5.93 ± 1.04 and after treatment was 1.24 ± 1.50. There were 60 (69.77%) males and 26 (30.23%) female patients. Diabetes was diagnosed in 17 (19.77%) patients. Success of AMT was observed in 76 (88.37%) and AMT was unsuccessful in just 10 (11.63%) patients.

Conclusion: By encouraging epithelial repair, reducing discomfort and inflammation without causing any complications, amniotic membrane transplantation can effectively treat severe corneal ulcers that are not responding to medical treatment.

Keywords: Amniotic membrane transplantation, corneal ulcer.

Comparison of Patients’ Outcome Having Anterior Wall Myocardial Infarction with & without Right Bundle Branch Block Undergoing Primary Percutaneous Coronary Intervention in Terms of Major Adverse Cardiovascular Events at 30-Days Follow-up

2025-06-12T08:45:40+00:00

Background: Acute anterior wall myocardial infarction (AWMI) is frequently complicated by a number of complications, and right bundle branch block (RBBB) is an uncommon association leading to higher morbidity and mortality rates.

Objectives: To compare the 30-day outcomes of MACE in participants presenting with anterior wall MI having RBBB pattern versus patients presenting with non-RBBB pattern on ECG undergoing primary PCI.

Study Design: In-hospital, prospective, comparative, and observational study.

Duration and Setting: Faisalabad Institute of Cardiology (FIC) between January and December 2022.

Methodology: A total of 204 patients with AWMI undergoing pPCI were recruited. Post-PCI follow-ups of the patients were carried out as by direct observation and telemonitoring of the patients and one-to-one interviews if required, during the hospital stay and after discharge patients were requested for a follow-up visit in the OPD, and in case the patient was unable to come, a telephone call was made for follow-up. SPSS v26 was utilized for data analysis. Among 204 patients, 68 (33.3%) had RBBB and were relatively younger. AWMI was more common in males (86.3%). RBBB was more frequent in males (88.2%), while females more often had AWMI without RBBB (14.7%). Smoking was the leading risk factor with RBBB (47.1%, p=0.045), hypertension without (47.1%, p=0.094). In-hospital (5.9%) and 30-day (10.29%) mortality, Re-MI (17.6%), and heart failure (35.3%) were higher in RBBB. CVA was higher without RBBB (2.9%).

Conclusion: We inferred that in the patients with AWMI undergoing pPCI, there is an increased risk of 30-day mortality if the RBBB complicates the AWMI.

Keywords: Anterior Wall Myocardial Infarction, Right Bundle Branch Block, Primary Percutaneous Coronary Intervention, Major Adverse Cardiovascular Events, 30-day Follow-up

Early Pain Outcome of Open Lumbar Discectomy Versus Endoscopic Lumbar Discectomy

2025-06-13T09:52:14+00:00

Introduction: A prolapsed intervertebral disc is one of the principal causes of low back pain in the adult population. It is most common in the fourth and fifth decades of life and occurs in lumbosacral and cervical regions.

Objectives: This study was conducted to compare mean postoperative pain after endoscopic discectomy and open discectomy for the surgical treatment of lumbar disc herniation by utilization VAS.

Methodology: This was a randomized controlled trial conducted in the department of Neurosurgery Sir Ganga Ram Hospital Lahore. The study was conducted from 15 January 2020 to 15 August 2021. Inclusion and exclusion criteria were defined and a total of 100 patients were recruited for the study. The patients were randomized into two groups. VAS scores for both the groups were recorded pre-operatively and were compared with post-operative VAS scores. One group underwent open discectomy, whereas, others underwent minimally invasive endoscopic lumbar discectomy.

Results: A total of 100 subjects with a mean age of 41.32 ± 11.88 years were recruited for this study. Males accounted for 67% of the subjects whereas females accounted for 33% of the subjects. L4-L5 disc prolapse accounted for 71% of the cases. The average duration of complaint was 72.17 ± 27 days. VAS Score improvement at 24 hours, 01 week and 01 month was compared among the 2 groups and a statistically significant difference was found among endoscopic and open discectomy with a p value of <0.005.

Conclusion: Our results have shown that minimally invasive endoscopic lumbar discectomy is superior to conventional open discectomy in terms of pain outcomes. In trained hands, endoscopic lumbar discectomy is a better treatment modality as compared to conventional open discectomy if patient is carefully selected.

Keywords: Sciatica, Intervertebral Disc Displacement, Discectomy, Percutaneous, Intervertebral Disc Degeneration

Treatment and Prognosis of Upper Tract Urothelial Cancer

2025-06-17T14:47:09+00:00

Background: The uncommon tumor known as Upper Tract Urothelial Carcinoma (UTUC) can begin anywhere in the urinary tract, from the calyces of the kidneys to the openings of the ureter.

Objective: Aim was to determine the effectiveness of treatment upper tract urothelial cancer among patients admitted to hospital.

Methods: Total 30 patients of both genders were presented in this study. All the patients had upper tract urothelial cancer and admitted for treatment. 30 Patients received laparoscopic nephroureterectomy in group I and and 30 patients of group II received chemotherapy or radiation for treatment. Outcomes among both groups were compared. SPSS 24.0 was used to analyze all data.

Results: Mean age of the patients in group I was 70.8 years and in group II mean age was 68.15 years. Majority of the patients were males among both groups. 17 cases of group I and 14 cases of group II had smoking history. We found group I had better outcomes as compared to group II but results were statistically insignificant. Recurrence rate in group II was 6 (20%) higher as compared to group I was 4 (13.3%).

Conclusion: We concluded in this that both treatment was effective for UTUC carcinoma and had minimum recurrence rate.

Keywords: UTUC, laparoscopic nephroureterectomy, Chemotherapy radiation, Recurrence

Role of Antioxidants in Helicobacter pylori Infection among patients with Cirrhosis: A Cross-Sectional Observational Study

2025-06-25T11:30:19+00:00

Background: Cirrhosis is frequently associated with impaired immune function and elevated oxidative stress, which may predispose to persistent Helicobacter pylori (H. pylori) infection.

Objective: To evaluate the relationship between serum antioxidant levels and H. pylori infection in patients with liver cirrhosis and to determine whether antioxidant deficiencies are associated with infection prevalence and liver disease severity.

Methods: This was a cross-sectional observational study conducted at Sahiwal Teaching Hospital, Sahiwal from November 2022 to May 2023. A total of 235 patients were enrolled in the study. Non-probability consecutive sampling was employed to recruit eligible participants. A structured proforma was used to record demographic data, etiology and severity of cirrhosis (Child-Pugh and MELD scores), clinical history, medication use, and lifestyle factors.

Results: H. pylori infection was found in 124 (52.8%) patients. Antioxidant levels were significantly lower in infected individuals compared to non-infected counterparts (p < 0.001 for all markers). Strong inverse correlations were observed between antioxidant levels and liver disease severity (e.g., TAC vs. MELD: r = –0.41, p < 0.001). On multivariate analysis, low Vitamin C (OR = 2.45), low TAC (OR = 2.89), and Child-Pugh Class C (OR = 2.11) were independently associated with H. pylori positivity.

Conclusion: Antioxidant deficiencies are significantly associated with H. pylori infection in cirrhotic patients and correlate with the severity of liver dysfunction.

Keywords: H. pylori, Cirrhosis, Antioxidants, Oxidative stress, Child-Pugh score, Total Antioxidant Capacity.

Prevalence and Radiological Evaluation of Work Related Musculoskeletal Disorder in Upper Extremity: Anatomical Insight and Public Health Implications of Wrist Pain

2025-06-28T12:20:56+00:00

Background: In modern world, use of computer has become increasing day by day. Prolonged use of computer in different offices may cause wrist pain or discomfort. Wrist pain occur in 50-60% of computer users who spent many hours working on computer either use of keyboard or mouse.

Objective: To find the frequency of wrist pain in computer workers in different offices of Sheikh Zayed Hospital/Medical College Rahim Yar Khan.

Methodology: Study Design was cross-sectional, Study setting area was different offices of Sheikh Zayed hospital/Medical College Rahim Yar Khan. Total 139 workers were selected as sample size through convenient sampling technique. Inclusion Criteria was; all computer workers who gave verbal consent and Exclusion criteria was; who didn’t give verbal consent and not willing to participate in study. Data Collection was carried out using a questionnaire which was developed and distributed among study subjects. Variables of questionnaire include age, computer usage hours, pain frequency and severity, breaks from work, pain type, pain occurrence time and effect of pain on daily activities, etc. Data and variables were analyzed in SPSS V23.

Results: Out of 139 study subjects 73 subjects (52.5%) reported complain of wrist pain and out of all study subjects 61.9% of study subjects work on computer 7-8 hours daily and 36% works on computer 5-6 hours daily. Out of all study subjects 28.1% experience wrist pain during work, 6% experience wrist pain after work and 18% experience wrist pain both during and after work.

Conclusions: Wrist pain in computer workers was very common. Almost half of the computer workers had complaint of wrist pain. Among the computer workers who had wrist pain, most of them spend 7-8 hours working on computer daily.

Keywords: Frequency, Wrist pain, Computer use

Assessing the Role of Community-Based Screening in Early Detection of Hepatocellular Carcinoma in Hepatitis B and C at a Tertiary Care Hospital

2025-06-28T12:30:22+00:00

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, especially in countries with a high burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In Pakistan, late-stage diagnosis remains a significant challenge due to limited surveillance and delayed access to tertiary care. Community-based screening offers a promising approach to detect HCC at earlier, more treatable stages.

Objective: To evaluate the effectiveness of community-based hepatitis screening in the early detection of HCC among HBV- and HCV-infected patients referred to a tertiary care hospital.

Methods: This cross-sectional observational study was conducted at Bolan Medical University Hospital, Quetta, from June 2022 to June 2023. A total of 70 patients aged 30–70 years with HBV or HCV infection were referred from rural community screening camps. All underwent abdominal ultrasound, serum alpha-fetoprotein (AFP) testing, and contrast-enhanced MRI/CT where indicated. Diagnosed HCC cases were staged using the Barcelona Clinic Liver Cancer (BCLC) system.

Results: Of the 70 patients, 14 (20%) were diagnosed with HCC. Among these, 9 patients (64.3%) were classified as BCLC Stage A, 3 (21.4%) as Stage B, and 2 (14.3%) as Stage C. No patients presented at Stage D. Early-stage detection was notably higher than in typical hospital-based presentations.

Conclusion: Community-based screening significantly improves early-stage detection of HCC in high-risk populations. Integrating ultrasound and AFP testing into outreach programs may shift diagnosis to curative stages and reduce liver cancer mortality in resource-limited settings.

Keywords: Hepatocellular carcinoma, community screening, hepatitis B, hepatitis C, BCLC staging, early detection, Pakistan, tertiary hospital

Impact of Obesity on Female Reproductive Hormones and Ovulatory Function. A Clinical and Biochemical Evaluation of Endocrine Disruption in Women of Reproductive Age

2025-06-28T12:33:38+00:00

Background: Obesity is a global health concern that significantly affects female reproductive health. It is strongly associated with hormonal imbalances and ovulatory dysfunction, which may compromise fertility. The present study clinically and biochemically evaluates the impact of obesity on female reproductive hormones and ovulatory patterns in women of reproductive age.

Objective: To assess the endocrine disruption and ovulatory dysfunction associated with obesity in reproductive-aged women through clinical and biochemical evaluation.

Methodology: This cross-sectional clinical study was conducted over six months (January–June 2023) at the Department of Gynecology and Reproductive Endocrinology, Bolan Medical University Hospital, Quetta, and Mayo Hospital, Lahore, Pakistan. A total of 100 women aged 20 to 45 years were enrolled and categorized into obese (BMI ≥30 kg/m²) and non-obese (BMI <30 kg/m²) groups. Clinical data regarding menstrual regularity, ovulation history, and signs of hyperandrogenism were recorded. Biochemical parameters including serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), progesterone, total testosterone, fasting insulin, and glucose were measured during the early follicular phase. Ovulatory function was evaluated using mid-luteal serum progesterone levels.

Results: Obese women showed a significantly higher incidence of menstrual irregularities and anovulation compared to non-obese women (p<0.05). Serum LH/FSH ratio and total testosterone levels were significantly elevated, while mid-luteal progesterone levels were reduced in obese participants (p<0.01). A strong correlation was observed between increased BMI and insulin resistance markers, suggesting an interplay between metabolic and reproductive hormonal disturbances.

Conclusion: Obesity in reproductive-aged women is strongly associated with endocrine disruption, particularly involving altered gonadotropin ratios, hyperandrogenism, and ovulatory dysfunction. These findings underscore the need for early screening and weight management strategies to restore reproductive hormonal balance and improve fertility outcomes in obese women.

Keywords: Obesity, Female Reproductive Hormones, Ovulatory Dysfunction, Endocrine Disruption, Infertility, BMI, Hyperandrogenism, Insulin Resistance.

Assessing Emotional Intelligence, Workplace Stress, and Health Outcomes in Clinical Postgraduate Trainees: A Study in Lahore’s Tertiary Care Hospitals

2025-07-02T15:54:21+00:00

Background: Emotional intelligence (EI) plays a vital role in influencing general health (GHQ) and workplace stress across various professions, especially in healthcare. Clinical postgraduate trainees often experience high stress due to patient demands, emotional strain, and poor working conditions. Research suggests that individuals with higher EI manage stress better and enjoy improved health outcomes.

Objectives: This study aimed to assess the relationship between EI, workplace stress, and general health status among clinical postgraduate trainees in Lahore's tertiary care hospitals. It also evaluated gender and age differences and compared outcomes between high- and low-EI groups.

Methods: A correlational, cross-sectional study was conducted at the University of Health Sciences, Lahore, from May to December 2015. A total of 241 FCPS trainees from various tertiary hospitals were included. Data were collected using validated questionnaires measuring EI, workplace stress, and GHQ.

Results: Mean age was 28.86±2.57 years; 51.5% were male. EI was negatively correlated with stress but showed no correlation with GHQ or age. GHQ positively correlated with age. No significant gender differences were found in EI, stress, or GHQ.

Conclusion: EI is inversely associated with workplace stress among clinical postgraduate trainees, regardless of age, gender, or general health, suggesting EI may buffer stress in demanding medical environments.

Keywords: Emotional Intelligence, Stress, General Health, Postgraduate trainees, General health quality (GHQ).

Assessment of the Efficacy of Virtual Reality Rehabilitation in Stroke Patients

2025-07-02T16:01:27+00:00

Background: Stroke is still one of the most prominent causes of adult disability globally and often results in both long-term physical and cognitive impairments. While traditional rehabilitation methods do have some effectiveness, they are sometimes hampered by low engagement and adherence levels from the patients. The use of virtual reality technology (VR) offers a new way to approach rehabilitation which could result in better outcomes because it creates an immersive experience that is inherently interactive. This study aimed to assess the effectiveness of VR-based rehabilitation in improving motor function, functional independence, and cognitive performance in stroke patients, compared with traditional therapy.

Methods: Seventy-one stroke patients participated in the study and were randomized into two groups: one receiving virtual reality rehabilitation and the other receiving standard physiotherapy as a control arm to conventional treatment. The therapies were both provided over a six-week period, five days per week. The primary outcome measures were Fugl-Meyer Assessment and Barthel Index. Other outcome measures included cognitive assessment using Montreal Cognitive Assessment (MoCA), mobility measured by Timed Up and Go (TUG) test, and satisfaction level reported by the patients which were all considered as secondary outcomes.

Results: Participants in the VR group demonstrated significantly greater improvements in motor function and independence in daily activities compared to the control group (p < 0.01). Cognitive gains were higher in the VR group, although this did not reach statistical significance (p = 0.058). Patient adherence and satisfaction were notably higher among VR participants.

Conclusion: VR-based rehabilitation is a promising and effective approach to enhance post-stroke recovery, offering better patient outcomes and engagement than conventional methods. Further large-scale studies are recommended to confirm these findings and explore long-term effects.

Keywords: Stroke rehabilitation, virtual reality therapy, motor recovery, cognitive function, patient engagement, Fugl-Meyer, Barthel Index.

Prevalence of ESBL-Producing Klebsiellaisolated from Burn Wound Infections in a Tertiary Care Burn Hospital in Peshawar

2025-07-02T16:05:56+00:00

Background: Patients with burns and other skin wounds suffer from skin damage and often prolonged hospitalization which compromises their immunological protection by skin and increases the chance of infections. Klebsiellain particular, have become one of the leading causes of such infections. Of even greater concern is their ability to produce extended spectrum beta-lactamases (ESBLs), enzymes that render many antibiotics useless. This study aimed to determine the prevalence of ESBL-producing Klebsiella, among the isolates from burn wound infections and to analyze their antimicrobial susceptibility patterns.

Methods: A total of 363 Klebsiella isolates were obtained from wound swabs of burn patients over a one-year period from August 2021 to July 2022 were used for identification. The ESBL production was confirmed using the combination disc method. Antimicrobial sensitivity testing was performed following CLSI guidelines.

Results: Out of 363 isolates, 74% were confirmed ESBL producers. Most patients belonged to the age group of 21–30 years, and a slight male predominance was observed. ESBL-producing isolates showed very low sensitivity to third-generation cephalosporins (only 2% to cefotaxime and 4% to ceftazidime), as well as reduced susceptibility to fluoroquinolones. Carbapenems remained the most effective antibiotics, over 85% demonstrating sensitivity."

Conclusion: The high prevalence of ESBL-producing Klebsiella in burn wound infections is alarming and highlights the need for strict infection control measures, routine surveillance, and rational antibiotic use in burn units.

Keywords: ESBL, Klebsiella, burn wound infection, antimicrobial resistance, prevalence, carbapenem, multidrug resistance.

Comparative Diagnostic Accuracy of Digital and Conventional Radiography in the Detection of Bone Fractures

2025-07-02T16:08:07+00:00

Background: Bone fractures represent a substantial proportion of cases presenting to emergency and orthopedic departments worldwide, including in resource-limited settings like Nishtar medical university/Hospital, Multan. Timely and precise diagnosis is vital for the initiation of appropriate treatment, minimizing complications, and improving long-term functional outcomes. Conventional radiography (X-ray) has historically been the cornerstone of fracture detection. However, recent advancements in digital imaging technology have introduced digital radiography as a potentially superior alternative, offering improved image resolution, faster processing times, ease of storage and retrieval, and reduced radiation exposure. Despite these advantages, its diagnostic performance in comparison to conventional methods remains a subject of investigation, particularly in developing healthcare settings.

