Pakistan Journal of Health Sciences

When the Scan Gets Shorter: Long-Axial PET and the Choices We Make

Syed Amir Gilani — Sat, 31 Oct 2026 00:00:00 +0000

PET imaging has been operating for the most part of its history under an unwritten contract: you got a quick scan, or a great scan, but not both. That bargain has been called into question by long-axial field-of-view (LAFOV) PET/CT. A conventional scanner scans approximately 20 cm of the body at a time, meaning that less than 1/8 of the body is in view at any given time. The potential increase in sensitivity by extending the detector to cover the entire body is approximately 40-fold for whole-body imaging, which can be applied to improving image quality, speed, dose, or both. [1] The team claimed to have obtained diagnostic-quality images from about a minute or less of acquisitions with the 194 cm EXPLORER scanner when it was first tested on human volunteers, and from activities injected as low as 25 MBq [2]. This was a feasibility study of a few topics, not a clinical trial. A later study head-to-head with another commercial scanner provided more concrete statistics. Out of 44 patients who were scanned on both systems the same day, the long-axial scanner matched the image quality and lesion quantification of routine imaging in less than 2 minutes, compared to 16 minutes. Although more distracting, even half-minute acquisitions were sufficient to reveal target lesions in certain circumstances [3]. These studies report image quality, but not patient outcomes, and are from early systems and single centers. Nevertheless, the message is clear: speed does not have to compromise diagnostic quality.

This is actually more of a personal preference than anything else for the person on the table. Traditional PET/CT requires patients to stay completely stationary for as long as 20 minutes [4]. Everybody who has been in the PET suite will know what this sounds like: The patient in pain trying to keep his arms up, the anxious one who can't stop breathing, the frail one who's been waiting hours. In a recent Australian study, patients were asked about their experience before and after a metropolitan hospital switched from the traditional, long axial PET/CT. The results were obtained from over 100 patients each. Following this, there were fewer patients reporting the scan as being too long and feeling anxious or concerned about the radiation, and less time was spent in the camera room and uptake room [4]. It wasn't necessarily a bright and sunny all year, however. The groups were not different with regard to claustrophobia and physical discomfort, even though the longer bore [4] was used. It's a kindness of a shorter scan, but it's not the answer to all problems: let's not pretend it is.

The greater question is what do we do with the increased sensitivity. The same increase in speed that contributes to the scan's speed can help to make it lighter. If the Bern scan had been kept for a 10-minute period, then it would have been possible to reduce the injected activity proportionally, resulting in a PET dose below 1 mSv [5]. Some patients are at risk for the consequences of that choice. In a small series of 2 pregnant females, the dose to the fetus from the PET was estimated to be between 0.11 and 0.44 mGy, and the physicians considered the images to be more than adequate for staging [6]. Two patients are a case series, not a guideline, but it demonstrates the possibilities of a dose-first choice. So, the department is at a crossroads. It can save the sensitivity on throughput, treating more patients within the working day and reducing a queue which could be several weeks long. Or it can use the dose, providing less radiation per patient. Both are defensible. The only one I can't defend is letting it be done automatically, by the person who sets the schedule template.

That default is most likely to be set in money, and the economics are not quite as dire as they sound at the budget meeting. According to a modelling study conducted internationally, the one LAFOV system could process as many patients daily as two traditional scanners, while requiring fewer technologists, less radiopharmaceutical activity and less dose to staff in each country modelled, and even cost less per scan in all countries modelled. The least effective solution that was found to add capacity on conventional scanners was extended operating hours [6]. If this is the case, as it is in practice, speed and dose are not just a matter of solvency or safety. However, a model is not a budget, and savings do not walk on their own. Unless we plan for the gift (with written protocols); open reporting of dose and throughput, and not pay for the volume alone, we will not get the gift to the person on the table. The detector has served its purpose. The meaning of the one-minute scan will be determined by people and not by the scanner in a budget meeting.

Prevalence of Endometriosis in Women Presenting with Infertility: Hospital-based Cross-sectional Study

Bushra Gull, Lubna Noor, Sadia Majeed, Sadaf Mumtaz, Nadia Naheed — Sat, 31 Oct 2026 00:00:00 +0000

