Pakistan Journal of Health Sciences

Period Poverty Beyond Hygiene: Intersectional and Feminist Public Health Research Perspectives

2026-06-01T07:59:54+00:00

Period poverty is often discussed as a matter of hygiene. Sometimes it is framed as a problem of access to sanitary products. Yet such descriptions are too narrow for what has become one of the clearest expressions of gendered public health inequality in low- and middle-income countries (LMICs) [1]. Period poverty is not simply about pads, cloths, medications, or menstrual cups. It reflects the unequal social organization of health, dignity, mobility, education, and power. It is a structural, social, political, and public health phenomenon, deeply relational [2]. Menstruation health remained hidden within policy and research spaces. Period health remained invisible in mainstream public health discourse for decades. Conditions that affect millions of menstruating individuals across schools, workplaces, prisons, refugee camps, and households were treated as private discomforts rather than collective policy failures [3]. This absence was never neutral, which reflected longstanding patriarchal assumptions about whose bodies matter in health systems and whose suffering remains socially acceptable. Research from LMICs consistently documents stigma, shame, taboos, and social isolation associated with menstruation. Girls miss school because they cannot afford sanitary materials or because schools lack WASH, including water, safe toilets and waste management facilities. Women improvise with unsafe materials, due to which some remain isolated during menstruation, whereas others continue to work in unsafe and unhygienic environments because missing a day's wage is also not a good option to choose for them [4]. These experiences are not isolated incidents, but they represent patterned inequalities that public health systems can measure, observe, and prevent. Manifestation of period poverty is relational and intersectional [5]. Menstruation itself may be biological, but menstrual disadvantage is socially produced. A girl studying in an urban private school with functioning toilets, disposal systems, water access, and family support experiences menstruation differently from a rural adolescent within the same country, supposed to be Pakistan, attending a school without support and sanitation facilities. A refugee adolescent faces different vulnerabilities than a university student. A menstruating person living with disability experiences barriers differently from others [2, 6]. These differences matter because period poverty is shaped through the interaction of gender with class, geography, disability, displacement, education, and social exclusion [7]. Period poverty is a measurable structural deprivation with identifiable biological, social, economic, institutional, and political determinants [8]. Research studies should map multidimensional indicators, including school and workplace absenteeism, menstrual stigma, psychosocial distress, WASH access, product affordability, disposal facilities, and mobility restrictions. Furthermore, participation barriers, reproductive infections, policy exclusion, gender norms, decision-making autonomy, safety concerns, productivity loss, and social isolation would also be considered to better understand its ontological and intersectional realities [9, 10]. This ongoing lack of visibility of period poverty is symptomatic of women's and marginalized communities' wider experience of structural inequality affecting them drastically. Thus, a critical and emancipatory public health strategy must go beyond the measurement of rates of prevalence. It requires interrogation of systems that normalize menstrual inequity. Menstrual taxation, as a treatment of essential products, rather than a luxury, underscores inequities in governance and economic policy. The understanding of menstrual inequity can only happen through an informed conversation [11]. Valid knowledge and facts in the field of public health must be backed up with quantitative evidence, as well as lived experiences. For the future of progress, political commitment and institutional recognition of the importance of menstrual health as not being a peripheral development issue will be required in LMICs. Instead, it is at the heart of education, gender equality, employment, social inclusion, and psychosocial well-being. Public health could not claim commitment to equity while menstrual needs remain neglected across societies, households, schools, workplaces, health systems, and humanitarian settings. Period poverty is not only a women's issue but a public health concern that has social and economic intergenerational implications. It requires more than awareness slogans to discuss this very important matter. It calls for structural action based on dignity, equity, empowerment, and justice. Addressing the menstrual situation in LMICs is no longer about 'better management' of menstruation, but about challenging unequal structures that persist in excluding, silencing, and disadvantaging millions of people from the function of menstruation. Women need to be supported inclusively so that they can be empowered socially, legally, morally, and economically.

Comparison of Efficiency of Intermaxillary Fixation Screws Versus Erich Arch Bars for Maxillomandibular Fixation in Maxillofacial Trauma

2026-06-01T08:03:59+00:00

Maxillomandibular fixation (MMF) is a popular intervention tool for maxillofacial fractures. Erich arch bars are used historically, but intermaxillary fixation screws provide some potential benefits, including less time in surgery and better oral health. Objective: To compare the Erich arch bar with intermaxillary fixation screws in maxillomandibular fixation in facial fractures. Methods: This prospective comparative trial was carried out in Sharif Medical and Dental College and involved 60 patients who needed maxillomandibular fixation after maxillofacial trauma. There were two groups of patients: intermaxillary fixation screws (n=30) and Erich arch bars (n=30). The assessment of the post-operative occlusal stability, duration of the surgery, and the assessment of oral hygiene based on the Oral Hygiene Index were performed with the help of SPSS version 23.0. Results: The intermaxillary fixation screw group showed a shorter surgical time, as well as superior oral hygiene (p<0.05). The groups did not show any significant difference in the postoperative occlusal stability (p=0.389). Conclusion: intermaxillary fixation screws offer similar occlusion potentialities at lower operative duration and with improved oral health as compared with Erich arch bar.

Change in C-Reactive Protein Level with Anti-Tuberculosis Therapy in Patients with Pulmonary Tuberculosis

2026-06-01T08:02:35+00:00

Pulmonary tuberculosis is a widespread disease with high mortality and morbidity rates in developing countries, caused by Mycobacterium tuberculosis. However, there is limited information on how serum CRP levels relate to the severity of pulmonary tuberculosis. Objective: To determine the mean change in C-reactive protein with anti-tuberculosis therapy in patients with pulmonary tuberculosis. Methods: The quasi-experimental study was conducted at the Department of Pulmonology, Mayo Hospital, Lahore, from August 25, 2020, to February 25, 2021, enrolling 85 patients with pulmonary tuberculosis. A blood sample was obtained by using a 5cc disposable syringe under aseptic measures and stored in sterile vials for assessment of CRP level at baseline. Then all patients were given anti-tuberculosis therapy and followed up in OPD for 2 months. Change in CRP level was calculated. The data were analysed statistically by using SPSS version 25.0. A p-value ≤0.05 was taken as significant. Results: 60 (70.6%) were males, while 25 (29.4%) were females. Baseline levels of CPR were 60.15 mg/dl and 17.76mg/dl after 2 months; the mean change in CPR levels was 42.39mg/dl. The average change in CRP levels was 42.39 ± 21.52mg/dL (p-value<0.05). Conclusions: The results of the study showed a significant reduction in mean CRP levels before and after treatment with ATT. The patients with pulmonary tuberculosis had a high level of serum C-reactive protein (CRP), which implies that CRP can be used as an effective biomarker in the assessment of disease activity and treatment response.