Objective: This study aimed to compare the diagnostic accuracy of digital and conventional radiography in the detection of bone fractures among patients presenting to the emergency and orthopedic departments at Nishtar medical university/Hospital, Multan.

Methodology: A descriptive cross-sectional study was carried out over an eight-month period from 1^st October 2022 to 31^st March 2023. A total of 200 patients of various age groups and both genders, presenting with clinical suspicion of bone fractures, were enrolled through consecutive sampling. Each patient underwent both conventional and digital radiographic imaging of the affected area. The radiographs were independently interpreted by two qualified radiologists who were blinded to each other’s findings and to the clinical details. The findings were then validated against a reference standard, which included either computed tomography (CT) findings or intraoperative surgical confirmation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic concordance rates were calculated and compared for both modalities.

Results: The study revealed that digital radiography outperformed conventional radiography in terms of both sensitivity and specificity. Digital radiography demonstrated a sensitivity of 94.5% and a specificity of 91.2%, whereas conventional radiography showed a sensitivity of 83.0% and a specificity of 85.0%. The difference in diagnostic performance was particularly evident in the detection of fractures involving smaller or more complex anatomical regions, such as the wrist, hand, ankle, and foot. Inter-observer agreement was also higher for digital images, suggesting better clarity and interpretability. Moreover, the turnaround time for digital imaging was shorter, facilitating faster decision-making in emergency settings.

Conclusion: The findings of this study indicate that digital radiography provides significantly higher diagnostic accuracy compared to conventional X-ray, particularly in identifying subtle or small bone fractures. Given its superior image quality, reduced radiation dose, and operational efficiency, digital radiography should be considered the preferred imaging modality in emergency and orthopedic practice, especially in facilities where resources permit. The integration of digital systems may lead to improved diagnostic confidence, faster clinical decision-making, and ultimately, better patient outcomes.

Keywords: Digital radiography, conventional X-ray, bone fractures, diagnostic accuracy, emergency imaging, orthopedic trauma, sensitivity, specificity

The Effect of Hormonal Status on the Results of Aromatase Inhibitor Maintenance Following Adjuvant Chemotherapy for High-Grade Serous Ovarian Cancer (HGSOC)

2025-07-08T11:45:30+00:00

Background: The prognosis of epithelial ovarian cancer (EOC) depends on the patient's receptor status, which is influenced by hormones. Although there is conflicting evidence about the predictive power of molecular targets such as ER and PgR for tumor response, hormone therapy has the potential to aid patients with advanced EOC.

Objective: The purpose of this study was to analyze the relationship between hormonal status and the success of aromatase inhibitor maintenance after adjuvant chemotherapy for HGSOC.

Method: This study was conducted at the department of Gynae and Obs, DHQ hospital, KDA, Kohat during June 2022 to June 2023. One hundred and ten patients participated in this prospective clinical trial to see how well and safely aromatase inhibitor (AI) maintenance endocrine therapy with 2.5 mg of letrozole daily, given off-label, worked. Patients were treated for a maximum of five years, or until side effects, symptomatic recurrence, or the need for more chemotherapy became apparent. Immunohistochemistry was used to evaluate correlations with ER and PgR. SPSS 22.0 was used to analyze all data.

Results: The included had mean age 53.12 years and had mean BMI 31.54 kg/m². Frequency of postmenopausal was higher found in 70 (63.6%) as compared to premenopausal cases 40 (33.6%). Most common symptoms was abdominal pain found in 93 (84.5%) cases. Rate of relapse was found in 46 (41.8%) cases. 26 cases of relapsed disease and 35 cases of non-relapsed received aromatase inhibitorn (AI) maintenance. However, when looking at disease-free survival and relapse rates together, no significant differences were seen.

Conclusion: Our data do not support aromatase inhibitor maintenance therapy for HGSOC. AIs are appealing due to their low cost and safety, but our group's lack of significant improvement in RR or DFS suggests more targeted and customized treatment.

Keywords: HGSOC, aromatase inhibitor, disease free survival, Symptoms

Prevalence of Hypothyroidism in Diabetic Foot Ulcer Patients

2025-07-11T11:52:09+00:00

Introduction: Diabetes foot ulcers (DFUs) is a severe complication of diabetes mellitus, and it can be affected by a large number of metabolic and endocrine factors. Hypothyroidism which has been most of the time ignored could be a factor in pathogenesis and seriousness of DFUs.

Objective: To establish the incidence of hypothyroidism among diabetic foot ulcer patients and evaluate its relationships with the severity and nature of ulcers.

Materials and Methods: It was a cross-sectional study, which was carried out in the Endocrinology Ward of Hayatabad Medical Complex, Peshawar, in the range of December, 2022 to May, 2023. Among 150 patients with diabetic foot ulcers (DFUs), 100 percent of them were tested on their level of thyroid hormones and their ulcers were classified using the wagner classification system. The SPSS was used to analyse the data.

Results: The present study revealed that twenty-eight percent of the patients who had DFU had Hypothyroidism. There was a significant association between hypothyroidism and higher Wagner grades, female gender as well as greater duration of diabetes (p<0.05).

Conclusion: Routine thyroid screening in DFU patients may aid early detection and improve clinical outcomes.

Keywords: Diabetic foot ulcer, hypothyroidism, Wagner grade, thyroid dysfunction, prevalence, diabetes mellitus.

The Burden of Thalassemia Major in Punjab, Pakistan: A Cross-Sectional Analysis from Sargodha with Focus on Gynecology Parameters

2025-07-11T12:28:12+00:00

Aim of Study: This study aimed to assess the burden of thalassemia major in Punjab, Pakistan, with a particular focus on gynecological complications among female patients. The study evaluated disease prevalence, associated complications, and healthcare challenges in the region.
Study Duration: January 2022 to March 2023.
Study Place: Niazi Medical College and District Headquarter (DHQ) Hospital, Sahiwal, Punjab, Pakistan.
Study Type: Cross-sectional observational study with retrospective chart review and structured patient interviews.
Methodology: A sample of 162 thalassemia major patients was enrolled. Data were collected through structured questionnaires, medical records, and laboratory reports. Variables analyzed included demographic characteristics, clinical symptoms, transfusion frequency, iron overload complications, and gynecological parameters for females aged 12 and above. Quantitative data were assessed using SPSS v26 with descriptive statistics and chi-square tests.
Results: Key findings included high prevalence rates, frequent transfusion dependence, and significant gynecological complications such as delayed puberty (32%) and menstrual irregularities (28%). Eight tables were included, with detailed analysis of demographic, clinical, and gynecological parameters.
Discussion: The study highlights the substantial burden of thalassemia major in Punjab, with notable reproductive health challenges. Socioeconomic factors, lack of awareness, and inadequate healthcare infrastructure exacerbate disease management difficulties.
Conclusion: Thalassemia major imposes a heavy burden on patients and healthcare systems in Punjab, necessitating improved screening, genetic counseling, and specialized gynecological care for female patients.
Keywords: Thalassemia major, Punjab, Pakistan, gynecology, transfusion-dependent anemia, reproductive health.

Achieving Natural Aesthetics in Brow Hair Transplantation: Challenges and Solutions

2025-07-12T09:49:02+00:00

Background: Eyebrow transplantation has emerged as a reliable solution for eyebrow loss, yet achieving natural aesthetics remains challenging due to the unique anatomical, directional, and density-related factors of brow hair. This study evaluates aesthetic outcomes, patient satisfaction, and the effectiveness of technical innovations in overcoming poor donor density and hair angle discrepancies.

Materials and Methods: A prospective study was conducted at Bolan Medical Complex, Quetta, between January 2022 and January 2023. Forty patients with partial or complete eyebrow loss were included. FUE was employed in all cases, with special attention to recipient site design, hair angle, and use of ultra-fine blades and implanters. Patients were evaluated using the FACE-Q scale, Global Aesthetic Improvement Scale (GAIS), and a 5-point satisfaction score at 6 months. Challenges such as poor donor density, improper curl, or low survival rate were documented. Statistical analysis was performed using SPSS v25.0, including paired t-tests and Pearson correlation.

Results: The mean satisfaction score was 4.3 ± 0.5. FACE-Q showed high scores in psychosocial impact and satisfaction with appearance (85 ± 7.2). GAIS showed that 77.5% of patients were rated as “much improved” or “very much improved.” Complication rate was low (7.5%), and significant correlation (r = 0.42, p = 0.003) was found between donor density and satisfaction levels.

Conclusion: With meticulous technique and aesthetic planning, eyebrow transplantation can yield natural and satisfying results, even in patients with limited donor density. Angled implantation and follicle selection are key to overcoming challenges and optimizing outcomes.

Keywords: Eyebrow transplantation, FUE, donor site density, natural aesthetics, brow hair angle, FACE-Q, GAIS

Diagnostic Accuracy of Serum Procalcitonin in Early Onset Neonatal sepsis: A tertiary care experience

2025-07-12T09:53:15+00:00

Background: Early-onset neonatal sepsis (EONS) is a life-threatening condition with nonspecific clinical features and delayed culture results, leading to diagnostic uncertainty.

Objective: To evaluate the diagnostic accuracy of serum procalcitonin in early-onset neonatal sepsis and compare its performance with C-reactive protein (CRP) and total leukocyte count (TLC), using blood culture as the gold standard.

Methods: This cross-sectional analytical study was conducted at Mayo Hospital Lahore from January 2023 to June 2023. A total of 185 neonates were enrolled in the study. After obtaining informed written consent from parents or legal guardians, clinical history and relevant demographic data were recorded. Under strict aseptic precautions, blood samples were collected before the initiation of empirical antibiotic therapy. Samples were sent for serum procalcitonin assay, C-reactive protein (CRP), total leukocyte count (TLC), and blood culture.

Results: Out of 185 neonates, 68 (36.8%) were blood culture-positive. Mean PCT levels were significantly higher in culture-positive cases (4.87 ± 1.6 ng/mL) compared to culture-negative cases (0.91 ± 0.6 ng/mL) (p < 0.001). At a cut-off of ≥2.0 ng/mL, PCT showed 88.2% sensitivity, 84.6% specificity, 77.4% PPV, and 92.3% NPV, with an AUC of 0.89. CRP and TLC demonstrated lower diagnostic accuracy. Elevated PCT levels also correlated with poor clinical outcomes such as the need for ventilation, inotropic support, and mortality.

Conclusion: It is concluded that serum procalcitonin is a reliable and early diagnostic marker for neonatal sepsis, outperforming CRP and TLC. Its incorporation into neonatal sepsis protocols may improve early detection, guide clinical decisions, and reduce unnecessary antibiotic use.

Keywords: Procalcitonin, Neonatal sepsis, Biomarkers, Diagnostic accuracy, Blood culture, CRP, TLC.

Pediatric Early Warning Score in Predicting Length of Stay in Hospital

2025-07-12T20:52:56+00:00

Objective: “To determine the predictive accuracy of pediatric early warning score to predict the length of hospital stay in children”

Study Design: Cross sectional study

Study place and duration: Department of Pediatrics, The Children’s Hospital, Lahore from June 2022 to August 2022.

Methodology: After meeting inclusion and exclusion criteria 190 children were enrolled. Then child was examined for PEWS and score was noted. Then children were labeled as positive or negative for prolonged hospital stay (as operational definition). Children were managed as per standard protocol. All the children were followed-up in wards or intensive care unit till discharge and total hospital stay was noted.

Results: The mean age of the children was 7.89±4.49 years, 103(54.21%) children were male. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PEW score of the children was 88.03%, 80.82%, 88.03%, 80.82% & 85.26% children respectively taking actual prolonged hospital stay as gold standard.

Conclusion: From the findings of this study we may conclude that pediatric early warning score is a useful and reliable tool to predict the length of hospital stay in children.

Keywords: Length of Hospital Stay, Pediatric Early Warning Score,

Correlation Between High-Sensitivity C-Reactive Protein (HS-CRP) and Severity of Coronary Artery Disease in Diabetic Patients

2025-07-12T20:57:46+00:00

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Systemic inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), has been implicated in the pathogenesis of atherosclerosis, yet its correlation with angiographic CAD severity in diabetic patients remains underexplored.

Objective: To assess the relationship between serum hs-CRP levels and the angiographic severity of CAD in patients with T2DM and evaluate the associated clinical and biochemical risk factors.

Methods: This cross-sectional study included 100 patients with type 2 diabetes mellitus (T2DM), aged between 40 and 75 years, who underwent coronary angiography for suspected coronary artery disease (CAD). Based on angiographic findings, patients were categorized into three groups according to disease severity: mild, moderate, and severe CAD. Clinical data, including age, gender, duration of diabetes, hypertension status, and body mass index (BMI), were systematically recorded. Laboratory investigations comprised high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, glycated hemoglobin (HbA1c), complete lipid profile, and serum creatinine. The association between hs-CRP levels and CAD severity was evaluated using IBM SPSS version 25.0, with a p-value of <0.05 considered statistically significant.

Results: Serum hs-CRP levels increased significantly with CAD severity (2.4 ± 0.9 mg/L in mild, 4.6 ± 1.1 mg/L in moderate, and 6.8 ± 1.5 mg/L in severe CAD; p < 0.001). Patients with severe CAD also had significantly higher fasting blood glucose, HbA1c, total cholesterol, LDL, triglycerides, and serum creatinine, and lower HDL levels compared to those with mild disease (all p < 0.05). Male predominance, older age, longer diabetes duration, higher BMI, and hypertension were more common in patients with advanced CAD.

Conclusion: Elevated hs-CRP levels show a strong and independent association with angiographic severity of CAD in patients with T2DM, supporting the role of systemic inflammation in diabetic atherogenesis. hs-CRP may serve as a valuable adjunctive biomarker for cardiovascular risk stratification in diabetic individuals undergoing CAD evaluation.

Keywords: Type 2 diabetes mellitus, Coronary artery disease, hs-CRP, Inflammatory biomarkers, Atherosclerosis, Angiography, Cardiovascular risk, Glycemic control

Evaluating Synergistic Nephroprotective Effect of Parsley Extract and Ramipril in a Rat Model of Gentamicin-Induced Nephrotoxicity

2025-07-17T11:46:49+00:00

Background: The kidney has an essential function in maintaining homeostasis by carrying out functions such as blood filtration, hormone synthesis, and drugs metabolism. This study is done to examine the combined effects of ramipril and parsley Leaves water-soluble extract on nephrotoxicity induced by gentamicin.

Methods: A case control study was carried out at the Pharmacology Department Islamic International Medical College in collaboration with NIH Islamabad, from September 2019 to August 2020. This study was conducted with a sample of 50 healthy male albino rats. After collecting baseline measurements of urea and creatinine randomly, rats were divided into two groups. Group 1 was designated as the control group and remaining four groups were experimental groups. On day 35, the results were analyzed using biochemical parameters and histopathological evaluations. The statistical analysis was conducted using SPSS version 22. The One-way ANOVA test was applied to ascertain any variations in mean values. The post hoc Tukey's test has been used to perform several comparisons among the groups. A significance level was p<0.05.

Results: The treatment group 5, which received both parsley and ramipril, exhibited a significant decrease in serum creatinine and urea levels in nephrotoxic rats, in comparison to group 3 (Group treated with parsley) and group 4 (Group treated with Ramipril). It also exhibited significant improvements in histological evaluation. The group reported reduced indications of renal injury, including minimal infiltration of inflammatory cells, minimal vacuolation and necrosis.

Conclusion: The current investigation has determined that the aqueous extract of parsley leaves and the drug ramipril both independently improve the nephrotoxic effects caused by gentamicin.

Keywords: Gentamicin, Nephrotoxicity, Ramipril, Parsley leaves extract, Serum Creatinine & Urea level.

Diagnostic Utility of Qualitative MRI and T2 Relaxometry in Hippocampal Assessment for Temporal Lobe Epilepsy

2025-07-22T13:08:14+00:00

Objectives: To determine the diagnostic value of qualitative MRI and T2 relaxometry in hippocampal assessment for temporal lobe epilepsy.

Study Settings: Department of Radiology, Sheikh Zayed Hospital, Rahimyarkhan.

Duration of Study: January to June 2023

Data Collection: A cross-sectional, single-center study was conducted involving 110 EEG-confirmed seizure patients. All participants underwent MRI with a dedicated epilepsy protocol including T2 relaxometry. Hippocampal T2 relaxation times were calculated by placing Regions of Interest (ROIs) on each slice of the hippocampus.

Results: A total of 110 TLE patients were studied; 65.5% were aged 10–40 years and 58.2% were male. T2 relaxometry detected hippocampal sclerosis in 34.5%, while visual MRI identified 41.8%. Diagnostic accuracy showed 31.8% true positives, 55.5% true negatives, 2.7% false negatives, and 10.0% false positives.

Conclusion: T2 relaxometry showed strong agreement with visual MRI in identifying hippocampal sclerosis. It serves as a reliable adjunct tool for enhancing diagnostic accuracy in temporal lobe epilepsy.

Keywords: Temporal Lobe Epilepsy, Mesial Temporal Sclerosis, T2 Relaxometry, MRI, EEG, Hippocampus

Comparative Outcome of Cesarean Hysterectomy Versus Myometrial Resection among Patients of Morbid Adherent Placenta

2025-07-22T13:10:39+00:00

Background: Due to various aspects related to the complications observed in the morbid adherent placenta, there are different ways to treat the effective condition including surgical techniques like myometrial resection or also known as local resection or cesarean hysterectomy.

Objective: To compare the outcome of cesarean hysterectomy versus myometrial resection among patients of morbid adherent placenta.

Study Design: Prospective study.

Place and Duration of Study: Department of Obstetrics & Gynaecology, Gujranwala Medical College, Gujranwala from 1^st January 2023 to 30^th June 2023.

Methodology: On hundred cases of pregnant women admitted with ultrasonographic diagnosis of morbid adherent placenta, requiring hysterectomy and age between 18-45 years were included. The patients were divided into two groups. Group 1 was those patients who underwent cesarean hysterectomy while in group 2 underwent myometrial resection as planned. A well-structured proforma was designed for entering data in relation to mode of surgery, the status of booking, hospital stay and complications related within both procedural comparison. The risks and outcomes of both procedures in terms of blood transfusion requirements and other complications were recorded.

