Pakistan Journal of Health Sciences http://thejas.com.pk/index.php/pjhs <p><strong>Title of Journal: </strong><strong>Pakistan Journal of Health Sciences (Lahore)</strong></p> <p><strong> (ISSN Online: 2790-9352, Print: 2790-9344)</strong></p> <p><strong>Frequency: </strong><strong>Monthly (w.e.f July-2022)</strong></p> <p><strong>Affiliated with:</strong> Lahore Medical Research Center</p> <p><strong>Website:</strong> (<a href="http://www.lmrc.com.pk">www.lmrc.com.pk</a>)</p> <p><strong>Publisher:</strong> <strong>CrossLinks International Publishers LLC, (w.e.f 23/4/25)</strong></p> <p><strong>Website:</strong> (<a href="http://www.clip.com.pk">www.clip.com.pk</a>)</p> <p><strong>Address:</strong> 117 S Lexington St Ste 100, Harrisonville, MO 64701, USA</p> <p>Lahore Medical Research Center has published <strong>"Pakistan Journal of Health Sciences (Lahore)</strong><strong> (PJHS-Lahore)</strong>"; A Monthly, Double Blind peer-reviewed open access Journal. The aim of the Journal is to provide a platform for allied health professionals to publish their research work. All materials, articles and information published in <strong>PJHS-Lahore</strong> will be peer-reviewed.</p> <p>Research papers, Short communications, Review or mini-reviews, Commentaries, Perspectives, opinion, Meta-analysis, Case reports, Case studies, Case-control studies</p> <p>Reviews on recent progress in Health Sciences are commissioned by the editors. The purpose of the <strong>PJHS-Lahore</strong> is to publish scientific and technical research papers to bring attention of international researchers, scientists, academicians, health care professionals towards recent advancements in Health Sciences. The articles are collected in the form of reviews, original studies, clinical studies etc. It may serve as a global platform for scientists in relevant fields to connect and mutually share ideas. This journal is open to all the research professionals whose work fall within our scope. </p> <p><strong>Aim &amp; Scope</strong></p> <p>The Pakistan Journal of Health Sciences (Lahore) (PJHS-Lahore) provides a platform for research and discussion across a broad spectrum of disciplines. Its scope encompasses Medical and Clincal Sciences, Public Health, Physical Therapy, Dentistry, Pharmacology, Nursing and Medical/Health Professions Education. Through comprehensive coverage, PJHS aims to foster collaboration and advance knowledge in these vital areas of healthcare and academia.</p> <p><span style="text-decoration: underline;"><strong>Accreditation:</strong></span></p> <p><strong>Approved by Higher Education Commission of Pakistan for the year 2024-25</strong></p> <p><strong>Approved by Pakistan Medical and Dental Council till 31st July, 2025</strong></p> <p><span style="text-decoration: underline;"><strong>Fee &amp; Subscription Charges</strong></span></p> <p>Article Processing Fee: Rs 5000/ Article (w.e.f 1st May, 2024) <strong>(Non-Refundable)</strong></p> <p>Article Publication Fee (National) Rs 30000 / Article</p> <p>Article Publication Fee (International ) 200 USD / Article</p> <p>Printed Version (Selected Articles on Authors Request) : Rs 2500/per copy (For InLand Delivery)</p> <p><span style="text-decoration: underline;"><strong>Annual Subscription for Printed Versions</strong></span></p> <p>For Institutes: Rs 20,000/ Annually</p> <p>Single Copy (Selected Articles): Rs 2500/-</p> <p><span style="text-decoration: underline;"><strong>Bank Details</strong></span></p> <p style="margin: 0cm;">Account Title: Lahore Medical Research Center LLP</p> <p style="margin: 0cm;">Bank Name: Meezan Bank</p> <p style="margin: 0cm;">IBAN: PK36MEZN0002840105377903</p> <p style="margin: 0cm;">Account # 02840105377903</p> <p><span style="text-decoration: underline;"><strong>Waiver Policy</strong></span></p> <p>If an author has no funds to pay such charges, he may request for full or partial waiver of publication fees. The decision may however vary from case to case.</p> <p>We do not want charges to prevent the publication of worthy material.</p> <p><strong><u>Submissions</u></strong></p> <p>Submission are welcome and may be submitted here: <u><a href="mailto:editor@thejas.com.pk">editor@thejas.com.pk</a></u></p> CrossLinks International Publishers en-US Pakistan Journal of Health Sciences 2790-9344 <p>This is an open-access journal and all the published articles / items are distributed under the terms of the <a href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments</p> <p><a href="mailto:editor@tjas.lmrc.com.pk">editor@thejas.com.pk</a></p> A Climate Wake-Up Call: Pakistan’s Floods Reveal a Healthcare Crisis http://thejas.com.pk/index.php/pjhs/article/view/3309 <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>In response, the World Health Organization (WHO) and Pakistan's Ministry of National Health Services are maintaining emergency operations in the affected regions.