Diagnostic Value of Umbilical Artery Systolic/Diastolic Ratio and Amniotic Fluid Index for the Prediction of Respiratory Distress Syndrome among Term Pregnancies: A Cross-Sectional Validation Study

2026-06-01T08:01:28+00:00

The introduction of UA S/D ratio monitoring into the routine antenatal Doppler monitoring can improve the early detection of the at-risk baby and optimize the perinatal care. Objectives: To evaluate the diagnostic accuracy of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of RDS, keeping postnatal findings as the gold standard. Methods: This cross-sectional validation study was carried out at Department of Diagnostic Radiology, Pakistan Navy Ship Hafeez Hospital, Islamabad, from November 2024 to June 2025. There were 594 enrolled term pregnant women with term pregnancies. The obstetric ultrasound with color Doppler was performed to measure the umbilical artery S/D ratio and AFI. S/D ratio was declared positive when its >3, and AFI positive when it was < 8 cm. Neonates were followed 72 hours after birth, and the RDS diagnosis was confirmed by clinical and radiological means. Data were evaluated with SPSS version 25.0, and diagnostic indices were calculated. Results: The overall prevalence of RDS was 12.6%. For the umbilical artery S/D ratio, sensitivity and specificity were 77.3% and 88.1%, respectively. While for AFI, sensitivity and specificity were 64.0% and 75.7%, respectively. Conclusions: The Umbilical artery S/D ratio is a better and more reliable ultrasound parameter than AFI in predicting postnatal RDS in term pregnancies, as the AUC for the UA S/D ratio was found to be 0.840, which reflects its optimal performance, while the AUC for AFI was found to be 0.305, which shows its poor discriminative ability.

Frequency of Recurrence of Seizures with Intravenous Versus Intramuscular Magnesium Sulphate in Women with Eclampsia

2026-06-01T08:03:22+00:00

Magnesium sulphate is increasingly being utilized in women with eclampsia. But there is still debate on the ideal route of administration. Objectives: To compare the recurrence of seizures between intravenous (IV) and intramuscular (IM) magnesium sulphate (MgSO₄) in women with eclampsia. Methods: This open-label, parallel-group, randomized controlled trial was conducted at the Department of OBG, Nishtar Hospital, Multan, from 13th May to 12th November 2025. A total of 200 women aged 18–45 years, admitted with eclampsia, were enrolled after informed consent and demographic data were collected. Women with intracranial bleeding or prior use of anticonvulsants were excluded. Participants were randomly divided to receive either IV (4g IV bolus then 1g/hour infusion) or IM MgSO4 (4g IV+6g IM loading dose, followed by 2.5g IM, 4 hourly). MgSO₄ was continued for 24 hours post-seizure or delivery. The primary outcome was seizure recurrence within 48 hours. Data were analyzed using SPSS version 25.0 with the chi-square test. Results: The mean age was 24.5 ± 4.9 years, and the mean gestational age was 29.0 ± 3.1 weeks. Most participants were ≤25 years (67%), <30 weeks of gestation (60.5%), and obese (64%). Baseline characteristics were comparable across both groups. Seizure recurrence was higher in the IM group (70%) compared to the IV group (30%), with no statistically significant difference (p=0.059). No significant predictors of seizure recurrence were identified after stratification. Conclusions: Although seizure recurrence was high in the intramuscular MgSO₄ group, this was not statistically significant. The intramuscular route can be considered an alternative to the intravenous route.

Vitamin D Deficiency and Distal Radius Fractures: A Case-Control Study

2026-06-01T08:04:18+00:00

Deficiency of vitamin D is considered a significant risk factor for fragile fractures. It is highly prevalent in South Asia despite the fact that sunlight is abundant. In the literature, there is limited data available regarding any association between deficiency of vitamin D levels and distal radius fractures (DRFs) specifically for the Pakistani population. Objectives: To find out the prevalence and severity of deficiency of vitamin D in patients with DRFs and to determine the association of fracture type, severity, and mechanism of injury with vitamin D levels. Methods: It was a case–control study that was conducted at Naseer Memorial Hospital, Azad Kashmir, consisting of 216 cases and 100 controls. Vitamin D in serum was estimated using a chemiluminescent immunoassay (Abbott Architect i2000SR). DRFs were confirmed on radiography due to a standard PA and lateral view of the wrist using a GE Optima XR220amx digital X-ray system. The AO system was used to classify the fractures. Statistical analysis of the data was done in SPSS version 23.0, while p<0.05 was taken as significant. Results: Vitamin D deficiency was significantly higher among patient’s vs controls (p<0.001). Lower vitamin D levels correlated inversely with fracture severity (r = –0.47, p<0.01). Extra-articular fractures and low-energy trauma predominated. Female and elderly patients exhibited greater deficiency and more complex fractures. Conclusions: The deficiency of vitamin D is an important and independent predictor of DRFs specially in elderly female patients, and routine screening of vitamin D levels should be integrated into the fracture prevention strategy.