Results: The mean age of the patients were 31.3±5.1 years with majority having an emergency cesarean hysterectomy/myometerial resection procedure. There were 64% versus 60% such cases which arrived for their hysterectomy of morbid adherent placenta without prior booking. Majority of the patients were multiparous with only 14% patients from myometrium resection being nulliparous. The hospital stay post cesarean was less in myometrium resection than cesarean hysterectomy respectively (5.1±1.3 days vs 6.4±2.5 days). In the present study the bladder injury, blood loss and relaparotomy was only presented in 8%, 18% and 4% cases in myometrium resection in comparison to 24%, 36% and 16% those in cesarean hysterectomy. The post operative infections as well as hematoma formation were also presented only in 20% and 8% patients in Group MR vs 44% and 20% in cesarean hysterectomy respectively.

Conclusion: The myometrium resection is a more reliable, effective method in comparison to cesarean hysterectomy with less complications and blood loss, minimal hospital stay, less infection and hematoma risks.

Keywords: Outcome, Cesarean hysterectomy, Myometrial resection, Morbid adherent placenta

Outcomes of Uterine Artery Ligation Versus Internal Iliac Artery Ligation in Controlling Intractable Postpartum Hemorrhage

2025-07-27T18:52:47+00:00

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low-resource settings.

Objective: To compare the outcomes of uterine artery ligation and internal iliac artery ligation in controlling intractable postpartum hemorrhage for surgical effectiveness, operative parameters, and complication rates.

Methodology: This was a retrospective comparative study conducted at Department of Obstetrics and Gynaecology, Saidu Group of Teaching Hospitals, Swat, and Sahiwal Teaching Hospital, Sahiwal from December 2022 to May 2023. A total of 109 patients diagnosed with intractable postpartum hemorrhage unresponsive to medical management were included in the study. Patients were retrospectively categorized into two groups based on the surgical intervention performed.

Results: UAL had a significantly shorter operative time (55 ± 12 vs. 80 ± 15 minutes; p < 0.001) and lower blood loss (950 ± 220 vs. 1200 ± 270 mL; p = 0.001). Hemorrhage was successfully controlled in 90.6% of UAL cases and 95.5% of IIAL cases (p = 0.31). Emergency hysterectomy was required in 6.3% of UAL and 4.4% of IIAL patients (p = 0.69). The rate of postoperative complications was higher in the IIAL group (20.0% vs. 12.5%), though not statistically significant. The average hospital stay was significantly shorter in the UAL group (4.2 ± 1.1 vs. 5.6 ± 1.3 days; p = 0.003).

Conclusion: Both uterine artery ligation and internal iliac artery ligation are effective in controlling intractable postpartum hemorrhage. UAL is associated with shorter operative time, reduced blood loss, fewer complications, and shorter hospital stay, making it a preferred first-line surgical option. IIAL remains valuable for refractory cases or when broader pelvic vascular control is needed.

Keywords: Postpartum hemorrhage, uterine artery ligation, internal iliac artery ligation, obstetric emergency, maternal morbidity.

Assessment of Early Microvascular Changes in the Eye and Ear in Patients with Metabolic Syndrome: A Cross-Sectional Study

2025-07-30T12:17:24+00:00

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities, including central obesity, insulin resistance, hypertension, and dyslipidemia. These factors contribute to systemic microvascular dysfunction, which may manifest early in highly vascularized organs such as the eye and ear. Early detection of subclinical microangiopathy could serve as a biomarker for impending systemic vascular complications.

Objective: To assess early microvascular changes in the retina and cochlea in patients with metabolic syndrome using non-invasive ophthalmological and audiological methods.

Methods: A cross-sectional study was conducted from January 2022 to May 2023 at Mughal Eye Hospital, Lahore, and Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat. A total of 100 participants were enrolled, including 70 patients with MetS (per IDF criteria) and 30 healthy controls. Retinal vessel diameters were assessed through fundus photography, and microvascular perfusion was evaluated using optical coherence tomography angiography (OCT-A). Cochlear function was examined using pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAEs). Biochemical parameters including fasting glucose, lipid profile, and hsCRP were recorded.

Results: Patients with MetS showed significantly narrower retinal arteriolar diameters (CRAE: 134.6 ± 10.5 µm) and wider venular diameters (CRVE: 231.1 ± 15.3 µm) compared to controls (p < 0.001). OCT-A revealed reduced capillary density and enlarged foveal avascular zone (FAZ) (p = 0.008). High-frequency sensorineural hearing loss was present in 45.7% of MetS patients, with 52.9% showing absent or diminished DPOAEs. Positive correlations were found between triglyceride levels and both retinal and cochlear changes (p < 0.01).

Conclusion: Metabolic syndrome is associated with early subclinical microvascular changes in the eye and ear. Fundus imaging, OCT-A, and basic audiological assessments can serve as non-invasive, cost-effective tools for early detection and monitoring of microvascular impairment in MetS. These findings underscore the importance of multidisciplinary screening approaches in managing cardiometabolic risk.

Keywords: Metabolic syndrome, retinal microvasculature, cochlear dysfunction, OCT-A, otoacoustic emissions, microangiopathy.

Pelvic Pathologies in Primary Infertility: A Diagnostic Laparoscopy Study of 106 Patients

2025-07-31T10:14:20+00:00

Objective: To evaluate the frequency of pelvic pathologies diagnosed via diagnostic laparoscopy in patients with primary infertility.

Methods: A retrospective study was conducted on 106 women diagnosed with primary infertility who underwent diagnostic laparoscopy between September 2022 to August 2023. Clinical records, laparoscopy findings, and patient outcomes were reviewed. The most common pelvic pathologies identified were recorded and analyzed.

Results: Among the 106 patients, the most frequent pelvic pathologies included tubal occlusion (30%), endometriosis (25%), pelvic adhesions (18%), and uterine anomalies (10%). A significant correlation was found between the presence of endometriosis and tubal occlusion (p<0.05). Additionally, adhesions were most commonly associated with previous pelvic surgeries or infections.

Conclusion: Diagnostic laparoscopy is a valuable tool for identifying pelvic pathologies in primary infertility. Tubal factors and endometriosis are the most common causes, with significant implications for fertility management.

Keywords: Primary infertility, diagnostic laparoscopy, pelvic pathologies, tubal occlusion, endometriosis, adhesions, uterine anomalies.

Assessment of Coronary Artery Calcification in Chronic Kidney Disease Patients Using Multislice CT Correlation with Serum Phosphate Levels

2025-08-01T12:14:20+00:00

Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality, largely due to accelerated vascular calcification.

Objective: This study aims to assess the burden of CAC using multislice computed tomography (MSCT) and evaluate its correlation with serum phosphate levels in patients with CKD.

Methods: This cross-sectional analytical study was conducted at Medicine Department, Pakistan Atomic Energy Commission General Hospital, Islamabad from January 2023 to June 2023. A total of 189 patients diagnosed with chronic kidney disease. Demographic and clinical information, including age, sex, duration of CKD, and comorbidities, were recorded on a predesigned data collection form. Venous blood samples were collected under aseptic precautions to measure serum phosphate levels using standard enzymatic methods.

Results: The mean age of patients was 57.8 ± 12.3 years, with 64% being male. CAC was detected in 77.8% of patients, with 22.8% exhibiting severe calcification. A significant positive correlation was observed between serum phosphate levels and Agatston scores (rho = 0.472, p < 0.001). Patients with severe CAC had higher phosphate levels (6.1 ± 1.0 mg/dL) compared to those with no calcification (4.4 ± 0.7 mg/dL, p < 0.001). Dialysis patients showed significantly greater CAC burden and higher phosphate levels than non-dialysis patients (p < 0.01). Phosphate levels also increased progressively with advancing CKD stage (p < 0.001).

Conclusion: Coronary artery calcification is highly prevalent in CKD patients and is significantly associated with elevated serum phosphate levels. These findings highlight the importance of early phosphate control and vascular screening, even in non-dialysis CKD patients.

Keywords: Chronic kidney disease, coronary artery calcification, serum phosphate, multislice computed tomography.

Evaluation of Percutaneous Peritoneal Drainage in High-Risk Patients with Perforated Peritonitis

2025-08-14T11:25:07+00:00

Background: Perforated peritonitis is a critical condition associated with high mortality, especially in high-risk patients. Percutaneous peritoneal drainage (PPD) has emerged as a promising intervention for stabilizing these patients before surgery.

Objective: This study aims to evaluate the efficacy and safety of PPD in 105 high-risk patients diagnosed with perforated peritonitis.

Methods: A prospective cohort study was conducted from July to June 2023 at Department of surgery DHQ / Mufti Mehmood Teaching hospital and Gomal Medical college Dera ismail khan. A total of 105 high-risk patients with perforated peritonitis underwent PPD. Outcomes were assessed in terms of hemodynamic stabilization, reduction in septic load, and survival rates.

Results: The survival rate post-procedure was 74%, with a 26% mortality rate. Significant improvements were observed in blood pressure, urine output, and white blood cell count. Mortality was higher in patients with pre-existing comorbidities, particularly ischemic heart disease.

Conclusion: PPD is an effective intervention for stabilizing high-risk patients with perforated peritonitis. It improves survival rates and surgical outcomes by reducing septic load and enhancing clinical stability.

Keywords: Percutaneous peritoneal drainage, perforated peritonitis, high-risk patients, septic load, surgery, mortality.

Impact of Polycystic Ovary Syndrome (PCOS) on Female Fertility and Metabolic Health

2025-08-18T12:43:03+00:00

Background: PCOS is one of the widespread endocrine illnesses during the reproductive years in women. It is characterized by the hormonal deficiency, ovulatory imbalance, and disorder of metabolism. PCOS occurs as one of the leading factors of infertility alongside insulin resistance, obesity and the risk of type 2 diabetes, and can occur to both metabolic and reproductive health.

Objective: To identify the impact of PCOS on fertility and on metabolic indicators in women and also, to analyses the clinical outcomes of PCOS patient population and control population.

Study Design: A cross-sectional study.

Place and Duration of Study: The study was Conducted in Department of Gynae & Obs, KTH-MTI Peshawar Khyber Teaching hospital (MTI) Peshawar from June 2022 to july 2023.

Methods: A cross-sectional study was done by including a sample of 100 women with PCOS based on the Rotterdam criteria. Hormonal Profile, menstrual history, metabolic parameters, and data on fertility were taken. The controls were matched to the PCOS patients of the same age and analyzed. The results were established using the mean values, standard deviations and p-value in calculating significance in the differences found between groups.

Results: The sample to conduct the study was 100 and the average age was 27.5 0 4.2. The androgens present in the serum (p=0.001), indicators of insulin resistance (p=0.002) and body mass index (BMI) (p=0.004) were highly increased in the PCOS patients as compared to controls. Eighty-five per cent of the patients compared to 10 per cent control showed ovulatory dysfunction (p<0.001). There was a very high prevalence of the metabolic syndrome in the PCOS group (p=0.005).

Conclusion: In summary: COS reduces female fertility remarkably in terms of hormonal and ovulatory disturbances and is strictly linked with the adverse repercussions on metabolism health. Reproductive and metabolic complications are the other issues that present serious reproductive challenges to the affected women and reproductive care should be carried out early and comprehensively.

Keywords: PCOS, Fertility, Metabolic Health, Insulin Resistance

Comparison of Perioperative Safety and Recovery Profiles between Low-Pressure and Standard-Pressure Laparoscopic Cholecystectomy

2025-08-20T12:42:56+00:00

Background: To compare perioperative safety and recovery outcomes between low-pressure (8–10 mmHg) and standard-pressure (12–15 mmHg) laparoscopic cholecystectomy.

Methods: This prospective comparative study included 73 patients undergoing elective laparoscopic cholecystectomy from June 2022 to June 2023. Patients were randomized into two groups: low-pressure (n = 36) and standard-pressure (n = 37). Intraoperative safety parameters, postoperative pain scores, analgesic use, recovery milestones, complications, and patient satisfaction were recorded and analyzed.

Results: Both groups were similar in baseline demographics and comorbidities. Peak end-tidal CO₂ was lower in the low-pressure group (p = 0.002) without prolonging operative time. Postoperative pain scores at 6 hours were significantly reduced (p = 0.01) in the low-pressure group, with lower opioid requirements (p = 0.002) and less shoulder-tip pain (p = 0.03). Early ambulation and shorter hospital stays were also noted (p = 0.04). Complication rates were low and comparable between groups.

Conclusion: Low-pressure laparoscopic cholecystectomy offers superior postoperative comfort and earlier recovery without compromising intraoperative safety. It may be considered a safe alternative to standard-pressure pneumoperitoneum in suitable patients.

Keywords: Laparoscopic cholecystectomy, low-pressure pneumoperitoneum, postoperative pain, recovery time, gallstone surgery, intraoperative safety

Exploring the Relationship Between Sleep Disturbances and Suicidal Ideation in Individuals with Post-Traumatic Stress Disorder (PTSD): A Cross-Sectional Study

2025-08-20T12:45:33+00:00

Introduction: Post-Traumatic Stress Disorder (PTSD) is commonly coupled with sleep disorders that include sleeping disorders and nightmares, which have been verbosely addressed with suicidal thoughts. This relationship is very critical in determining what can be done to intervene and prevent suicides.

Objective: To investigate the relationship between sleep disturbances and suicidal ideation among people with PTSD using a cross-sectional clinical study.

Materials and Methods: This cross-sectional study was carried at Neurosurgery Department, Lady Reading Hospital Peshawar, Abbottabad Medical Complex, Mekran Medical College Turbat and Saidu Group of Teaching Hospital, Swat in the duration from May, 2022 to April, 2023. One hundred and sixty-seven PTSD patients have undergone the Pittsburgh Sleep Quality Index (PSQI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Analysis of data was carried out with SPSS v26.

Results: Sleep disturbance was present in 75.4 per cent of respondents, in which insomnia and nightmares were significantly linked to suicidal ideation (p < 0.05). The strongest predictor was identified to be insomnia with an OR = 2.34 in logistic regression.

Conclusion: Sleep disturbances, particularly insomnia and nightmares, are strongly correlated with suicidal ideation among PTSD patients.

Keywords: PTSD, sleep disturbances, insomnia, suicidal ideation, nightmares, cross-sectional study.

Outcome of Stapedotomy in the Treatment of Otosclerosis in a Tertiary Care Hospital: A Retrospective Study

2025-08-25T22:52:03+00:00

Background: Otosclerosis is a major ear disorder that causes conductive hearing loss. Proper treatment is crucial to prevent hearing loss.

Objective: The objective of this study was to determine the outcome of stapedotomy in the treatment of otosclerosis in a tertiary care hospital

Material and Method: This retrospective study was conducted at the Department of ENT, Bolan Medical College / Complex Hospital, Quetta from April 2023 to September 2023 after taking approval from the research committee of the institute. We obtained and examined the clinical records of otosclerosis individuals who had done stapedotomy at the ENT department. A total of 55 Individuals diagnosed with otosclerosis and evaluated on the basis of tone audiogram and tympanometry were included. Pure tone audiometry was performed for each individual just before surgery, on the first day following the procedure, and three months later during the post-operative follow-up. Data on the comparison of the air bone gap (ABG) frequencies 0.5, 1, 3, and 4 KHz before and after surgery has been collected. The difference in pre- and post-operative (at three months' follow-up) ABG was used to compute the postoperative hearing gain. The resulting increase in hearing thresholds was categorized as best (>30dB), better (21-30dB), good (11-20dB), and fair (0-10dB) for the purposes of the analysis.

Results: In the present study a total of 55 individuals were enrolled out of which 31(56%) were male and 24(44%) were female and the age ranged from 18-46 years. It was observed that thirty of the participants (54.4%) had hearing improvements of greater than 30 dB (best), whereas 12 (21.8%), eight recipients (14.5%), and 5 patients (9%) had improvements of 21–30 dB (better), 11–20 dB (good), and 0–10 dB (fair) respectively. Although all the participants presented some improvement, nobody experienced a drop in their hearing. Individuals under 35 years old had a significant improvement in their hearing thresholds when compared to those over 35 (value of p equal to 0.013). Nevertheless, the statistical evaluation revealed that the participants' gender had no significant impact on the improvement in their hearing thresholds (value of p equal to 0.446).

Conclusion: The study concluded that stapedotomy is a choice of therapy for otosclerosis, improved hearing thresholds in individuals with hearing loss.

Keywords: Outcome; Stapedotomy; Treatment; Otosclerosis

Biomechanical Comparison of Locking Versus Non-Locking Plates in Distal Femur Fractures

2025-08-27T16:44:29+00:00

Background: To compare the ‘biomechanical performance, radiographic healing, and functional outcomes of locking versus non-locking plates in the surgical fixation of distal femur fractures’.

Methods: This prospective comparative study was conducted at the Department of Orthopaedic Surgery, Bolan Medical Complex Hospital, Quetta, from January 2022 to June 2023. A total of 57 adult patients with distal femur fractures were included, with 29 managed using locking plates and 28 with non-locking plates. Primary outcome was time to radiographic union. Secondary outcomes included knee range of motion, KOOS score, pain level, malalignment, and complication rates. Data were analyzed using SPSS version 26, with p < 0.05 considered statistically significant.

Results: The locking plate group demonstrated a significantly shorter mean time to union (17.3 ± 3.2 weeks vs. 19.5 ± 3.7 weeks, p = 0.02) and greater mean knee flexion at one year ‘(118.4° ± 8.6° vs. 112.2° ± 9.1°, p = 0.01)’. ‘KOOS scores were also higher in the locking plate group (78.6 ± 6.3 vs. 74.1 ± 6.8, p = 0.02)’. There was no significant difference in malalignment, delayed union, or infection rates. Implant failure occurred only in the non-locking plate group.

Conclusion: Locking plates provided faster fracture healing and better functional outcomes compared to non-locking plates, without increasing complication rates. Their use is particularly beneficial in comminuted fractures, poor bone quality, and cases requiring early mobilization.

Keywords: Distal femur fracture, Locking plate, Non-locking plate, Biomechanical stability, Functional outcome, Fracture union

Comparative Evaluation of Mammography and Ultrasound in Detecting Breast Masses in Women Under 40 Years

2025-08-27T23:32:08+00:00

Background: Breast cancer is increasingly being diagnosed in younger women, yet diagnostic imaging in this age group remains challenging due to higher breast density and aggressive tumor biology. Mammography is limited in sensitivity among women under 40 years, whereas ultrasound provides a radiation-free, real-time modality that may offer improved detection.

Objective: To compare the diagnostic performance of mammography and ultrasound in the detection of breast masses among women younger than 40 years in Pakistan.