&nbsp; They are concentrating on long-term preparedness, healthcare restoration, medicine supply, and disease surveillance.&nbsp; However, it is imperative that these endeavors be dramatically increased.&nbsp; Millions of individuals continue to be vulnerable to preventable illnesses due to their lack of access to basic care and proper sanitation.&nbsp; 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.&nbsp; Pakistan's silent emergency may soon become too loud to ignore if sustained action is not taken.</p> Riffat Mehboob Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 01 01 10.54393/pjhs.v6i6.3309 Effect of Exercise and Nutrition on Oxidative Stress in Females with Polycystic Ovary Syndrome, a Current Status and Future Perspective in Narrative Review http://thejas.com.pk/index.php/pjhs/article/view/3179 <p>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.</p> Maria Mustafa Naveed Babur Saleh Shah Almina Shafiq Rabia Aslam Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 02 08 10.54393/pjhs.v6i6.3179 Histopathological and Radiological Findings in Nasolabial Cysts http://thejas.com.pk/index.php/pjhs/article/view/3117 <p>Nasolabial cysts are relatively rare, non-odontogenic soft tissue cysts that are usually found in the nasolabial fold, just beneath the nasal ala. <strong>Objectives:</strong> To analyse the clinical, histopathological, and radiological features of nasolabial cysts and evaluate their association with symptom duration, cyst size, and bone remodelling. <strong>Methods:</strong> 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. <strong>Results:</strong> 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). <strong>Conclusions:</strong> 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.</p> Vijay Kumar Khatri Syed Muhammad Moosa Raza Sabhagi Kumari Syed Mohsin Ahmed Rizvi Saima Batool Jaffri Fiza Irfan Ali Muntazir Naqvi Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 10.54393/pjhs.v6i6.3117 Obstetric Outcomes after Cervical Cerclage in Women with Cervical Insufficiency http://thejas.com.pk/index.php/pjhs/article/view/3071 <p>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. <strong>Objective: </strong>To determine the obstetric outcomes after cervical cerclage in women with cervical insufficiency. <strong>Methods: </strong>This descriptive study was carried out at the Gynaecology Department, Khyber Teaching Hospital, during the period 22<sup>nd</sup> May 2024 till 31<sup>st</sup> March 2025. Women aged 18-35 years with gestational age 13 to 20 weeks and transvaginal ultrasound showing cervical length &lt;2.5cm were enrolled. Cervical cerclage was performed, and pregnancy outcomes were noted in terms of miscarriage, preterm, PROM, prolonged pregnancy and term pregnancy. <strong>Results: </strong>Mean age of the participants was 30.42 ± 5.616 years, mean BMI was 24.070 ± 2.704kg/m<sup>2</sup> 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%). <strong>Conclusions: </strong>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.</p> Mahjabeena Bilal Uzma Rashid Asma Shakeel Mahnoor Habib . Sara Sabrina Yousaf Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 09 13 10.54393/pjhs.v6i6.3071 Diagnostic Accuracy of Chest Ultrasound in Diagnosing Rib Fractures, Keeping CT Chest as Gold Standard http://thejas.com.pk/index.php/pjhs/article/view/2961 <p>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. <strong>Objectives: </strong>To assess the accuracy of chest ultrasound in diagnosing rib fractures, keeping CT chest as a gold standard. <strong>Methods: </strong>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. <strong>Results: </strong>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%. <strong>Conclusions: </strong>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.</p> Sara Rashid Riffat Raja Saba Binte Kashmir Nasir Khan Anam Zahoor Beenish Nadeem Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 14 19 10.54393/pjhs.v6i6.2961 Association of C-Reactive Protein and D-dimer Status with Maternal Outcomes in Pregnant Women with COVID-19 http://thejas.com.pk/index.php/pjhs/article/view/2676 <p>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. <strong>Objectives: </strong>To find the association of CRP and D-dimer status with maternal outcomes in pregnant women with COVID-19. <strong>Methods: </strong>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. <strong>Results: </strong>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. <strong>Conclusions: </strong>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.