Pakistan Journal of Health Sciences

A Climate Wake-Up Call: Pakistan’s Floods Reveal a Healthcare Crisis

Riffat Mehboob — 2025-06-30

Flooding has become a recurring nightmare in Pakistan, exacerbated by both natural and human-induced factors. The devastating monsoon floods of 2022 exposed the country’s deep vulnerability, damaging nearly 2,000 health facilities showing 13% of all in the country, and displacing more than 600,000 people. Vast areas of farmland, including three million acres of cereal crops and over 1.2 million livestock, were lost, severely disrupting food security and livelihoods.

Since July 2022, floods have inundated 116 districts, affecting 33 million people and placing immense strain on the already fragile healthcare system. More than 1,000 people lost their lives, 1,500 were injured, and over 161,000 were forced into overcrowded and unhygienic relief camps. As of now, 66 districts remain critically impacted. This crisis is not just a one-off disaster it is a symptom of worsening climate extremes, poor planning, and under-resourced public infrastructure. In 2025 alone, Pakistan has already witnessed deadly spring weather, including severe hailstorms, which claimed at least 32 lives.

The 2025 Climate Risk Index ranks Pakistan as the world’s most climate-impacted country, based on data from 2022. A third of the country was submerged, over 1,700 lives were lost, and economic damages surpassed $30 billion. At least 6.4 million people still require humanitarian assistance, and healthcare access remains dangerously limited. Although roughly half of the displaced population has returned home, the absence of clean water and sanitation continues to drive the spread of disease.

As the nation reels under relentless monsoon rains and deteriorating conditions, a public health emergency is unfolding silently alongside the visible destruction. The World Health Organization (WHO) has warned that flooding is fueling outbreaks of diseases such as dengue, malaria, acute watery diarrhea, COVID-19, and polio. With immunization campaigns disrupted and stagnant water everywhere, disease is spreading unchecked. Even before the floods, Pakistan had recorded over 4,500 measles cases and 15 instances of wild poliovirus. These fragile public health gains are now at grave risk.

In response, the World Health Organization (WHO) and Pakistan's Ministry of National Health Services are maintaining emergency operations in the affected regions. They are concentrating on long-term preparedness, healthcare restoration, medicine supply, and disease surveillance. However, it is imperative that these endeavors be dramatically increased. Millions of individuals continue to be vulnerable to preventable illnesses due to their lack of access to basic care and proper sanitation. This crisis is no longer solely about water; it is also about the future of healthcare, resilience, and survival in a world that is warming. Pakistan's silent emergency may soon become too loud to ignore if sustained action is not taken.

Histopathological and Radiological Findings in Nasolabial Cysts

Vijay Kumar Khatri — 2025-06-30

Nasolabial cysts are relatively rare, non-odontogenic soft tissue cysts that are usually found in the nasolabial fold, just beneath the nasal ala. Objectives: To analyse the clinical, histopathological, and radiological features of nasolabial cysts and evaluate their association with symptom duration, cyst size, and bone remodelling. Methods: This retrospective case series study included 10 patients diagnosed with nasolabial cysts. Patient data, including age, gender, ethnicity, cyst size, location, and duration of symptoms, were collected. Radiological assessments focused on bone remodelling and scalloping through computed tomography (CT) scans. Histopathological examination of excised cysts assessed the type of epithelial lining. Statistical analysis was performed to evaluate associations between cyst characteristics, symptom duration, and radiological findings, using Pearson’s correlation and Chi-square tests. Results: The mean age of patients was 44.9 years, with a male predominance (60%). A significant association was found between longer symptom duration and the presence of bone changes on CT (p=0.03), and a moderate positive correlation existed between cyst size and symptom duration (r=0.32, p=0.009). Conclusions: It was concluded that nasolabial cysts can lead to bone remodelling when symptoms persist for extended periods. Early diagnosis and treatment are critical in preventing complications. Further research is needed to explore minimally invasive treatment approaches for managing nasolabial cysts.

Obstetric Outcomes after Cervical Cerclage in Women with Cervical Insufficiency

Mahjabeena Bilal — 2025-06-30

Most of the local studies in Pakistan have focused only on the prevention of preterm labour after cervical cerclage in women with cervical insufficiency. Still, these studies lack data regarding other outcomes like abortion and premature rupture of membranes after cervical cerclage in women with cervical insufficiency. Objective: To determine the obstetric outcomes after cervical cerclage in women with cervical insufficiency. Methods: This descriptive study was carried out at the Gynaecology Department, Khyber Teaching Hospital, during the period 22^nd May 2024 till 31^st March 2025. Women aged 18-35 years with gestational age 13 to 20 weeks and transvaginal ultrasound showing cervical length <2.5cm were enrolled. Cervical cerclage was performed, and pregnancy outcomes were noted in terms of miscarriage, preterm, PROM, prolonged pregnancy and term pregnancy. Results: Mean age of the participants was 30.42 ± 5.616 years, mean BMI was 24.070 ± 2.704kg/m² and mean gestational age was 24.37 ± 4.844 weeks. 85 patients (50.3%) were aged more than 30 years. Participants with parity up to 3 were 94 (55.6%), and 126 patients (74.6%) were housewives. Preterm was the most common pregnancy outcome, recorded in 58 patients (34.3%), 34 patients (20.1%) had a term pregnancy, and prolonged labor was the least common (n=8, 4.7%). Conclusions: Preterm delivery was the most common pregnancy outcome after cervical cerclage in this cohort of patients. However, a reasonable number of patients were found with a term pregnancy, showing the adequate prolongation of pregnancy with cerclage in cervical insufficiency.

Diagnostic Accuracy of Chest Ultrasound in Diagnosing Rib Fractures, Keeping CT Chest as Gold Standard

Sara Rashid — 2025-06-30

Blunt chest trauma is a frequent cause of emergency visits with a high risk of rib fractures, timely identification of which is crucial for effective patient management. Objectives: To assess the accuracy of chest ultrasound in diagnosing rib fractures, keeping CT chest as a gold standard. Methods: A cross-sectional validation study was conducted at the Radiology Department, Holy Family Hospital, Rawalpindi, for six months (Jun–Nov 2023). Adult patients presenting with blunt chest trauma in the Emergency Department who fulfilled eligibility criteria were included. The presence of rib fractures was assessed in each patient by chest ultrasound and verified by CT chest. The diagnostic power of the ultrasound method was assessed and reported as sensitivity, specificity and predictive values by comparison with the gold standard. Results: The mean age reported was 35.3 ± 5.93 years; there were 61 (57.5%) male and 45 (42.4%) female. The accuracy of chest ultrasound in detecting rib fracture, with CT-chest as the reference standard, demonstrated 92.1% sensitivity, 95.2% specificity, 96.7% and 88.8% positive and negative predictive values, and an accuracy of 93.3%. Conclusions: It was concluded that chest ultrasound has good diagnostic power (93.3%) to establish the diagnosis of broken ribs in patients with trauma in emergency settings compared with CT-chest scan.

Association of C-Reactive Protein and D-dimer Status with Maternal Outcomes in Pregnant Women with COVID-19

Summera Aslam — 2025-06-30

C-reactive protein (CRP) and D-dimer are crucial biomarkers that play a key role in maternal health, helping to assess risks and minimize complications. Objectives: To find the association of CRP and D-dimer status with maternal outcomes in pregnant women with COVID-19. Methods: The prospective cohort study was carried out at the Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to September 2020. Demographic data, laboratory parameters including COVID-19, D-dimer and CRP levels and maternal outcomes were recorded. Crosstabs and binary logistic regression analyses were performed to measure the risk of adverse maternal outcomes. Results: Among 112 COVID-19 suspects, 58 (51.8%) were diagnosed as COVID-19 positive, 82 (73.2%) tested positive for CRP, and 19 (17.0%) were D-dimer positive. COVID-19 positive women exhibited twice the mean D-dimer levels (0.92 ± 1.36 vs. 0.43 ± 0.70 µg/mL) and a slightly lower mean CRP level (26.47 ± 31.55 vs. 29.30 ± 32.79 mg/L). Ventilator requirement (32.8% vs. 11.1%) and maternal death rate (29.3% vs. 11.1%) were three times higher in COVID-19 positive cases as compared to the COVID-19 negative cases.CRP positive status and COVID-19 positive showed a statistically significant association and higher risk for ventilator requirement as well as maternal death. However, D-dimer positive status did not show any association with ventilator requirement and maternal death. Conclusions: COVID-19 positivity and CRP positivity in pregnant women are associated with adverse maternal outcomes, including increased ventilator requirement and mortality. However, D-dimer positivity was not related to these adverse maternal outcomes.