Methods: A prospective diagnostic accuracy study was conducted at Ziauddin Medical University Hospital, Karachi, and Khyber Teaching Hospital, Peshawar, between January 2022 and March 2023. Ninety women aged 18–39 years with clinically suspected breast masses underwent same-day mammography and targeted breast ultrasound. Images were interpreted independently using BI-RADS criteria. Histopathology from biopsy or 12-month imaging follow-up served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both modalities, and subgroup analyses were performed by age group and breast density.

Results: The mean age of participants was 31.4 ± 5.2 years, with 64.4% in the 30–39 year age group. The majority presented with palpable lumps (78.9%). Histopathology confirmed malignancy in 27 cases (30%) and benign lesions in 63 (70%). Ultrasound demonstrated a sensitivity of 92.6%, specificity of 90.5%, PPV of 80.6%, NPV of 96.6%, and overall accuracy of 91.1%. Mammography achieved a sensitivity of 74.1%, specificity of 85.7%, PPV of 69.0%, NPV of 88.5%, and accuracy of 82.2%. Ultrasound outperformed mammography in invasive carcinomas, while mammography remained superior in detecting microcalcification-dominant DCIS. Subgroup analyses showed ultrasound was particularly advantageous in younger women (18–29 years) and those with dense breasts.

Conclusion: Ultrasound is more sensitive and diagnostically accurate than mammography for breast mass detection in women under 40 years, especially in dense breast tissue. Mammography, while less sensitive overall, retains complementary value for identifying microcalcification-based lesions. Ultrasound should be considered the primary imaging modality in this age group, with selective mammography reserved for equivocal cases or suspected DCIS.

Keywords: Breast ultrasound, mammography, dense breast, BI-RADS, young women, diagnostic accuracy

Comparative Evaluation of Problem-Based Learning and Traditional Teaching Methods in Enhancing Preventive Health Strategies Among Medical Students

2025-08-27T23:36:09+00:00

Background: Preventive health is a critical component of medical education, requiring both theoretical knowledge and applied skills. While lecture-based learning (LBL) remains the traditional teaching method, problem-based learning (PBL) has been proposed as a more interactive and student-centered approach. Evidence comparing these methods in preventive medicine remains limited, particularly in Pakistan.

Objective: To compare the effectiveness of problem-based learning and lecture-based learning in teaching preventive health strategies among undergraduate medical students.

Methods: A quasi-experimental study was conducted at Gambat Medical College, Gambat, and Women Medical College, Abbottabad, from January 2022 to May 2023. A total of 150 third-year MBBS students were enrolled, with 75 allocated to PBL and 75 to LBL. Both groups covered identical content on six core areas of preventive medicine. Outcomes measured included performance in a four-station Objective Structured Clinical Examination (OSCE), a 50-item knowledge test, a self-efficacy scale for preventive counseling, an attitude scale, and student satisfaction. Data were analyzed using SPSS version 26.0, with independent t-tests and chi-square tests applied where appropriate.

Results: Students in the PBL group achieved significantly higher composite OSCE scores compared with the LBL group (82.6 ± 7.4 vs. 76.8 ± 8.1; p < 0.001). Station-wise analysis revealed superior performance in all four stations, particularly in tobacco cessation counseling. Knowledge scores were higher in the PBL group (38.9 ± 4.6) than in the LBL group (36.2 ± 5.1; p = 0.001). Self-efficacy was also significantly greater (4.2 ± 0.5 vs. 3.7 ± 0.6; p < 0.001), as were attitudes toward preventive medicine (4.0 ± 0.4 vs. 3.7 ± 0.5; p = 0.002). Satisfaction was higher among PBL students, with 84% rating the method highly satisfactory compared with 62% in the LBL group (p = 0.004).

Conclusion: Problem-based learning was found to be more effective than lecture-based teaching in enhancing preventive health education among medical students. PBL improved applied performance, knowledge retention, self-efficacy, attitudes toward prevention, and overall satisfaction. These findings support the integration of PBL into medical curricula for effective training in preventive health strategies.

Keywords: Problem-Based Learning, Lecture-Based Learning, Preventive Medicine, Medical Education, OSCE, Self-Efficacy, Attitudes

Radiological Evaluation of Bone Mineral Density in Diabetic Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

2025-08-27T23:38:58+00:00

Background: Diabetes mellitus is associated with multiple systemic complications, including significant effects on musculoskeletal health. Chronic musculoskeletal pain is common among diabetic patients and may indicate early skeletal fragility. Radiological evaluation of bone mineral density (BMD) provides valuable insight into the extent of bone involvement in this population.

Objective: To evaluate bone mineral density in diabetic patients presenting with chronic musculoskeletal pain and to determine the association of BMD with diabetes duration, glycemic control, and body mass index.

Methods: A cross-sectional study was conducted in the Department of Radiology in collaboration with the Department of Medicine at Al-Nafees Medical College and Hospital, Islamabad, from June 2022 to May 2023. A total of 100 patients with type 2 diabetes mellitus and musculoskeletal pain persisting for more than three months were included. Demographic and clinical data were collected, and BMD was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DEXA). Patients were categorized as normal, osteopenic, or osteoporotic according to WHO criteria. Data were analyzed using SPSS version 26, with p < 0.05 considered statistically significant.

Results: The mean age of participants was 55.8 ± 9.6 years, with a female predominance (56%). Normal BMD was found in 30% of patients, while 44% had osteopenia and 26% had osteoporosis. Reduced BMD was significantly associated with longer diabetes duration (≥10 years; p < 0.05) and poor glycemic control (HbA1c > 7.5%; p < 0.05). Female patients and those with lower BMI were more likely to exhibit osteoporosis, while obese individuals showed preserved hip BMD but reduced lumbar spine density.

Conclusion: Osteopenia and osteoporosis are highly prevalent in diabetic patients with chronic musculoskeletal pain. Duration of diabetes, poor glycemic control, and low BMI are key risk factors associated with reduced BMD. Routine radiological evaluation using DEXA is strongly recommended in such patients to enable early diagnosis and preventive management of osteoporosis.

Keywords: Diabetes mellitus, Bone mineral density, Osteopenia, Osteoporosis, Musculoskeletal pain, DEXA

Comparative Analysis of Zinc Levels in Patients with Chronic Leg Ulcers and Healthy Individuals: A Cross-Sectional Study

2025-09-01T21:45:47+00:00

Background: Zinc is an essential trace element critical to immune function and wound healing. Chronic leg ulcers are persistent wounds that affect millions of individuals globally. Zinc deficiency has been implicated in the pathophysiology of wound healing, but its role in chronic leg ulcers remains underexplored.

Objective: To compare the serum zinc levels in patients with chronic leg ulcers to those of healthy individuals.

Methodology: A cross-sectional study was conducted with 110 participants, divided into two groups: 55 patients with chronic leg ulcers and 55 age- and sex-matched healthy individuals. Serum zinc levels were measured using atomic absorption spectrometry. Statistical analysis was performed using the t-test (for normally distributed data) or Mann-Whitney U test (for non-normally distributed data).

Results: The mean zinc level in the chronic leg ulcer group was significantly lower than the healthy control group (p < 0.05). The results also showed a negative correlation between zinc levels and the severity of the ulcers.

Conclusion: Chronic leg ulcer patients have significantly lower zinc levels compared to healthy individuals, suggesting a potential link between zinc deficiency and impaired wound healing in such patients.

Keywords: Zinc, chronic leg ulcers, wound healing, serum zinc levels, deficiency, cross-sectional study.

To Assess Role of Circulating Micro RNAs in Aplastic Anemia Patients

2025-09-03T22:05:55+00:00

Introduction: Aplastic anemia is an acquired bone marrow failure categorized by marrow hyperplasia due to immune mediated effect on bone marrow.

Objective: To assess role of plasma micro RNAs (miR-150-5p) and (miR-146b-5p) in patients of aplastic anemia by (real time PCR technique) and to correlate plasma microRNA’s with severity in patients of aplastic anemia.

Methods: Eight ml blood sample was collected from patients, and then distributed into two EDTA tubes. 3 ml EDTA tube was used for Complete blood count (CBC) and 5 ml EDTA sample was used for RNA isolation for performing MicroRNA testing. Bone marrow examination was performed at the department of Pathology, LUMHS Jamshoro, Diagnostic and Research Laboratory at Liaquat University Hospital Hyderabad, and Department of Medicine and Pediatrics at Civil Hospital Hyderabad for diagnosis of Aplastic anemia during July 2019 to December 2019. All the data was recorded via self-made proforma and analyzed by using SPSS version 21.

Results: Out of 72 cases, 36 were patients and 36 were controls, males were most common in both groups. According to severity of aplastic anemia 19 (52.8%) patients seen with very severe aplastic anemia, 10(27.8%) found with non-severe aplastic anemia and 7 (19.4%) found with severe aplastic anemia. Micro RNA 150.5p was positive among all patients, while negative in all controls. Micro RNA 146b.5p was positive among 5 patients, while it was negative in all controls p-value 0.001. Mean of micro RNA 150.5p was higher 34.89+13.99 in very severe aplastic anemia, 29.33+1.99 in severe and 28.76+2.37 in non-severe aplastic anemia. There was a negative correlation between Micro RNA 150.5p and hemoglobin, r-value 0.029, negative correlation between Micro RNA 150.5p and WBC, r-value 0.008, strong negative correlation between Micro RNA 150.5p and MCV, r-value 0.408 and weak negative correlation between Micro RNA 150.5p and platelets, r-value 0.017.

Conclusion: It was concluded that plasma micro RNA’s (miR-150-5p) is a potential diagnostic marker of aplastic anemia. It was positive among all patients of aplastic anemia and showed a strong negative correlation with haemoglobin level, WBC, MCV and platelets.

Keywords: Aplastic Anemia, miR-150-5p, miR-146b-5p, Bio-markers

Histopathological Spectrum and Clinical Correlation of Gastrointestinal Mucosal Biopsies in Patients with Chronic Diarrhea. A Cross-Sectional Study

2025-09-03T22:13:39+00:00

Background: Chronic diarrhea, defined as diarrhea lasting four weeks or more, is a common clinical problem with a wide range of etiologies. Its causes may include infectious, inflammatory, autoimmune, and neoplastic conditions. While clinical assessment and laboratory investigations provide useful insights, histopathological evaluation of gastrointestinal mucosal biopsies remains the gold standard for accurate diagnosis and management.

Objective: To determine the histopathological spectrum of gastrointestinal mucosal biopsies in patients with chronic diarrhea and to correlate these findings with clinical features.

Methods: This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Gastroenterology, Khyber Teaching Hospital, Peshawar, Pakistan, from January 2022 to July 2023. A total of 100 patients with diarrhea persisting for more than four weeks were included. Endoscopic biopsies were obtained and processed using hematoxylin and eosin staining. Special stains were employed when required. Clinical features were recorded, and correlation with histopathological findings was analyzed using SPSS version 25.

Results: The mean age of patients was 39.2 ± 13.1 years, with a male predominance (55%). The most common presenting symptom was watery diarrhea (62%), followed by weight loss (48%) and abdominal pain (40%). Histopathology revealed inflammatory bowel disease in 28% of cases, chronic nonspecific colitis in 22%, infectious colitis in 15%, celiac disease in 12%, microscopic colitis in 8%, and neoplastic lesions in 7%. Significant clinicopathological correlations were observed, particularly in cases of IBD (p=0.01) and celiac disease (p=0.02).

Conclusion: Histopathological examination of gastrointestinal mucosal biopsies provides invaluable diagnostic information in patients with chronic diarrhea. Routine biopsy is recommended in all such patients to differentiate overlapping conditions, ensure accurate diagnosis, and guide effective treatment strategies.

Keywords: Chronic diarrhea, gastrointestinal mucosa, histopathology, inflammatory bowel disease, celiac disease, colitis.

Diagnostic Accuracy of Ultrasound in Detecting Choledocholithiasis in Patients with Obstructive Jaundice: A Comparative Study with MRCP as Gold Standard

2025-09-10T20:02:35+00:00

Objective: To evaluate the diagnostic accuracy of ultrasound (US) in detecting choledocholithiasis in patients with obstructive jaundice, comparing it with Magnetic Resonance Cholangiopancreatography (MRCP) as the gold standard.

Methods: A prospective study was conducted on 130 patients with suspected obstructive jaundice from January 2023 to June 2023. All patients underwent ultrasound and MRCP. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were determined.

Results: The sensitivity of US was found to be 65%, specificity 92%, PPV 84%, and NPV 80%. MRCP showed higher sensitivity (91%) and specificity (96%) in detecting choledocholithiasis.

Conclusion: Ultrasound is a useful screening tool for choledocholithiasis but has limitations in sensitivity compared to MRCP. Its high specificity suggests it remains valuable in confirming the absence of the disease, while MRCP is preferred for definitive diagnosis.

Keywords: Ultrasound, Choledocholithiasis, Obstructive Jaundice, Magnetic Resonance Cholangiopancreatography, Diagnostic Accuracy, Sensitivity, Specificity

Impact of Radial Compared to Femoral Access on Major Bleeding and Mortality in ACS Patients Undergoing PCI

2025-09-17T19:33:41+00:00

Background: Bleeding complications after percutaneous coronary intervention (PCI) remain a major determinant of morbidity and mortality in acute coronary syndrome (ACS). Vascular access site is a critical factor influencing these outcomes.

Objective: To compare the incidence of major bleeding and in-hospital mortality between radial and femoral access in patients with ACS undergoing PCI.

Methods: This prospective observational study included 345 patients with ACS undergoing PCI at Punjab Institute of Cardiology, Lahore from February 2023 to July 2023. Patients were divided into radial access (n=176) and femoral access (n=169) groups. Demographic characteristics, cardiovascular risk factors, clinical presentation, and procedural details were recorded. Outcomes assessed included major bleeding (BARC 3–5), transfusion requirement, access-site complications, in-hospital mortality, major adverse cardiovascular events (MACE), and hospital stay duration.

Results: Baseline characteristics were comparable between groups, though femoral patients were slightly older and more often presented with Killip class II–IV. Major bleeding occurred in 2.8% of radial patients versus 10.7% of femoral patients (p=0.004). Any bleeding was observed in 6.8% of radial versus 17.2% of femoral cases (p=0.002). Transfusion requirements (1.7% vs. 7.1%, p=0.01) and hemoglobin drop ≥3 g/dL (2.3% vs. 8.3%, p=0.01) were significantly lower in the radial group. In-hospital mortality was 4.0% with radial access compared to 10.7% with femoral (p=0.02). MACE occurred in 10.8% of radial versus 22.5% of femoral patients (p=0.004). Mean hospital stay was shorter in the radial group (4.9 vs. 6.1 days, p<0.001). On multivariable analysis, radial access independently reduced the odds of major bleeding (aOR 0.38, 95% CI 0.15–0.91, p=0.03) and mortality (aOR 0.41, 95% CI 0.17–0.97, p=0.04).

Conclusion: Radial access significantly reduces bleeding complications, mortality, and major adverse cardiovascular events compared to femoral access in ACS patients undergoing PCI. These findings support the adoption of radial access as the preferred strategy to improve short-term outcomes in this high-risk population.

Keywords: Acute coronary syndrome, PCI, radial access, femoral access, major bleeding, mortality, MACE

Impact of High-Volume Fat Removal on Physical and Psychological Parameters in Obese and Overweight Females

2025-09-17T19:35:41+00:00

Objective: To evaluate the physiological and psychological changes following large-volume liposuction in overweight and obese women.

Methods: This prospective study was conducted at plastic surgery department of Bakhtawar Amin Medical & Dental College, Multan, from June 2022 to June 2023, and included 50 overweight and obese female patients undergoing large-volume liposuction. Baseline demographic data, weight, body mass index (BMI), and blood pressure were recorded preoperatively and reassessed postoperatively. Psychological assessment was performed using the Hospital Anxiety and Depression Scale (HADS) and body image scores, measured preoperatively and at 1 and 3 months postoperatively. Statistical analysis was carried out to assess changes over time.

Results: The mean age of participants was 38.4 ± 7.6 years, with a mean preoperative BMI of 33.8 ± 3.9 kg/m² and weight of 87.2 ± 11.5 kg. Following liposuction, significant reductions were observed in weight (p<0.001) and BMI (p<0.001). Systolic and diastolic blood pressures also decreased significantly postoperatively (p=0.01 and p=0.02, respectively), along with a reduction in heart rate (p=0.01). Psychologically, patients demonstrated a significant improvement in HADS-anxiety (p<0.001) and HADS-depression scores (p<0.001) across follow-up intervals. Body image scores showed positive correlation with total aspirated fat volume (r=0.42, p=0.01).

Conclusion: Large-volume liposuction in overweight and obese women leads to significant improvements in both physiological parameters, such as weight, BMI, and blood pressure, and psychological well-being, including anxiety, depression, and body image. These findings suggest that liposuction may play a beneficial role beyond aesthetics, contributing to overall health and quality of life in obese women.

Keywords: Liposuction; Obesity; Overweight women; Body mass index; Psychological well-being; Body image;

A Randomized Controlled Trial Comparing Three-Port and Four-Port Laparoscopic Cholecystectomy for Acute Cholecystitis

2025-09-19T18:29:12+00:00

Objective: To compare the efficacy, safety, and postoperative outcomes of three-port versus four-port laparoscopic cholecystectomy (LC) in patients with acute cholecystitis.

Methods: A prospective, randomized controlled trial was conducted involving 170 patients diagnosed with acute cholecystitis. Patients were randomly assigned to undergo either three-port or four-port LC. Demographic data, operative time, postoperative pain (measured by Visual Analog Scale), analgesic requirements, hospital stay duration, and complication rates were recorded and analyzed.

Results: The three-port group (n=85) had a mean age of 42.5 years, while the four-port group (n=85) had a mean age of 43.2 years. The male-to-female ratio was 1:2 in both groups. Operative times were comparable between the two groups (mean 45 minutes for three-port vs. 47 minutes for four-port, p=0.35). Postoperative pain scores were significantly lower in the three-port group (mean VAS score 2.1 vs. 3.4, p<0.001). Analgesic requirements were also reduced in the three-port group (mean 120 mg pethidine vs. 180 mg, p<0.01). Hospital stay was shorter in the three-port group (mean 2.3 days vs. 3.1 days, p<0.05). No significant differences were observed in complication rates or conversion to open surgery between the two groups.