</p> Summera Aslam Zeeshan Kashif Sajida Razzaq Ushna Laraib Shamila Ijaz Munir Shamsa Humayun Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 20 25 10.54393/pjhs.v6i6.2676 Prevalence and Effects of Self-Medication Practice among Pharmacy Students: A Cross-Sectional Study in Karachi http://thejas.com.pk/index.php/pjhs/article/view/2893 <p>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. <strong>Objectives:</strong> To determine the prevalence and effects of self-medication practice among pharmacy students: a cross-sectional study in Karachi. <strong>Methods:</strong> 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. <strong>Results:</strong> 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). <strong>Conclusions: The </strong>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.</p> Leena Anjum Tayyab Raza Fraz Fiza Islam Leena Iftikhar Ammara Khalid Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 26 32 10.54393/pjhs.v6i6.2893 Association of Cutaneous Manifestations with Undiagnosed Diabetes Mellitus in Adults http://thejas.com.pk/index.php/pjhs/article/view/3195 <p>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. <strong>Objectives</strong>: To determine the association between characteristic skin lesions (acanthosis nigricans, skin tags, xerosis) and undiagnosed diabetes in adults. <strong>Methods</strong>: 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. <strong>Results</strong>: The prevalence of cutaneous markers was significantly higher in prediabetes and diabetes groups (p&lt;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. <strong>Conclusions</strong>: 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.</p> Muhammad Zubair Aneela Gillani Muhammad Khan Malik Saira Niazi Zahida Perveen Asma Bano Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 33 36 10.54393/pjhs.v6i6.3195 Caregiver-Reported Reasons and Outcomes of Treatment Default among Pediatric Oncology Patients at a Tertiary Care Hospital in Pakistan http://thejas.com.pk/index.php/pjhs/article/view/3132 <p>Despite the availability of free care, many children in Pakistan fail to complete cancer therapy, leading to poor outcomes and increased mortality. <strong>Objective:</strong> To determine reasons and outcomes of pediatric cancer patients defaulting treatment at tertiary care hospital in Pakistan. <strong>Methods:</strong> This descriptive cross-sectional study was conducted at Pediatric Hematology/Oncology unit of Children Hospital, Lahore. Total 82 pediatric oncology patients (&lt;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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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.</p> Aimen Gull Rahat Ul Ain Mahwish Faizan Shazia Riaz Waqar Mushtaq Luqman Iqbal Sana Gull Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 37 41 10.54393/pjhs.v6i6.3132 Beyond Weight Loss: Investigating Irritability and Mood Swings after Bariatric Surgery: A Prospective Study http://thejas.com.pk/index.php/pjhs/article/view/3007 <p>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. <strong>Objectives:</strong> To determine the prevalence of Irritability and Mood Swings After Bariatric Surgery and its impact on hormonal and nutritional changes. <strong>Methods:</strong> 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. <strong>Results:</strong> 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&lt;0.001). Compared to 740 (73%) before surgery, 902 (89%) of patients experienced moderate to severe irritation at three months (p&lt;0.001). After six months, this percentage dropped to 446 (44%). <strong>Conclusions:</strong> 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.</p> Mushtaq Ahmad Maria Alamgir Waqar Ahmad Mah Noor Dad Khan Abdul Haseeb Sahibzada Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 42 47 10.54393/pjhs.v6i6.3007 Prevalence of Vitamin D Deficiency in Pregnant Women and Its Association with Musculoskeletal Pain: A Cross-Sectional Study http://thejas.com.pk/index.php/pjhs/article/view/3165 <p>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. <strong>Objective:</strong> To assess vitamin D levels during pregnancy and explore their association with musculoskeletal pain in pregnant women<strong> Methods:</strong> 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. <strong>Results:</strong> Out of 250 pregnant women, 72.4% (n=181) had deficiency of vitamin D (&lt;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 &lt;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). <strong>Conclusions:</strong> 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.</p> Muneeb Ur Rehman Mehreen Zafar Muhammad Khan Malik Rida Ajmal Khan Saddiqa Azmat Muhammad Zubair Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 48 52 10.54393/pjhs.v6i6.3165 Association Between Anemia and Prevalence of Gestational Diabetes vs Non-Gestational Diabetes among Pregnant Women http://thejas.com.pk/index.php/pjhs/article/view/3191 <p>Gestational diabetes mellitus (GDM) affects a large number of pregnant women globally and generates significant health complications for both mothers and their newborns. <strong>Objectives:</strong> 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. <strong>Methods: </strong>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. <strong>Results: </strong>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&lt;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). <strong>Conclusion: </strong>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.