Pakistan Journal of Health Sciences

Aprepitant, When Used with Chemotherapy, Reduces the Risk of Recurrence, Metastasis, And Mortality in Patients with Breast Cancer

2026-09-01T04:51:19+00:00

The study included a large number of women (n=13,811) who had been treated with chemotherapy and antiemetics for early-stage breast cancer (2008-2020), with follow-up for metastasis and death until 2021. Compared with any other class of antiemetic, researchers determined that the neurokinin-1 receptor (NK-1R) antagonist aprepitant (125 mg on day 1, 80 mg daily on days 2 and 3) proved to significantly improve survival and decreased the risk of metastasis when used in combination with chemotherapy. Triple-negative breast cancer (TNBC) patients had the highest risk reduction, with a rate reduction of 34% for recurrence and 39% for death [1]. In addition, a cohort study of 654 patients showed that aprepitant improved prognosis in chemosensitizer BC patients. Importantly, treatment with the drug was found to be associated with improved overall survival as well as a longer disease-free interval in all three subtypes, such as triple-negative, HR-positive, and HER2-positive BC [2]. These data support the idea that aprepitant enhances the therapeutic effects of standard chemotherapy drugs, which has been previously suggested for the treatment of TNBC [3]. Hence, in this editorial, aprepitant as an NK-1R antagonist is described in terms of the molecular cascades that result in the heightened cellular chemosensitivity, which leads to better antitumor results in BC [3, 4].

There is a growing body of epidemiological evidence highlighting the therapeutic utility of aprepitant as a chemopreventive drug in the treatment of breast BC [1, 2]. Beyond its well-established role in relieving chemotherapy-induced nausea and vomiting (CINV), aprepitant increases the sensitivity of BC cells to cytotoxic agents, while providing multiorgan protection against chemotherapy-induced toxicities, including cardiotoxicity, neurotoxicity, nephrotoxicity, and hepatotoxicity [4]. Standard regimens for BC typically include anthracyclines, taxanes, and cisplatin, the latter being particularly essential in protocols for TNBC. Despite their clinical efficacy, agents such as doxorubicin and cisplatin often lead to chemoresistance, tumor recurrence, and severe systemic toxicity [3]. However, the co-administration of aprepitant with cisplatin or doxorubicin enhances apoptotic pathways and the generation of reactive oxygen species (ROS) specifically in TNBC cells [3]. Furthermore, this combination inhibits the transcription of genes that drive metastasis, inflammation, cell cycle progression, and drug resistance, while protecting functional tissues—for example, against cisplatin-induced cytotoxicity or cisplatin-induced cardiotoxicity [3]. From a mechanistic perspective, these cellular findings offer a plausible explanation for the survival benefits observed in patients with early-stage BC who receive aprepitant in addition to primary chemotherapy.

The substance P (SP)/NK-1R signaling axis acts as a key factor in BC pathogenesis [5, 6]. NK-1R expression is ubiquitous in all breast cancer subtypes and is vital for BC cell survival [5]. Elevated plasma levels of SP have been found in clinical cohorts of BC patients, but not in healthy subjects. While SP actively stimulates BC cell proliferation, pharmacological inhibition by NK-1R antagonists, such as L-733,060, L-732,138, and aprepitant, inhibits proliferation and triggers time- and dose-dependent breast cancer cell death [5]. In addition, NK-1R antagonists, such as aprepitant, inhibit neovascularization and exhibit anti-metastatic properties by suppressing the invasion and migration of BC cells [6].

Off-label applications. A clinical trial in HIV-positive patients demonstrated that aprepitant administered at a daily dose of 375 mg for two weeks was safe and well-tolerated. This regimen effectively reduced CD4+ cells expressing PD-1, as well as circulating levels of soluble CD163 and SP [3, 6]. Furthermore, a case study of a lung cancer patient who received palliative radiotherapy combined with compassionate use aprepitant (1140 mg daily for 45 days) showed complete regression of an 8 × 7 cm tumor mass following treatment. Notably, the patient experienced no serious adverse events throughout the course of therapy [3, 6].

In conclusion, epidemiological data indicate that adding aprepitant to chemotherapy regimens for BC—specifically, TNBC—is associated with lower rates of recurrence, distant metastasis, and overall mortality. At the same time, laboratory studies show that combining aprepitant with standard drugs, such as doxorubicin or cisplatin, enhances the elimination of BC cells and offers protection against treatment-related toxicities. Proposed next steps. Phase I: Dose escalation: Evaluate the safety and tolerability of higher doses of aprepitant, beyond standard antiemetic regimens, to achieve therapeutic saturation. Phase II: Clinical evaluation: Evaluate clinical efficacy, overall survival, and recurrence-free survival when administered in combination with systemic chemotherapy in patients with TNBC.

Comparison of Mean Duration of Postoperative Analgesia Following QL2 Block Versus QL3 Block Using Ropivacaine 0.25% In Patients Undergoing Unilateral Inguinal Hernia Repair

2026-09-01T04:55:47+00:00

Effective postoperative pain management after inguinal hernia repair enhances recovery and reduces opioid use. Among quadratus lumborum block variants, evidence remains uncertain as to whether the posterior (QLB-2) or trans-muscular (QLB-3) approach provides superior analgesia. Objectives: To compare the mean duration of postoperative analgesia produced by posterior quadratus lumborum block (QLB-2) and trans-muscular quadratus lumborum block (QLB-3) using 0.25% ropivacaine in patients undergoing unilateral inguinal hernia repair. Methods: The randomised controlled trial was conducted in the Department of Anaesthesia at Bahawal Victoria Hospital, Bahawalpur, from July to December 2024. Sixty-four male patients aged 18-50 years who underwent unilateral inguinal hernia repair under general anaesthesia were included and randomly divided into two groups of 32 participants each. Group QLB-2was given the posterior quadratus lumborum block, and Group QLB-3 was given the trans-muscular approach. Twenty millilitres of 0.25% ropivacaine was applied in both groups under ultrasound guidance. The visual analogue scale (VAS) was used to measure postoperative pain, and the duration of analgesia was defined as the time from entering the recovery room to achieving a VAS score>3. Results: The mean time to first analgesic request was significantly longer in QLB-3 (457.7 ± 161.3 min) than in QLB-2 (271.8 ± 94.6 min; p<0.001). Rescue analgesia was required in 40.6% of QLB-3 and 62.5%of QLB-2 patients. Conclusions: The trans-muscular quadratus lumborum block provided significantly longer and more effective postoperative analgesia than the posterior approach using 0.25% ropivacaine in unilateral inguinal hernia repair.