Conclusion: Three-port laparoscopic cholecystectomy is a safe and effective alternative to the traditional four-port approach for acute cholecystitis, offering benefits in terms of reduced postoperative pain, lower analgesic requirements, and shorter hospital stays without compromising safety or efficacy.

Keywords: Three-port laparoscopic cholecystectomy, four-port laparoscopic cholecystectomy, acute cholecystitis, postoperative pain, hospital stay, surgical outcomes

Frequency of Metabolic Syndrome in Case with Ischemic Stroke

2025-09-23T12:47:02+00:00

Background: Ischemic stroke is a leading cause of mortality and long-term disability worldwide, with a complex interplay of genetic and environmental risk factors. Among these, modifiable risk factors such as smoking, hypertension, dyslipidaemia, and diabetes have been well-established. In addition, Metabolic Syndrome (MetS), a cluster of conditions including obesity, insulin resistance, hypertension, elevated triglycerides, and reduced HDL cholesterol, significantly heightens the risk of ischemic stroke.

Objective: This study aimed to assess the prevalence of Metabolic Syndrome in patients with ischemic stroke.

Study Design: A cross-sectional observational study.

Duration: 6-month period from May 16, 2019, to December 16, 2019.

Methods: The study was conducted at the Department of Medicine, Lady Reading Hospital, Peshawar, involving 120 CT-confirmed ischemic stroke patients. These patients were evaluated for the presence of Metabolic Syndrome using standard diagnostic criteria.

Results: The cohort had a mean age of 58.8 ± 9.8 years, with 64.2% being male. Metabolic Syndrome was identified in 55% of the study participants, highlighting its significant association with ischemic stroke.

Conclusion: Metabolic Syndrome is a prevalent and substantial risk factor for ischemic stroke. This underscores the importance of early detection and management of MetS, as well as the need for community-based research to further explore its role in stroke pathogenesis.

Keywords: Ischemic stroke, metabolic syndrome, obesity, hypertension, dyslipidaemia, smoking.

Frequency of Umbilical Port Site Infection after Cholecystectomy: A Single Centre Cross-Sectional Study

2025-09-23T12:48:54+00:00

Background: Laparoscopic surgery may be used to treat cholelithiasis, pancreatic inflammation, gallbladder stones, and gallbladder tumours, often known as polyps. Due to its safety and status as the gold standard, gallbladder resection combined with a laparoscopic cholecystectomy is regarded as the preferred surgical procedure.

Objective: To determine the frequency of umbilical port site infection after cholecystectomy

Study Design: Descriptive cross-sectional study

Place and study duration: The current study was done at the Surgery Department, BMC/Bolan Medical Complex Hospital Quetta for a period of six months from Feb 2023 to July 2023.

Methods: The study was approved from the ethical committee of the hospital. A total of 100 patients participated in our study. Data were acquired by observing patients and laboratory reports; furthermore, the analysis was conducted using the newest version of SPSS 24.

Results: In our study, totally 100 patients were selected. The mean age of the patients was. The mean age of the enrolled patients was 42 (11.2) years with minimum age of 20 and maximum age of 70 years. The male patients in our study were 42 (42%) and females were 58 (58%). The frequency of port site infection after cholecystectomy was 15 (15 %). The most common of infection was umbilical port site in 9 (60 %) followed by epigastric infection in 4 (26.67 %) patients, suprapubic infection in 1 (6.67 %) patient and Palmer’s point infection in 1 (6.67 %) patient.

Conclusion: Our study concludes that port site infection after cholecystectomy is a common problem. The most common complication after cholecystectomy in our study was umbilical port site infection followed by epigastric infection. Consequently, this may be reduced with appropriate aseptic methods and postoperative patient care.

Keywords: laparoscopy; cholecystectomy, post-surgical infection; suprapubic infection

The Impact of PSA Screening on Pharmacological Management in Asymptomatic Men and Those with Lower Urinary Tract Symptoms

2025-09-26T06:22:52+00:00

Aim of Study: To evaluate the impact of Prostate-Specific Antigen (PSA) screening on the initiation and type of pharmacological management in two distinct cohorts: asymptomatic men undergoing routine health check-ups and symptomatic men presenting with Lower Urinary Tract Symptoms (LUTS).

Study Duration: November 2022 to June 2023.

Study Place: Rai Foundation Medical College, Sargodha.

Methodology: A prospective cohort study included 450 men aged 50–75. Group A had 225 symptom-free people, while Group B had 225 LUTS patients. All participants took the PSA test. PSA and clinical observations guided pharmaceutical therapy documentation and classification.

Results: PSA screening significantly improved pharmacological therapy in both groups. Due to increased PSA results, 18.2% of asymptomatic Group A patients needed medication following screening, mostly 5-alpha reductase inhibitors (5-ARIs). In symptomatic Group B, 76.4% of individuals took phosphodiesterase-5 inhibitors, alpha-blockers, and 5-ARIs. PSA levels directly affected treatment aggressiveness, especially with the exclusion of prostate cancer as a cause of LUTS.

Conclusion: PSA screening alters pharmaceutical management. It identifies asymptomatic males who need early BPH treatment or cancer screening. Diagnostics and treatment are more accurate and effective when administered to symptomatic guys. PSA improves urological therapy, even though it's not ideal.

Keywords: Prostate-Specific Antigen, PSA Screening, Pharmacological Management, Lower Urinary Tract Symptoms, Asymptomatic Men, Benign Prostatic Hyperplasia.

Clinical Spectrum and Outcome in Children Presenting with Empyema Thoracis in Tertiary Care Hospital: Role of Intrapleural Streptokinase

2025-09-30T16:22:10+00:00

Aims and Objectives:

To correlate clinical symptoms of empyema thoracis with treatment outcome.
To analyze role of intra-pleural streptokinase in Empyema thoracis.

Material and Methods: This cross sectional study was carried out at the department of pediatric medicine unit, UCHS and The Children Hospital, Lahore, spanning from December 10, 2022, to June 9, 2023. Non-Probability, Consecutive sampling technique was used. A total of 70 children who met the inclusion criteria were enrolled in the study. The patients were classified based on their need for various treatment options such as IV antibiotics with chest tube drainage, intrapleural streptokinase, and decortication surgery. The data was inputted and analyzed using SPSS version 25, stratified by age and gender in relation to treatment outcomes. A significance level of p≤0.05 was deemed as significant.

Results: Of these 70 study cases, 55(78.6%) were male patients and 15(21.4%) were female patients. Mean age of our study cases was 7.6±4.6 years. According to clinical spectrum of empyema thoracis distribution, 70(100.0%) had fever, 59(84.3%) had respiratory distress, 61(87.1%) had cough, 42(60.0%) had hemoptysis and 32(45.7%) had chest pain.

Conclusion: Prompt recognition and appropriate management of pneumonia can avert the progression to empyema. Utilizing antibiotics alongside chest tube placement and administration of streptokinase has shown to be a successful approach in addressing pyogenic empyema thoracis in children residing in resource-limited environments.

Keywords: Parapneumonic Effusion, Complications, Clinical Spectrum, Outcome, Chest Tube.

Antibiotic Sensitivity and Resistance Patterns in Complicated Urinary Tract Infections

2025-10-04T09:39:44+00:00

Background: It is important to diagnose UTIs and identify the bacteria causing them in order to choose the best antibiotic treatment and prevent the emergence of antibiotic resistance.

Objective: The aim of this study was to determine the antibiogram in Complicated Urinary Tract Infections at tertiary care hospital.

Material and Methods: The current cross-sectional multicentre study was carried out at MMC, DHQ hospital Kohat, AWKUM, KUST from February 2023 to August 2023 after taking permission from the ethical committee of the institute. A total of 127 individual with complex urinary tract infections of both genders and different age group (16 to 80) years were included. Midstream urine samples were taken in sterile containers from each individual and were sent immediately to the microbiology lab for culturing. Samples were stored at 4°C if they were delayed. These samples were inoculated on blood agar and MacConkey and incubated for 24-48 hours and colonies were counted according to the lab protocols. Severe bacteriuria was defined as growth of greater than 105 CFU/mL. Antibiotic susceptibility profile was done using both disc diffusion and the VITEK-2 compact system direct Antimicrobial Susceptibility Testing (AST). The isolated bacteria were tested for sensitivity to commonly prescribed drugs. All the data was analyzed using SPSS version 26.

Results: A total of 127 individuals were examined in this study out of which 43.3% were male and 56.65% were female. The most prevalent uropathogen in our study was E. Coli which was followed by Staphlococcus aureus and Klebsiella pneumoniae . E.coli was highly sensitive to colistin followed by fosfomycin, imipenem, meropenem, Amikacin, Nitrofurantoin ,Piperacillin / Tazobactum and ciprofloxacin while it was highly resistant to Cefixime followed by Co amoxiclave and Co-trimoxizole respectively. Similarly K Pneumoniae was 100% resistant to ciprofloxacin, levofloxacin and moxifloxacin while sensitive to imipenem and meropenem. P.uroginosa was 100% resistant to trimoxizole, ciprofloxacin levofloxacin and colisten. S.aureus was (100%) sensitive to Piperacillin/Tazobactum followed by imipenem and leofloxacin respectively while 100% resistant to moxifloxacin, nitrofurantoin and cefixime.

Conclusion: The present study concluded that the most prevalent bacteria causing urinary tract infections are E. coli followed by S. aureus and K. pneumonia. Most of these bacteria were sensitive to imipenem and meropenem and resistant to commonly prescribed antibiotics.

Keywords: Antibiotic Sensitivity; Resistance; Urinary Tract Infections.

Comparing Betadine and Clotrimazole for Otomycosis Treatment: A Study of Clinical Efficacy and Recurrence Rates

2025-10-10T10:16:32+00:00

Background: Otomycosis is a common fungal infection of the external auditory canal, often causing significant discomfort and complications. Various treatments are available, with Betadine (povidone-iodine) and Clotrimazole being commonly used. This study aims to compare the efficacy of these two treatments in 130 patients.

Methods: A randomized controlled trial was conducted with 130 patients diagnosed with otomycosis. Patients were assigned to receive either Betadine (10% povidone-iodine) or Clotrimazole (1%) ear drops for 14 days. Clinical assessments, including symptom resolution, fungal culture results, and recurrence rates, were recorded at days 10 and 21 post-treatment.

Results: Both treatments demonstrated significant symptom relief and fungal clearance. By day 21, 87.7% of the Betadine group and 85.4% of the Clotrimazole group showed symptom resolution. The fungal culture was negative in 90.8% and 88.5% of patients, respectively. Recurrence rates at 21 days were comparable (12.3% for Betadine, 14.6% for Clotrimazole).

Conclusion: Both Betadine and Clotrimazole are effective for the treatment of otomycosis, with no significant difference in outcomes. This provides clinicians with two reliable treatment options for managing otomycosis.

Keywords: Otomycosis, Betadine, Clotrimazole, Antifungal Therapy, Povidone-Iodine, External Auditory Canal Infection

Outcomes of Trabeculectomy with Mitomycin C in Glaucoma Patients: A Study on the Mean Change in Intraocular Pressure in 200 Patients

2025-10-10T10:18:23+00:00

Objective: This study aims to evaluate the outcomes of trabeculectomy with Mitomycin C (MMC) in terms of mean change in intraocular pressure (IOP) in 200 glaucoma patients.

Methods: A cohort of 200 glaucoma patients undergoing trabeculectomy with MMC was analyzed. Preoperative and postoperative IOP measurements were taken at intervals (1 month, 3 months, 6 months, and 12 months). Demographic variables, surgical complications, and postoperative interventions were also recorded.

Results: The mean preoperative IOP was 26.4 mmHg, which decreased significantly to 12.3 mmHg at 12 months post-surgery. The success rate in achieving target IOP (< 21 mmHg) was 87%. The incidence of postoperative complications such as hypotony, infection, and bleb leaks was low.

Conclusion: Trabeculectomy with MMC is highly effective in reducing IOP in glaucoma patients, with a significant mean change in IOP from preoperative to postoperative stages. MMC plays a key role in improving surgical success by preventing scarring and bleb failure.

Keywords: Trabeculectomy, Mitomycin C, intraocular pressure, glaucoma, surgical outcomes, postoperative complications.

A Retrospective Study of Esophageal Foreign Bodies in Children: Incidence, Management, and Complications in a Tertiary Care Center

2025-10-21T07:25:38+00:00

Background: Esophageal foreign body (EFB) ingestion is a prevalent issue in pediatric emergency care, often leading to significant complications if not promptly addressed. Early intervention is crucial to avoid morbidity, such as esophageal perforation, mucosal injury, or mediastinitis.

Objective: This study aims to evaluate the incidence, clinical presentation, management strategies, and complications associated with EFBs in a tertiary care pediatric hospital.

Methods: We conducted a retrospective analysis of 252 pediatric patients diagnosed with EFBs between April 2022 and June 2023. Data on demographics, type of foreign body, location, clinical symptoms, management approach, and complications were collected and analyzed.

Results: The majority of patients were male (65%), with a mean age of 4.5 years. Coins were the most commonly ingested foreign bodies (45%), followed by food bolus (30%) and sharp objects (15%). The upper esophagus was the most frequent site of impaction (60%). Endoscopic removal was successful in 90% of cases, while 10% required surgical intervention due to complications such as perforation and mediastinitis.

Conclusion: Prompt diagnosis and intervention are essential for managing EFBs in children. Endoscopic techniques remain the gold standard, with surgical intervention required in complicated cases.

Keywords: Esophageal foreign body, pediatric emergency, endoscopic removal, complications, tertiary care hospital.

Comparative Study of Ultrasound-Guided vs Landmark-Based Pudendal Nerve Block for Labour Analgesia

2025-10-21T07:30:50+00:00

Background: Pudendal nerve block (PNB) is a regional anesthetic procedure frequently performed in the second stage of labor to relieve perineal pain. Traditionally done with anatomical landmarks, ultrasound guidance is an alternative that is considered more accurate. The purpose of this study is to compare the efficacy and safety of ultrasound-guided and landmark-based PNB in parturients during labor.

Methods: Participants were randomly assigned to receive USG-PNB or LMR-PNB; a total of 180 parturients was recruited in the study. The onset time of analgesia, duration of analgesia and Visual Analog Scale (VAS) scores for pain relief were the main outcomes measured. Secondary outcomes were the rate of complications and patient satisfaction scores.

Results: Onset time of analgesia was significantly shorter and duration longer in the ultrasound-guided group than that in landmark-based. VAS of the ultrasound-guided group was lower than that of the landmarks-guided group, suggesting that pain relief was better. Complications were similar in both groups, and patient satisfaction was greater for the ultrasound-guided group.

Conclusion: Ultrasound-guided PNB results in better analgesia and patient satisfaction, without increase of the complication rate when compared with the conventional landmark-based approach.

Keywords: Pudendal Nerve Block, Ultrasound Guidance, Landmark-Based Technique, Labor Analgesia, Regional Anesthesia, Obstetric Pain Management

Association Between Lipid Profile and Prognostic Scores in Cirrhotic Patients

2025-10-23T13:06:23+00:00

Background: Cirrhosis is a high morbidity and mortality severe progressive liver disease. Dyslipidemia is a common finding among patients with cirrhosis, but the association between dyslipidemia and prognostic scores has not been well investigated. Lipid abnormalities can be conceptualized to shed some light on the course and outcome of diseases.

Objective: The purpose of the study is to examine the association between the lipid profile abnormalities (HDL, LDL, triglycerides) and prognostic scores (MELD, Child-Turcotte-Pugh) of patients with cirrhosis.

Methods: The study was a prospective observational study involving 100 cirrhotic patients from Medicine Department Saidu Group Teaching Swat, KPK from 1^st November, 2022 to 30^th April, 2023. The prognostic scores (MELD and Child-Turcotte-Pugh) and lipid profiles (total cholesterol, HDL, LDL, and triglycerides) were measured. Correlation test and regression test were performed to determine the correlation between lipid profiles and the prognostic scores.

Results: HDL had a strong negative association with MELD and Child-Turcotte-Pugh scores, and the triglycerides had a positive relationship. Low levels of triglycerides and high levels of HDL cholesterol were linked to poor outcomes.

Conclusion: The low levels of HDL and high levels of triglycerides correlate with the poorer prognosis among cirrhotic patients, which means that they should be considered as prognostic biomarkers.

Keywords: Cirrhosis, lipid profile, HDL, triglycerides, MELD, Child-Turcotte-Pugh, prognosis.

Role of Serum Alkaline Phosphatase and Osteocalcin in Predicting Bone Healing after Internal Fixation of Long Bone Fractures

2025-11-01T00:32:17+00:00

Background: Bone healing is a complex biological process that depends on coordinated cellular and biochemical mechanisms. Traditional radiographic evaluation often fails to reflect early biological healing. Therefore, biochemical markers such as serum alkaline phosphatase (ALP) and osteocalcin (OC) may serve as valuable indicators of osteoblastic activity and bone regeneration. This study aimed to assess the predictive role of ALP and OC in monitoring bone healing following internal fixation of long bone fractures.

Methods: A prospective observational study was conducted from June 2022 to May 2023 at the Department of Orthopedic Surgery, Social Security Hospital, Shahdara, Lahore, in collaboration with the Department of Radiology, Gambat Institute of Medical Sciences, Sindh. A total of 150 patients aged 18–65 years with long bone fractures managed by internal fixation were included. Serum ALP and OC levels were measured preoperatively and at 4, 8, and 12 weeks postoperatively. Radiographic healing was evaluated using the Radiographic Union Scale for Tibial fractures (RUST), and correlations between biochemical markers and healing scores were analyzed.

Results: Both ALP and OC levels increased significantly during the healing period (p < 0.001). ALP peaked at 8 weeks (129.7 ± 18.8 IU/L), while OC showed a steady rise up to 12 weeks (28.7 ± 7.1 ng/mL). Osteocalcin demonstrated a stronger correlation with RUST scores (r = 0.72, p < 0.001) than ALP (r = 0.66, p < 0.01). Patients with higher OC and ALP values showed faster and more complete union at 12 weeks.

Conclusion: Serial measurement of serum ALP and osteocalcin provides a reliable, non-invasive method to predict and monitor bone healing following internal fixation of long bone fractures, with osteocalcin serving as a more sensitive marker of late-stage bone formation.

Keywords: Alkaline phosphatase, Osteocalcin, Bone healing, Internal fixation, Long bone fractures, Biochemical markers.