Prevalence and Effects of Self-Medication Practice among Pharmacy Students: A Cross-Sectional Study in Karachi

Leena Anjum — 2025-06-30

The prevalence of self-medication is notably high among medical students compared to the general population, which is primarily attributed to advanced knowledge of pharmacology and easier access to pharmaceuticals either through educational resources or hospital attachments, potentially underestimating the risks involved. Objectives: To determine the prevalence and effects of self-medication practice among pharmacy students: a cross-sectional study in Karachi. Methods: The study employed a cross-sectional descriptive design conducted on 283 pharmacy students using a structured, self-administered questionnaire developed specifically. The collected data were analyzed by SPSS-21 software. Results: The outcomes revealed the response rate of 92.93%, with the largest group of participants (23%) being first-year students, comprised mainly female respondents (72.24%), between the ages of 21-23. The relationship between both age and year of study with the usage of self-medication without consulting a doctor is found to be significant. Students were engaged in the use of self-medication occasionally. The commonly reported symptoms and conditions practiced were headaches (55.1%). However, a statistically significant relationship was observed between certain medical conditions, particularly fever, diarrhea, and nausea/vomiting, and gender. Further evaluated perceptions of the safety of self-medication, with statistical analysis highlighting significant associations with both age (p=0.036) and year of study (p=0.014). Conclusions: The Prevalence of self-medication among pharmacy students is high. It is needed to focus on developing and implementing programmes about the risks of self-medication, and to ensure self-practices along with a control system and monitoring of drug sales by health decision-makers and policymakers.

Association of Cutaneous Manifestations with Undiagnosed Diabetes Mellitus in Adults

Muhammad Zubair — 2025-06-30

Diabetes mellitus (DM) remains underdiagnosed in resource-limited settings, where access to laboratory screening is constrained. Cutaneous manifestations may serve as visible, cost-effective indicators. Objectives: To determine the association between characteristic skin lesions (acanthosis nigricans, skin tags, xerosis) and undiagnosed diabetes in adults. Methods: A cross-sectional study involving 400 participants was conducted at a Teaching Hospital with adult patients without known diabetes (aged 18–70) attending dermatology and general medicine clinics. Detailed dermatological examinations documented predefined skin manifestations, while biochemical assessments (fasting plasma glucose, HbA1c, and oral glucose tolerance test) classified participants into normoglycemic, pre-diabetic (IFG/IGT), or diabetic groups per ADA criteria. Statistical analysis was done on SPSS version 26.0. Results: The prevalence of cutaneous markers was significantly higher in prediabetes and diabetes groups (p<0.001). Acanthosis nigricans was present in 61.4% of cases, nearly eight times more prevalent than in normoglycemic individuals (8.1%). Similarly, multiple skin tags (≥5) affected 52.9% of diabetics compared to just 12.4% of controls, while xerosis showed a fourfold increase from 9.5% in normoglycemic subjects to 44.3% in diabetics. Conclusions: It was concluded that specific dermatological manifestations exhibit a robust correlation with undiagnosed diabetes and pre-diabetes. Incorporating cutaneous markers into routine clinical examinations may enhance early detection, particularly in resource-limited settings.

Caregiver-Reported Reasons and Outcomes of Treatment Default among Pediatric Oncology Patients at a Tertiary Care Hospital in Pakistan

Aimen Gull — 2025-06-30

Despite the availability of free care, many children in Pakistan fail to complete cancer therapy, leading to poor outcomes and increased mortality. Objective: To determine reasons and outcomes of pediatric cancer patients defaulting treatment at tertiary care hospital in Pakistan. Methods: This descriptive cross-sectional study was conducted at Pediatric Hematology/Oncology unit of Children Hospital, Lahore. Total 82 pediatric oncology patients (<16 years) who started treatment but defaulted at any stage between 1st January and 30th June 2024 were included. Caregivers were interviewed regarding default reasons, and relevant clinical data were analyzed using SPSS version 27.0 for descriptive statistics. Results: Most frequently reported contributing factors were financial issues (100%), out-of-pocket expenses (98.8%), long travel distance (92.7%), and poor socioeconomic status (91.5%). Family-related challenges included other responsibilities (89%), parental job issues (84.1%), poor understanding of disease (81.7%), and lack of family support (63.4%). Additional reasons included large family size (72%) and family pressure to abandon treatment (29.3%). Patient-related causes were faith-based healing (50%), perceived long treatment duration (31.7%), consent withdrawal (25.6%), and fear of surgery (18.3%). System-related barriers included treatment unavailability (11%) and dissatisfaction with care (7.3%). Upon return, 54.3% were eligible only for palliative care, 25.6% resumed curative treatment, 14.8% expired, 3.7% were cured, and 2.5% were lost to follow-up. Conclusion: Treatment default in pediatric oncology is driven by financial, social, and systemic challenges. Overcoming these obstacles is essential to enhance treatment adherence and improve patient outcomes.

Beyond Weight Loss: Investigating Irritability and Mood Swings after Bariatric Surgery: A Prospective Study

Mushtaq Ahmad — 2025-06-30

The physical changes after bariatric surgery are evident, but the significant changes in psychological and emotional effects are underscored and have not received much attention. Objectives: To determine the prevalence of Irritability and Mood Swings After Bariatric Surgery and its impact on hormonal and nutritional changes. Methods: This prospective observational study was conducted from February 2022 to January 2023. Patients undergoing any type of bariatric surgery with no existing psychiatric conditions that required medication were included. Structured questionnaires were distributed among the participants, and informed consent was also provided. Results: The study comprised 1,014 patients, with a mean age of 33 ± 13 years. According to the Profile of Mood States (POMS), 679 (67%) of participants had clinically severe mood abnormalities before surgery, which then increased to 844 (83%) at three months and then reduced to 355 (35%) at six months (p<0.001). Compared to 740 (73%) before surgery, 902 (89%) of patients experienced moderate to severe irritation at three months (p<0.001). After six months, this percentage dropped to 446 (44%). Conclusions: The research concluded notable changes in mood, irritability, and hormone levels after bariatric surgery, including increased irritability and mood disturbance at three months, with improvement at six months. Prevalent nutritional deficiencies of vitamins B12 and D regression were also found to be associated with increased mood and irritability. Multiple hormonal variations and nutritional deficiencies were found to result in postoperative mood variation significantly.

Prevalence of Vitamin D Deficiency in Pregnant Women and Its Association with Musculoskeletal Pain: A Cross-Sectional Study

Muneeb Ur Rehman — 2025-06-30

Vitamin D deficiency is recognized as widespread public health issue especially prevalent in pregnant women, has been associated with negative maternal health consequences, including musculoskeletal pain. Objective: To assess vitamin D levels during pregnancy and explore their association with musculoskeletal pain in pregnant women Methods: A cross-sectional study was performed at a teaching hospital in Sargodha over a 16-month period (09/2023-12/2024). Biochemical assessment of vitamin D status was performed through serum 25(OH)D quantification, while musculoskeletal symptoms were documented using structured pain questionnaires. Statistical evaluation, including chi-square analysis of associations, was performed using SPSS Statistics version 26.0. Results: Out of 250 pregnant women, 72.4% (n=181) had deficiency of vitamin D (<20 ng/mL), while 18% (n=45) had insufficiency (20-30 ng/mL). The association revealed between vitamin D deficiency and musculoskeletal pain was significant as (p <0.001), moderate to severe pain was evident in 68.2% of deficient women compared to 31.8% in the sufficient group (≥30 ng/mL). Conclusions: Current evidence reveals alarmingly high rates of vitamin D deficiency among pregnant women and is significantly associated with musculoskeletal pain. Routine screening and supplementation should be considered to improve maternal health outcomes.

Association Between Anemia and Prevalence of Gestational Diabetes vs Non-Gestational Diabetes among Pregnant Women

Safder Ali Pervez — 2025-06-30

Gestational diabetes mellitus (GDM) affects a large number of pregnant women globally and generates significant health complications for both mothers and their newborns. Objectives: To establish anemia prevalence among pregnant women with and without gestational diabetes mellitus (GDM) by investigating how various demographic and clinical factors influence this relationship. Methods: A six-month comparative cross-sectional study was conducted at Khairpur Medical College, Khairpur Mir’s. The study enrolled pregnant women n=200 between 18-40 years of age who had single child pregnancies during the gestational period of 24 to 28 weeks. The criteria established by WHO distinguished anemia while the diagnosis of GDM followed the OGTT results using a 75g Oral Glucose Tolerance Test (OGTT) as per WHO/ADA 2013 guidelines. Data were analyzed using descriptive statistics with chi-square tests and logistic regression. Results: The mean age of maternal individuals (29.8 years) along with body mass index (BMI 29.4 kg/m²) was higher in GDM group members than in non-GDM group individuals; p<0.001. GDM mothers had higher anemia prevalence at 78.3% compared to 57.1% in the other group (p=0.004), alongside lower average hemoglobin measurement results (9.8 g/dL compared to 10.5 g/dL, p=0.001). The analysis using logistic regression established both anemia along BMI and maternal age as independent risks for GDM diagnosis (OR: 2.35, p=0.006). Conclusion: It was concluded that anemia occurs more frequently in pregnant women with GDM, while remaining an independent GDM factor, which also correlates with elevated maternal age and BMI compared to non-GDM women.