</p> Safder Ali Pervez Sarwat Ashraf Abdul Hayee Phulpoto Ratan Kumar Ramani Munir Ahmed Channa Asif Aziz Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 53 57 10.54393/pjhs.v6i6.3191 Changes in Blood Pressure and Pulse Rate in Patients Following the Injection of Lidocaine with 2% Adrenaline in A Mandibular Nerve Block http://thejas.com.pk/index.php/pjhs/article/view/2416 <p>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. <strong>Objectives</strong>: To evaluate the blood pressure and pulse rate alterations in patients after administering a mandibular nerve block using 2% lidocaine with adrenaline. <strong>Methods: </strong>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)). <strong>Results</strong>: 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. <strong>Conclusions</strong>: 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.</p> . Misbah Ameer Hamza Muhammad Ahmed Shaikh Muhammad Owais Suneel Kumar Punjabi Faiza Hasan Salman Shams Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 58 62 10.54393/pjhs.v6i6.2416 Assessing the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Pyelolithotomy or Nephrectomy Patients http://thejas.com.pk/index.php/pjhs/article/view/2970 <p>Nephrectomy and pyelolithotomy are invasive surgical procedures often associated with significant postoperative pain, necessitating effective analgesia for optimal recovery. <strong>Objectives: </strong>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. <strong>Method: </strong>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. <strong>Results: </strong>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. <strong>Conclusions</strong>: 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.</p> Sumayya Tariq Shaheer Nayyar Shumaila Ashfaq Anum Zeb Hafiz Naseer Ahmad Maria Arshad Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 63 68 10.54393/pjhs.v6i6.2970 Barriers to the Implementation of Evidence-Based Practice in A Tertiary Care Hospital Mirpur, Azad Kashmir, Pakistan: A Cross-Sectional Study http://thejas.com.pk/index.php/pjhs/article/view/2963 <p>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). <strong>Objective: </strong>To assess the organizational and individual barriers to implementing Evidence-based practice among registered nurses in a tertiary care hospital in Mirpur, Azad Kashmir. <strong>Method</strong><strong>s</strong><strong>:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusions: </strong>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.</p> Safia Noreen Fozia Fatima Kashmala Ejaz Zubaida Khatoon Tanveer Kousar Rubab Tariq Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 69 74 10.54393/pjhs.v6i6.2963 Labor Augmentation in Primigravida: A Comparative Evaluation of Drotaverine and Tramadol http://thejas.com.pk/index.php/pjhs/article/view/3153 <p>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. <strong>Objective:</strong> 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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> 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.</p> Maria Tasneem Benish Fatima Makhdoom Durre Shahwar Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 75 79 10.54393/pjhs.v6i6.3153 Comparison of Pressure Support versus T-Piece Trial for Weaning from Mechanical Ventilation http://thejas.com.pk/index.php/pjhs/article/view/3235 <p>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. <strong>Objective: </strong>To compare PSV versus T-Piece trial for weaning from Mechanical Ventilation. <strong>Methods: </strong>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. <strong>Results:</strong> 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. <strong>Conclusion: </strong>This study indicated that PSV results in successful extubation and liberation from mechanical ventilation than T piece trial.</p> Sheeza Bashir Muhammad Rashid Ayesha Qureshi Asma Bhatti Fariha Munir Mian Sajjad Ahmad Muhammad Usman Sarwar Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 80 84 10.54393/pjhs.v6i6.3235 Comparing Probiotics Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy http://thejas.com.pk/index.php/pjhs/article/view/2871 <p>A neuropsychiatric condition known as hepatic encephalopathy (HE) is brought on by liver malfunction, which accumulates poisons like ammonia and impairs brain activity. <strong>Objectives:</strong> To compare the viability of combining probiotics with lactulose versus utilizing lactulose alone within the treatment of obvious hepatic encephalopathy. <strong>Methods</strong>: 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. <strong>Results</strong>: 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&lt;0.05), indicating enhanced recovery in the combination therapy group. <strong>Conclusions:</strong> The addition of probiotics to lactulose significantly improves clinical outcomes in patients with overt hepatic encephalopathy by reducing hospital stay and enhancing treatment efficacy.