Comparison Of Operative Outcomes of Open Versus Percutaneous Pedicle Screw Fixation for the Treatment of Lumbar Spondylolisthesis

2026-06-01T08:02:45+00:00

Lumbar spondylolisthesis often requires surgical correction, with options like open or percutaneous pedicle screw fixation. Objectives: To compare their outcomes, focusing on reduced trauma, blood loss, and postoperative pain with the percutaneous approach. Methods: A quasi-experimental trial at Sir Ganga Ram Hospital, Lahore, included 44 patients with lumbar spondylolisthesis. Exclusion criteria were metabolic bone diseases, prior spine surgery, pregnancy, and spinal malignancy. Patients were divided into Group A (percutaneous fixation) and Group B (open Pedicle screw fixation). Intraoperative time, blood loss, and VAS pain scores were recorded. The outcome variables were postoperative hospital stay, blood loss, and surgery duration. Data was analyzed by using SPSS 25.0. Results: Among 44 participants, 20 were male, and 24 were female. Group A had 6 males (27.3%) and 16 females (72.7%), while Group B had 14 males (63.6%) and 8 females (36.4%). Mean intraoperative time was 44.45 ± 6.87 minutes in Group A vs. 51.27 ± 3.45 in Group B. Blood loss was significantly lower in Group A (52.82 ± 3.45 mL) compared to Group B (349.23 ± 92 mL, p<0.05). Postoperative pain at 6 weeks (Group A: 3.09 ± 1.41 vs. Group B: 3.36 ± 1.59) and 3 months (Group A: 2.18 ± 1.09 vs. Group B: 2.0 ± 1.02), indicating no statistical difference. Conclusions: Compared with traditional posterior muscle stripping treatments, percutaneous pedicle screw fixation proves an effective treatment in terms of less postoperative blood loss and operative time. This highlights the technique’s potential advantages in improving patient recovery without compromising long-term pain outcomes.

Impact of Early and Delayed Stoma Closure on Patients and Their Family Life

2026-06-01T08:00:54+00:00

Temporary intestinal stomas are to preserve the distal anastomosis following colorectal surgery. Although stoma reversal is necessary to provide bowel continuity, the time of closure is debatable. Early closure might be more beneficial by minimizing stoma complications, hospitalization, and adverse psychosocial effects. Objectives: To compare clinical outcomes and psychosocial effects of early versus delayed stoma closure in patients with temporary stomas. Methods: This retrospective cohort study was done in the Surgical Wards of Jinnah Postgraduate Medical Centre (JPMC), Karachi, and involved 81 patients whose intestinal stoma was reversed. Patients were sorted into two groups: early closure (less than 6 weeks; n=40) and delayed closure (more than 6 weeks; n=41). The analysis of data was performed with the help of SPSS version 26. The p-value of 0.05 was taken to be statistically significant. Results: A total of 81 patients were included, with 40 undergoing early and 41 delayed stoma closure. Baseline characteristics were comparable between groups. Early closure was associated with shorter hospital stay (4.3 ± 1.9 vs 7.1 ± 2.4 days) and earlier resumption of oral intake (2.8 ± 1.2 vs 4.9 ± 1.8 days). Overall, postoperative complications were lower after early closure (17.5% vs 36.5%), particularly wound infection (10.0% vs 22.0%). Delayed closure showed higher psychological stress and greater socioeconomic burden. Conclusions: An earlier stoma closure had better clinical and psychosocial outcomes than a late stoma closure, which were characterized by quicker recovery.

Frequency of Fetomaternal Outcomes Among Pregnant Women Presenting with Thrombocytopenia

2026-06-01T08:01:48+00:00

Thrombocytopenia is a prevalent hematological disease during pregnancy that may cause fetomaternal adverse outcomes. It is imperative to know its prevalence and the complications associated with it so that it can be identified and dealt with at a very early stage. Objective: To determine the frequency of fetomaternal outcomes among pregnant women with thrombocytopenia. Methods: A descriptive cross-sectional study was done in the Department of Obstetrics and Gynecology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, AJ and K, among 151 pregnant women diagnosed with thrombocytopenia. Patients were also classified according to the severity. The outcomes of the mothers were measured in terms of preeclampsia, HELLP syndrome, placental abruption, and preterm birth. The low birth weight and preterm birth were among the fetal outcomes. Analysis of data was done through SPSS version 25.0. Results: The 151 participants presented the highest number of mild thrombocytopenia, 83(54.9%), moderate 40(26.4%), and severe thrombocytopenia 28(18.5%). Preeclampsia occurred in 54 (35.8%) of cases, HELLP syndrome in 15 (9.9%), and placental abruption in 3 (2.0%). Preterm birth was observed in 15 (9.9%) and low birth weight in 6 (4.0%) of neonates. Maternal and fetal outcomes showed no statistically significant differences across thrombocytopenia severity groups (P-value >0.05). Conclusions: Thrombocytopenia in pregnancy was predominantly mild to moderate in severity, with generally favorable maternal and fetal outcomes. No statistically significant differences were observed across severity groups. Early identification and careful monitoring may help optimize maternal and neonatal care.

A Quantitative Cross-Sectional Study Assessing the Prevalence and Distribution of Renal Amyloidosis Subtypes (AA and non-AA) in Biopsy-Proven Adult Cases

2026-06-01T08:01:05+00:00

Renal amyloidosis is a multisystem disease characterized by the deposition of misfolded proteins in various organs, leading to organ dysfunction. Renal amyloidosis subtypes vary across populations, depending on underlying conditions such as inflammatory diseases and plasma cell disorders. Objectives: To evaluate the prevalence and distribution of the different subtypes of renal amyloidosis. Methods: The sample for this quantitative, observational, cross-sectional study comprised 94 patients with biopsy-proven renal amyloidosis, aged 18 years or older, diagnosed during the period between January and December 2025. Renal biopsies were analyzed with the help of Congo red stain to confirm the amyloid deposition, and subtyping was done with the help of amyloid A (AA) immunostain. Cases with negative AA staining were classified as non-AA amyloidosis. Results: The most common subtype was AA amyloidosis (80%), followed by non-AA amyloidosis (20%). Males were 54.3 percent of the participants, while females were 45.7%. Mean age was 51.19 ± 20.45 years. There were no statistically significant gender differences in the distribution of amyloid subtypes or in biochemical parameters (p>0.05). Conclusions: The most common type of renal amyloidosis was AA amyloidosis, in which there were no significant gender-based differences in demographic or biochemical factors. The results are valuable to aid clinical planning and disease management.