Determination of Association between Onychoscopy Features and Nail Plate Potassium Hydroxide Test Positivity in Diagnosis of Onychomycosis: A Cross-Sectional Study

2026-09-01T04:52:47+00:00

Onychomycosis is a common chronic fungal infection of the nails, causing significant physical and psychological morbidity. In Pakistan, access to fungal culture and molecular diagnostics is limited, creating a need for non-invasive, rapid, and cost-effective diagnostic tools. Objectives: To determine the association between onychoscopic features and KOH positivity in clinically suspected onychomycosis. Methods: This cross-sectional study was conducted in the Department of Dermatology, Ghurki Trust and Teaching Hospital, Lahore, Pakistan, from 7 August 2025 to 10 January 2026. A total of 52 patients with clinically suspected onychomycosis were enrolled. Each patient underwent onychoscopic examination followed by nail plate potassium hydroxide (KOH) testing for fungal confirmation. Onychoscopic features, including onycholysis, jagged edge with spikes, longitudinal striae, subungual hyperkeratosis, and chromonychia, were documented. Sensitivity, specificity, predictive values, and diagnostic accuracy were calculated for each feature using KOH microscopy as the reference standard. Results: KOH test was positive in 82.7% of cases. Onycholysis had the highest sensitivity (86.1 %) while jagged edge with spikes demonstrated the highest specificity (88.9%). Onycholysis was significantly associated with KOH positivity (p=0.026), and jagged edge with spikes also showed a highly significant association (p=0.002). The combination of jagged edge and onycholysis yielded an accuracy of 76.9%. Chromonychia (p=0.160) and longitudinal striae (p=0.716) showed weaker associations. Conclusions: Specific onychoscopic features, particularly jagged edges with spikes and onycholysis, demonstrated a significant association with KOH positivity. However, given variability in sensitivity and specificity, these findings should be interpreted alongside confirmatory testing (culture or PCR, where available) rather than as standalone diagnostic criteria.

Clinical Outcome of Autoinoculation in the Management of Multiple Viral Warts: A Single-Arm Interventional Study

2026-09-01T04:53:24+00:00

Autoinoculation is a relatively inexpensive immunotherapeutic treatment for viral warts, which is claimed to trigger a specific immune response. Objective: To determine the clinical outcome of autoinoculation, in terms of complete, partial, or no response, among patients presented with multiple viral warts. Methods: This is a single-arm interventional (quasi-experimental) study, which recruited 60 patients with multiple viral warts through non-probability sampling between March to October 2025. Autoinoculation was done by excision, mincing, and implantation of a donor wart into a pocket made in the subcutaneous area. Follow-ups were made monthly following initiation of treatment, and outcome measured at 12 weeks in terms of complete, partial, or no response. SPSS version 25.o was used to perform a statistical analysis. Chi-square tests and ordinal logistic regression were used to determine significant associations and to derive adjusted ORs. Results: Study results illustrate that 73.3% (n=44) of patients achieved a complete response, 15.0% (n=9) a partial response, and 11.7% (n=7) showed no response. Mean number of warts reduced significantly from 7.7 (pre-treatment) to 1.75 (post-treatment). Stratification analysis revealed a significant association of age with treatment outcome (p=0.031). Patients in the age group 15-30 years showed the highest rate of complete response. No other demographic or clinical factors demonstrated a significant association. Conclusions: Autoinoculation is a considerable practicing, safe and effective therapeutic modality in treating various viral warts. Its better results among young patients highlight the critical role of a strong immune system in the implementation of its therapeutic action.

Comparative efficacy of High-Flow Nasal Cannula (HFNC) versus Continuous Positive Airway Pressure (CPAP) in Preventing Bronchopulmonary Dysplasia (BPD) among Preterm Neonates

2026-09-01T04:52:18+00:00

Bronchopulmonary dysplasia (BPD) remains a major cause of respiratory morbidity in preterm infants requiring respiratory support. Non-invasive ventilation strategies such as nasal continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) are commonly used, but evidence comparing their effectiveness in preventing BPD remains limited, particularly in low- and middle-income settings. Objectives: To compare HFNC and CPAP as primary non-invasive respiratory support in preterm neonates <34 weeks’ gestation, with BPD at 36 weeks postmenstrual age as the primary outcome. Methods: This cohort study was conducted in a tertiary-care neonatal intensive care unit in Peshawar, Pakistan. Preterm neonates <34 weeks who received HFNC or CPAP as initial respiratory support between April 2024 and March 2025 were included. Multivariable logistic regression was performed to identify predictors of BPD. Results: A total of 189 neonates were analyzed (HFNC n=95; CPAP n=94). The incidence of BPD was similar between HFNC and CPAP groups (25.3% vs 27.7%; p=0.709). Mortality and major neonatal complications were also comparable. Respiratory modality was not independently associated with BPD (aOR 1.41; 95% CI 0.69–2.90; p=0.348). Intubation was strongly associated with BPD (aOR 19.30; p=0.005), while complete antenatal steroid exposure was protective (aOR 0.24; p=0.016). Conclusions: HFNC and CPAP showed similar outcomes in preterm neonates <34 weeks. However, due to the observational design, further prospective studies are needed to confirm these findings.

Digital Literacy in Medical Education: Strengths, Gaps, and the Way Forward

2026-09-01T04:53:26+00:00

Digital transformation of healthcare has transformed clinical practice, medical education, and professional competencies around the world. Digital literacy includes technological skills, ethical use, artificial intelligence (AI), and cybersecurity. It is now regarded as a safe, effective, and future-ready healthcare practice. Despite increased exposure to digital tools, evidence reveals that healthcare students may lack structured capabilities in new digital domains. Objectives: To evaluate the level of digital literacy among undergraduate medical and dental students and identify domain-specific strengths and gaps, particularly in emerging areas such as artificial intelligence and cybersecurity. Methods: An analytical cross-sectional study was conducted using a validated 24-item self-report instrument. The survey measured seven domains of digital literacy using a 5-point Likert scale. A total of 304 MBBS and BDS students participated. Data were analyzed using SPSS v26, applying descriptive statistics, t-tests, and Spearman’s correlation. Results: Among the participants, 77.6% were MBBS students and 22.4% were from BDS, with 60.9% females and 39.1% males. No significant gender-based differences were found in any digital literacy domain. First-year students scored significantly higher in the digital security domain than second-year students (p=0.002). Overall, students demonstrated moderate digital literacy, with comparatively lower scores in AI and cybersecurity domains. Conclusions: While digital literacy is generally consistent across gender and academic levels, low competency in AI and cybersecurity signals an urgent need for targeted curricular interventions. Integrating digital literacy, especially AI and data security, into undergraduate curricula is essential for preparing future-ready healthcare professionals.