Changes in Blood Pressure and Pulse Rate in Patients Following the Injection of Lidocaine with 2% Adrenaline in A Mandibular Nerve Block

. Misbah — 2025-06-30

Local anaesthetic like lidocaine are commonly used in dental and maxillofacial procedures, but their systemic vasoconstrictive effects can cause physiological changes, especially in cardiovascular parameters. Objectives: To evaluate the blood pressure and pulse rate alterations in patients after administering a mandibular nerve block using 2% lidocaine with adrenaline. Methods: Three hundred patients aged 14-60 who came for extraction were selected through non-probability consecutive sampling. Clinical examinations were performed, and diastolic, systolic blood pressure, and pulse rate were recorded with an automatic digital blood pressure monitor in four stages (before local anesthesia (5 minutes’ rest), before local anesthesia (sitting at chair), after local anesthesia (immediate) and after local anesthesia (10 minutes)). Results: A study of 300 mandibular nerve block patients found that male patients (69.3%) and female patients (30.7%) had a mean age of 32.95 ± 11.19 years. Blood pressure, pulse rate, and oxygen saturation significantly varied in all four stages. In the first stage, most patients had normal blood pressure (120/80 mmHg), while in stages 2-4, most had stage 1 blood pressure (139/89 mmHg). In stages 3 and 4, patients had stage 2 blood pressure (140/90 mmHg), and in stage 4, 1.3% experienced hypertensive crisis. In stages 1-4, most patients had normal pulse rate, followed by tachycardia and bradycardia. Conclusions: The study found significant differences in blood pressure and pulse rate among patients after administration of a mandibular nerve block using 2% lidocaine with adrenaline.

Assessing the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Pyelolithotomy or Nephrectomy Patients

Sumayya Tariq — 2025-06-30

Nephrectomy and pyelolithotomy are invasive surgical procedures often associated with significant postoperative pain, necessitating effective analgesia for optimal recovery. Objectives: To evaluate the efficacy of ultrasound-guided erector spinae plane block (ESPB) in patients undergoing nephrectomy or pyelolithotomy, with a focus on pain relief, dermatome coverage, and duration of analgesia. Method: This quasi-experimental study was conducted over 12 months in the Anesthesia Department of Sharif Medical City Hospital, Lahore, enrolling 66 patients. After receiving ESPB, postoperative pain was assessed using the Visual Analogue Scale (VAS) at rest, where 0 indicated no pain and 10 indicated the worst possible pain. Dermatomal coverage was evaluated via pinprick testing, and the time to first rescue analgesia was recorded. Data analysis was performed using SPSS version 25.0. Results: Out of the 66 patients, 47 were male and 19 female. VAS scores showed a significant reduction from 2.98 ± 1.31 at 24 hours to 0.87 ± 0.83 at 72 hours (p=0.000). Pain on movement significantly decreased (p=0.000), while sleep quality showed no significant improvement. The proportion of patients reporting adequate pain relief rose from 67.3% at 24 hours to 81.5% at 72 hours (p=0.000). Peak rescue analgesia demand occurred at 15–16 hours postoperatively (25 patients), indicating prolonged initial analgesia. Conclusions: It was concluded that the ultrasound-guided erector spinae plane block (ESPB) effectively manages pain, significantly reducing VAS scores over 72 hours. This method delivers high-quality analgesia with consistent dermatome coverage following pyelolithotomy and nephrectomy.

Barriers to the Implementation of Evidence-Based Practice in A Tertiary Care Hospital Mirpur, Azad Kashmir, Pakistan: A Cross-Sectional Study

Safia Noreen — 2025-06-30

An approach to providing care to patients is based on problem-solving decisions on the greatest reliable and current data is known as Evidence-Based Practice (EBP). Objective: To assess the organizational and individual barriers to implementing Evidence-based practice among registered nurses in a tertiary care hospital in Mirpur, Azad Kashmir. Methods: A descriptive cross-sectional study was conducted from December 2023 to July 2024 at a tertiary care hospital in Mirpur, Azad Kashmir. Data were collected from 120 registered nurses from different departments with more than one year of clinical experience. The sample size was determined using the Yamane formula. Before starting the data collection process, the study protocol was approved by the Institutional Review Board, and written informed consent was obtained before data collection. A validated questionnaire comprises 24 statements on a five-point Likert scale from strongly disagree to strongly agree was used. Results: The most significant organizational barriers are lack of financial encouragement for using evidence-based practice (M = 4.41), inadequate resources at the workplace (M = 4.25), limited access to updated nursing journals (M = 4.39), and lack of human resources to implement EBP (M = 4.24). Resistance to adopting new strategies (M = 4.22) and limited autonomy in modifying procedures (M = 4.15) are the most common individual barriers. Conclusions: The study highlighted the prevalence of practical barriers that prevent nurses from implementing evidence-based practice and emphasizes the need for healthcare organizations to address them.

Labor Augmentation in Primigravida: A Comparative Evaluation of Drotaverine and Tramadol

Maria Tasneem — 2025-06-30

Prolonged labor increases maternal and fetal risks. Pharmacological agents such as Drotaverine hydrochloride and Tramadol have been utilized to shorten the duration of labor by facilitating cervical dilation and uterine activity. However, comparative evidence regarding their efficacy and safety remains limited. Objective: To compare the effectiveness of Drotaverine hydrochloride and Tramadol in reducing the duration of active labor in primigravida women, and to assess associated maternal and neonatal outcomes. Methods: This quasi-experimental study was conducted at the Department of Obstetrics and Gynecology, Niazi Medical and Dental College, Sargodha. A total of 146 primigravida women in active labor were divided into two groups (n=73 each) using non-probability consecutive sampling. Group A received intravenous Drotaverine hydrochloride (40 mg every 2 hours, up to 3 doses), while Group B received intramuscular Tramadol (100 mg, single dose). Duration of labor stages, cervical dilation rate, maternal side effects, and neonatal outcomes were recorded and analyzed using SPSS version 20.0. A p-value ≤ 0.05 was considered significant. Results: The first stage of labor was significantly shorter in the Drotaverine group (208.7 ± 38.5 min) compared to the Tramadol group (228.9 ± 42.3 min, p = 0.001). Drotaverine also showed a significantly higher cervical dilation rate and fewer maternal side effects such as nausea and dizziness. Neonatal outcomes were comparable between both groups. Conclusion: Drotaverine hydrochloride was more effective than Tramadol in shortening the first stage of labor with fewer maternal side effects, making it a preferable agent in primigravida labor management.

Comparison of Pressure Support versus T-Piece Trial for Weaning from Mechanical Ventilation

Sheeza Bashir — 2025-06-30

Post-operative patients are particularly vulnerable to hazardous effects of prolonged ventilation owing to their limited reserves, catabolic state and acute injury related to surgical incision and dissection. Thus, early weaning protocols are required for better outcome in this population. Objective: To compare PSV versus T-Piece trial for weaning from Mechanical Ventilation. Methods: The quasi experimental study was conducted at ICU of Mayo Hospital Lahore from 28-05-2021 to 28-11-2021. Total 60 patients undergoing elective post-operative mechanical ventilation were selected after taking written informed consent. Patients were divided in two groups, Group A: Pressure support ventilation and Group B: T piece ventilation. Frequency and percentage of successful extubation were recorded in both groups. Data were analysed with SPSS version 26.0. Frequency of successful extubation was compared using chi square test taking p-value ≤0.05 as significant. Results: In Group A, 93.33% (n=28) of patients had successful extubation, while only 66.66% (n=20) patients in Group B had successful extubation, p-value=0.009. Conclusion: This study indicated that PSV results in successful extubation and liberation from mechanical ventilation than T piece trial.