Dyslipidemia in Type II Diabetes Mellitus Patients Presenting With Foot Ulcer

2025-11-04T20:30:26+00:00

Background: Dyslipidemia constitutes one of the most common co-existing metabolic disorders in type II Diabetes Mellitus. It has a significant impact in the development of peripheral vascular disease and diabetic foot ulcers. Changes in the lipid profile promote the development of atheromas and impact microcirculation which delays healing of wounds and increases the likelihood of infections, amputations and other poor outcomes in the patient.

Objectives: To assess dyslipidemia frequency and pattern as well as dyslipidemia and ulcer severity correlation among Type II diabetes patients with foot ulcers.

Methodology: This cross-sectional study included 100 hospitalized patients with Types II Diabetes Mellitus and patients with diabetic foot ulcers admitted to the medical and surgical wards. Fasting lipid profiles including total cholesterol, triglycerides, HDL and LDL were obtained. Data were analyzed with SPSS version 24.0. Continuous variables were described as mean ± standard deviation and the relationship between levels of lipids and the grade of ulcers were analyzed with the chi-square test.

Results: Among the 100 participants, the demographic breakdown revealed 64% as male and 36% as female, with an average age of 56.8 years and a standard deviation of 9.2 years. Dyslipidemia occurred in 72 patients. We found elevated total cholesterol levels in 58% of patients, Tri glycerol levels in 62%, low levels of HDL 69% and elevated levels of LDL cholesterol in 55%, thus all these values signify the presence of dyslipidemia. There was a statistically significant relationship between elevated Wagner ulcer grades and low HDL levels (p = 0.021). The presence of multiple dyslipidemias was predictive of prolonged ulcer and poor wound healing (p = 0.037).

Conclusion: Dyslipidemia remains highly prevalent among Type II diabetic patients with foot ulcers and has been shown to have a significant association with ulcer severity. Specifically, low HDL and high triglyceride levels indicate greater dyslipidemia severity and ulcer progression. Dyslipidemia screening and early corrective measures may facilitate healing and improve ulcer management, thereby potentially ameliorating amputation incidences. Integrating lipid management with comprehensive diabetic foot care is pivotal in advancing the outcomes of these patients.

Keywords: Type 2 Diabetes Mellitus; Dyslipidemias; Diabetic Foot Ulcer; Lipid Profile

Comparison of Laparoscopic Versus Open Surgery for the Treatment of Ectopic Pregnancy: A Prospective Cohort Study

2025-11-12T07:08:51+00:00

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality, accounting for a large proportion of first-trimester complications.

Objective: To compare the efficacy, safety, and postoperative outcomes of laparoscopic surgery versus open surgery n the treatment of ectopic pregnancy.

Methods: This was a prospective cohort study conducted at the department of Obstetrics and Gynaecology, Lahore General Hospital, Lahore from June 2021 to November 2021. A total of 185 patients diagnosed with ectopic pregnancy were enrolled and allocated into two groups based on the surgical approach: Group A (n = 95) underwent laparoscopic surgery, while Group B (n = 90) underwent open laparotomy. The study aimed to compare intraoperative and postoperative outcomes between both techniques in terms of efficacy, safety, and recovery profile.

Results: The mean operative time was slightly longer in the laparoscopic group (74.3 ± 18.2 min) than the open group (68.5 ± 15.9 min; p = 0.04). However, mean blood loss was significantly lower (96.4 ± 32.1 mL vs. 182.3 ± 40.6 mL; p < 0.001). Patients who underwent laparoscopy reported less postoperative pain (VAS 3.2 ± 1.1 vs. 5.8 ± 1.3; p < 0.001), shorter hospital stays (2.6 ± 0.9 vs. 5.4 ± 1.2 days; p < 0.001), and faster recovery (10.4 ± 3.1 vs. 17.2 ± 4.5 days; p < 0.001). The overall complication rate was lower in laparoscopy (6.3%) than open surgery (17.8%; p = 0.02).

Conclusion: Laparoscopic surgery is a superior and safer alternative to open laparotomy for the treatment of ectopic pregnancy, providing significantly less blood loss, reduced pain, shorter hospital stay, and quicker recovery. It should be considered the preferred surgical approach in hemodynamically stable patients to enhance postoperative recovery and preserve reproductive potential.

Keywords: Ectopic pregnancy, laparoscopy, laparotomy, minimally invasive surgery, postoperative outcomes

Condition of Metal-Ceramic Restorations after Five Years in Function: A Cross-Sectional Evaluation

2025-11-13T23:14:42+00:00

Objective: To assess the clinical condition and complications associated with metal-ceramic restorations (MCRs) after five years in function.

Materials and Methods: A cross-sectional evaluation was conducted the Department of Prosthodontics Kohat from January 2022 to December 2022, among patients who had MCRs placed five or more years previously. Restorations were clinically evaluated for marginal integrity, colour match, porcelain chipping, occlusal wear, and periodontal responses using modified USPHS criteria. Patient hygiene status and occlusal factors were also recorded.

Results: A total of 124 restorations in 73 patients were examined. Marginal integrity was rated clinically acceptable in 92.7% of restorations. Minor porcelain chipping was found in 14.5%, while major chipping requiring repair occurred in 5.6%. Colour match was rated satisfactory in 86.3%. Gingival inflammation was observed in 25.8%, primarily in patients with inadequate plaque control.

Conclusion: Metal-ceramic restorations show high survival and functional stability after five years. The most common complications observed were porcelain chipping and mild periodontal inflammation. Regular follow-up and maintenance care can reduce biological complications.

Keywords: Metal-ceramic restorations, porcelain chipping, marginal integrity, periodontal status.

Comparison of Effectiveness of Modified Del Nido Vs Conventional Del Nido Cardioplegia in Cardiac Surgery

2025-11-16T10:09:39+00:00

Background: Myocardial protection during cardiac surgery is crucial to minimize ischemic injury and postoperative complications. Del Nido cardioplegia (DNC), originally developed for pediatric patients, has gained widespread use in adult cardiac surgery due to its long-acting myocardial arrest properties. However, its high crystalloid content raises concerns of hemodilution and myocardial edema. Modified Del Nido cardioplegia (MDN), with a reversed blood-to-crystalloid ratio (4:1), aims to overcome these limitations while maintaining adequate myocardial protection.

Objective: This study compared the clinical effectiveness of Modified Del Nido versus Conventional Del Nido cardioplegia in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB).

Methods: A prospective, cross-sectional, non-interventional study was conducted at the Punjab Institute of Cardiology, Lahore, including 102 patients aged 18–75 years undergoing elective on-pump cardiac surgery. Group A received conventional DNC (1:4 blood-to-crystalloid), and Group B received MDN (4:1 ratio). Primary endpoints included CK-MB, CPK, hemodilution, and inotropic support. Secondary endpoints were aortic cross-clamp time, CPB duration, and postoperative ventilation time. Statistical analysis was performed using SPSS v20, with significance set at p<0.05.

Results: MDN cardioplegia demonstrated significantly lower CK-MB levels at 12 hours postoperatively (p<0.05), indicating reduced myocardial injury. Hemodilution and blood transfusion requirements were lower in the MDN group. ALT levels were slightly higher in MDN, while ionotropic support needs were lower in DNC (p<0.05*).

Conclusion: Modified Del Nido cardioplegia provided superior myocardial protection and reduced hemodilution compared to Conventional Del Nido. Further multicenter prospective studies are warranted to validate these findings and assess long-term clinical outcomes.

Keywords: Modified Del Nido cardioplegia, Conventional Del Nido cardioplegia, Myocardial protection, Cardiac surgery, Cardiopulmonary bypass

Association Between Uric Acid Levels and Metabolic Risk Factors in Overweight and Obese Children

2025-11-21T01:28:36+00:00

Background: Childhood overweight and obesity are increasing rapidly in Pakistan and are strongly associated with early metabolic disturbances. Uric acid, once considered an inert metabolic by-product, is now recognized as a potential biomarker linked to insulin resistance, lipid abnormalities, and elevated blood pressure. This study aims to evaluate the association between serum uric acid levels and major metabolic risk factors among overweight and obese children.

Methods: This cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, and the Punjab Institute of Cardiology, Lahore, from October 2022 to July 2023. A total of 100 overweight and obese children aged 6–17 years were enrolled using consecutive sampling. Anthropometric measurements, blood pressure, and fasting biochemical parameters serum uric acid, glucose, insulin, and lipid profile were obtained. Insulin resistance was calculated using the HOMA-IR formula. Participants were categorized into uric acid tertiles, and metabolic parameters were compared across groups. Statistical analysis included ANOVA, Pearson correlation, and multivariable linear regression.

Results: Higher uric acid levels were significantly associated with increased fasting insulin (p < 0.001), higher HOMA-IR (p < 0.001), elevated triglycerides (p < 0.001), higher LDL-cholesterol (p < 0.01), lower HDL-cholesterol (p = 0.02), and increased systolic blood pressure (p < 0.01). Uric acid showed moderate positive correlations with BMI percentile, fasting insulin, HOMA-IR, triglycerides, and systolic blood pressure. Regression analysis confirmed uric acid as an independent predictor of insulin resistance after adjusting for confounders (β = 0.35, p = 0.002).

Conclusion: Elevated serum uric acid is strongly associated with multiple metabolic risk factors among overweight and obese children. Routine assessment of uric acid may serve as a simple, cost-effective tool for early identification of high-risk pediatric groups requiring metabolic monitoring and intervention.

Keywords: Uric acid, Childhood obesity, Insulin resistance, Metabolic syndrome, Pediatric dyslipidemia.

Intravenous Dexmedetomidine Versus Dexmedetomiddine-Dexamethasone Combination A Comparative Study on Postoperative Nausea and Vomiting after Abdominal Surgeries

2025-11-29T02:51:40+00:00

Background: Postoperative nausea and vomiting (PONV) is a well-known and unpleasant complication after abdominal surgeries that may negatively affect recovery and increase hospitalization. Dexmedetomidine has demonstrated opioid sparing and sympatholytic effects that can potentially decrease PONV with dexamethasone being a proven antiemetic. This paper has compared the effectiveness of intravenous dexmedetomidine versus dexmedetomidine-dexamethasone combination to prevent PONV.

Methods: A comparative clinical trial was done between January 2022 and March 2023 in a tertiary-care hospital. A total of 80 adult patients that were undergoing elective abdominal surgeries were recruited and grouped into 2 equal groups: Group D control group that used dexmedetomidine only, and Group DD involving dexmedetomidine and dexamethasone 8 mg. Standardized anesthesia protocols were used. The PONV incidence, nausea scores, vomiting frequency and rescue antiemetic needs were measured after 24 hours of postoperative period. The SPSS version 26 was used to conduct statistical analysis with p<0.05 being significant.

Results: Group D had significantly more cases of nausea (55% vs. 22.5, p=0.003) and vomiting (37.5% vs. 12.5, p=0.01) than Group DD. The mean nausea scores as well as vomiting frequency were significantly low in the combination group. Group DD (15% vs. 45%, p=0.004) showed a decrease in the use of rescue antiemetic. The intraoperative need of fentanyl was also much smaller in the combination group (98 + 18 µg vs. 125 + 22 µg, p<0.001). There was no difference between the similar rates of bradycardia and hypotension in both groups.

Conclusion: Dexmedetomidine-dexamethasone combination is much more effective than dexmedetomidine alone in the prevention of PONV and the limit use of rescue antiemetic in the post abdomen surgical times. It also reduces the need to take opioids without escalating its adverse effects, which justifies its use in multimodal perioperative management.

Keywords: Dexmedetomidine, Dexamethasone, PONV, Abdominal surgery, Antiemetic.

Role of Helicobacter pylori Eradication in Preventing Gastric Cancer and Reducing Surgical Burden

2025-11-29T02:52:37+00:00

Background: Helicobacter pylori (H. pylori) is a WHO-classified class I carcinogen and the leading modifiable risk factor for non-cardia gastric cancer. Early eradication interrupts the inflammatory cascade responsible for chronic gastritis, atrophy, intestinal metaplasia, and eventual malignancy. In addition to preventing gastric cancer, successful eradication decreases complications of peptic-ulcer disease, potentially reducing the long-term surgical burden. This study evaluates eradication outcomes among adult patients and analyzes the preventive impact on precancerous gastric pathology.

Methods: This descriptive cross-sectional study was conducted at MTI Hayatabad Medical Complex (HMC), Peshawar, and Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, from June 2022 to June 2023. A total of 100 adult patients presenting with dyspepsia or suspected H. pylori infection were recruited through non-probability consecutive sampling. Diagnosis was confirmed using urea breath test, stool antigen test, or endoscopic biopsy where indicated. Patients received either bismuth-based quadruple therapy or concomitant therapy. Post-treatment eradication was reassessed after four weeks. Endoscopy with histopathology was performed in symptomatic or clinically indicated cases. Data were analyzed using SPSS version 25, with chi-square and t-tests applied where appropriate.

Results: The mean age of participants was 41.8 ± 12.6 years, with males comprising 54% of the sample. Common symptoms included epigastric pain (73%), bloating (52%), and early satiety (38%). The overall eradication success rate was 81%, higher among patients receiving bismuth-based quadruple therapy compared with concomitant therapy. Smoking significantly reduced treatment success (62% vs. 86% in non-smokers). Among 32 patients who underwent endoscopy, chronic active gastritis was found in 68.7%, gastric atrophy in 21.8%, and intestinal metaplasia in 9.3%. Patients with advanced mucosal changes showed lower eradication rates. The findings suggest a clear potential for reducing future gastric cancer incidence and lowering surgical workload through timely eradication.

Conclusion: H. pylori eradication is highly effective and represents a central strategy for primary gastric-cancer prevention. Early diagnosis and treatment halt progression toward premalignant lesions and reduce ulcer-related complications, thereby diminishing the need for major upper-gastrointestinal surgeries such as gastrectomy and emergency ulcer repair. Integrating widespread testing, eradication protocols, and patient counseling into routine clinical practice can significantly reduce the long-term surgical burden in high-prevalence regions.

Keywords: Helicobacter pylori, gastric cancer prevention, eradication therapy, peptic ulcer, precancerous lesions, surgical burden.

Outcome of Lobectomy in Inflammatory Lung Diseases: A Four-Year Experience at Nishtar Hospital Multan

2025-12-05T17:51:43+00:00

Background: Inflammatory lung diseases such as bronchiectasis, pulmonary destruction related to tuberculosis, chronic abscess, and fungal cavities are still common indications of lung resection in developing countries. Lobectomy is important when medical therapy is unsuccessful, although there is still little outcome data from local centres.

Objective: To assess postoperative results of lobectomy done for inflammatory lung diseases over 4 years at Nishtar Hospital Multan.

Methodology: A retrospective study was done in the Department of Thoracic Surgery, Nishtar Hospital Multan from January 2020 to December 2022. All patients who had undergone lobectomy for non-malignant inflammatory lung disease were included. Demographic data, cause of disease, type of lobectomy, operative time, complications, hospitalization, and recovery after the operation were evaluated.

Results: A total of 126 patients were patients who underwent lobectomy for inflammatory lung diseases. The most common indication was bronchiectasis (48%), followed by post-tuberculous destroyed lung 34%, chronic lung abscess 10% and fungal cavity 8%. The average operative time was 138+-22 minutes, and the average hospital stay was 7.6+3.1 days. Postoperative complications occurred in 28% of patients: prolonged air leak (12%), empyema (6%), wound infection (5%) and atelectasis requiring bronchoscopy (5%). Mortality was 1.6% (n=2). Symptomatic improvement was obtained in 92% of the cases at 3-month follow-up.

Conclusion: Lobectomy is a safe and effective way of treating selected inflammatory lung diseases with acceptably low morbidity and low mortality. Early referral and careful selection of patients can have a major impact on improving outcomes.

Keywords: Lobectomy, Inflammatory lung disease, Bronchiectasis, Tuberculosis, Thoracic surgery.

Prevalence of Subclinical Optic Nerve Changes in Patients With Chronic Otitis Media: A Prospective Observational Study

2025-12-06T18:36:55+00:00

Background: Chronic otitis media (COM) is traditionally considered a localized inflammatory disease of the middle ear; however, chronic inflammation and cholesteatoma-related destruction may extend toward neuro-ophthalmic structures. Emerging evidence suggests that subtle optic nerve involvement may occur silently, yet remains under-recognized in routine clinical practice.

Objective: To determine the prevalence of subclinical optic nerve changes in patients with chronic otitis media using optical coherence tomography (OCT) and visual evoked potentials (VEP), and to identify associated risk factors.

Methods: This prospective observational study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, and Mughal Eye Hospital, Lahore, from January 2022 to February 2023. A total of 90 adults with clinically confirmed COM underwent comprehensive ophthalmic evaluation, including RNFL and GCC measurements using spectral-domain OCT and P100 latency/amplitude assessment through VEP. Subclinical optic nerve change was defined as structural thinning or abnormal VEP responses without visual symptoms. Associations with COM type, laterality, and disease duration were analyzed.

Results: Subclinical optic nerve involvement was identified in 27 patients (30%). Optic nerve changes were significantly more common in unsafe COM (57.1%) compared with safe COM (17.7%) (p < 0.001). Patients with disease duration >2 years (44.7%) and bilateral COM (42.1%) demonstrated higher prevalence compared with shorter-duration (19.0%) and unilateral cases (21.1%) (p < 0.05). OCT revealed significant RNFL and GCC thinning, particularly in temporal and inferior quadrants, while VEP showed markedly prolonged P100 latency.

Conclusion: A substantial proportion of COM patients exhibit silent optic nerve alterations. Early OCT and VEP screening, especially in unsafe or long-standing COM, may prevent progression to clinically significant optic neuropathy.

Keywords: Chronic otitis media, optic nerve, subclinical neuropathy, OCT, VEP, RNFL thinning, cholesteatoma.

Assessing the Efficacy of Peripheral Nerve Blocks in Predicting Functional Recovery Post-Nerve Reconstruction after Limb Amputation

2025-12-06T18:39:27+00:00

Background: Predicting neurological and functional recovery after nerve reconstruction in amputated limbs remains a major clinical challenge. Early response to peripheral nerve block (PNB) may offer a simple, non-invasive method to assess underlying nerve viability and forecast long-term outcomes.

Objective: To evaluate the efficacy of early PNB response in predicting sensory, motor, and functional recovery following peripheral nerve reconstruction in traumatic limb amputation patients.