Prevalence of Eosinophilia in Chronic Obstructive Pulmonary Disease Exacerbation

2026-09-01T04:53:18+00:00

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. Objectives: To determine the prevalence of eosinophilia in COPD exacerbation, and to evaluate its association with exacerbation severity. Methods: This cross-sectional study was conducted at the Department of Pulmonology, Indus Hospital and Health Network, Karachi, Pakistan, during April 2024 to September 2024. A total of 141 diagnosed cases of COPD patients were analyzed. Eosinophilia was labeled as a blood eosinophil count ≥ 2%. Stratification analysis was performed to observe the effects of effect modifiers on the prevalence of eosinophilia, applying Chi-square or Fisher's exact test, taking p<0.05 as statistically significant. Results: In a total of 141 patients, 101 (71.6%) were males, and the median age was 62.0 (52.0-71.0) years. Monthly family income was classified as low in 80 (56.7%) patients. Smoking status was ‘never smoked’ in 65 (46.1%), ‘ex-smoker’ in 61 (43.3%), and ‘current smoker’ in 15 (10.6%) patients. Hypertension and diabetes mellitus were reported in 92 (65.2%) and 73 (51.8%) patients. Eosinophilia was identified in 58 (41.1%) patients. Smoking status differed significantly with respect to the prevalence of eosinophilia (p=0.024). Severity of COPD exacerbation differed by eosinophilia status, as increasing severity was significantly associated with eosinophilia (p<0.001). Conclusions: Blood eosinophilia was frequently observed among patients admitted with COPD exacerbation and showed a significant association with smoking status and exacerbation severity.

Knowledge, Skills, and Attitudes of Recent Medical Graduates Regarding the Management of Poisoning Cases

2026-09-01T04:52:58+00:00

Poisoning remains a major cause of emergency department visits and preventable mortality, particularly in low- and middle-income countries. Newly graduated medical officers are frequently the first responders in poisoning emergencies. Objectives: To evaluate the knowledge, skills, and attitudes of recent medical graduates regarding the diagnosis, management, and medico-legal responsibilities associated with poisoning cases. Methods: An analytical cross-sectional study was conducted among 201 recent MBBS graduates working in tertiary care teaching hospitals in Lahore, Pakistan. A structured, pilot-tested questionnaire assessed knowledge using multiple-choice and scenario-based questions, skills through structured clinical scenarios, and attitudes using Likert-scale items. Data were analyzed using SPSS version 26.0. Independent t-tests, chi-square tests, Pearson correlation, and multiple linear regression were applied. A p-value ≤0.050 was considered statistically significant. Results: Graduates who completed an emergency department rotation demonstrated significantly higher knowledge scores than those without such training. Greater exposure to poisoning cases was associated with improved practical skills, and a moderate positive correlation was observed between the number of poisoning cases managed and overall competence. Emergency rotation and clinical exposure independently predicted competence after adjustment for demographic variables. Major competence gaps were identified in toxidrome recognition, decontamination sequencing, airway protection, corrosive poisoning management, and medico-legal documentation. Conclusions: Recent medical graduates possess moderate theoretical knowledge but demonstrate important deficiencies in practical and medico-legal competencies. Structured emergency rotations and simulation-based toxicology training are essential to improve preparedness for poisoning management.

Comparative Evaluation of the WHO Labour Care Guide and Modified Partograph in Cesarean Section Frequency, Delivery Outcomes, and Maternal Stress in Tertiary Care Hospitals in Hyderabad

2026-09-01T04:52:02+00:00

The global rise in cesarean section (CS) rates has raised concerns due to associated maternal and neonatal risks, increased healthcare costs, and psychological stress. To address this issue, the World Health Organization introduced the Labour Care Guide (LCG) as an updated, evidence-based tool for monitoring labour and improving childbirth outcomes. Objectives: To compare the frequency of cesarean sections among women managed using the WHO Labour Care Guide (LCG) and those managed with the Modified Partograph in tertiary care hospitals of Hyderabad, Sindh. Methods: A comparative cross-sectional study was conducted at Liaquat University Hospital and Khidmat-e-Khalq Foundation Hospital over four months. A total of 430 pregnant women were enrolled, with 215 participants in each group. Maternal stress levels were assessed using the Perceived Stress Scale (PSS). Data were analyzed using SPSS version 26.0, and the Chi-square test was applied to compare categorical variables. Results: Women managed with the LCG had a significantly lower CS rate compared with those monitored using the Modified Partograph (40 vs. 65; p=0.02). The LCG group also demonstrated improved neonatal outcomes, including higher birth weights and better Apgar scores. Additionally, maternal stress levels were significantly lower and satisfaction with care was higher among women in the LCG group (p<0.050). Conclusions: The WHO Labour Care Guide appears to be more effective than the Modified Partograph in reducing cesarean section rates and improving maternal and neonatal outcomes while lowering maternal stress during labour.

Effect of Infiltration in Temporomandibular Joint with Triamcinolone Acetonide for Pain Relief in Internal Derangement

2026-09-01T04:52:55+00:00

Orofacial pains are frequently caused by disorders of the temporomandibular joint (TMJ), which are often associated with masticatory difficulties, joint noises, and limited mouth opening. Despite the availability of several treatment options, a standardized management approach has yet to be developed. Intra-articular infiltration with Triamcinolone acetonide has been explored as a minimally invasive intervention for local symptomatic relief; clinical evidence regarding its effectiveness remains variable. Objective: To evaluate the effect of intra-articular triamcinolone acetonide injection on pain reduction in patients with TMJ internal derangement. Methods: A single-arm interventional pre–post study was performed on 71 patients with symptomatic TMJ internal derangement. Each patient received a local injection of 40mg/ml Kenacort (triamcinolone acetonide) under standard aseptic outpatient settings. The Wong-Baker FACES^® Pain Rating Scale was employed to assess pain both before and one month following the intervention. Joint. Results: Among the 71 patients who reported pre-intervention pain, the mean pain score decreased from 6.085 to 2.423, and this change was statistically significant on paired t-testing (t=17.905, p<0.001). Improved joint sounds and jaw mobility were observed along with a statistically significant decrease in pain scores (p≤0.050). Conclusion: Intra-articular triamcinolone acetonide injection demonstrated a significant reduction in TMJ-related pain for short-term relief in this outpatient cohort.