Comparing Probiotics Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy

Omer Hassaan Aftab Ahmad — 2025-06-30

A neuropsychiatric condition known as hepatic encephalopathy (HE) is brought on by liver malfunction, which accumulates poisons like ammonia and impairs brain activity. Objectives: To compare the viability of combining probiotics with lactulose versus utilizing lactulose alone within the treatment of obvious hepatic encephalopathy. Methods: This quasi-experimental study took place in the Gastroenterology and Hepatology Department at the Pakistan Institute of Medical Sciences in Islamabad from August 2019 to January 2020. A total of 160 patients diagnosed with overt HE were included and divided into two groups. Group A received a combination of probiotics and lactulose, while Group B received lactulose alone. Treatment outcomes were evaluated over six months based on improvement in HE symptoms, Model for End-Stage Liver Disease (MELD) scores, length of hospital stay, and potential precipitating factors. Results: The mean age of participants was 44.08 ± 11.31 years. Group A comprised 64 males (80%) and 16 females (20%), while Group B had 30 male (37.5%) and 50 female (62.5%). The MELD scores were comparable between groups (p=0.648). However, the mean hospital stay was significantly shorter in Group A (2.34 ± 0.56 days) than in Group B (2.42 ± 0.63 days; p<0.05), indicating enhanced recovery in the combination therapy group. Conclusions: The addition of probiotics to lactulose significantly improves clinical outcomes in patients with overt hepatic encephalopathy by reducing hospital stay and enhancing treatment efficacy.

Detection of Intrauterine Growth Retardation in 2nd And 3rd Trimester with Fetal Parameters and Umbilical Artery Doppler

Sidra Saleem — 2025-06-30

Intrauterine Growth Restriction (IUGR) occurs when a fetus fails to reach its growth potential. Ultrasound plays a key role in diagnosis by assessing fetal biometry, and estimated weight. Umbilical artery Doppler studies evaluate placental function, with abnormal findings like increased resistance or absent/reversed end-diastolic flow. Objective: To detect Intrauterine growth retardation in 2^nd and 3^rd trimester with fetal parameters and umbilical artery doppler. Methods: This descriptive cross-sectional research took place at Diagnostic centre, Combined Military Hospital, Lahore from September to December 2024. All eligible 130 females in 2^nd and 3rd trimester had recruited excluding females with Polyhydromnias. The examination involved the use of a curvilinear transducer (3-5MHz). Non probability convenient technique was employed for data collection. IBM (SPSS) version 26.0 was used for data analysis. For inferential statistics, Chi square test was employed. Statistical p-value <0.05 was considered as a significant value. Results: The study involved 130 pregnant women (mean age 28.82 ± 4.64), with 29.2% in the 2nd and 70.8% in the 3rd trimester. IUGR history (25.4%), gestational hypertension (50.8%), and diabetes (19.2%) were noted. IUGR was diagnosed in 52 cases with 3–6week growth delays. Abnormal PI values in all cases confirmed PI as a reliable marker. Conclusions: In conclusion, fetal biometric parameters (BPD, HC, AC, FL) below the 10th percentile indicated IUGR in over one-third of 2nd and 3rd trimester pregnancies, with growth lags of 15–43 days. Abnormal umbilical artery Doppler PI was present in all IUGR cases, highlighting PI as a consistent and reliable detection marker.

Age-Specific Risk Factors and Post-Operative Complications in Patients with Intestinal Obstruction

Hassan Shoukat — 2025-06-30

Intestinal obstruction is among the most prevalent surgical challenges, which impacts millions of individuals and contributes significantly to morbidity and mortality. Objectives: To investigate the age-specific causes and post-operative complications in patients with intestinal obstruction. Methods: All patients who were clinically diagnosed with intestinal obstruction and subsequently underwent surgical intervention were enrolled in this prospective study. Participants were categorized into four age groups. Patients found to have peritonitis without evidence of obstruction during laparotomy were excluded. Operative and histopathological findings were documented, and the data were summarized using frequencies and percentages. Results: The study included 305 patients, 146 males (47.9%) and 159 females (52.1%). The most common causes of intestinal obstruction in group A were tuberculosis (n=32, 35.2%), and adhesions (n=22, 33.3%) were a common etiological factor in group B; malignancies predominated in the elderly. The incidence of post-operative complications was 7.21%. Conclusions: It was concluded that the etiology of intestinal obstruction in adults varies significantly with age, necessitating age-specific diagnostic and therapeutic approaches.

Frequency of Types of Jejunoileal Atresia among Neonates Presenting With Intestinal Obstruction

Fatima Majid — 2025-06-30

Jejunoileal Atresia (JIA) is a significant cause of neonatal intestinal obstruction, accounting for a substantial number of surgical emergencies in the first weeks of life. It results from congenital occlusion of the intestinal lumen, primarily due to intrauterine vascular accidents. Despite improvements in surgical techniques and neonatal care, early diagnosis and intervention remain critical for favorable outcomes. Objective: To determine the frequency of common types of jejunoileal atresia among neonates presenting with intestinal obstruction. Methods: This descriptive cross-sectional study was conducted at the Department of Paediatric Surgery, National Institute of Child Health (NICH), Karachi, from November 16, 2019, to May 15, 2020. A total of 97 neonates diagnosed with intestinal obstruction and meeting the inclusion criteria were enrolled. Detailed history, antenatal workup, and clinical examination were recorded. Diagnosis was confirmed intraoperatively, and types of JIA were documented. Results: The mean age at presentation was 5.78±4.24 days. Among the 97 neonates, 42 (43.3%) were male and 55 (56.7%) were female. The distribution of JIA types was as follows: Type I in 20 cases (20.6%), Type II in 11 cases (11.3%), Type IIIa in 45 cases (46.4%), Type IIIb in 10 cases (10.3%), and Type IV in 11 cases (11.3%). Conclusions: Type IIIa was identified as the most frequent type of jejunoileal atresia. Early recognition and surgical management are essential to reduce morbidity, mortality, and length of hospital stay in affected neonates.

Prevalence of Speech and Language Disorders in Children Presenting to a Tertiary Care Center

Kausar Aftab — 2025-06-30

Speech and language disorders (SLDs) are among the most common developmental challenges in children. While some children may experience only a speech disorder or a language disorder. Objective: To determine the prevalence of SLDs in children presenting to a tertiary childcare hospital in South Punjab, Pakistan. Methods: This cross-sectional study was conducted at the Developmental and Behavioural Pediatric Department, The Children’s Hospital and Institute of Child Health, Multan. A sample size of 300 was calculated. Children aged 2 to 16 years were analyzed. Non-probability, a convenient sampling technique was adopted. Socio-demographic data, including gender, age, residence and socio-economic status, were collected, and SLDs were identified. SLDs were correlated with gender and age groups, applying a chi-square test (p<0.05 considered significant). Results: 12,055 (81.0%) had SLDs, with a male predominance (8441, 70.0%). The mean age was 5.04 ± 2.69 years. The most common SLDs were global developmental delay (GDD) (31.3%), cerebral palsy (17.3%), intellectual disability (17.0%), and autism spectrum disorder (ASD) (11.2%). GDD (34.1% vs. 30.1%, p<0.001), cerebral palsy (18.3% vs. 16.8%, p<0.001), and hearing loss (4.2% vs. 1.9%, p<0.001) were more common in females, while ASD (12.3% vs. 8.6%, p<0.001) and stammering (5.3% vs. 3.1%, p<0.001) were more common in male. GDD and ASD were more prevalent in younger children (p<0.001), while cerebral palsy and articulation disorders were more common in older children (p<0.001). Conclusions: The prevalence of SLDs among children visiting the developmental and behavioural pediatric outpatient department of a tertiary childcare setting is very high, particularly among male, and younger children.

Incidence of Post-Operative Stricture Following Hepaticojejunostomy for Benign and Malignant Disease

Muhammad Amin — 2025-06-30

Hepaticojejunostomy remains essential for biliary obstruction management, yet postoperative strictures significantly impact outcomes. Current incidence estimates (4-19%) vary widely due to methodological differences, and recent evidence questions the validity of the commonly referenced 12.5% benchmark used for study design. Objective: To: 1) determine contemporary stricture incidence using standardized criteria, 2) compare benign versus malignant cases, and 3) evaluate 3-month follow-up adequacy. Methods: A prospective cohort study was conducted involving 52 consecutive patients who underwent hepaticojejunostomy, with a mean age of 53.8 years (95% CI: 50.5–57.1). Strictures required both clinical (ICD-9 coding plus symptoms/biochemical evidence) and radiographic confirmation (CT/MR cholangiography). Statistical analyses included exact binomial CIs and chi-square tests (significance at p<0.05). Results: The overall stricture incidence was 19.2% (10/52, 95% CI: 9.6-32.5%). Benign cases showed significantly higher stricture rates (33.3% [8/24], 95% CI: 15.6-55.3%) versus malignant cases (7.1% [2/28], 95% CI: 0.9-23.5%; p=0.017). Conclusions: This study confirmed significantly higher stricture risk in benign disease and suggests current surveillance protocols may require pathology-specific modifications. The statistically significant association (p=0.017) between benign pathology and stricture formation underscores the need for risk-adapted management. Future research should prioritize multicenter cohorts with extended follow-up to validate these findings and refine surveillance guidelines.