Comparison of the Video Laryngoscopes with the Macintosh Laryngoscope for Nasotracheal Intubation in Patients Undergoing Oral and Maxillofacial Surgeries

2026-06-01T08:01:16+00:00

Nasotracheal intubation is more desirable, whereas Macintosh may be challenging to perform in certain patients. The video laryngoscopes offer an indirect, magnified image of the glottis, which may enhance the effectiveness of intubation and shorten the length of the procedure. Objectives: To assess the video laryngoscopes and the Macintosh laryngoscopes in nasotracheal intubation of patients undergoing oral and maxillofacial surgeries. Methods: This prospective observational comparative study was done at Jinnah Postgraduate Medical Centre, Karachi, between March and August of 2023. The time of intubation, the success of the first attempt, and complications were noted. A statistical test was conducted for data analysis, and p ≤ 0.05 was regarded as significant. Results: Group A (98%) scored higher than Group B (76%) in terms of first-attempt intubation success (p=0.001). Video laryngoscopy lowered the mean intubation time (31.7 ± 3.97s) compared to Macintosh (54.7 ± 6.93s) (p=0.001). The stratified analysis showed a consistently better performance of video laryngoscopes in terms of age, gender, ASA status, BMI, and Mallampati class. Conclusions: Video laryngoscopes significantly improve first-attempt success and reduce intubation time for nasotracheal intubation in oral and maxillofacial surgery patients. Their use can enhance airway safety and procedural efficiency.

Comparison of the Effect of Induction of General Anesthesia with Propofol Vs Ketamine + Midazolam on Perfusion Index in Cardiac Patients Undergoing Non-Cardiac Surgery

2026-06-01T08:03:03+00:00

Hemodynamic stability is a critical concern in cardiac patients. The choice of induction agent significantly influences cardiac output and tissue perfusion. Objectives: To compare the effect of induction with ketamine and midazolam vs. propofol on perfusion index in cardiac patients under general anesthesia. Methods: This quasi-experimental study was done from January 2024 to June 2024 at the Department of Anesthesia, Mayo Hospital, Lahore. Total 146 patients undergoing non-cardiac surgery were included after taking written consent. Patients were assigned to two equal Groups: M (midazolam and ketamine) or Group P (propofol). Outcome parameters, including SBP, MAP, and perfusion index, were recorded pre- and post-induction. Data were collected using a proforma and analyzed with SPSS-26. Results: Post-induction, mean SBP in Group M was higher, 126.02 ± 12.58 mmHg, vs Group P, 120.61 ± 13.09 mmHg, p-value=0.01. Post-induction mean MAP in Group M and P calculated was 74.17 ± 10.06 mmHg, and 71.02 ± 9.82 mmHg, p-value=0.05. Post-induction PI in Group M was also higher, 1.88 ± 0.40, vs Group P, 1.69 ± 0.28, p-value=0.001. Conclusions: Findings of the current study suggest that induction with ketamine and midazolam may lead to increased post-induction mean perfusion index as compared to propofol in cardiac patients. Therefore, assists in maintaining peripheral perfusion in cardiac patients, which could be beneficial for postoperative recovery and minimizing complications.

Effect of Tamsulosin in Prevention of Postoperative Urinary Retention

2026-06-01T08:01:58+00:00

Tamsulosin has shown effectiveness in the treatment of lower urinary tract symptoms, especially post-operative urinary retention (POUR). Objectives: To assess the efficacy of tamsulosin in the prevention of POUR and to determine the relationship between POUR incidence and urinary parameters such as urine pH, specific gravity, and color. Methods: This cohort (longitudinal) research was carried out at the Department of Urology, Liaquat University of Health Sciences, Jamshoro, for 6 months (from January 2025 to June 2025) after approval from the IRB. Data collection included baseline demographics, comorbidities, and pre-operative information. At 6, 12, and 24 hours post-operative post-void residual (PVR) was assessed. Analysis of urine was done for measuring urinary pH, color, and specific gravity. SPSS was used for analyzing the data, keeping p<0.05 statistically significant. Results: From 150 post-operative cases, the mean age was 53.5 ± 11.3 years, with around 71 % male. Tamsolusin substantially decreased POUR with a reduction in PVR from 186 ml (6 hours) to 82 ml (24 hours). Incidence of POUR reduced from 24.7 % to 6 %. Cases having POUR showed lower pH of urine, high specific gravity, and dark colored urine. Conclusions: The present study demonstrated that tamsulosin was effective in preventing postoperative urinary retention (POUR) by significantly reducing post-void residual volumes and improving urinary flow within the first 24 hours after surgery.

Hand-Made Extra-Corporeal Knotting Versus Clip for Stump Closure in Laparoscopic Appendectomy

2026-06-01T08:02:08+00:00

Acute appendicitis represents one of the most frequent surgical emergencies encountered in Pakistan. The delayed appendicitis and increased infection risks may impact postoperative outcomes and surgical decision-making. Objectives: To evaluate and compare hand-made extracorporeal knotting with polymeric clip closure in laparoscopic appendectomy, focusing on intraoperative performance measures and the incidence of early postoperative complications, including postoperative ileus, wound infection, and intra-abdominal infection within 15 days. Methods: A randomized controlled trial (NCT ID: 07281612) was carried out in the Department of Surgery, Abbas Institute of Medical Sciences, Muzaffarabad, over a period of twelve months. Using simple lottery-based random allocation, 190 patients diagnosed with uncomplicated acute appendicitis were recruited and assigned to either the hand-made extracorporeal knotting group (n=95) or the polymeric clip closure group (n=95). Relevant demographic, clinical, and intraoperative parameters were systematically documented. Results: The two groups demonstrated broadly comparable baseline profiles. However, the mean duration of surgery was modestly but significantly greater in the knotting group than in the clip group (45.8 ± 8.9 vs 42.8 ± 8.2 minutes; p=0.025). Intra-abdominal infection was observed in 1.1% of patients undergoing knotting compared with 6.3% of those receiving polymeric clips (p=0.049). On logistic regression, polymeric clip use was associated with increased odds of intra-abdominal infection (adjusted odds ratio 4.82; 95% confidence interval 1.01–22.73; p=0.048). Conclusions: Hand-made extracorporeal knotting results in a significantly lower rate of intra-abdominal infection compared to polymeric clip closure. Despite a modest increase in operative time, the knotting technique may offer a safer and more effective option for stump closure.