Comparative Efficacy of Microneedling with and without Topical Vitamin D3 in Localized Alopecia areata

2026-09-01T04:53:29+00:00

Alopecia areata represents a T-cell-mediated autoimmune disorder causing non-scarring hair loss. While microneedling demonstrates therapeutic potential, adjunctive strategies to enhance efficacy remain underexplored. Objectives: To compare the efficacy and safety of microneedling combined with topical vitamin D3 versus microneedling monotherapy in localized alopecia areata. Methods: An open-label randomized controlled trial enrolled 80 participants (April–October 2025) with localized patchy alopecia areata affecting <50% scalp. Participants were randomly allocated to microneedling combined with topical vitamin D3 (MN+VD3, n=40) or microneedling alone (MN, n=40). Treatment consisted of six biweekly sessions over 12 weeks. Primary efficacy endpoints included Severity of Alopecia Tool (SALT) score reduction and percentage hair regrowth. Results: Mean SALT reduction was significantly greater in the MN+VD3 group (13.27 ± 4.284 points) compared with MN (9.66 ± 3.827 points, p=0.001). Hair regrowth percentage was superior in MN+VD3 (65.737 ± 18.6252%) versus MN (48.137 ± 24.0500%, p<0.001). Excellent or good response was achieved in 82.5% of MN+VD3 participants versus 50.0% of MN participants (p=0.002). Stratified analysis demonstrated consistent treatment superiority across age groups (18–40 and 41–60 years), both sexes, and disease duration categories. Adverse events were mild and transient, occurring in 30.0% overall with no serious complications or treatment discontinuations. Conclusions: Topical vitamin D3 combined with microneedling substantially enhances therapeutic outcomes compared with monotherapy, with excellent tolerability and sustained efficacy across demographic substrata. These findings support adjunctive vitamin D3 as an effective treatment strategy for localized alopecia areata.

Effectiveness of Pressurized Metered Dose Inhaler (pMDI) Versus Dry Powder Inhaler (DPI) in Delivering Inhaled Corticosteroid and Long Acting Beta Agonist Among Patients with Uncontrolled Asthma in a Tertiary Care Hospital

2026-09-01T04:52:33+00:00

Uncontrolled asthma remains common in Pakistan despite regular use of inhaled corticosteroid and long-acting beta-agonist combination therapy. Drug delivery may differ according to the inhaler device. Pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) are the most frequently prescribed devices, but local comparative evidence remains limited. Objective: To compare the short-term effectiveness of pMDI and DPI in delivering inhaled corticosteroid and long-acting beta-agonist therapy among adults with uncontrolled asthma in a tertiary care hospital. Methods: This parallel randomized controlled trial was conducted at the Department of Pulmonology, Services Institute of Medical Sciences, Lahore. A total of 146 adults with uncontrolled asthma were randomized equally to pMDI (n=73) or DPI (n=73). The primary outcome was the proportion of participants achieving at least a 0.5-point reduction in Asthma Control Questionnaire (ACQ) score at 8 weeks. Secondary outcomes included mean ACQ change, change in forced expiratory volume in one second (FEV₁ % predicted), exacerbations, inhaler technique score, and adverse events. Results: Baseline age, sex, body mass index, asthma duration, baseline FEV₁ % predicted, and ACQ score were comparable between groups. Greater mean ACQ improvement was observed in the pMDI group than in the DPI group (4.6 ± 3.1 vs 3.2 ± 2.9; p = 0.006). FEV₁ improvement was also greater with pMDI (p=0.021). Exacerbations occurred in 24.7% of pMDI users and 39.7% of DPI users (p=0.048). Adverse events were mild and similar between groups. Conclusion: pMDI use was associated with better short-term asthma control and fewer exacerbations; larger multicentre studies are needed.

Professionalism in Medical Students: Emotional Intelligence Matters

2026-09-01T04:52:59+00:00

Emotional intelligence (EI) and professionalism are the core competencies that medical education requires; however, their interconnection is still not explored much. Objectives: To identify the relationship between EI and professionalism in clinical-year medical students, as well as to investigate the differences based on gender and academic year. Methods: A comparative cross-sectional study was performed among 191 MBBS students of Aziz Fatima Medical and Dental College, Faisalabad. All the participants filled out the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) and a modified version of the Professionalism Mini Evaluation Exercise (PMEX). Statistical techniques such as Pearson's correlation, independent t-tests, ANOVA, and multiple linear regression were employed for data analysis. Results: Global EI and professionalism relationship was weak but positive and significant (r=0.216, p=0.003). EI domains displayed opposite correlations: emotionality (r=0.285) and sociability (r=0.371) were positively correlated, and well-being (r=-0.419) and self-control (r=-0.306) were negatively correlated with professionalism, all at p < 0.01. Third-year students had significantly higher well-being scores as compared to fourth-year students (p=0.021). Regression analysis revealed global EI to be an independent predictor of professionalism (B=0.657, p=0.005), explaining 7.7% of the variance. Conclusions: Emotional intelligence significantly predicts professionalism, with global EI emerging as an independent predictor. Emotionality and sociability showed positive associations, while self-control and well-being showed negative associations with professionalism. Well-being declines significantly from the third to fourth year, while no gender differences were observed.

Grading Anterior Urethra Stricture to Predict Surgical Complexity and Outcome Using the Urethra Stricture Score

2026-09-01T04:55:53+00:00

Urethral stricture is a cause of impedance of urine outflow and is quite common in urology. 300 out of 100,000 men are affected by this disease. There is no objective system for determining the structure's complexity. Objectives: To appraise the relationship between Urethral Stricture Score (USS) and surgical complexity, standardize the surgical approaches, and predict the surgical outcomes with the use of USS. Methods: This was a descriptive study conducted in the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi. The duration for sample collection was six months. Non-probability consecutive sampling was employed. Mean and standard deviation were computed for age, duration of disease, duration of surgery, BMI, and USS. Effect modifiers like age, duration of disease, and BMI were stratified to see the effect of this on the outcome. Post stratification spearman correlation and Anova test were applied. The p-value <0.005 was considered significant. Results: A total of 45 patients were included in this study that was diagnosed with anterior urethral strictures. We found a significant association of USS with surgical complexity. As the score increased, surgical complexity increased; the F-value of the ANOVA test was 61.25, and the p-value was <0.001. The study also found a significant correlation between USS and duration of surgery, with a correlation coefficient of 0.806 and p-value <0.001. Conclusion: This study affirms the positive correlation between the increasing USS and increasing surgical complexity.