</p> Omer Hassaan Aftab Ahmad Amat Amtul Hafeez Aiman Asif Ammarah Amjad Mehwish Tayyab Sidra Mumal Mashhood Ali Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 85 90 10.54393/pjhs.v6i6.2871 Detection of Intrauterine Growth Retardation in 2nd And 3rd Trimester with Fetal Parameters and Umbilical Artery Doppler http://thejas.com.pk/index.php/pjhs/article/view/3012 <p>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.<strong> Objective: </strong>To detect Intrauterine growth retardation in 2<sup>nd</sup> and 3<sup>rd</sup> trimester with fetal parameters and umbilical artery doppler. <strong>Methods: </strong>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<sup>nd</sup> 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 <u>&lt;</u>0.05 was considered as a significant value.<strong> Results: </strong>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.<strong> Conclusions: </strong>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.</p> Sidra Saleem Khadija Tul Kubra Zobia Saleem Asim Raza Yasser Khan Areeba Rizwan Adeeba Anwaar Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 91 96 10.54393/pjhs.v6i6.3012 Age-Specific Risk Factors and Post-Operative Complications in Patients with Intestinal Obstruction http://thejas.com.pk/index.php/pjhs/article/view/2741 <p>Intestinal obstruction is among the most prevalent surgical challenges, which impacts millions of individuals and contributes significantly to morbidity and mortality. <strong>Objectives:</strong> To investigate the age-specific causes and post-operative complications in patients with intestinal obstruction. <strong>Methods:</strong> 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. <strong>Results:</strong> 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%. <strong>Conclusions:</strong> It was concluded that the etiology of intestinal obstruction in adults varies significantly with age, necessitating age-specific diagnostic and therapeutic approaches.</p> Hassan Shoukat Muhammad Ismail Yar Khan Uttra Muhammad Khan Malik Abdus Salam Madeeha Shahid Tariq Mahmood Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 97 101 10.54393/pjhs.v6i6.2741 Frequency of Types of Jejunoileal Atresia among Neonates Presenting With Intestinal Obstruction http://thejas.com.pk/index.php/pjhs/article/view/3148 <p>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.<strong> Objective: </strong>To determine the frequency of common types of jejunoileal atresia among neonates presenting with intestinal obstruction.<strong> Methods: </strong>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.<strong> Results: </strong>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%).<strong> Conclusions: </strong>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.</p> Fatima Majid Sana Aslam Muhammad Anwar Misbah Abdul Ghaffar Yasir Ahmed Fareeha Nazar Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 102 106 10.54393/pjhs.v6i6.3148 Prevalence of Speech and Language Disorders in Children Presenting to a Tertiary Care Center http://thejas.com.pk/index.php/pjhs/article/view/2882 <p>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. <strong>Objective: </strong>To determine the prevalence of SLDs in children presenting to a tertiary childcare hospital in South Punjab, Pakistan. <strong>Methods: </strong>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&lt;0.05 considered significant). <strong>Results:</strong> 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&lt;0.001), cerebral palsy (18.3% vs. 16.8%, p&lt;0.001), and hearing loss (4.2% vs. 1.9%, p&lt;0.001) were more common in females, while ASD (12.3% vs. 8.6%, p&lt;0.001) and stammering (5.3% vs. 3.1%, p&lt;0.001) were more common in male. GDD and ASD were more prevalent in younger children (p&lt;0.001), while cerebral palsy and articulation disorders were more common in older children (p&lt;0.001). <strong>Conclusions:</strong> 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.</p> Kausar Aftab Erum Afzal Imran Maqsood Rukhsana Tabassum Hafiz Muhammad Ishfaq Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 107 111 10.54393/pjhs.v6i6.2882 Incidence of Post-Operative Stricture Following Hepaticojejunostomy for Benign and Malignant Disease http://thejas.com.pk/index.php/pjhs/article/view/3110 <p>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. <strong>Objective:</strong> To: 1) determine contemporary stricture incidence using standardized criteria, 2) compare benign versus malignant cases, and 3) evaluate 3-month follow-up adequacy. <strong>Methods:</strong> 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&lt;0.05). <strong>Results:</strong> 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). <strong>Conclusions:</strong> 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.