Frequency of Hypocalcaemia and Hypomagnesaemia in Neonates with Birth Asphyxia

. Aikta — 2025-06-30

Birth asphyxia is a major cause of mortality and morbidity in neonates in developing nations. Objective: To determine the frequency of hypocalcaemia as well as hypomagnesaemia amongst neonates having birth asphyxia. Methods: This descriptive cross-sectional study was performed at the department of Pediatrics, Ziauddin Campus, north nazimabad, Karachi from July 2021 to December 2021. A total of 207 asphyxiated term neonates with postnatal age up to 48 hours, and history of birth asphyxia were analyzed. Venous blood sample of 5 ml was drawn by a trained phlebotomist and sent to institutional laboratory for serum analysis of calcium and magnesium levels within first 24 hours of admission. Frequency of hypocalcaemia and hypomagnesaemia were recorded. Chi square or fisher’s exact test were applied taking p≤0.05 as significant to judge inferential statistics. Results: In a total of 207 neonates, 112 (54.1%) were male. The mean post-natal age, and gestational age were 16.6±8.4 hours, and 37.7 ± 0.9 weeks, respectively. The mode of delivery was cesarean section in 121 (58.5%) cases. The frequency of hypomagnesaemia, and hypocalcaemia were documented in 36 (17.4%), and 46 (22.2%) neonates with birth asphyxia, respectively. Conclusions: Among term neonates with birth asphyxia, considerable frequency of hypocalcemia and hypomagnesemia was observed. These findings highlight the frequent occurrence of electrolyte imbalances in asphyxiated neonates, supporting the need for routine early biochemical screening.

Demographic, Clinical, and Lifestyle Risk Factors Associated with Lower Gastrointestinal Bleeding: A Cross-Sectional Study at A Tertiary Care Hospital

Qandeel Jamali — 2025-06-30

Gastrointestinal bleeding is classified into upper and lower types; lower GI bleeding occurs distal to the ligament of Treitz, presenting as rectal bleeding with symptoms like fatigue, pallor, or shock. Objectives: To assess the demographic, clinical, and lifestyle risk factors associated with lower gastrointestinal bleeding (LGIB) among patients presenting to a Tertiary Care Hospital, Hyderabad. Methods: This cross-sectional descriptive study was conducted from August 12, 2023, to February 11, 2024, at the Department of Gastroenterology, Liaquat University of Medical and Health Sciences, Jamshoro. A total of 105 male and female patients aged 18–70 years presenting with active rectal bleeding as their main complaint, and the duration of bleeding was not more than 6 months, were included in the study. The biodata of patients, such as age, duration of bleeding, and causes of bleeding, was collected. Results: The Age range of the patients in this study was 18 to 70 years, with a mean age was 42.29 ± 11.64 years. The most common cause of LGIB was internal hemorrhoids 32 (24%) followed by rectal ulcers 12 (9%), ulcerative colitis 10 (7.4%), rectal polyps 9 (6.6%), colitis 8 (5.9%), ileocecal ulcers 4 (2.9%), ileitis and colonic ulcers 3 (2.2%) in patients with Lower Gastrointestinal Bleeding. Conclusions: It was concluded that the most common cause of colorectal bleeding in our patients was carcinomas, while in Western countries, diverticulosis is the commonest cause, and ulcerative colitis is the most common cause in some Eastern countries. Male individuals are more commonly affected by LGIB.

Beyond the Ridge: Exploring Fingerprints to Determine the Predominant Pattern in the Pakistani Population

Roman Ashraf — 2025-06-30

Fingerprint patterns are widely used in forensic science due to their uniqueness and permanence. While pattern types like loops, whorls, and arches are well studied, fingerprint symmetry and its association with genetic and demographic factors remain underexplored in the Pakistani population. Objectives: To assess the distribution of fingerprint patterns and evaluate their symmetry by gender, age, ethnicity, region, hand dominance, and parental consanguinity. Methods: A cross-sectional study was conducted at Sahara Medical College, Narowal, from June to November 2021. Fingerprints from 110 participants were collected using the rolled ink method and categorized using the Henry Classification System. Fingerprint symmetry was evaluated by comparing matching fingers on both hands. Chi-square tests and Cramér’s V were used to analyzed associations. Results: Loops were the most frequent pattern, followed by whorls and arches. Symmetry was present in 45.5% of participants, while 54.5% were asymmetrical. Symmetry was significantly associated with gender (p=0.037), dominant hand (p=0.001), consanguinity (p<0.001), age group (p=0.003), region (p<0.001), and ethnicity (p<0.001). No significant link was found between symmetry and pattern type. Conclusions: It was concluded that fingerprint symmetry is influenced by several demographic and genetic factors. These findings support the need for population-specific biometric research and may contribute to forensic, genetic, and anthropological applications.

Assessing the Outcomes of Combined Surgical Techniques in Spondylolisthesis: A One Year Retrospective Analysis

Kamran Ullah — 2025-06-30

Surgical intervention is the treatment of choice in cases of severe pain in spondylolisthesis that doesn't respond to conservative measures. Decompression and fusion surgery is the gold standard surgical procedure for treating lumbar spondylolisthesis with foraminal stenosis, and it can be carried out in a variety of ways. Objectives: To investigate the outcomes of combined surgical techniques, including facetectomy along with foraminotomy, to secure the normal alignment of the lumbar spine in patients with spondylolisthesis. Methods: This retrospective cross-sectional study included the records of fifty-two patients who underwent facetectomy along with foraminotomy for spondylolisthesis from January 2022 to March 2023. Assessment of demographic information, clinical presentations, and outcomes was conducted. Descriptive statistics were analyzed via IBM SPSS software version 26. Results: The Mean age of the participants was 42 ± 15 years. The majority were female, 31(59%), as compared to male. The most frequent level which demonstrated listhesis was L4-L5 23 (45%), followed by L5, S1 18 (34%) and L3, L4 11(21%). In Type 1 listhesis, Full correction was achieved in 100% of cases, while in Type 2 listhesis, 80% of cases achieved correction. Further significant association (p≤0.05) was found among post-surgical outcomes including pain, functional disability and neurological status. Conclusions: It was concluded that facetectomy combined with foraminotomy is associated with improved clinical outcomes in the management of spondylolisthesis, particularly in Type 1 cases. The procedure was linked to pain relief, enhanced functional ability, and improved neurological status. Further longitudinal studies are required to assess long-term efficacy and safety.

GP73 Level in Patients with Chronic Hepatitis B: Relationship with Liver Biopsy, Levels of ALT, AST and HBV DNA

Ratan Kumar Ramani — 2025-06-30

GP73 is a serum protein that increases with liver disease progression in chronic hepatitis B (CHB) and has been proposed as a marker for liver status monitoring. Objectives: To evaluate the correlation between GP73 levels, Histological Activity Index (HAI), and fibrosis stages in CHB patients, assessing its potential as a non-invasive biomarker. Methods: A cross-sectional study was conducted over six months (May to October 2024) at the Department of Infectious Diseases, Khairpur Medical College/Civil Hospital Khairpur. A total of 250 CHB patients were enrolled and categorized by fibrosis stages and HAI scores. GP73 concentrations were measured using ELISA. Patients were classified based on fibrosis stage (F0-F4) and HAI scores, determined through liver biopsy, with F0 representing no fibrosis and F4 indicating cirrhosis. Statistical analysis included one-way ANOVA, Kruskal-Wallis test, and correlation analysis. Results: GP73 levels increased progressively with fibrosis stages: 5.3 ng/mL in Group 1, 6.1 ng/mL in Group 2, and 7.5 ng/mL in Group 3 (p=0.001). GP73 also rose with HAI scores, from 5.0 ng/mL in minimal to 8.0 ng/mL in severe activity groups (p=0.05). GP73 showed a moderate correlation with fibrosis stage (r=0.6, p<0.05) and a strong correlation with HAI (r=0.75, p<0.001). Conclusions: GP73 is a promising non-invasive biomarker for evaluating liver fibrosis and necroinflammation in CHB, warranting further validation in larger studies.

Clinical Outcomes and Frequency of Electroencephalographic Abnormalities in Patients with First Unprovoked Seizure in a Tertiary Care Hospital: A Cross-Sectional Study

Rabbiyah Masood — 2025-06-30

Epilepsy is a common medical condition that has widespread neurobiological, cognitive, psychological, and social consequences. Recurrent seizures are a common feature of this illness. Individuals experiencing their first unprovoked seizure generally present with Electroencephalographic (EEG) abnormalities, which might reflect a broad range of underlying neurophysiological changes. Identifying and measuring these abnormalities is critical for differentiating between epileptic and non-epileptic seizures, determining suitable treatment techniques, and predicting future seizure risk. Objective: To determine the frequency of abnormal EEG in patients presenting after first unprovoked seizures. Early detection of these abnormalities will better guide for better management and to predict recurrence. Methods: The study was a six-month cross-sectional retrospective held at the Punjab Institute of Neurosciences, Lahore, Pakistan from January 2024 to June 2024. This study employed the non-probability consecutive sampling method. The study included 95 patients who met the inclusion and exclusion criteria. Previous medical data included a complete patient history, clinical examination, and EEG results. Data were then analyzed using SPSS version 21.0. Results: Out of 95 patients, 52.63% were male and 47.37% were female, averaging 52.6 + 5.6 years. A total of 46 individuals (48.42%) had abnormal EEG irrespective of age, gender, length of symptoms, and awareness of symptoms. Conclusion: This study concluded that EEG abnormalities are highly frequent among individuals following their first unprovoked seizure.