Impact of Iron Deficiency Anemia on the Severity of Bronchiolitis in Pediatric Patients

2026-09-01T04:53:27+00:00

Bronchiolitis is an acute inflammatory respiratory illness involving the lower respiratory tract occurring in the first 2 years of life. Objectives: To determine the impact and outcomes of the severity of iron deficiency anemia (IDA) in patients with acute bronchiolitis (AB). Methods: This analytical, cross-sectional study was conducted in the Department of Pediatric Medicine, Ziauddin University Hospital, Karachi, Pakistan, from April 2025 to September 2025. A total of 126 children aged 2–23 months with AB were enrolled through non-probability consecutive sampling. Bronchiolitis severity was classified by the Wang score. Data were analyzed using SPSS version 26.0, with p<0.05 considered significant. Results: In 126 children, 73 (57.9%) were males, and the median age was 10.0 months (IQR 6.0–14.0). Mild IDA was present in 38 (31.2%), moderate in 64 (50.8%), and severe in 24 (19.0%) cases. With increasing anaemia severity, weight decreased (8.7 vs 7.6 kg; p=0.038), SpO₂ declined (92.4% vs 88.7%; p=0.016), respiratory rate rose (p=0.009), and Wang score increased (5.3 vs 9.4; p=0.004). Severe IDA showed longer tachypnoea resolution (5.1 vs 3.2 days; p<0.001), retraction recovery (6.2 vs 3.9 days; p=0.002), greater oxygen requirement (18 [75.0%] vs 13 [34.2%]; p=0.002), and prolonged hospital stay (7.2 vs 5.1 days; p<0.001). Severe IDA was significantly associated with severe bronchiolitis (p=0.004). Conclusions: The severity of IDA was strongly associated with worse clinical presentation and delayed recovery in children with acute bronchiolitis. Lower haemoglobin and microcytic indices correlated with higher Wang respiratory scores, greater oxygen support requirements, and longer hospital stays.

Association Between Maternal Serum Ferritin Concentration and Risk of Gestational Diabetes Mellitus and Adverse Fetal Outcomes

2026-09-01T04:55:50+00:00

Gestational diabetes mellitus (GDM) is a common pregnancy-related metabolic disorder linked to serious maternal and fetal complications. Rising evidence indicates that elevated maternal iron stores, especially serum ferritin, may contribute to GDM and adverse neonatal outcomes, yet data from South Asia, particularly Pakistan, are limited. Objectives: To evaluate the association between maternal serum ferritin concentrations at different gestational ages and the risk of GDM and adverse fetal outcomes. Methods: A retrospective cohort study of 146 singleton pregnancies at Combined Military Hospital Multan measured ferritin at 16–18 and 28–32 weeks. Participants were categorized into ferritin quartiles, GDM was diagnosed via a 75-g Oral Glucose Tolerance Test (OGTT), and logistic regression assessed associations after adjusting for key maternal covariates. Results: Higher mid-gestation serum ferritin levels demonstrated a significant relationship with increased risk of GDM (adjusted OR for Q4 vs. Q1: 1.43; p=0.016). Elevated ferritin was also linked to macrosomia (adjusted odds ratio (AOR)=2.01; 95% confidence interval (CI): 1.09–3.67), large for gestational age (LGA) infants (AOR=2.01; 95% CI: 1.09–3.72), and increased neonatal head circumference (AOR=2.70; 95% CI: 1.53–4.77). Although higher ferritin levels were associated with a reduced risk of small for gestational age (SGA) (AOR=0.44; 95% CI: 0.17–1.17), this association was not statistically significant. In late pregnancy, ferritin showed an inverse relationship with macrosomia, suggesting time-dependent effects. Conclusions: Elevated maternal serum ferritin levels during mid-pregnancy are associated with an increased risk of GDM and fetal overgrowth outcomes.

Prognostic Factors Associated with Renal Survival in Children with Rapidly Progressive Glomerulonephritis

2026-09-01T04:52:40+00:00

Rapidly progressive glomerulonephritis (RPGN) is a severe pediatric renal disorder characterized by rapid deterioration in kidney function. In low-resource settings such as Pakistan, delayed presentation and limited access to specialized nephrology services may adversely affect renal outcomes. Objectives: To identify clinical, serological, histopathological, and healthcare access–related predictors of renal survival in children diagnosed with RPGN. Methods: This prospective observational cohort study was conducted at the Department of Pediatric Nephrology, The Children's Hospital and Institute of Child Health, Multan, between 15 February 2025 and 15 October 2025. All patients were followed for three months after confirmation of diagnosis. Children aged 1–18 years diagnosed with RPGN were consecutively enrolled after informed consent. Participants were followed for three months from diagnosis or until development of end-stage kidney disease (ESKD), whichever occurred first. Multivariable logistic regression was used to identify independent predictors of ESKD. Results: Among 110 enrolled children, 78 (70.9%) achieved renal survival, while 32 (29.1%) progressed to ESKD. Patients developing ESKD had significantly lower baseline estimated glomerular filtration rate (eGFR), higher serum creatinine and urine protein-to-creatinine ratio, longer delay before nephrology consultation, and greater crescent burden on biopsy (all p≤0.006). Conclusions: Histopathological severity, impaired baseline renal function, hypertension, and treatment delay are key determinants of short-term renal survival in pediatric RPGN.

Frequency of Thrombocytopenia and Its Etiologies in the Last Trimester of Pregnancy

2026-09-01T04:53:00+00:00

Thrombocytopenia is a frequent hematological abnormality in late pregnancy with diverse etiologies and potential maternal-fetal implications. Objective: To determine the frequency of thrombocytopenia and its etiologies in pregnant women in the last trimester. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan, from June to December 2025. A total of 210 pregnant women in the third trimester were enrolled through non-probability consecutive sampling. Demographic and obstetric data were recorded, and platelet counts were assessed using a complete blood count. Thrombocytopenia severity and etiologies were determined using standardized clinical and laboratory criteria. Results: Among 210 women evaluated in the last trimester, the mean maternal age was 29.63 ± 5.03 years, and the mean gestational age was 36.46 ± 3.21 weeks. Mean gravidity and parity were 2.79 ± 1.26 and 1.90 ± 1.26, respectively, with overall platelet count 210.26 ± 57.04 ×10³/µL. Thrombocytopenia was detected in 26 (12.4%). Platelet counts differed significantly between thrombocytopenia and non-thrombocytopenia groups (115.73 ± 32.45 vs 223.61 ± 46.08 ×10³/µL; p<0.001). Severity was mild in 18 (69.2%), moderate in 6 (23.1%), and severe in 2 (7.7%). Gestational thrombocytopenia predominated (57.7%), followed by pre-eclampsia (11.5%), eclampsia (7.7%), disseminated intravascular coagulation (7.7%), infection-related causes (7.7%), HELLP syndrome (3.8%), and immune thrombocytopenic purpura (3.8%) overall. Conclusions: Thrombocytopenia affected 12.4% of late-pregnancy women, mostly mild. Gestational thrombocytopenia predominated, with smaller contributions from hypertensive disorders, disseminated intravascular coagulation, and infections.