</p> Muhammad Amin Misbah Ullah Maryam Munir Ishfaq Ullah Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 112 116 10.54393/pjhs.v6i6.3110 Frequency of Hypocalcaemia and Hypomagnesaemia in Neonates with Birth Asphyxia http://thejas.com.pk/index.php/pjhs/article/view/3049 <p>Birth asphyxia is a major cause of mortality and morbidity in neonates in developing nations. <strong>Objective: </strong>To determine the frequency of hypocalcaemia as well as hypomagnesaemia amongst neonates having birth asphyxia. <strong>Methods: </strong>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. <strong>Results: </strong>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. <strong>Conclusions: </strong>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.</p> . Aikta Mohammad Iqbal Vijeet Kumar Farhana Zafar . Arti Lubna Khan Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 117 121 10.54393/pjhs.v6i6.3049 Demographic, Clinical, and Lifestyle Risk Factors Associated with Lower Gastrointestinal Bleeding: A Cross-Sectional Study at A Tertiary Care Hospital http://thejas.com.pk/index.php/pjhs/article/view/3111 <p>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. <strong>Objectives:</strong> To assess the demographic, clinical, and lifestyle risk factors associated with lower gastrointestinal bleeding (LGIB) among patients presenting to a Tertiary Care Hospital, Hyderabad. <strong>Methods: </strong>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. <strong>Results:</strong> 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. <strong>Conclusions:</strong> 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.</p> Qandeel Jamali Nand Lal Seerani Atif Ahmed Shahzad Ali Jariko Muhammad Kaleem Sheeba Faryal Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 122 126 10.54393/pjhs.v6i6.3111 Beyond the Ridge: Exploring Fingerprints to Determine the Predominant Pattern in the Pakistani Population http://thejas.com.pk/index.php/pjhs/article/view/3233 <p style="margin: 0in; text-align: justify;"><span lang="EN-GB" style="font-size: 10.0pt;">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. <strong>Objectives: </strong>To assess the distribution of fingerprint patterns and evaluate their symmetry by gender, age, ethnicity, region, hand dominance, and parental consanguinity. <strong>Methods:</strong> 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. <strong>Results:</strong> 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&lt;0.001), age group (p=0.003), region (p&lt;0.001), and ethnicity (p&lt;0.001). No significant link was found between symmetry and pattern type. <strong>Conclusions: It was concluded that f</strong>ingerprint 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.</span></p> Roman Ashraf Durdana Zafar Sheeba Shabbir Saima Manzoor Zulfiqar Ali Buzdar Tayyaba Tahir Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 127 132 10.54393/pjhs.v6i6.3233 Assessing the Outcomes of Combined Surgical Techniques in Spondylolisthesis: A One Year Retrospective Analysis http://thejas.com.pk/index.php/pjhs/article/view/2743 <p>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. <strong>Objectives:</strong> 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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusions:</strong> 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.</p> Kamran Ullah Rizwan Ullah Khattak Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 133 137 10.54393/pjhs.v6i6.2743 GP73 Level in Patients with Chronic Hepatitis B: Relationship with Liver Biopsy, Levels of ALT, AST and HBV DNA http://thejas.com.pk/index.php/pjhs/article/view/2821 <p>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. <strong>Objectives:</strong> 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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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<em>&lt;</em>0.05) and a strong correlation with HAI (r=0.75, p<em>&lt;</em>0.001). <strong>Conclusion</strong><strong>s</strong><strong>:</strong> GP73 is a promising non-invasive biomarker for evaluating liver fibrosis and necroinflammation in CHB, warranting further validation in larger studies.