Methods: This prospective observational study was conducted at Social Security Hospital Shahdara, Lahore, and POF Hospital Wah Cantt from February 2022 to March 2023. A total of 100 patients undergoing reconstructive nerve surgery were assessed. Early response to ultrasound-guided PNB was recorded at 15 and 30 minutes. Motor recovery (MRC scores), sensory recovery (two-point discrimination, monofilament testing), electrophysiological reinnervation, and functional outcomes (DASH/LEFS scores) were evaluated at 1, 3, and 6 months. Pearson correlation analysis assessed associations between early block response and long-term recovery.

Results: Sixty-three patients (63%) were early responders. Early responders demonstrated significantly better motor recovery at six months (4.09 ± 0.82 vs. 2.92 ± 1.14; p = 0.001) and superior sensory outcomes (p < 0.001). Functional disability scores improved markedly in responders (DASH p < 0.001; LEFS p = 0.002). Early PNB response showed strong correlations with motor recovery (r = 0.71, p < 0.001), sensory improvement (r = 0.65, p = 0.002), and functional outcomes (r = 0.68, p < 0.001).

Conclusion: Early clinical response to peripheral nerve block is a strong predictor of neurological and functional recovery after nerve reconstruction in amputated limbs. PNB responsiveness should be incorporated into preoperative evaluation to optimize surgical planning and rehabilitation strategies.

Keywords: Peripheral nerve block, nerve reconstruction, limb amputation, functional recovery, sensory reinnervation, MRC score, DASH, LEFS.

Molecular Targets, Population Outcomes: A Biochemical Bridge between Drug Discovery and Community Medicine

2025-12-06T18:39:22+00:00

Aim of Study: This study aims to investigate the translational pathway from identifying molecular drug targets to achieving measurable improvements in community health outcomes, using a multidisciplinary framework integrating pharmacology, biochemistry, and community medicine principles.

Study Duration: March 2022 to March 2023.

Study Place: Gambat Medical College, Gambat, Niazi Medical & Dental College, Sargodha.

Methodology: A mixed-methods approach was employed, comprising: 1) A systematic review of novel drug approvals (2020-2024) to classify molecular targets and therapeutic areas; 2) Quantitative analysis of anonymized local pharmacoepidemiological data from the Niazi Medical College catchment area to assess drug utilization patterns and therapeutic outcomes for chronic diseases; 3) Qualitative focus group discussions with community healthcare workers to identify barriers to effective medication adherence and access; and 4) In silico molecular docking studies on a select target (SARS-CoV-2 Main Protease) to demonstrate the biochemical rationale for drug discovery.

Results: The systematic review highlighted a continued focus on kinase inhibitors, monoclonal antibodies, and antiviral agents, with 35% of 2023's novel approvals targeting cancer pathways. Local data revealed suboptimal control rates for hypertension (45%) and type 2 diabetes (38%), with access and adherence cited as major barriers. Molecular docking identified several natural product derivatives with high binding affinity to the SARS-CoV-2 Mpro target. Integrated analysis demonstrated a significant disconnect between the proliferation of targeted therapies and their penetration into primary care formularies for common chronic conditions.

Conclusion: A chasm exists between sophisticated molecular drug discovery and real-world community health impact. Bridging this gap requires a deliberate, multidisciplinary strategy encompassing target selection aligned with population disease burdens, drug design informed by pharmacoeconomics and access considerations, and community-engaged implementation science. Future drug development must embed public health outcome metrics from the earliest stages of target identification.

Keywords: Molecular Pharmacology, Drug Discovery, Community Medicine, Translational Research, Pharmacoepidemiology, Molecular Docking, Health Outcomes.

Antibiotic Resistance Patterns in Gram-Negative Bacterial Infections Among Pediatric Patients: A Cross-Sectional Study at a Tertiary Care Hospital

2025-12-10T11:47:38+00:00

Background: Gram-negative bacterial infections are a major cause of morbidity and mortality among pediatric patients, with rising antimicrobial resistance further complicating treatment.

Objective: This study assessed the prevalence, resistance patterns, and clinical outcomes of gram-negative infections in children.

Methods: This was a cross-sectional observational study conducted at Children Hospital, Faisalabad from December 2022 to May 2023, including a total of 220 pediatric patients diagnosed with gram-negative bacterial infections. Clinical and demographic information was recorded for each patient, including age, gender, admission unit (ward/NICU/PICU), and suspected infection site. Specimens such as blood, urine, cerebrospinal fluid, tracheal aspirates, wound swabs, and sputum were collected under aseptic conditions and sent to the microbiology laboratory for processing.

Results: The mean age of the cohort was 3.2 ± 3.8 years, with NICU/PICU patients significantly younger (1.1 ± 1.4 years) than ward patients (5.3 ± 4.2 years, p < 0.001). E. coli was the most common organism (38.6%), while Pseudomonas and Acinetobacter were more prevalent in NICU/PICU (20.0% and 16.3%). Resistance to third-generation cephalosporins (68.2%), fluoroquinolones (52.7%), and carbapenems (18.6%) was high, with significantly higher resistance in NICU/PICU patients (p < 0.05). ESBL-producing strains accounted for 41.8%, MDR for 37.2%, and carbapenem-resistant isolates for 18.6%, with all resistance types significantly more common in critically ill patients. NICU/PICU children had significantly worse outcomes, including higher rates of mechanical ventilation (32.7%), septic shock (21.8%), prolonged hospital stay (50.9%), and mortality (13.6%).

Conclusion: Gram-negative infections in pediatric patients exhibit alarming levels of antimicrobial resistance, especially in critically ill children. The high prevalence of MDR, ESBL, and carbapenem resistance underscores the need for strengthened antibiotic stewardship, improved infection-control strategies, and ongoing surveillance to ensure effective treatment outcomes.

Keywords: Gram-negative bacteria, pediatric infections, antibiotic resistance, MDR, ESBL, carbapenem resistance

Visual and Anatomical Outcomes of Early versus Delayed Vitrectomy in Diabetic Vitreous Hemorrhage

2025-12-10T11:51:45+00:00

Background: Diabetic vitreous hemorrhage (VH) is a major cause of sudden vision loss in patients with proliferative diabetic retinopathy (PDR).

Objective: To compare the visual and anatomical outcomes of early versus delayed pars plana vitrectomy in patients presenting with diabetic vitreous hemorrhage.

Methods: This comparative interventional study was conducted at Lahore General Hospital, Lahore from September 2022 to February 2023, including 185 patients diagnosed with diabetic vitreous hemorrhage. Patients were divided into two groups: Group A underwent early vitrectomy within six weeks of hemorrhage onset, and Group B underwent delayed vitrectomy after six weeks of observation. All patients underwent 25-gauge PPV with intraoperative panretinal photocoagulation (PRP). Best-corrected visual acuity (BCVA) was measured preoperatively and at one, three, and six months postoperatively.

Results: Among 185 patients, 92 underwent early and 93 underwent delayed vitrectomy. The mean age was 54.3 ± 8.7 years in the early group and 55.8 ± 9.2 years in the delayed group. At six months, mean postoperative BCVA improved from 1.88 ± 0.24 to 0.68 ± 0.19 logMAR in the early group and from 1.85 ± 0.27 to 0.91 ± 0.23 logMAR in the delayed group (p < 0.001). Anatomical success was achieved in 97.8% of early cases and 91.4% of delayed cases (p = 0.06). Recurrent vitreous hemorrhage occurred in 10.9% of early cases and 22.6% of delayed cases (p = 0.03). The mean operative time was significantly shorter in the early group (64.2 ± 11.3 vs. 79.6 ± 14.7 minutes; p < 0.001).

Conclusion: It is concluded that early vitrectomy provides better visual recovery, faster rehabilitation, and fewer postoperative complications compared to delayed vitrectomy in diabetic vitreous hemorrhage.

Keywords: Diabetic vitreous hemorrhage, Early vitrectomy, Delayed vitrectomy, Pars plana vitrectomy, Visual outcomes

Comparative Effectiveness of Exclusive Breastfeeding Versus Formula Feeding on Infant Growth and Development

2025-12-10T11:54:26+00:00

Background: Infant nutrition during the first six months of life plays a pivotal role in shaping long-term growth, health, and neurodevelopmental outcomes.

Objective: To compare the effectiveness of exclusive breastfeeding versus formula feeding on infant growth and developmental outcomes.

Methodology: This cross-sectional comparative study was conducted at Department of Pediatric Medicine, Avicenna Medical College & Hospital Lahore from 1^st January 2023 to 30^th June 2023. A total of 555 infants aged 6 to 12 months were enrolled using non-probability consecutive sampling. Participants were divided into two groups: group A was treated with exclusively breastfed (n = 278) and group B treated with exclusively formula-fed (n=277). Data were collected through structured questionnaires, anthropometric measurements, and developmental assessments using the Denver Developmental Screening Test II.

Results: The mean age was 8.6±1.9 months. Formula-fed infants had higher mean body weight (8.55±1.15 kg) compared to breastfed infants (8.20±1.05 kg; p=0.004), but also a higher proportion above the 90th weight-for-age percentile (13.0% vs. 5.0%; p=0.001). Exclusively breastfed infants demonstrated superior developmental performance across gross motor (93.2% vs. 88.1%), fine motor (94.6% vs. 89.2%), language (90.3% vs. 83.8%), and social domains (92.1% vs. 85.2%), with overall developmental delay significantly lower in this group (6.1% vs. 14.8%; p = 0.001). Logistic regression analysis identified exclusive breastfeeding (AOR = 2.14; 95% CI: 1.25–3.65) and maternal education (AOR = 1.76; 95% CI: 1.09–2.83) as independent predictors of normal growth and development.

Conclusion: The exclusive breastfeeding during the first six months of life leads to healthier growth patterns and superior developmental outcomes compared to formula feeding. Despite formula feeding providing adequate nutrition, it was associated with rapid weight gain and higher risk of developmental delay.

Keywords: Exclusive breastfeeding, Formula feeding, Infant growth, Developmental outcomes

Comparative Analysis of Oral and Intravenous Rehydration Therapy in Paediatric Acute Gastroenteritis

2025-12-10T11:57:34+00:00

Background: Acute gastroenteritis remains one of the leading causes of morbidity and mortality among children worldwide, particularly in developing countries.

Objective: To compare the clinical effectiveness, safety, and overall outcomes of oral rehydration therapy and intravenous rehydration therapy in pediatric patients with acute gastroenteritis.

Methodology: This comparative cross-sectional study was at Department of Pediatric Medicine, Continental Medical College, Hayat Memorial Hospital Lahore from 1^st October 2022 to 31^st March 2023. A total of 240 children aged 6 months to 10 years diagnosed with acute gastroenteritis and presenting with mild to moderate dehydration were enrolled. They were equally divided into two groups: Group A received oral rehydration therapy using WHO-formulated reduced-osmolarity oral rehydration solution, and Group B received intravenous rehydration with isotonic fluids.

Results: Both therapies achieved 100% rehydration success. The mean time to rehydration was significantly shorter in the IV group (5.8±1.7 hours) than in the oral group (7.4±2.2 hours, p<0.001). However, the oral rehydration group demonstrated a significantly shorter hospital stay (1.6±0.8 days vs. 2.8±1.2 days, p<0.001) and earlier resumption of feeding (p = 0.04). Complications such as vomiting occurred in 15% of the oral group, while IV site phlebitis (6.7%) and mild electrolyte imbalance (7.5%) were noted in the IV group.

Conclusion: Both oral and intravenous rehydration therapies are effective for managing dehydration in pediatric acute gastroenteritis. However, oral rehydration therapy offers comparable efficacy with fewer complications, lower costs, and shorter hospitalization, making it the preferred choice for mild to moderate dehydration.

Keywords: Dehydration, Patients, Acute gastroenteritis, Diagnosed, Effectiveness

Prevalence Of Anemia and Its Systemic Effects in Women with Chronic Abnormal Uterine Bleeding

2025-12-16T02:31:48+00:00

Background: Chronic abnormal uterine bleeding (AUB) is a common gynecological disorder and a major cause of iron deficiency anemia in women of reproductive age. Persistent blood loss not only reduces hemoglobin levels but also leads to systemic manifestations that significantly impair physical functioning and quality of life.

Objective: To determine the prevalence and severity of anemia and to evaluate its systemic effects among women with chronic abnormal uterine bleeding presenting to a tertiary care hospital.

Methods: This hospital-based cross-sectional study was conducted in the Gynaecology Unit-II, Sahiwal Teaching Hospital, Pakistan, from June 2022 to May 2023. A total of 90 women aged 18–50 years with chronic AUB of at least six months’ duration were enrolled. Detailed clinical history and physical examination were performed. Hemoglobin levels and red cell indices were measured using automated hematology analysis. Anemia was defined as hemoglobin <12 g/dL and categorized as mild, moderate, or severe. Systemic effects including fatigue, weakness, exertional dyspnea, palpitations, dizziness, headache, and functional limitation were documented. Data were analyzed using descriptive and comparative statistics.

Results: Anemia was detected in 62 women, yielding a prevalence of 68.9%. Mild anemia was present in 31.1%, moderate anemia in 26.7%, and severe anemia in 11.1% of participants. Microcytic anemia was the predominant pattern, indicating iron deficiency. Systemic manifestations were significantly more frequent among anemic women, particularly fatigue (83.9%), generalized weakness (74.2%), exertional dyspnea (50.0%), and reduced daily functional capacity (61.3%). The severity of symptoms increased with worsening anemia.

Conclusion: Anemia is highly prevalent in women with chronic AUB and is associated with considerable systemic morbidity. Early screening and integrated management of anemia should be a routine component of care in these patients.

Keywords: Abnormal uterine bleeding; Anemia; Iron deficiency; Systemic effects; Women; Chronic bleeding

Frequency of Common Clinical Presentation in patients with Molar Pregnancy in Gomal Medical College, Dera Ismail Khan, Pakistan

2025-12-19T00:15:25+00:00

Introduction: Hydatidiform mole, frequently referred to as molar pregnancy, represents the most prevalent and benign variant of gestational trophoblastic disease. The occurrence rate of molar pregnancy exhibits significant geographical variability, ranging from one in every one hundred and fifty live births in Southeast Asia to one in every one thousand and five hundred pregnancies in the United States. This study identifies the most commonly presenting clinical features of molar pregnancy. The results will help clinicians in early diagnosing of molar pregnancy and prompt management.

Material and Method: The study was carried out in the Obstetrics and Gynecology Unit at MTI Gomal, located in DI Khan. The timeframe allocated for this study spanned one year, commencing on the 14th of June 2022 and concluding on the 13th of December 2022. Sample Size was 139 patients that were diagnosed and managed as cases of Molar pregnancy. Sampling Technique was convenience sampling or Non probability purposive and study design was descriptive study

Results: Within the scope of this research, a total of 139 patients diagnosed with molar pregnancy were meticulously observed in the obstetrics and gynecology department. Various clinical outcomes were identified and followed and hence put to further management. In these 139 patients the age range was from 18-48 years. It was found that the majority of the patients were complete moles. Abnormal vaginal bleeding emerged as the predominant clinical manifestation of molar pregnancy, being documented in 62 (44.6%) of the patients evaluated.

Conclusion: Targeting these various clinical outcomes and close surveillance will then help in

improving mortality and morbidity from molar disease.

Keywords: Molar Pregnancy, Abnormal vaginal bleeding, Hyperemesis, Theca Lutein cysts, Hyperthyroidism.

Evaluating the Impact of Posterior Pericardiotomy on Early Postoperative Outcomes in Valve Surgery Patients

2025-12-21T10:56:41+00:00

Objective: to evaluate the early outcomes of posterior pericardiotomy in patients undergoing heart valve surgery, with a focus on reducing the incidence of postoperative atrial fibrillation (AF), pericardial effusion (PE).

Study Setting: This study was conducted at Cardiac Surgery Department, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, from January 2023 to July 2023.

Methods: A total of 150 patients undergoing elective valve heart surgery at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, were included in this prospective observational study. The mean age of patients was 35.26 years, with a gender distribution of 70.2% female and 29.8% male. Patients were followed up for postoperative complications, including AF, PE, and tamponade requiring intervention. ICU and total hospital stay durations were recorded and analyzed based on the presence of complications.

Results: Among 150 patients undergoing posterior pericardiotomy (PP) during elective heart valve surgery, the incidence of postoperative atrial fibrillation (POAF) was 4% (6 patients), with no significant association with age, gender, smoking, or residential status (p > 0.05). Pericardial effusion occurred in 2% (3 patients) but needs no drainage, predominantly in smokers, although this was not statistically significant (p = 0.121). The mean ICU stay was 1.82 ± 0.54 days, and the mean hospital stay was 5.06 ± 0.99 days. No cases of cardiac tamponade or significant pericardial effusion requiring intervention were observed. These findings suggest that PP may contribute to a low incidence of early postoperative complications in heart valve surgery patients.

Conclusion: Posterior pericardiotomy is a safe and effective procedure that can significantly reduce the incidence of postoperative AF, PE, and left pleural effusion following valve heart surgery. The procedure is associated with shorter ICU and hospital stays in patients without complications, contributing to improved postoperative outcomes.

Keywords: Posterior pericardiotomy, Heart valve surgery, Postoperative atrial fibrillation, Pericardial effusion, Early outcomes.

Outcomes of Emergency Laparotomy in Pregnant and Postpartum Patients

2025-12-25T22:58:16+00:00

Background: Emergency laparotomy in pregnant and postpartum patients is a rare but critical intervention, associated with high maternal and fetal morbidity and mortality. Obstetric and non-obstetric emergencies, including uterine rupture, postpartum hemorrhage, intestinal obstruction, and perforation, often necessitate urgent surgical exploration. Understanding local patterns of indications and outcomes is essential for improving clinical protocols and multidisciplinary care.

Objective: To assess maternal and fetal outcomes following emergency laparotomy in pregnant and postpartum patients and identify factors associated with adverse clinical outcomes at a tertiary care hospital in Peshawar.

Methods: This hospital-based observational study included all pregnant women and postpartum patients (up to 42 days post-delivery) undergoing emergency laparotomy over a defined study period. Demographic, clinical, operative, and postoperative data were collected using a structured proforma. Maternal outcomes included ICU admission, blood transfusion, surgical site infection, re-exploration, and mortality. Fetal outcomes assessed among pregnant patients included live birth, preterm delivery, fetal distress, and intrauterine fetal demise. Statistical analysis was performed using SPSS, with p-values <0.05 considered significant.