Association between CT-Detected Coronary Artery Calcification and Serum Homocysteine Level in Asymptomatic Adults

2026-09-01T04:51:54+00:00

The association between CT-detected CAC and serum homocysteine levels in asymptomatic adults may provide valuable insights into the pathophysiological mechanisms underlying subclinical atherosclerosis. Objectives: To determine the association between CT-detected coronary artery calcification and serum homocysteine levels in the asymptomatic Pakistani population. Methods: A cross-sectional analytical study was conducted on 384 asymptomatic Pakistani adults aged 30–65 years. Coronary artery calcification was assessed using non-contrast CT (Agatston score), and serum homocysteine levels were measured. Associations were analyzed using descriptive statistics and Pearson correlation using SPSS. Results: Among 384 asymptomatic adults, coronary artery calcification (CAC) was detected in 41.7% of participants. Individuals with CAC had significantly higher serum homocysteine levels compared to those without calcification (p < 0.001). Serum homocysteine increased progressively with CAC severity and showed a significant positive correlation with CAC score. Statistical testing demonstrated that serum homocysteine was significantly associated with coronary artery calcification after adjusting for traditional cardiovascular risk factors. Conclusions: Elevated serum homocysteine was independently associated with the presence and severity of CT-detected coronary artery calcification in asymptomatic adults. These findings suggest that homocysteine may serve as a useful biomarker for identifying individuals at increased risk of subclinical coronary atherosclerosis.

Maternal Outcomes in Pregnant Females at Term Having Low Amniotic Fluid Index

2026-09-01T04:53:21+00:00

Low amniotic fluid index (AFI) at term is associated with increased obstetric intervention, but its relationship with maternal outcomes remains uncertain. Objectives: To assess maternal outcomes in term pregnancies with low AFI and evaluate their association with maternal age, BMI, parity, and previous cesarean section. Methods: This analytical cross-sectional study included 137 singleton term pregnancies with low AFI (<5 cm) admitted to a tertiary care hospital in Quetta from 22-09-2025 to 30-12-2025. Sample size was estimated using n = Z²P(1-P)/d² at a 95% confidence level with P = 65% and d = 8%. Outcomes included induction of labor, mode of delivery, prolonged labor, instrumental delivery, postpartum hemorrhage, infection, and hospital stay. Chi-square or Fisher’s exact test was applied as appropriate. Results: Mean age was 28.39 ± 6.65 years, and mean BMI was 27.00 ± 4.82 kg/m². Median hospital stay was 3 days (IQR: 2–4). Labor was induced in 101 (73.7%) patients, cesarean section occurred in 94 (68.6%), prolonged labor in 32 (23.4%), instrumental delivery in 13 (9.5%), postpartum hemorrhage in 11 (8.0%), and infection in 7 (5.1%). No statistically significant association was found between maternal outcomes and age group, BMI, parity, or previous cesarean section (all p>0.050). Conclusions: In this analytical cross-sectional study, pregnancies with low AFI at term showed high rates of induction and cesarean delivery; however, maternal age, BMI, parity, and previous cesarean section were not significantly associated with adverse maternal outcomes within the study sample.

Frequency of Cystic Duct Anatomical Variations on ERCP- A Retrospective Cross-Sectional Study

2026-09-01T04:55:51+00:00

Cystic duct (CD) anatomical variations are common, but they frequently go unrecognized. Their prevalence differs among different studies. A proper understanding of these variations is important before performing any percutaneous, surgical, or endoscopic interventions to avoid complications. Objectives: To evaluate the frequency of anatomical variations of cystic duct insertion observed on endoscopic retrograde cholangiograms. Methods: A total of 500 cholangiograms (2020-2022) fulfilling the inclusion criteria were analyzed retrospectively for various CD insertion patterns from the Endoscopy suite of Lahore General Hospital, Lahore, after approval from the IRB. Patient information, including age, gender, and indication of ERCP were also recorded. Data were processed on SPSS v.25. Results of continuous measurements were expressed as mean ± SD (min, max), and results of categorical measurements were presented as number (%). Results: Among 500, there were 45% male and 55% female. Normal cystic duct mid-lateral insertion was seen in 62.2% of patients, while 37.8% showed anatomical variations. Among these variations, the most frequent one was low medial (15.4%), followed by middle medial (8.6%) and high lateral (7%). Conclusions: The study identified a high frequency of CD variations, thus highlighting the importance of imaging for the identification of these variations before performing any surgical or endoscopic procedures.

Self-Reported Personal Hygiene Practices and Associated Factors among Prison Inmates in a Jail in Pakistan

2026-09-01T04:53:19+00:00

Prison inmates are a vulnerable population with increased risk of exposure to poor water, sanitation, and hygiene (WASH) conditions, which raises communicable diseases. Objective: To determine self-reported personal hygiene practices and associated factors among inmates in Nara Jail, Hyderabad. Methods: This institution-based cross-sectional observational study was conducted at Nara Jail, Hyderabad (December 2025–January 2026). Ninety-one inmates were selected through simple random sampling. Data were collected using a structured interviewer-administered questionnaire and a standardized observational checklist adapted from WHO WASH guidelines. Associations were analyzed using Chi-square or Fisher’s exact tests, with statistical significance set at p <0.005. Results: Although 96.7% of inmates acknowledged the importance of soap use, only 40.7% had prior awareness of formal WASH practices, and nearly all reported the absence of hygiene education during incarceration. While 94.5% reported handwashing after toilet use, 23.1% relied solely on water. Direct observation identified poor hygiene conditions, including unclean fingernails (42.9%) and visible dermatological conditions (31.9%). Poor fingernail hygiene was significantly associated with recent gastrointestinal morbidity (p <0.005). Conclusions: There were significant gaps in formal WASH knowledge, institutional hygiene support, and observed hygiene conditions among prison inmates. Structural deficiencies in prison WASH infrastructure and lack of institutional health education contribute to preventable health risks, highlighting the need for evidence-based prison health reforms in Pakistan.