Impact of Structured Early Clinical Exposure on Confidence and Competence among Undergraduate Health Science Students in Islamabad

Khaliq Aman — 2025-06-30

Transitioning from classroom to clinical settings can be overwhelming for undergraduate health sciences students. Early Clinical Exposure (ECE) has been proposed to enhance confidence and competence during early training, yet its impact remains under-evaluated in local contexts. Objective: To assess the effect of structured early clinical exposure on the self-reported confidence and perceived competence of undergraduate medical, dental, and nursing students. Methods: This quasi-experimental pretest-posttest study was conducted from November 2024 to April 2025 at Rawal Institute of Health Sciences, Islamabad. A total of 71 students from 3rd, 4th, and final year were enrolled through convenience sampling. Participants completed a validated self-assessment questionnaire before and after a structured ECE session, which included classroom orientation, ward rotations, bedside interaction, and debriefing. The tool was pilot tested and showed strong internal consistency (Cronbach’s alpha = 0.86). Paired t-tests and chi-square tests were used for analysis (p < 0.05). Results: Post-intervention scores showed significant improvements across all five domains of clinical confidence, including history taking, communication, examination skills, case presentation, and anxiety management (p < 0.001). Gender was significantly associated with comfort in ward settings and understanding hospital hierarchy. No significant differences were observed across academic years. Conclusions: Structured early clinical exposure significantly enhanced students’ clinical confidence and preparedness across domains. Integrating ECE into undergraduate curricula can foster smoother transitions into clinical environments.

Frequency of Hypoalbuminemia in Acute Ischemic Stroke Patients Presenting at Tertiary Care Hospital, Karachi

Habiba Aman — 2025-06-30

Stroke is regarded as the second most commonly reported death worldwide. The effect of albumin is mainly in the early reperfusion phase of acute ischemic stroke. Objective: To determine the frequency of hypoalbuminemia in patients with acute ischemic stroke. Methods: This cross-sectional observational study was carried out for six months (from April 2024 to October 2024) at the Department of Medicine, Al-Tibri Medical College, Karachi. 196 patients newly diagnosed with stroke patients presented within 24 hours were included, while patients with renal impairment, liver disease, etc., were excluded. SPSS version 24.0 was used for data analysis. Demographical data were reported with post-stratification chi-square applied, keeping p-value<0.05 as statistically significant. Results: A total of 196 patients with acute ischemic stroke were included in this study. The mean age in our study was 44.14 ± 4.49 years. 146 (74.5%) were male and 50 (25.5%) were female. Out of 196 acute ischemic stroke patients, 90 (45.9%) and 106 (54.1%) had and did not have hypoalbuminemia. Conclusions: It was concluded that a significant frequency of hypoalbuminemia was observed among patients presenting with acute ischemic stroke. However, association with stroke severity could not be established. Therefore, patients presenting with ischemic stroke ought to be screened for serum albumin levels when presenting to the hospital. In addition, patients with low serum albumin levels must be considered high risk and should be managed accordingly.

Effect of Thrombocytopenia in Pregnancy and Their Maternal Outcome

Hina Mukhtar — 2025-06-30

Gestational thrombocytopenia is a common hematological disorder during pregnancy that can significantly impact maternal health, depending on its severity. Objective: To assess the effects of thrombocytopenia severity on key maternal outcomes, including antepartum and postpartum hemorrhage, and placental abruption. Methods: In this prospective study, 192 pregnant women diagnosed with thrombocytopenia were analyzed at the Department of Obstetrics and Gynecology, Tertiary Care Hospital, Bahawalpur, from March 07, 2023, to September 06, 2023. We evaluated the severity of thrombocytopenia, maternal age, platelet count, and gestational age, examining their associations with maternal health outcomes using chi-square and correlation analysis. Results: No significant correlation was found between thrombocytopenia severity and maternal age (p=0.467). Severe thrombocytopenia was strongly associated with increased risks of antepartum hemorrhage (100% of cases), postpartum hemorrhage, and placental abruption (p<0.001 for both). Additionally, a moderate positive correlation was observed between platelet count and gestational age (r=0.478, p<0.001), indicating a potential link between the progression of pregnancy and changes in thrombocytopenia severity. Conclusions: It was concluded that severe gestational thrombocytopenia markedly increases maternal risks, underscoring the importance of diligent monitoring and management. The findings advocate for early detection and proactive interventions to enhance maternal outcomes in thrombocytopenic pregnancies.

Age and Gender Specific Associations between Hyperuricemia and Hypertension: A Cross-Sectional Study in Karachi

Yameen Bocha — 2025-06-30

Hyperuricemia is increasingly linked to hypertension and various metabolic disorders. Objectives: To investigate the relationship between hyperuricemia and various anthropometric indices among individuals newly diagnosed with hypertension, with an emphasis on identifying potential age- and gender-specific patterns. Methods: The cross-sectional study enrolled 370 newly diagnosed hypertensive adults (230 male and 140 female), aged 18 years and above, using stratified sampling. Anthropometric data, blood pressure, and serum uric acid levels were recorded. Serum uric acid (SUA) levels above 7 mg/dL in males and above 6 mg/dL in females were used to define hyperuricemia. SPSS version 22.0 was used for statistical analysis. Independent t-tests, Pearson's correlation, Chi-square tests, and ANOVA were applied to analyze the data, with a significance level of p<0.05. Results: The research found a 27.5% prevalence of hyperuricemia, significantly higher in male (33.9%) than female (17.1%) (p<0.001). Male had significantly elevated systolic BP (p=0.043), waist circumference (p<0.001), and serum uric acid levels (p<0.001). Serum uric acid showed positive correlations with systolic BP (p=0.001), diastolic BP (p=0.007), BMI (p<0.001), waist circumference (p<0.001), and age (p=0.024). Hyperuricemic individuals had significantly higher age, BP, BMI, and waist circumference (all p<0.01). Females with hyperuricemia were older (p=0.04) and more frequently in the >50 age group (p=0.036). Conclusions: It was concluded that male showed a higher prevalence of hyperuricemia, while older age was a significant factor for females. These findings suggest the importance of monitoring serum uric acid as an early marker for cardiovascular and metabolic risks, particularly in populations at risk based on gender and age.

Mandibular Symphyseal Height Determination in Various Vertical Patterns

Saadia Ata — 2025-06-30

The mandibular symphysis is a crucial anatomical structure influencing facial aesthetics and harmony. Its morphology is pivotal in determining optimal lower incisor positioning, especially in borderline orthodontic cases requiring meticulous treatment planning. Objective: To determine and compare symphyseal dimensions in different vertical patterns of skeletal class I cases. Methods: The study was designed as a cross-sectional study. Data was analyzed using SPSS 25, with mean and standard deviations used for quantitative variables and frequency and proportions for qualitative data. Statistical significance was assessed using chi-square tests for gender and ANOVA for symphysis height and vertical facial patterns, with a P-value ≤0.05 considered significant. Results: Male subjects with Hypodivergent (↓D), Normodivergent (ND)and Hyperdivergent (↑D) profiles showed no statistically significant difference in Id-Me, whereas female subjects showed statistically significant difference in Id-Me between (↓D) and (↑D) subjects. Additionally, a notable sex difference was observed in Id-Me, with significant variations between males and females. In contrast, the differences in LI between males and females were found to be statistically non-significant (P > 0.05). Conclusion: This article reflected that males show longer chin than females.

Changes in Physiological and Biochemical Parameters in Women During the Spontaneous Menstrual Cycle and Following Oral Contraceptives

Sanodia Afridi — 2025-06-30

Oral contraceptive pills (OCPs) are widely used for birth control and management of various gynaecological conditions. While their primary mechanism is to regulate the reproductive cycle, they are known to exert broader systemic effects. However, comparative data on physiological, hormonal, and metabolic parameters between OCP users and women with natural menstrual cycles remain limited. Objectives: To evaluate and compare selected physiological signs, reproductive hormones, and metabolic indicators among women experiencing natural menstrual cycles and those on OCPs. Methods: A comparative cross-sectional study was conducted involving 80 women aged 18–40 years, divided into two equal groups: natural cycle (n=40) and OCP users (n=40). Data were collected on demographic details, vital signs, and laboratory measures including estrogen, progesterone, LH, FSH, SHBG, TSH, testosterone, HDL cholesterol, and fasting glucose. Statistical analysis was performed using SPSS version 26.0. Results: Significant differences were observed in estrogen, progesterone, LH, and SHBG levels, with OCP users showing notably altered hormonal profiles. OCP users also had higher systolic blood pressure and HDL cholesterol, while glucose levels were slightly elevated. No significant differences were found in prolactin, FSH, or haemoglobin. Conclusions: It was concluded that OCP use is associated with measurable changes in several physiological, hormonal, and metabolic parameters. These findings highlight the importance of routine monitoring in long-term users and support individualized contraceptive counselling based on clinical risk profiles.