Association of Puerperal Sepsis with Income Level, Booking Status, and Mode of Delivery Among Patients at A Tertiary Care Setting

2026-06-01T08:04:08+00:00

According to the World Health Organization (WHO), puerperal sepsis is a contracted infection of the genital tract that occurs during labor or in a period of 42 days following the birth. It is the leading cause of preventable maternal disease and death in rich and poor countries. In Pakistan, it ranks third after hemorrhage and hypertensive diseases among women. Objectives: To determine the association of puerperal sepsis with booking status and mode of delivery among patients admitted at the Department of Obstetrics, Shaikh Zaid Women Hospital, Larkana. Methods: The study included 170 patients with puerperal sepsis in total. Demographic data were collected, including age, parity, socioeconomic position, and time since delivery. All the collected data were entered and analyzed using SPSS version 26.0. Results: According to the findings of this study, the mean age was 28.96 ± 6.41 years, the mean time since delivery was 22.11 ± 5.68 days, the mean parity was 1.58 ± 0.895, and the mean BMI was 24.51 ± 4.43. 103 (60.59%) patients were primigravida. 81 (47.65%) patients reported a monthly income of less than 50 thousand, and 81 (47.65%) patients reported a delay of more than 28 days. The income level (p-value=0.018) and mode of delivery (p-value=0.04) were found to have a significant association with puerperal sepsis. Conclusions: The puerperal sepsis is found to have a significant association with the caesarean section deliveries, income level, and case which remain un-booked during pregnancy.

Frequency of Sexual Dysfunction among Female Patients Presenting with Urinary Incontinence

2026-06-01T08:03:12+00:00

Urinary incontinence can negatively affect women’s quality of life, often leading to reduced confidence and sexual dysfunction. Determining its frequency helps guide comprehensive clinical assessment and improve patient-centered management strategies. Objective: To determine the frequency of sexual dysfunction among female patients presenting with urinary incontinence. Methods: A cross-sectional study was conducted in the Department of Urology, The Indus Hospital, Karachi, Pakistan, from 1^st April 2024 to 30^th September 2024. This study included 180 sexually active women aged 16–80 years presenting with urinary incontinence. Participants were enrolled using non-probability consecutive sampling. Sexual function was assessed using the Female Sexual Function Index (FSFI), with a score ≤26.55 indicating dysfunction. Demographic data, comorbidities (diabetes, hypertension), and urinary incontinence characteristics (type and duration) were recorded. Data were analyzed using SPSS version 26. Chi-square and Fisher’s exact tests were applied, and p≤0.05 was considered statistically significant. Results: Of the 180 participants, 44 (24.4%) had sexual dysfunction, and 136 (75.6%) had normal sexual function. Median age was 46 years, and mean BMI was 31.9 ± 5.8 kg/m². Sexual dysfunction showed no significant association with age, BMI, diabetes, hypertension, residence, or type and duration of urinary incontinence. However, FSFI domain scores—including desire, arousal, lubrication, orgasm, satisfaction, and pain were significantly lower among women with sexual dysfunction (p<0.001 for all). Conclusions: Nearly one-fourth of women with urinary incontinence experienced sexual dysfunction, independent of demographic or comorbid factors. Urinary incontinence adversely affected multiple aspects of sexual health.

Association of TCF7L2 rs7903146 TT Genotype with Dyslipidemia in Type 2 Diabetes: A Case–Control Study in Pakistani Patients

2026-06-01T08:03:41+00:00

Type 2 diabetes is often accompanied by dyslipidemia, which markedly increases cardiovascular risk. Genetic factors, particularly the TCF7L2 rs7903146 variant, have been implicated in alterations in glucose and lipid metabolism in T2DM. Objectives: To assess the association between dyslipidemia and the TCF7L2 rs7903146 polymorphism in patients with T2DM as compared to healthy controls. Methods: In Karachi, Pakistan, 100 T2DM patients and 100 age- and sex-matched healthy controls participated in case-control research. Blood samples obtained during fasting were examined for cholesterol and glucose levels. PCR-RFLP was used to genotype TCF7L2 rs7903146, and sequencing was used to confirm the results. Associations (p<0.050) were assessed using logistic regression and ANOVA. Results: TT genotype and T allele frequencies were greater in T2DM patients than in controls (p<0.010). Hence, genotype carriers had significantly higher triglycerides, total cholesterol, and LDL-C levels, and lower HDL-C levels. Multivariate logistic regression demonstrated that the TT genotype independently predicted dyslipidemia. Conclusions: The TCF7L2 rs7903146 TT genotype is strongly associated with dyslipidemia in T2DM patients and may assist in risk stratification and personalized management planning.

Knowledge, Beliefs, and Perceptions among Alopecia Areata Patients: A Cross-Sectional Study in CMH Kharian

2026-06-01T08:01:39+00:00

Alopecia areata (AA) is an autoimmune condition, which is associated with hair loss that has a strong negative effect on the psychological and social well-being of patients. Objective: To determine the knowledge, beliefs, and perceptions of the patients with Alopecia Areata at CMH Kharian. Methods: This was a cross-sectional study that was carried out in 84 patients with alopecia areata. A structured questionnaire was used to collect demographic information, medical history, information on AA, beliefs, perceptions, coping strategies, and expectations of treatment. Associations between variables were determined using statistical procedures such as chi-square tests. Results: The mean age was 30.5 ± 11.4 years having females (59.5%) dominant. The main bulk, 45.2% of the patients, presented with symptoms of alopecia for less than one year. The majority of the patients (78.6%) were already aware of AA before being diagnosed. A large percentage of them considered that AA was hereditary (59.5%) and that stress was a contributing factor (73.8%). Chi-square tests showed significant relationships between educational level and the assumptions concerning the hereditary nature of AA (p=0.037) and perceived seriousness or effects on daily life (p = 0.008). Fifty-six (66.7%) patients agreed that the treatment had affected mental health, and half 42 (50.0%) of the patients had a view that with treatment, they would get complete hair regrowth. Conclusions: Comprehensive medical and psychosocial support techniques are essential in order to improve the quality of life for patients and address the psychosocial aspects related to alopecia areata.