Comparison of Incision and Drainage with Needle Aspiration in the Treatment of Breast Abscess

2026-09-01T04:55:48+00:00

Breast abscess is a common complication of mastitis in low- and middle-income countries and may impair cosmetic appearance and breastfeeding. Conventional incision and drainage (I/D) are effective but associated with scarring and delayed recovery. Ultrasound-guided needle aspiration is a minimally invasive alternative. Objective: To compare the efficacy of ultrasound-guided needle aspiration and I/D in the management of breast abscesses. Methods: This retrospective comparative study was conducted in the Department of Surgery, Hayatabad Medical Complex, Peshawar, from August to October 2025. A total of 110 female patients (18–60 years) with breast abscesses of ≥3 days duration was included using record-based sampling. Patients with BMI >29.9 kg/m², chronic diabetes, or recent breast intervention were excluded. Group A (n=55) underwent I/D, while Group B (n=55) received ultrasound-guided needle aspiration. All patients received antibiotics. The primary outcome was treatment success (complete resolution without recurrence). Data were analyzed using SPSS version 23.0, and a chi-square test was applied. A p-value <0.05 was considered significant. Results: Mean age was 29.17 ± 9.44 years in Group A and 30.11 ± 8.56 years in Group B. Overall, 63.6% were lactating women. Treatment success was achieved in 37/55 (67.3%) patients in Group A and 53/55 (96.4%) in Group B. The difference was statistically significant (p<0.01). Conclusions: Ultrasound-guided needle aspiration demonstrated significantly higher success rates than I/D and offers a less invasive approach with a better recovery profile. It should be considered the preferred first-line treatment in appropriately selected patients.

Effectiveness of Intravitreal Bevacizumab (Avastin™) in Vitreous Hemorrhage Associated with Proliferative Diabetic Retinopathy

2026-09-01T04:53:20+00:00

Proliferative diabetic retinopathy (PDR) is a major cause of vision loss in diabetic patients. Vitreous haemorrhage (VH) is a common complication of PDR that significantly affects visual acuity. Intravitreal bevacizumab (Avastin™) has been used as a treatment option for VH associated with PDR. Objectives: To determine the effectiveness of intravitreal bevacizumab (Avastin™) in clearing vitreous haemorrhage and improving visual acuity in patients with PDR. Methods: This quasi-experimental study was conducted at the Ophthalmology Department, Hayatabad Medical Complex, Peshawar, from 01-01-2025 to 30-06-2025. A total of 79 patients with PDR-associated VH were included. Patients received three intravitreal bevacizumab injections at monthly intervals. Outcomes included VH clearance, improvement in best corrected visual acuity (BCVA), and requirement of pars plana vitrectomy. Data were analysed using SPSS version 22.0. Paired sample t-test and Chi-square test were applied, with p≤0.05 considered statistically significant. Results: The mean age of participants was 41.49 ± 10.54 years. VH clearance was observed in 67 (84.8%) patients, while improvement in BCVA occurred in 57 (72.2%) patients. Pars plana vitrectomy was required in 14 (17.7%) patients. Mean BCVA significantly improved from 0.81 ± 0.10 logMAR pre-therapy to 0.45 ± 0.24 logMAR post-therapy (p<0.001). Significant associations were observed between baseline BCVA and improvement in visual acuity (p=0.011) and requirement of vitrectomy (p=0.046). Conclusions: Intravitreal bevacizumab (Avastin™) is an effective treatment for VH in PDR, resulting in significant improvement in visual acuity, enhanced haemorrhage clearance, and reduced need for surgical intervention.

Efficacy of Oral Potassium Citrate in Reducing Double-J Ureteric Stent Encrustations: A Retrospective Cohort Study from a Single Tertiary Care Center

2026-09-01T04:51:47+00:00

Double-J (DJ) ureteric stent encrustation is a significant complication in endourological practice. The role of oral potassium citrate in mitigating stent encrustations remains inadequately studied. Objectives: To evaluate the efficacy of oral potassium citrate supplementation in reducing DJ stent encrustations and identify associated risk factors. Methods: A retrospective cohort study was conducted at Gujranwala Teaching Hospital (October 2022 to October 2025) involving 504 patients with DJ stents. Group 1 (n=249) received oral potassium citrate (20 mEq twice daily) until stent removal; Group 2 (n=255) received no supplementation. Encrustation was assessed using the KUB grading system. Results: Overall encrustation prevalence was 18.05% (91/504) with a mean KUB score of 6.2 ± 2.90. Encrustation rates were significantly lower in Group 1 (5.2%) versus Group 2 (30.58%) (p<0.001). Urinary tract infections were more common in Group 2 (55.8%) than in Group 1 (30%) (p=0.006). Multivariate regression identified non-utilization of potassium citrate (adjusted OR: 0.52, 95% CI: 0.37-0.74), prolonged indwelling duration >180 days (adjusted OR: 3.45, 95% CI: 2.41-4.94), and male gender (adjusted OR: 1.62, 95% CI: 1.18-2.23) as independent predictors (all p<0.005). Conclusions: Oral potassium citrate supplementation significantly reduced DJ stent encrustations. Male gender, prolonged indwelling time, and non-utilization of potassium citrate were strong independent predictors. Prospective randomized trials are recommended to validate these findings.

Evaluation of Radiopacity of Endosequence Bio-ceramic Sealer and AH Plus by Digital Radiography

2026-09-01T04:53:22+00:00

Radiopacity is a key requirement for endodontic sealers to allow radiographic distinction between obturation material and surrounding tooth structures. American National Standards Institute (ANSI) and American Dental Association (ADA) mandate a minimum of 3 millimetres of aluminium (mm Al). Objectives: To compare, in vitro, the radiopacity of Endo-Sequence BC Sealer versus AH Plus using digital radiography on extracted human single-rooted teeth. Methods: An experimental in vitro study was conducted at the Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro. A total of 60 single‑rooted teeth were selected using a non-probability convenience sampling method and allocated into two groups (n=30 each) without randomization. Care was taken to ensure that the two groups were comparable in terms of tooth type and root morphology and obturated with gutta-percha plus either Endosequence BC or AH Plus. After 7 days at 37°C/100 % humidity, radiopacity was expressed as millimetres of aluminium (mm Al). Data were compared using an independent-samples t-test (α = 0.05). Results: The sample analyzed consisted of 60 samples (30 samples per group). AH Plus demonstrated significantly higher radiopacity (6.94 ± 0.46 mm Al) compared to Endosequence BC (3.83 ± 0.35 mm Al). The confidence intervals were not overlapping (AH Plus: 6.77 7.10 mm Al; Endosequence BC: 3.71 ± 3.96 mm Al). The difference was statistically very significant (p<0.01). Conclusions: AH Plus demonstrated significantly higher and more consistent radiopacity than Endosequence BC, offering superior radiographic contrast and a wider safety margin for clinical detection of obturation quality.