Minimal Hepatic Encephalopathy in Patients with Cirrhosis Using Psychometric Hepatic Encephalopathy Score Tests

Humaira Zakir — 2025-06-30

Minimal hepatic encephalopathy (MHE) is defined as changes in cognitive ability, electrophysiology, and homeostasis of neurotransmission and blood flow in the cerebrum. It is observed in patients with chronic liver disease and cirrhosis who do not have clinical features of overt hepatic encephalopathy. The International Society for Hepatic Encephalopathy and Nitrogen recommend the Psychometric Hepatic Encephalopathy Score (PHES) to easily detect and treat these patients. Objectives: To calculate the frequency of MHE amongst patients with cirrhosis of the liver based on the Psychometric Hepatic Encephalopathy Score. Methods: This cross-sectional study was conducted at the Department of Medicine, Al Tibri Medical College, Karachi. A total of 235 patients with cirrhosis of the liver with normal mental status were included. Patients were given 5 printed sheets of paper, one each for the number connection test A and test B, line tracing, serial dotting test and digit symbol test. A score of two or less was labelled as minimal hepatic Encephalopathy. Chi-square test was applied for checking the association, and a p-value≤0.05 was considered significant. Results: There were 62.13% male and 37.87% female. The mean age was 45.47 ± 13.28 years. The mean duration of cirrhosis was 5.54 ± 3.7 years. Most of the patients (53.6%) successfully performed four and five PHES tests, while 22.13% patients successfully performed three tests. 15.32% and 8.94% were successfully performed two and one PHES test, respectively. Minimal hepatic encephalopathy was observed in 24.68% cases. Conclusions: It was concluded that the PHES is easily detected and can treat minimal hepatic encephalopathy.

Antibiotic Overuse in Paediatric Gastroenteritis: A descriptive cross-sectional study from Children's Hospital

Mumtaz Ali Bharo — 2025-06-30

There is a major role of gastroenteritis in pediatric patients. Knowing about prescription trends is very useful in optimizing treatment and minimizing the use of unnecessary medication. Objective: To assess the frequency of antibiotic prescriptions in children with gastroenteritis and evaluate the appropriateness of these prescriptions based on clinical criteria and the impact this line of management has on the duration of their hospital stay. Methods: A total number of participants was n= 200 children, diagnosed as gastroenteritis. Demographic, clinical and antibiotic data were collected. SPSS version 21.0 was used in performing statistical analysis with p < 0.001 as the level of significance. Results: In 200 children with gastroenteritis (mean age 4.5 ± 2.3 years; weight 14.2 ± 4.1 kg), 50% had severe dehydration, 60% had fever, and 75% had vomiting. IV rehydration was required in 65%, with a mean hospital stay of 24.2 ± 5.5 hours. Inappropriate antibiotic use occurred in 75% of cases. Dehydration (OR = 3.50), fever (OR = 1.87), and inappropriate antibiotic use (OR = 2.75) significantly predicted IV rehydration (all p < 0.001). Dehydration and inappropriate antibiotic use also significantly prolonged hospital stay. Conclusion: Antibiotic prescription rates for pediatric gastroenteritis are extremely high and alarmingly, the majority of them are inappropriate.

Effect of Sample Storage at 2-8°C for 24 Hours on Reticulocyte Count Determined by Manual Method

Abeeha Khalid — 2025-06-30

Reticulocytes are immature red blood cells that contain residual RNA and ribosomes but no nucleus. Reticulocytes count is a haematological test that assists in assessing bone marrow activity. It can be determined by manual and flow cytometric method. Reticulocytes mature in vitro within six hours of sample collection; hence the sample should be processed within this time frame for accurate results. Objective: To determine the difference in reticulocyte count between a fresh sample and a sample stored for 24 hours at 2-8°C by manual method. Methods: This quasi-experimental study included a total of 220 EDTA-anticoagulated blood samples submitted to the Hematology Department of Allama Iqbal Medical College/Jinnah Hospital, Lahore, from June 12, 2024, to December 18, 2024, for reticulocyte count analysis using non-probability consecutive sampling technique. Each sample was processed using brilliant cresyl blue stain, within one hour of collection and reported two times: within 6 hours of sample collection and after a period of 24 hours of storage. Results: The manual reticulocyte count showed a significant difference between freshly prepared slides and those stored for 24 hours. Mean reticulocyte count at 6 hours was 2.99 ± 0.09, while after 24 hours, it decreased to 2.41 ± 0.10, resulting in a mean difference of 0.58 ± 0.16. Conclusions: In regions where automated methods are not available, performing a reticulocyte count manually on a fresh sample can significantly contribute to improving healthcare quality. This simple yet essential test is crucial for diagnosing and managing various clinical conditions effectively.

Comparative Analysis of Surgical Outcomes in Chronic Otitis Media with Cholesteatoma: A Study of Canal Wall Up and Canal Wall Down Mastoidectomy

Muhammad Razzaq Dogar — 2025-06-30

Chronic otitis media with cholesteatoma (COMC) is a serious, potentially life-threatening middle ear condition characterized by keratinizing squamous epithelium growth, chronic inflammation, and progressive bone erosion. Surgical intervention remains the mainstay of treatment, with canal wall up (CWU) and canal wall down (CWD) mastoidectomies being the primary approaches. Objectives: To evaluate the prevalence, clinical presentation, and surgical outcomes of COMC, comparing the efficacy and complications of CWU and CWD mastoidectomy. Methods: A prospective study was conducted across multiple healthcare centers in Karachi. The study included 136 COMC patients, divided by surgical technique (CWU vs. CWD). Demographics, symptoms, audiometry, recurrence, and complications were assessed over six months. Data were analyzed using SPSS. Results: The mean age of patients was 32.6 ± 12.5 years, with a slight male predominance (60%). Otorrhea (80%) and hearing loss (73%) were the most common presenting symptoms. Recurrence was significantly higher in the CWU group (71.4%) compared to none in the CWD group (p=0.003). However, CWU surgery yielded better hearing outcomes postoperatively (mean gain: 15 dB) compared to CWD (mean gain: 8.9 dB), with a significant difference in final hearing thresholds (p=0.04). Complications were more frequent in the CWD group but were not statistically significant (p=0.19). Conclusions: It was concluded that canal wall down (CWD) offers better disease control with low recurrence, while canal wall up (CWU) preserves hearing. Surgical choice should balance disease clearance and function, with regular follow-up.

Efficacy between 3-Dimensional and Champy Plates in Anterior Mandibular Fracture

Bakhtawar Laghari — 2025-06-30

Facial bone fractures or maxillofacial fractures are on the rise, specifically as a result of more road traffic accidents and sports incidents. The face is very sensitive both in terms of appearance and functionality; people who have been attacked in the face can have difficulty eating and speaking, or are extremely shy to socialize due to disfiguration. Objective: To compare the results of using the 3D mini plates in the treatment of the anterior mandibular fracture with Champy’s mini plates. Methods: A Quasi-experimental study was conducted at the Department of Oral and Maxillofacial Surgery of LUMHS Jamshoro, Pakistan, in six months, and the sampling technique used was non-probability convenience sampling. Data analysis was done using statistical software SPSS version 26.0. Results: At the end of six weeks, the results showed that the average surgical time that was taken in the surgical procedure was shorter in Group B than in Group A, being (50.94 ± 6.89) and (55.43 ± 3.24) respectively; F=16.44, p=0.001. Just as in Group B, the incidence of infection was considerably lower (8.6%) than in Group A, where it reached 28.6%, with all the differences being statistically significant (p=0.031). Conclusions: 3D plates provide a biomechanically stable and versatile solution to Champy’s mini plates. Because of the high strength of the material and corresponding flexibility, as well as ease of utilization, there is evidence that the 3D plates used in surgeries should be effectively employed in managing mandibular fractures.