Results: A total of 120 patients were analyzed (74 pregnant, 46 postpartum). Postpartum patients had significantly higher ICU admission (47.8% vs 27.0%, p=0.02), blood transfusion (82.6% vs 54.1%, p=0.001), and maternal mortality (13.0% vs 2.7%, p=0.04) compared with pregnant patients. Live birth was achieved in 70.3% of pregnant patients, with preterm delivery in 18.9% and fetal distress in 8.1%. Obstetric indications predominated in both groups.

Conclusion: Emergency laparotomy in pregnant and postpartum patients carries substantial maternal and fetal risks, particularly in the postpartum period. Early recognition, timely surgical intervention, and multidisciplinary management are crucial to optimize outcomes.

Keywords: Emergency laparotomy, pregnancy, postpartum, maternal outcomes.

Psychological Morbidity and Quality of Life in Women with Abnormal Uterine Bleeding

2025-12-29T22:48:53+00:00

Background: Abnormal uterine bleeding (AUB) is a common gynaecological condition that adversely affects women's physical health, emotional stability, and social functioning. Chronic or excessive menstrual bleeding can result in anaemia, fatigue, and reduced daily productivity. These persistent symptoms often predispose affected women to psychological morbidity, particularly depression and anxiety, which further compromise overall health-related quality of life.

Objectives: To determine the frequency of depression and anxiety among women with abnormal uterine bleeding and to evaluate the association between psychological morbidity and impairment in quality of life.

Methodology: This cross-sectional study was conducted in the gynaecology department of a tertiary care hospital. A total of 100 women aged 18–50 years diagnosed with abnormal uterine bleeding were enrolled using non-probability consecutive sampling. Women with pre-existing psychiatric disorders or chronic systemic illnesses were excluded. Depression and anxiety were assessed using validated screening scales, while quality of life was evaluated using a standardised health-related quality-of-life questionnaire. Sociodemographic and clinical characteristics were recorded. Statistical analysis was performed using SPSS version 24.0, applying chi-square and independent t-tests, with a p-value < 0.05 considered statistically significant.

Results: The mean age of participants was 38.6 ± 7.9 years. Depression was observed in 46% of women, while 39% exhibited clinically significant anxiety. Depression was significantly associated with longer bleeding duration and lower hemoglobin levels (p = 0.002). Anxiety was more prevalent among women with heavy menstrual bleeding and cycle irregularity (p = 0.01). Quality-of-life scores were significantly lower in women with depression compared to those without (42.3 ± 9.6 vs. 58.7 ± 10.4; p < 0.001). Anxiety was also significantly associated with poor quality-of-life outcomes (p = 0.003).

Conclusion: Psychological morbidity is highly prevalent among women with abnormal uterine bleeding and is strongly associated with reduced quality of life. Incorporating routine psychological screening and multidisciplinary care into AUB management may improve overall patient outcomes.

Correlation between Myocardial Fibrosis Patterns and Sudden Cardiac Death in Young Adults: A Clinico-Anatomical and Forensic Study

2025-12-30T22:06:12+00:00

Background: The sudden cardiac death (SCD) in young adults is most likely to be without any previous symptoms, and underlying abnormalities in the myocardium can be difficult to detect in life. Myocardial fibrosis, especially with its existence in subtle or hidden patterns has become a possible structural marker which can predetermine lethal arrhythmias.

Objective: To examine the relationship between myocardial fibrosis patterns and SCD in young adults by integrating cardiac imaging, histopathology, and forensic autopsy findings.

Methodology: This retrospective study involved 72 consecutive cases of young adults (18 40 years old) who had suffered sudden cardiac death during the period between January 2021 and January 2022 in Khairpur Medical College, Khairpur Mir's. Review of cardiac MRI, histological sections, and autopsy examinations were done to evaluate the burden of fibrosis, anatomical distribution, late gadolinium enhancement (LGE) patterns and conduction system involvement. Predictors of SCD were determined by statistical comparisons and regression analysis.

Results: Mid-myocardial and patchy LGE images, replacement fibrosis and septal scarring had a strong correlation with high fibrosis burden (p < 0.001). Such individuals were also found to have increased heart weight, thickening of ventricle walls and increased involvement of the conduction system. Septal scar, replacement fibrosis and mid-myocardial LGE became independent predictors of SCD.

Conclusion: Among young adults, myocardial fibrosis is a major structural substrate of sudden cardiac death. The strong agreement of the imaging, microscopic and autopsy data points to the role of early detection of silent myocardial injury and the position of advanced imaging technology as the means of risk stratification.

Biochemical Diagnostic Significance of Cannabis Indica Misuse in Society- A Socio-Behavioral Validation Study

2025-12-30T22:36:27+00:00

Introduction: Cannabis indica, usually known as weed, has transitioned from a traditional herb to a widely misused psychoactive substance. While its medicinal value is acknowledged, its misuse especially among youth has become a silent epidemic. The normalization of recreational use, increased potency, and early exposure have contributed to a rise in cannabis use disorder (CUD), cognitive decline, and social dysfunction.

Objective: To determine the diagnostic significance of Cannabis indica misuse in society using behavioral screening tools as the gold standard.

Study Design: Cross-sectional validation study.

Material and Methods: A cross-sectional validation study was conducted on 140 individuals aged 15–45 years in urban centers of Kashmir from 01-01-2025 to 01-07-2025. Participants were screened for cannabis misuse using self-reported frequency, DSM-5 criteria, and the Cannabis Use Disorder Identification Test-Revised (CUDIT-R). Behavioral assessments were used as the gold standard.

Results: Among 140 participants, 94 (67.1%) were under 30 years of age. 46 (32.9%) were over 30. 48 individuals (34.3%) met criteria for cannabis misuse, while 92 (65.7%) did not. Of these, 36 were true positives, 12 false positives, 80 true negatives, and 12 false negatives. The sensitivity of self-reported cannabis misuse was 75.0%, specificity 86.9%, positive predictive value 75.0%, and negative predictive value 86.9%.

Conclusion: Cannabis misuse is underreported and often masked by cultural normalization. While self-reporting shows moderate sensitivity, behavioral screening tools offer higher diagnostic reliability. Early detection and intervention are essential to mitigate long-term harm.

Relationship between Serum Uric Acid Levels and Severity of Hypertension in Adult Patients

2025-12-31T16:19:01+00:00

Background: Hypertension is a major cardiovascular risk factor worldwide, and hyperuricemia has been implicated as both a marker and a potential contributor to increased blood pressure. Understanding the relationship between serum uric acid levels and hypertension severity may aid in risk stratification and management.

Objective: To evaluate the association between serum uric acid levels and the severity of hypertension in adult patients.

Methods: A retrospective observational study was conducted at a tertiary care institution from March 2023 to August 2023. Adult patients (≥18 years) diagnosed with hypertension were included. Demographic data, comorbidities, blood pressure readings, and serum uric acid levels were extracted from medical records. Hypertension was classified as mild, moderate, or severe according to established guidelines. Statistical analysis included mean ± SD, frequencies, percentages, and correlation analysis between uric acid levels and blood pressure. A p-value <0.05 was considered statistically significant.

Results: A total of 120 patients were analyzed, with a mean age of 52.6 ± 11.2 years. Serum uric acid levels increased significantly with hypertension severity, with mean levels of 5.8 ± 1.2 mg/dL in mild, 6.7 ± 1.4 mg/dL in moderate, and 7.9 ± 1.5 mg/dL in severe hypertension (p < 0.001). A positive correlation was observed between serum uric acid and both systolic and diastolic blood pressure. The findings were consistent across age and sex subgroups, suggesting an independent association.

Conclusion: Serum uric acid levels were positively associated with the severity of hypertension in adult patients. Monitoring and managing uric acid may provide a valuable tool for risk stratification and optimizing hypertension care.

Association of Coronary Artery Anatomical Variations with Myocardial Fibrosis and Interventional Outcomes

2025-12-31T20:14:54+00:00

Background: Coronary artery anatomical variations are frequently encountered during diagnostic coronary angiography and interventional cardiac procedures. Although traditionally considered incidental, emerging evidence suggests that altered coronary anatomy may influence myocardial perfusion and contribute to subclinical myocardial remodeling. Myocardial fibrosis represents an early marker of adverse myocardial change and carries important prognostic implications.

Objective: To evaluate the association between coronary artery anatomical variations, myocardial fibrosis, and interventional outcomes in patients undergoing coronary angiography.

Methodology: This prospective observational study was conducted at the Department of Cardiology, Peshawar Institute of Cardiology, from January 2022 to January 2023. A total of 120 adult patients undergoing clinically indicated coronary angiography were consecutively enrolled. Coronary anatomical variations including dominance patterns, myocardial bridging, anomalous coronary origins, coronary tortuosity, and luminal stenosis were documented. Myocardial fibrosis was assessed using cardiac magnetic resonance imaging and surrogate functional parameters. Interventional outcomes were correlated with underlying anatomical variations. Statistical analysis was performed using chi-square tests and multivariate logistic regression.

Results: Myocardial fibrosis was detected in 43.3% of patients. Myocardial bridging, anomalous coronary origins, coronary tortuosity, and significant luminal stenosis were significantly associated with myocardial fibrosis (p < 0.05). Patients with anatomical variations demonstrated significantly higher rates of percutaneous coronary intervention, multi-vessel revascularization, increased procedural complexity, and peri-procedural ischemic changes.

Conclusion: Coronary artery anatomical variations are significantly associated with myocardial fibrosis and adversely influence interventional outcomes. Recognition of these variations may enhance risk stratification and guide individualized interventional planning.

Early Mobilization is Better? Comparison of isolated Non-Displaced Medial Malleolus Fracture treated with pop Cast Versus Malleolar Screw Fixation

2026-01-03T13:15:08+00:00

Introduction: Medial malleolar fractures are among the most commonly encountered injuries in clinical practice. Plaster of Paris casting is commonly used for undisplaced fractures, while multiple surgical fixation techniques for closed reduction have been described, including Kirschner wires, cancellous screws, tension band wiring, and their modifications.

Objective: The objective of this study is to compare POP cast versus Single screw fixation for medial malleolus fracture of the foot.

Materials and Methods: This single-blinded randomized controlled trial was conducted at the Department of Orthopedic Surgery, King Edward Medical University, Mayo Hospital Lahore, from October 2022, to April 2023. Using a non-probability consecutive sampling technique, 314 patients aged 15–60 years with closed, isolated medial malleolus fractures were enrolled, while patients with open or pathological fractures were excluded. Participants were randomly allocated into two groups using a lottery method. Group I was managed conservatively with fracture reduction followed by Plaster of Paris cast application, while Group II underwent percutaneous malleolar screw fixation. Fracture reduction in both groups was confirmed using an image intensifier. Functional outcome was assessed at the 16th postoperative week according to the operational definition of the study.

Results: The mean age was 36.82 ± 13.65 years in Group A (POP cast) and 36.72 ± 14.11 years in Group B (screw fixation), with a range of 15–60 years in both groups. Group A comprised 30 males (63.82%) and 17 females (36.17%), while Group B included 26 males (55.31%) and 21 females (44.68%). Good to excellent outcomes were observed in 36 cases (76.59%) in Group A and 41 cases (87.23%) in Group B, whereas 10 (21%) and 6 (12.76%) cases, respectively, did not achieve good to excellent outcomes. Group B demonstrated a statistically significant difference in the functional outcomes compared to Group A (p < 0.05).

Conclusion: Malleolar screw fixation showed statistically significant difference in functional outcomes in patients with medial malleolus fractures of the lower limbs. This technique may be considered to enhance functional recovery and reduce the risk of severe impairment.

Keywords: Foot fracture, medial malleolus fractures, malleolar screw fixation, functional outcome, Olerud and Molander

Comparison of Airway Management Success Using Video Laryngoscopy in Patients with Difficult Airways

2026-01-03T19:04:27+00:00

Background: Difficult airway management is a critical component of anesthetic and emergency care.

Objective: This study compared the success and safety of video laryngoscopy and direct laryngoscopy in patients with difficult airways. Methods: A comparative cross-sectional study was conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad from November 2022 to April 2023, on 105 patients with anticipated or encountered difficult airways. Of these, 53 patients underwent video laryngoscopy and 52 underwent direct laryngoscopy. Data included first-pass success, total intubation attempts, intubation time, Cormack–Lehane grading, need for adjuncts, and airway-related complications.

Results: Video laryngoscopy achieved a higher first-pass success rate of 84.9% (45 of 53) compared with 57.7% (30 of 52) in the direct laryngoscopy group. The mean intubation time was shorter with video laryngoscopy at 28.6 ± 9.4 seconds, whereas direct laryngoscopy required 39.7 ± 12.3 seconds. Better glottic visualization was observed with video laryngoscopy, with 83.0% achieving Cormack–Lehane grades I–II compared with 48.0% in the direct laryngoscopy group. Adjunct use was lower in the video laryngoscopy group at 17.0% compared with 46.1% in the direct laryngoscopy group. Complications were fewer with video laryngoscopy, including desaturation in 7.5% versus 23.0%, airway trauma in 5.6% versus 17.3%, and esophageal intubation in 1.9% versus 9.6% in the direct laryngoscopy group. Conclusion: Video laryngoscopy proved superior to direct laryngoscopy in the management of difficult airways. It resulted in higher intubation success, better visualization, fewer complications, and reduced dependency on operator skill.

Keywords: Laryngoscopy, Patients, Complications, Airway, Anesthetic, Incubation

Prevalence of Latent Tuberculosis Infection among patients with Bronchial Asthma Receiving Inhaled or Oral Corticosteroids

2026-01-08T06:56:49+00:00

Background: Latent tuberculosis infection (LTBI) is extremely high in areas where tuberculosis disease is common and it is used as a reservoir to develop a disease. Inhaled or oral corticosteroids are often used to treat bronchial asthma patients, and that type of treatment can weaken cellular immunity and predispose patients to Mycobacterium tuberculosis infection and reactivation, but in the region, there is insufficient evidence of it.

Hypotheses: To estimate the LTBI prevalence in patients with bronchial asthma using corticosteroids and comparing LTBI prevalence in patients using inhaled corticosteroids (ICS) versus oral corticosteroids (OCS) users.

Methodology: The study was a cross-sectional study carried out at the department of Pulmonology Bacha Khan Medical College, Mardan from January 2023 to June 2023. One hundred adult patients with known bronchial asthma who have been diagnosed with the disease by a physician and have undergone a minimum of four weeks of corticosteroids treatment were enrolled. Participants were divided into ICS and OCS exposed. Symptom screening and chest radiography were used in screening out active tuberculosis. The diagnosis of LTBI was made in the form of tuberculin skin test (positive test 10 mm and above) or interferon-gamma release assay. Demographic factors, the level of asthma, comorbidities, and the pattern of corticosteroids were documented. Chi-square and independent t-tests were used to perform the comparisons with p<0.05 as a statistically significant value.

Results: The mean age of participants was 41.6 ± 12.4 years and 58% were female. Sixty patients were receiving ICS only, while 40 had recent or ongoing OCS exposure. LTBI was detected in 28 patients, giving an overall prevalence of 28%. LTBI was significantly more frequent in the OCS group than the ICS-only group (42.5% vs 18.3%, p=0.01). LTBI-positive patients were older than LTBI-negative patients (46.2 ± 11.9 vs 39.7 ± 12.3 years, p=0.02). Diabetes mellitus (35.7% vs 15.3%, p=0.03) and household TB contact (32.1% vs 11.1%, p=0.01) were also significantly associated with LTBI.

Conclusion: LTBI was present in almost one-third of the corticosteroid-treated asthma patients. Exposure to oral corticosteroids, older age, and the history of diabetes and previous TB contact were also risk factors, which indicated the importance of targeted LTBI screening in high-burden settings.

Keywords: Latent tuberculosis; asthma; corticosteroids; prevalence

A Review on Repurposing of Drug

2024-03-09T08:13:57+00:00

Background: For discovering novel drugs and to gain market acceptance process of conventional drug discovery is used in which various stages are involved.

Aim: To innovate new approaches for minimizing the cost and time of drug discovery.

Method: Several attempts were made for the building of plans based on computational tools and on bio-informatics to strengthen the repurposing method off-late. Various approaches used to invent novel signs for FDA accepted drugs are discussed in this review.

Results: The repurposing of the drugs has obtained significance in identifying novel therapeutic uses for existing drugs. It is a productive strategy for the discovery of drugs also time and cost-effective.It fills the gap for the absence of efficiency of conventional drug development.

Implications: In drug repurposing, selection and decision of suitable repurposing technique depend on previous knowledge and accessible data from particular studies. The best advantage of the drug repurposing technique is that for approved drugs all the required data is available.

Conclusion: This technique is currently appearing to overcome the restriction faced during conventional drug discovery in the form of resources, timeline, and financial support . The feasibility of repurposing technique is improved by its systematic application. Some examples of repurposed drugs are also reviewed here. This review also covers the skill of repurposing survival drugs for use against microbes.

Keywords: Conventional drug, drug repurposing, repurposing approaches, docking, proteinopathy.

The Impact of Artificial Intelligence on Cardiovascular Disease Diagnosis: A Review

2024-03-09T08:24:12+00:00

Background: Cardiovascular diseases present a significant global health challenge and remain the leading cause of death worldwide. However, traditional approaches to prevention, diagnosis, and treatment struggle to keep up with the increasing prevalence of these diseases.

Aim: To enhance patient outcomes and optimize healthcare resource utilization. Artificial intelligence (AI), specifically machine learning and deep learning, has rapidly emerged as a promising tool with the potential to revolutionize various aspects of cardiovascular disease management, including detection, diagnosis, and treatment.

Method: Reviewed the current literature surrounding AI techniques using PubMed, Science Direct, NCBI and Google Scholar, specifically exploring machine learning and deep learning, and their application in diagnosing heart disease. The focus was on AI's role in improving diagnostic techniques such as echocardiography, cardiac magnetic resonance imaging, computed tomography angiography, and electrocardiogram analysis.

Results: AI has promising applications in various aspects of cardiovascular disease management. Its application in diagnostic techniques can help detect, diagnose, and treat heart disease, ultimately leading to more accurate and personalized treatments.

Practical Implication: By integrating these advanced technologies into clinical practice, we can transform the diagnosis and management of heart diseases, leading to more accurate and personalized diagnostics and treatments.

Conclusion: AI presents a significant potential in transforming the global health landscape by enhancing cardiovascular disease management. By leveraging these advanced technologies, clinicians can improve patient care and overall outcomes while addressing the increasing prevalence of these diseases.

Keywords: Heart Diseases, Diagnosis, Deep Learning, Machine Learning, Public Health.