Assessment of Mortality Rate Using qSOFA Score among Patients with Sepsis outside the Intensive Care Unit (ICU) in a Tertiary Care Hospital

2026-09-01T04:52:56+00:00

Sepsis is a severe condition associated with a high risk of death. The Quick Sequential Organ Failure Assessment (qSOFA) score is an easy bedside instrument for mortality prediction. Objective: This study aims to assess the mortality rate in patients with sepsis having a qSOFA score of 2 or more. Methods: This cross-sectional research was done for 6 months, from July 2025 to December 2025, among 196 patients at Liaquat National Hospital Karachi. The sample comprised patients with sepsis, not admitted to the ICU, and aged between 18 and 75 years, with qSOFA assessed at admission, and followed until discharge or death. A qSOFA score of 2 was determined to be a predictive value of mortality. The statistical analysis was done in SPSS version 25.0; stratification and the Chi-square or Fisher’s exact test were. A p-value < 0.05 was considered statistically significant. Results: 196 non-ICU sepsis patients were included (mean age 55.9 ± 17.9 years; 55.1% male). The median qSOFA score was 2, with 104 (53.1%) patients having qSOFA ≥2. In-hospital mortality occurred in 97 (49.5%) patients. qSOFA ≥2 was significantly associated with older age, male gender, rural residence, hypertension, diabetes, anemia, hypotension, tachypnea, and GCS <15 (all p<0.05). ROC analysis showed good performance in predicting mortality (AUC = 0.862, 95% CI 0.805–0.907), with sensitivity 60.8% (95% CI 50.1–70.8%) and specificity 100% (95% CI 96.1–100%). Conclusion: qSOFA is a handy bedside tool that proves to be effective in mortality prognosis of sepsis when patients are not in the ICU.

Comparison of Early versus Late Trophic Feeding in Preterm Very Low Birth Weight Neonates at a Tertiary Care Hospital

2026-09-01T04:52:53+00:00

Very low birth weight (VLBW) neonates are vulnerable to complications, and nutritional management is an essential determinant of their outcomes. Objective: To compare the neonatal outcomes in early trophic feeding (TF) versus late TF in preterm VLBW neonates. Methods: This randomized controlled trial was performed at the Department of Paediatrics, Nishtar Hospital, Multan, Pakistan, from June 2025 to December 2025. Sixty preterm VLBW neonates were selected through simple random sampling. Infants were randomized (30 in each group) into early TF (≤48 hours) or late TF (≥72 hours) groups. Feeding was given via orogastric tube using expressed breast milk or preterm formula, along with parenteral nutrition. Outcomes included incidence of necrotizing enterocolitis (NEC), mortality, and hospital stay. Data were analyzed using SPSS 26.0, with p≤0.005 considered statistically significant. Results: In a total of 60 neonates, 35 (58.3%) were males, with a mean gestational age of 33.1 ± 2.1 weeks, and a birth weight of 1360.1 ± 67.2 grams, respectively. Overall, NEC occurred in 2 (3.3%), and mortality occurred in 4 (6.7%) neonates. The overall mean hospital stay was 15.4±1.9 days, significantly shorter with early feeding (13.0 ± 1.7 vs 19.3 ± 2.1 days, p<0.001). Conclusions: The early TF within 48 hours significantly reduced the hospital stay without increasing NEC or mortality among preterm VLBW infants.

Psychological Burden in Patients with Acne Vulgaris

2026-09-01T04:53:25+00:00

Acne vulgaris is a common and recurrent skin disorder that affects more than 70% of human beings across the world. Acne is associated with several psychological problems in addition to the physical ones. Objective: To evaluate the psychological burden of acne vulgaris, defined by anxiety levels (GAD-7) and acne-related quality of life (CADI), and to identify coping strategies among patients. Methods: This cross-sectional study was conducted at the Department of Dermatology, Combined Military Hospital, Kharian, between March and October 2024, and 135 patients aged 16 years and above, diagnosed with acne vulgaris, were enrolled through a non-probability convenience method. A pre-designed proforma was used to measure the demographic characteristics, clinical history, psychological burden (GAD-7 scale and Cardiff Acnes Disability Index), and coping mechanisms. SPSS version 25.0 was used to conduct descriptive and inferential analysis. Results: 61.48% female and 38.52% male, 45.93% had moderate anxiety, and 20.00% severe anxiety. The perceived stigma was quite high, and 51.11% respondents reported differential treatment, as well as 43.70% respondents avoided social situations. The impact of acne on the day-to-day life was also negative, with 60.74% of the respondents expressing concerns and 48.89% showing reduced performance in work or school. The coping strategies were makeup or cosmetic (42.22%), avoidance (25.19%), and talking to friends and family (20.74%). Conclusions: Acne vulgaris has a very strong impact on psychological well-being, as it increases significantly the rate of anxiety, stigma, and poor quality of life.

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Markers of Disease Activity in Rheumatoid Arthritis

2026-09-01T04:51:34+00:00

Rheumatoid arthritis (RA) is an inflammatory disease that adversely affects quality of life by impairing joint function. Objectives: To examine the use of NLR and PLR as activity indicators in RA. To ascertain their independent prediction by examining the relationships between these DAS28-ESR fractions of disease activity and other conventional inflammatory indicators like ESR and CRP. Methods: This study involved 230 rheumatoid arthritis patients assessed in the Department of Rheumatology, Khyber Teaching Hospital, Peshawar. Disease Activity Score 28 (DAS28) was used to assess disease activity together with clinical parameters, erythrocyte sedimentation rate, C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and others. Multivariate regression and rank correlation (Spearman) were done to determine the relationship between these biomarkers and DAS28. Results: Significant positive correlations were identified between inflammatory markers and activity of the disease (DAS28), with NLR (ρ = 0.772, p<0.001) and PLR (ρ = 0.768, p<0.001) demonstrating notable connections. ESR (ρ = 0.912, p<0.001) and CRP (ρ = 0.917, p < 0.001) exhibited more robust relationships. In multivariable regression analysis, CRP (β = 0.454, p<0.001) and ESR (β = 0.423, p<0.001) were the strongest independent predictors of disease activity, while NLR remained a significant contributor (β = 0.116, p=0.001). ROC analysis showed good diagnostic performance for both NLR (AUC = 0.892) and PLR (AUC = 0.898), with PLR demonstrating slightly higher accuracy in identifying high disease activity. Conclusions: NLR and PLR are useful and cost-effective markers of disease activity in rheumatoid arthritis.