Correlation of Depression and Nightmares in Young Medical Students

Kanza Yousaf — 2025-06-30

Consistent dream sequences that appear genuine and become more upsetting as they progress are known as nightmares. A prevalent condition that significantly impairs psychosocial performance and lowers quality of life is major depression. Insomnia and nightmares independently but additionally have an impact on the exacerbation of depression. Objectives: To find the correlation between depression and nightmares in young medical students. Methods: A cross-sectional study was carried out from September 2021 to June 2022, involving 350 medical students aged 18 to 30, distributed across all academic years. The symptoms of depression were measured and assessed using the CES-D scale, while nightmares were evaluated by using a validated sleep 50 questionnaire. Data were analyzed in SPSS version 27.0. Results: A total of 350 medical students (49.1% male and 50.9% female), with most aged 19 to 23 years, 91.4%, and single, 97.7%. The mean CES-D score was 23.0 ± 12.42, higher in females 24.8% than in males 21.0. Severe depression was more common in females 44.9%) and first-year students 58.6%. Frequency of nightmares was reported by 23.9%, and the depressed feelings and the frequency of nightmares are significantly correlated (P=0.019). Pearson correlation analysis shows a substantial correlation between the frequency of nightmares and depressive moods. (P≤0.01). Conclusion: The study concluded a significant association between depression symptoms and nightmares, particularly in females and younger medical students. Academic and social factors significantly influence depression symptoms.

YouTube, Med-Cram, Online Med-Ed, and Traditional Lectures: A Comparative Study of Healthcare Students' Preferences

Ayesha Butt — 2025-06-30

The computer technology revolution drove the widespread adoption of online learning resources in higher education, met the preferences of tech-savvy students, and was accelerated by the pandemic. Objective: To evaluate learning style preference among health care students. Methods: This comparative cross-sectional study was conducted between two groups: the first one attended conventional live lectures, and the second one used other online learning resources for undergraduate students at Combined Military Hospital (CMH) Lahore Medical College (LMC) and Institute of Dentistry (IOD) Lahore from May to July 2024. The study involved 296 undergraduate students from various healthcare disciplines. First-year students were excluded from the study. Data collection employed a validated questionnaire assessing dimensions such as social presence, interaction, and satisfaction. Results: The results revealed a strong preference for in-person learning, citing enhanced engagement, interaction, and immediate feedback as key advantages. Despite the convenience and flexibility of online learning, it fell short in replicating the depth of interpersonal communication and satisfaction achieved in traditional settings. Conclusions: It was concluded that a hybrid learning model, combining the strengths of both approaches, could better address diverse student needs. Future research should explore the effectiveness of such models in improving educational outcomes across healthcare fields.

Association of Oxytocin-Augmented Labor with Neonatal Jaundice Requiring Phototherapy: A Comparative Study

Nazia Ayyub Butt — 2025-06-30

Neonatal jaundice is a dangerous illness that, if left untreated, can lead to deadly consequences. Oxytocin seems to have a dose-dependent influence on elevated plasma bilirubin levels in cord blood, which are likely exacerbated by the breakdown of fetal red blood cells. Objectives: To determine the frequency of patients who undergo labour augmentation with the use of oxytocin and to compare the frequency of neonatal jaundice among the gravid female who labor with and without oxytocin augmentation. Methods: This analytical cohort study was conducted in the Department of Obstetrics and Gynaecology, Sughra Shafi Medical Complex, Narowal from 01-07-2021 to 31-12-2021. A total of 186 gravid females were included in this study. These patients were divided into two groups: Group A (augmentation with oxytocin, n=30) and Group B (spontaneous labour without oxytocin augmentation, n=156). Neonatal jaundice was assessed based on serum bilirubin levels and whether phototherapy was required. Data were analyzed using SPSS-25, with descriptive statistics and relevant comparisons between the groups. Results: The mean age of the participants was 26.9 ± 4.3 years. There were 56 primigravida (30.1%) and 130 multigravidas (69.9%). Neonatal jaundice requiring phototherapy occurred in 40% of neonates in Group A and in 19.2% in Group B. Conclusions: It was concluded that when maternal oxytocin is used to induce labor, newborn jaundice is more likely to occur and phototherapy is more frequently required. It is advisable to consider careful oxytocin dosing to avoid the risk of hyperbilirubinemia.

Prevalence and Characteristics of Early vs. Late-Onset Preeclampsia: A Cross-Sectional Descriptive Study

Faraz Bakht — 2025-06-30

Preeclampsia is the most frequent medical complication of pregnancy and a leading contributor to maternal morbidity and mortality. However, there is a lack of data on the outcomes of pre-eclamptic women, making the current study necessary. Objectives: To determine the prevalence and compare the clinical characteristics of early-onset and late-onset preeclampsia among pregnant women. Methods: It was a descriptive cross-sectional study conducted for 6 months at the Department of Obstetrics and Gynecology, Sughra Shafi Medical Complex, Narowal. It involved 95 pregnant women. Patients were selected using non-probability and consecutive sampling. Women at ≥20 weeks of gestation and diagnosed with preeclampsia were categorized as early onset (≤34 weeks) and late onset (>34 weeks) of preeclampsia, and their outcomes were compared based on age, parity, BMI and history of GDM and pre-existing hypertension. Data were analyzed using SPSS version 25.0. Results: The mean age of the patients was 26.2 ± 5.3 years, the mean gestational age was 34.4 ± 2.4 weeks, and the mean BMI was 26.9 ± 3.5 kg/m². There were 29 (30.5%) primiparas and 66 (69.5%) multiparas. Obesity was observed in 24 (25.3%) women, while 16 (16.8%) had pre-existing hypertension, and 23 (24.2%) had GDM. Early-onset preeclampsia was found in 27 (28.4%) women, while 68 (71.6%) had late-onset preeclampsia. Conclusions: It was concluded that a considerable proportion of women had early-onset preeclampsia. Both early and late onset preeclampsia warrant routine screening in pregnant women to allow timely identification and management, which may improve feto-maternal outcomes.

Frequency of Low Birthweight in Pregnant Women with Rheumatic Heart Disease

Rida Amjad — 2025-06-30

Rheumatic heart disease (RHD), a complication of rheumatic fever, can cause serious valve damage and is a significant risk during pregnancy. It increases the chances of maternal and fetal complications, including low birth weight and maternal morbidity. Objectives: To determine the prevalence of low birth weight in full-term pregnancies among women diagnosed with rheumatic heart disease. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Services Hospital in Lahore. A sample of 96 pregnant women aged 18–40 years with rheumatic heart disease and full-term gestation (37–41 weeks) was selected by using non-probability consecutive sampling. Relevant laboratory and radiological investigations, including ECG and echocardiography, were done. The diagnosis of RHD was established, and women were followed until delivery, and fetal birthweight was measured and assessed for LBW. The data were recorded on specially designed Performa and analyzed using SPSS version 25.0. Results: The average age of the women was 26.78 ± 6.22 years. The mean gestational age, BMI and birth weight were 38.68 ± 1.20 weeks, 24.93 ± 2.06 kg/m and 2550.13 ± 403.1 g. The fetal male gender was dominant, as 59 (61.5%). The frequency of LBW was 57 (59.4%). The analysis revealed no significant differences in the frequency of low birth weight (LBW) with age, gestational age and BMI groups (p>0.05). Conclusions: Pregnant women with rheumatic heart disease were found to have a high rate of low birth weight among their infants. However, no significant links were established between low birth weight and factors such as maternal age, gestational age, or BMI.

Effect of Exercise and Nutrition on Oxidative Stress in Females with Polycystic Ovary Syndrome, a Current Status and Future Perspective in Narrative Review

Maria Mustafa — 2025-06-30

Women in their reproductive years are prone to the widespread endocrinological disorder known as Polycystic Ovarian Syndrome (PCOS). To provide in-depth insights into the factors contributing to hormonal imbalances, inflammation, and oxidative stress in women with PCOS. Additionally, it evaluates the impact of exercise and nutritional interventions on oxidative stress and overall metabolic health in PCOS women to improve their quality of life. This review analyzed existing literature and clinical evidence related to endocrine disturbances in PCOS, including hormonal changes such as elevated androgens, insulin resistance, inflammation, and oxidative stress. The effects of lifestyle interventions specifically physical exercise, dietary modifications, and supplementation on these metabolic and hormonal abnormalities were studied. Hormonal Imbalance: Women with PCOS show dysregulated production of Growth Hormone (GH), ghrelin, LEAP-2, Gonadotropin-Releasing Hormone (GnRH), insulin, LH/FSH ratio, androgens, and estrogens. Inflammation and Oxidative Stress: Hyperandrogenism and insulin resistance promote chronic inflammation and increased Reactive Oxygen Species (ROS), leading to oxidative stress, gut microbiome alterations, and metabolic dysfunction. PCOS is a multifactorial disorder influenced by hormonal imbalance, chronic inflammation, and oxidative stress. Lifestyle modifications, particularly tailored exercise regimens and nutritional strategies, play a critical role in mitigating these factors.