Frequency of Iron Deficiency Anemia in Children Presenting with Febrile Seizures at Hayatabad Medical Complex, Peshawar: A Cross-Sectional Study

2026-06-01T08:00:33+00:00

Febrile seizures are the most common seizure disorder in early childhood. Iron deficiency anemia has been proposed as a potential risk factor due to iron’s role in neuronal metabolism and neurotransmitter synthesis; however, evidence remains inconsistent, particularly in populations with a high burden of infection. Objective: To determine the frequency of iron deficiency anemia among children presenting with febrile seizures. Methods: This cross-sectional study was conducted in the Department of Pediatrics, Hayatabad Medical Complex, over six months. A total of 103 children aged 6–60 months presenting with simple febrile seizures were enrolled through consecutive sampling. Demographic and clinical data were recorded. Laboratory evaluation included complete blood count, serum ferritin, serum iron, total iron-binding capacity, transferrin saturation, and CRP. Anemia was defined as hemoglobin <11 g/dL, and iron deficiency anemia as anemia with serum ferritin <15 ng/mL. Data were analyzed using SPSS version 26.0. Results: The mean age was 35.47 ± 15.78 months. Anemia was present in 39 (37.9%) children, while iron deficiency anemia was identified in 6 (5.8%). Children with IDA had significantly lower hemoglobin and serum ferritin levels compared to non-IDA children (p=0.001). No significant associations were observed between IDA and demographic or clinical variables. Conclusions: Anemia was common among children with febrile seizures, whereas iron deficiency anemia was infrequent when defined strictly by low ferritin. Given the influence of inflammation on ferritin levels, reliance on ferritin alone may underestimate iron deficiency. Incorporating transferrin saturation and inflammatory markers may improve diagnostic accuracy.

Association of Blood Baseline Parameters with Alpha-Fetoprotein and Its Importance as a Prognostic Factor in Intrahepatic Ductal Carcinoma Patients: An Analytical Cross-Sectional Study

2026-06-01T08:02:17+00:00

Intrahepatic Ductal Carcinoma (IHDC), a subtype of cholangiocarcinoma, is an aggressive liver cancer with a poor prognosis and rising global incidence. Although Alpha-Fetoprotein (AFP) is a common tumor biomarker, its prognostic value in IHDC is limited when used alone. Objectives: To determine the association between AFP and blood baseline parameters to evaluate their combined prognostic significance in patients with IHDC. Methods: This analytical cross-sectional study was conducted at MINAR Cancer Hospital, Multan, Pakistan, from January 2019 to December 2020. A total of 107 histologically confirmed IHDC patients (61 males, 46 females; mean age = 56.8 ± 11.2 years) were included. CBC, LFTs, and serum creatinine were analyzed using standard automated methods, while AFP was measured via electro-chemiluminescence immunoassay (ECLIA). Data were analyzed using SPSS version 24.0. Results: Significant gender-based differences were found in eosinophil counts (p = 0.041) and serum creatinine (p = 0.024). Elderly patients (≥60 years) showed higher monocytes (p=0.030) and Mean Platelet Volume (p=0.002). Across tumor stages, neutrophils increased (66.8% → 78.2%, p<0.001), lymphocytes decreased (25.1% → 18.5%, p < 0.001), and ALP and bilirubin rose significantly (p = 0.021; p=0.008). AFP correlated positively with ALP (r=0.85), SGOT (r=0.79), bilirubin (r=0.86), serum creatinine (r=0.99), and blood urea (r=0.98), and negatively with lymphocytes (r = –0.83). Conclusions: AFP was associated with hepatic, renal, and inflammatory parameters in IHDC, suggesting its potential as a composite biomarker for staging and prognosis.

Prevalence of Depression in Patients with Spondyloarthritis and Its Impact on Disease Activity: A Cross-Sectional Study

2026-06-01T08:00:24+00:00

Spondyloarthritis refers to a chronic inflammatory rheumatic disorder that is characterized by pain, disability, and poor quality of life, potentially predisposing the affected patients to psychological comorbidity, including depression. Depression can hurt disease activity, treatment response, and clinical outcomes, but the burden has not been well acknowledged in clinical practice among patients with spondyloarthritis. Objective: To find the prevalence of depression in patients with spondyloarthritis (SpA) and to identify the association of depression with disease activity. Methods: A cross-sectional study was carried out in the Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan. Adult patients who had verifiable cases of SpA were recruited in the study in six-month consecutive intervals between 1st February and 31st July 2025. Depression status was used to stratify the participants, and pertinent statistical tests were used to evaluate associations of normally and non-normally distributed variables. Independent t-test, Mann-Whitney U, and chi-square tests were used. Any p-value less than 0.050 was taken as statistically significant. Results: The prevalence of depressive symptoms in 323 spondyloarthritis patients was 51.1% with mild and moderate depression. Disease activity (BASDAI), inflammatory markers (ESR, CRP), and disease duration of depressed patients were considerably higher than those of non-depressed patients (p<0.050). Conclusions: Depression is very common among patients living with spondyloarthritis and is characterized by higher disease activity, systemic inflammation, and longer duration of disease, thereby supporting the importance of screening mental health during clinical care.

From Crash to Care: An Interdisciplinary Analysis of Road Traffic Accidents in Pakistan; Unifying Forensic Medicine and Public Health for Causes, Prevention and Emergency Response

2026-06-01T08:02:26+00:00

Road traffic accidents (RTAs) are an emerging public health concern in Pakistan and have become a major cause of death and disability worldwide. The escalation in traffic-related injuries and fatalities has been mostly caused by rapid urbanization, inadequate emergency services, bad infrastructure, and a lack of enforcement of traffic laws. Objectives: To determine the primary causes and contributing elements of traffic accidents in Pakistan. Methods: Secondary data from the District Emergency Service, Rescue 1122, for the years 2022–2023, were used in a descriptive retrospective study design. Data on 12,407 victims of 8,170 RTAs were analyzed. Major risk trends were identified using descriptive and inferential statistics. Results: Almost over 50% of crashes involved motorbikes, with the most impacted age group being those between the ages of 21 and 30. The most common cause of death and disability was head injuries. The most frequent causes were driving underage and speeding. During the study period, 177 fatalities were reported. Conclusions: The results highlight how important it is to improve emergency systems, enforce traffic laws, and raise public awareness in order to reduce RTAs.