</p> Ratan Kumar Ramani Sarwat Ashraf Abdul Hayee Phulpoto Safder Ali Pervez Abdul Qayoom Memon Asif Aziz Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 138 143 10.54393/pjhs.v6i6.2821 Clinical Outcomes and Frequency of Electroencephalographic Abnormalities in Patients with First Unprovoked Seizure in a Tertiary Care Hospital: A Cross-Sectional Study http://thejas.com.pk/index.php/pjhs/article/view/2363 <p>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. <strong>Objective: </strong>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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> This study concluded that EEG abnormalities are highly frequent among individuals following their first unprovoked seizure. </p> Rabbiyah Masood Madiha Malik Maimoona Tanwir Rana Samrat Habib Ali Nawaz Taha Habib Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 144 148 10.54393/pjhs.v6i6.2363 Impact of Structured Early Clinical Exposure on Confidence and Competence among Undergraduate Health Science Students in Islamabad http://thejas.com.pk/index.php/pjhs/article/view/3231 <p>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. <strong>Objective:</strong> To assess the effect of structured early clinical exposure on the self-reported confidence and perceived competence of undergraduate medical, dental, and nursing students. <strong>Methods:</strong> 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 (<em>p</em> &lt; 0.05). <strong>Results:</strong> Post-intervention scores showed significant improvements across all five domains of clinical confidence, including history taking, communication, examination skills, case presentation, and anxiety management (<em>p</em> &lt; 0.001). Gender was significantly associated with comfort in ward settings and understanding hospital hierarchy. No significant differences were observed across academic years. <strong>Conclusions:</strong> 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.</p> Khaliq Aman Bilqis Hassan Zaineb Qamar Wajiha Riaz Humera Gohar Sadaf Abdullah Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 149 153 10.54393/pjhs.v6i6.3231 Frequency of Hypoalbuminemia in Acute Ischemic Stroke Patients Presenting at Tertiary Care Hospital, Karachi http://thejas.com.pk/index.php/pjhs/article/view/2967 <p>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. <strong>Objective:</strong> To determine the frequency of hypoalbuminemia in patients with acute ischemic stroke. <strong>Methods:</strong> 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&lt;0.05 as statistically significant. <strong>Results:</strong> 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. <strong>Conclusions:</strong> 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.</p> Habiba Aman Humaira Zakir Bukhtawar Naz Amanullah Khokar Waqas Manzoor Nadeem Ul Haque Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 154 158 10.54393/pjhs.v6i6.2967 Effect of Thrombocytopenia in Pregnancy and Their Maternal Outcome http://thejas.com.pk/index.php/pjhs/article/view/2786 <p style="margin: 0in; text-align: justify;"><span style="font-size: 10.0pt;">Gestational thrombocytopenia is a common hematological disorder during pregnancy that can significantly impact maternal health, depending on its severity. <strong>Objective:</strong> To assess the effects of thrombocytopenia severity on key maternal outcomes, including antepartum and postpartum hemorrhage, and placental abruption. <strong>Methods: </strong>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. <strong>Results:</strong> 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&lt;0.001 for both). Additionally, a moderate positive correlation was observed between platelet count and gestational age (r=0.478, p&lt;0.001), indicating a potential link between the progression of pregnancy and changes in thrombocytopenia severity. <strong>Conclusions:</strong> 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.</span></p> Hina Mukhtar Syeda Uzma Sadia Zainab Ch Naheed Hayat Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 159 164 10.54393/pjhs.v6i6.2786 Age and Gender Specific Associations between Hyperuricemia and Hypertension: A Cross-Sectional Study in Karachi http://thejas.com.pk/index.php/pjhs/article/view/3086 <p>Hyperuricemia is increasingly linked to hypertension and various metabolic disorders. <strong>Objectives:</strong> 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. <strong>Methods:</strong> 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&lt;0.05. <strong>Results: </strong>The research found a 27.5% prevalence of hyperuricemia, significantly higher in male (33.9%) than female (17.1%) (p&lt;0.001). Male had significantly elevated systolic BP (p=0.043), waist circumference (p&lt;0.001), and serum uric acid levels (p&lt;0.001). Serum uric acid showed positive correlations with systolic BP (p=0.001), diastolic BP (p=0.007), BMI (p&lt;0.001), waist circumference (p&lt;0.001), and age (p=0.024). Hyperuricemic individuals had significantly higher age, BP, BMI, and waist circumference (all p&lt;0.01). Females with hyperuricemia were older (p=0.04) and more frequently in the &gt;50 age group (p=0.036). <strong>Conclusions:</strong> 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.</p> Yameen Bocha Aliya Jafri Faiza Agha Uzma Najam Syed Zaryab Ahmed Samina Mohyuddin Noureen Latif Copyright (c) 2025 Pakistan Journal of Health Sciences https://creativecommons.org/licenses/by/4.0 2025-06-30 2025-06-30 165 170 10.54393/pjhs.v6i6.3086