Peripheral Neuropathy in Pregnant Women with Iron Deficiency Anemia: A Cross-Sectional Analytical Study

2026-06-01T08:00:05+00:00

Pakistan faces a high burden of nutritional anemias, with iron-deficiency anemia being the most prevalent. Imbalanced iron levels had a central role in neuropathies. Objectives: To assess the prevalence of peripheral neuropathy in pregnant women having Iron deficiency anemia through associated clinical and laboratory Parameters. Method: A cross-sectional analytical study was done at the Department of Obstetrics and Gynecology and the Clinical Neurophysiology Unit of Niazi Welfare Foundation Teaching Hospital, Sargodha, from July 1^st, 2025 to November 30, 2025. A sample of 350 women was targeted using consecutive sampling. Both sensory and motor nerve conduction parameters of the lower limbs and upper limbs were evaluated. Data were analyzed using SPSS version 26. Chi-square tests assessed associations between anemia severity (mild: Hb 10–10.9 g/dL; moderate: 8–9.9 g/dL; severe: <8 g/dL) and peripheral neuropathy at significance level of p-value <0.050. Results: Out of 350 pregnant women, anemia was mild in 98 (28.0%), moderate in 164 (46.9%). Peripheral neuropathy was revealed in 102 women (29.1%,) Neuropathic symptoms involving numbness was revealed in 42.1%, tingling (paresthesia) in 38.7%, burning sensations in 35.5%, & reduced ankle reflexes in 27.4%. This study found a significant association between anemia severity and neuropathy frequency (χ² = 42.9, p<0.001), showing a marked increase in neuropathy prevalence with worsening anemia. Conclusions: Study reported that iron-deficiency anemia is associated with the onset and progression of peripheral neuropathy. These observations suggest that evaluation for iron deficiency should be routinely included when assessing patients presenting with peripheral neuropathy.

Comparison of Tranexamic Acid and Misoprostol in Reducing Blood Loss During Cesarean Section

2026-06-01T08:03:50+00:00

Excessive blood loss during cesarean section remains a major contributor to maternal morbidity and mortality. Various uterotonic and antifibrinolytic agents are used to reduce perioperative hemorrhage, with Tranexamic Acid and Misoprostol being commonly utilized options. However, evidence comparing their effectiveness in reducing intraoperative blood loss is limited. Objectives: To determine whether tranexamic acid or misoprostol is more effective in reducing blood loss during cesarean section. Methods: Between January 2025 and June 2025, this quasi-experimental study was conducted at the Department of Obstetrics and Gynecology, Shahida Islam Medical College, Lodhran. A total of 126 obstetric patients undergoing C-section were allocated into two groups, i.e. Tranexamic Acid group and the Misoprostol group, at the time of anesthesia. Baseline data regarding age, gravida, parity, and abortion history were recorded. Intraoperative mean blood loss was compared by using an independent samples t-test, and p≤0.050 was considered significant. Results: In the Tranexamic Acid group, mean intraoperative blood loss was lower as compared to the Misoprostol group (282.97 ± 82.80 mL vs. 366.68 ± 116.01 mL; p<0.001). Similar results were noted after stratification of gravida, parity, and abortion history. Postoperative hemoglobin and hematocrit decline were also less in the Tranexamic Acid group. Conclusions: Our results suggest that tranexamic acid provides superior control of blood loss during cesarean section when compared with misoprostol. Based on these outcomes, tranexamic acid may be a better choice for prophylactic use to limit intraoperative bleeding in cesarean deliveries.

Career Decision Making, Stress, and Its Association with Emotional Intelligence among Medical Undergraduates at HITEC-IMS Taxila Cantt

2026-06-01T08:02:53+00:00

Medical students are exposed to a wide range of medical specialties during their medical school journey. The most crucial decision at that time is the choice of a career. Objectives: To assess the level of career decision-making stress and determine its association with emotional intelligence among medical undergraduates of HITEC‑IMS, Taxila Cantt. Methods: A cross-sectional study was conducted among HITEC‑IMS medical undergraduates from June to October 2025 via stratified random sampling. Data were collected through a structured questionnaire, covering sociodemographic variables, the Career Decision Difficulty Questionnaire (CDDQ), and the Brief Emotional Intelligence Scale 10 (BEIS-10). SPSS version 26.0 was used for analysis. For continuous variables, mean and standard deviation, and for categorical variables, frequency and percentages were calculated. Association between two variables was seen using Chi Square test and Spearman Correlation. Results: 48.6% individuals experienced moderate career decision stress, with most (62.8%) struggling with a lack of readiness. The majority (85.3%) had average EI, while 14.7% scored below average. Overall, CDDQ showed a significant association with study year (p=0.004), mother and father occupation (p=0.021 and p=0.010), lack of readiness to number of siblings (p=0.033), and year of study with lack of information(p-0.043). Career‑decision stress showed a significant inverse correlation with emotional intelligence (p = –0.404, p<0.001). Conclusions: Almost half of the students face moderate stress in career decision-making, but those with higher Emotional Intelligence tend to experience less of it. Strengthening EI and implementing structured career counselling can be effective strategies to alleviate stress and support more informed, confident career choices.

Integration of Competency-Based Medical Education (CBME) in Undergraduate Curriculum: Opportunities and Challenges in Pakistani Medical Colleges

2026-06-01T08:03:31+00:00

Competency-Based Medical Education (CBME) is an outcome-oriented approach increasingly emphasized in undergraduate medical training. Its successful integration depends largely on faculty understanding and their perceptions of opportunities and barriers. Objectives: To assess the feasibility of integrating CBME into the undergraduate curriculum by examining faculty knowledge, perceived opportunities, and perceived challenges. Methods: This cross-sectional study was conducted at the Department of Medical Education, CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan, from September 2024 to December 2024. Seventy-eight faculty members involved in undergraduate teaching were included through non-probability consecutive sampling. A structured self-administered questionnaire was used. The knowledge domain comprised five items scored 0-5; scores of 0-2 were categorized as inadequate knowledge and 3-5 as adequate knowledge. Opportunity and challenge domains were summarized as mean composite scores. Data were analyzed in SPSS version 26.0 using chi-square and independent-samples t-tests, with p<0.05 considered significant. Results: Mean age was 45.27 ± 9.17 years, and mean teaching experience was 12.17 ± 7.48 years. Mean CBME knowledge score was 2.50 ± 1.09. Knowledge level was significantly associated with gender (p=0.007). Faculty aware of PMDC guidelines had significantly higher Opportunity Scores (p=0.020). Challenge Scores did not differ significantly across subgroups. Conclusions: Faculty demonstrated modest knowledge of CBME, while perceptions of opportunities improved with greater policy awareness. Shared challenge scores suggest the need for broader institutional support, faculty development, and clearer dissemination of CBME guidance.

Frequency of Neonatal Morbidity and Mortality in Intrauterine Growth-Restricted Term Pregnancies in Karachi: A Hospital-Based Cross-Sectional Study

2026-06-01T08:00:14+00:00

Intrauterine growth restriction (IUGR) is a major cause of illness and death in neonates. Growth-restricted term neonates are susceptible to hypoglycemia, respiratory distress, and perinatal mortality. Objective: To determine the frequency of neonatal morbidity and mortality among intrauterine growth-restricted (IUGR) term pregnancies. Methods: A hospital-based cross-sectional study was performed at the Department of Obstetrics and Gynecology, Liaquat National Hospital, Karachi, from June to November 2024. A total of 143 women with singleton term pregnancies (≥ 37 weeks diagnosed with intrauterine growth restriction (IUGR) due to estimated fetal weight below the 10^th percentile were enrolled through consecutive sampling. Neonatal outcomes were documented. Categorical variables were presented as frequency and percentage. A p-value of ≤ 0.005 was deemed statistically significant. Results: The median maternal age was 29 years, with a 30.8% having a history of IUGR and 37.8% experiencing intrauterine death; 53.1% delivered vaginally and 46.9% through a cesarean section. Meconium aspiration occurred on 31.5%, low birth weight in 9.1%, and NICU admission in 35.0%, with hypoglycemia (2.1%) and perinatal mortality (4.9%) being uncommon. Lower maternal age was associated with low birth weight and hypoglycemia, adverse Apgar scores with adverse neonatal outcomes, and increased NICU admission after cesarean delivery. Conclusions: Intrauterine growth-restricted term pregnancies are strongly associated with adverse perinatal outcomes, including respiratory compromise, metabolic instability, and increased risk of mortality.

Diagnostic Accuracy and Surgical Outcomes of Deep Infiltrating Endometriosis Involving the Urinary Tract: A Systematic Review

2026-06-01T08:00:44+00:00

Deep infiltrating endometriosis (DIE) involving the urinary tract represents a severe phenotype of endometriosis that poses major diagnostic and surgical challenges. Accurate preoperative imaging and optimal surgical management are essential to prevent silent obstruction and long-term renal damage. Objectives: To evaluate the diagnostic accuracy of imaging modalities and to summarize surgical outcomes in patients with urinary tract deep infiltrating endometriosis. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched for studies published between January 2018 and March 2025. Diagnostic-accuracy studies and outcome-only surgical cohorts were synthesized as distinct evidence streams. Methodological quality was assessed using QUADAS-2 for diagnostic studies and the Newcastle–Ottawa Scale for surgical cohorts. Results: Twelve studies were included, comprising two formal diagnostic-accuracy studies and ten surgical outcome cohorts. Transvaginal ultrasonography using the IDEA protocol demonstrated high diagnostic performance (sensitivity 93.9%, specificity 99.4%, accuracy 98.7%), while magnetic resonance imaging showed good sensitivity (83.3%) and excellent negative predictive value (93.5%). Most surgical cohorts reported favorable postoperative outcomes with low urinary tract–specific recurrence when managed in specialized centers. However, none of the studies reported confidence intervals or complete diagnostic contingency matrices. Conclusions: Transvaginal ultrasonography and magnetic resonance imaging are complementary and highly specific modalities for diagnosing urinary tract DIE, and minimally invasive surgery yields favorable outcomes. Standardized diagnostic reporting and prospective multicenter diagnostic-accuracy studies are required to strengthen evidence-based clinical pathways.

Role of Cytochrome P450 Enzymes in Pediatric Drug Metabolism: Physiological and Biochemical Perspectives; Systematic Review

2026-06-02T07:59:58+00:00

Cytochrome P450 (CYP450) enzymes are central to pediatric drug metabolism. However, enzyme maturation (ontogeny) and pharmacogenetic variability produce substantial age-dependent differences in drug clearance, exposure, and toxicity risk across neonatal, infant, and childhood populations. Objectives: To synthesize contemporary evidence (2020–2025) on CYP450 ontogeny and pharmacogenetic variability in children and evaluate their clinical implications for drug clearance, dosing optimization, and safety. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched for pediatric studies evaluating CYP450 ontogeny, pharmacokinetics, or pharmacogenetics. Eligible designs included observational studies, physiologically based pharmacokinetic (PBPK)/population PK modeling, real-world analyses, and systematic reviews. Risk of bias was assessed using the Newcastle–Ottawa Scale and AMSTAR. Due to heterogeneity, findings were synthesized narratively. Results: Sixteen studies from Asia, Europe, North America, and Australia were included. CYP2C19, CYP3A4, and CYP2D6 were the most frequently investigated isoforms. Ontogeny demonstrated enzyme-specific maturation patterns: CYP3A4 and CYP2C19 activity increased rapidly during infancy, whereas CYP2D6 and CYP1A2 matured more gradually, contributing to reduced neonatal clearance and prolonged half-life of several substrates. Clinically significant genotype–drug interactions were consistently reported for CYP2D6–codeine and CYP2C19–voriconazole/proton pump inhibitors, where poor or ultrarapid metabolizer phenotypes markedly altered exposure and toxicity risk. Evidence supports genotype-guided dosing and therapeutic drug monitoring for selected high-risk drugs. Conclusions: Pediatric drug clearance is governed by enzyme-specific maturation and functional polymorphisms. Integrating developmental dosing principles with targeted pharmacogenetic strategies may improve therapeutic precision and reduce avoidable toxicity in children.