Endometriosis is a gynaecologic disorder that can impair fertility, yet it’s prevalence among women presenting with infertility remains variably reported across clinical settings. Objectives: To determine prevalence of endometriosis in women presenting with infertility. Methods: This descriptive cross-sectional study was performed at the Department of Obstetrics and Gynecology, Combined Military Hospital Multan. Ninety-five married women aged 20-40 years presenting with infertility were enrolled through non-probability consecutive sampling. Baseline sociodemographic, menstrual, and clinical characteristics were recorded. Hormonal evaluation included thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, and prolactin. All participants underwent diagnostic laparoscopy under general anesthesia by experienced consultants. Endometriosis was diagnosed based on characteristic peritoneal lesions visualized on laparoscopy. Data were analyzed utilizing SPSS version 27. Comparative analyses were performed utilizing an independent sample t-test and chi-square test. Results: Mean age was 29.9 ± 4.8 years. Primary infertility was present in 69 (72.6%) and obesity in 47 (49.5%). In 30 (31.6%) of cases women were illiterate, and 58 (61.1%) were from the lower middle socioeconomic class. Endometriosis was identified in 16 (16.8%) of the participants. Demographic, menstrual, and hormonal parameters were comparable between women with and without endometriosis, except obesity – endometriosis being more common in non-obese compared to obese women (27.1% vs. 6.4%, p-value=0.012). Conclusions: Endometriosis was detected in nearly one-sixth of infertile women undergoing diagnostic laparoscopy, supporting its clinically relevant prevalence.

Comparison of Remission with Autologous Serum Therapy versus Fixed-Dose Levocetirizine in Chronic Urticaria: A Quasi-Experimental Study

Sat, 31 Oct 2026 00:00:00 +0000

Chronic urticaria is a relapsing disorder characterized by recurrent wheals and pruritus for more than 6 weeks. Although second-generation H1-antihistamines remain first-line therapy, some patients show incomplete control, prompting interest in autologous serum therapy (AST). Objectives: To compare remission rates with AST versus fixed-dose levocetirizine in adults with chronic urticaria. Methods: This quasi-experimental study was conducted in the Department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan, from March 21, 2024, to September 20, 2024. Eighty-eight adults with clinically diagnosed chronic urticaria were enrolled by non-probability consecutive sampling and allocated non-randomly to AST (n=44) or levocetirizine 5 mg daily (n=44). AST was prepared from autologous venous blood and administered as 2 mL intramuscular injections once weekly during the active treatment phase. Outcome assessment was not blinded. The primary endpoint was the complete absence of wheals and itching during the final 7 consecutive days of treatment. Chi-square testing was used for efficacy comparisons, and relative risk (RR) with 95% confidence interval (CI) was calculated. Results: Complete remission was observed in 34/44 patients (77.3%) receiving AST and 21/44 (47.7%) receiving levocetirizine (p=0.004; RR 1.62, 95% CI 1.14–2.29). Exploratory subgroup analyses showed higher remission with AST among patients aged 31–45 years (p=0.027) and among those with disease duration <6 months (p=0.006). No major adverse events were documented in the available study records; however, minor adverse events were not systematically assessed or reported. Conclusions: This non-randomized, unblinded study, AST showed higher short-term remission than fixed-dose levocetirizine, but findings remain hypothesis-generating and require confirmation through randomized controlled trials.

Frequency of Peripheral Blood Eosinophilia and Factors Associated with it in Patients with Chronic Obstructive Pulmonary Disease

Namra Khalid, Talha Mahmud — Sat, 31 Oct 2026 00:00:00 +0000

Eosinophilic COPD is a known phenotype that has specific traits and favorable response to inhaled corticosteroids. Objective is to determine how often peripheral blood eosinophilia occurs in individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and identify its associated demographic and clinical factors. Objectives: To determine the frequency of peripheral blood eosinophilia and its associated factors among patients with chronic obstructive pulmonary disease (COPD) presenting in tertiary care hospital Lahore. Methods: This analytical cross-sectional study was carried out within the Department of Pulmonology, Shaikh Zayed Hospital, Lahore from ( September 2025 to December 2025). A total of 121 COPD patients were recruited through consecutive, non-probability sampling. Laboratory tests including blood eosinophil count, spirometry test, and serum IgE level were performed. Peripheral blood eosinophilia was defined as an absolute eosinophil count of 100 cells/μL or higher. Statistical analysis with chi-square tests and binary logistic regression was performed with SPSS version 26.0. Results: The frequency of peripheral blood eosinophilia was 62% (75/121). Mean age was 53.76 ± 10.77 years with 80.2% males. A strong association was observed with IgE levels: 48 (90.6%) patients with IgE >200 had peripheral blood eosinophilia, compared to 27 (39.7%) patients with IgE ≤200 (p<0.001). Binary logistic regression analysis demonstrated that, after adjusting for gender, BMI (>25 kg/m²), smoking status, diabetes mellitus, hypertension, and ischemic heart disease, elevated IgE levels remained significantly associated with the presence of peripheral blood eosinophilia among patients with COPD. Conclusions: Based on the findings of this study, the frequency of peripheral blood eosinophilia among COPD patients was 62%. Gender, smoking status, and IgE levels were initially found to be associated with the presence of eosinophilia; however, after regression analysis, only elevated IgE levels remained a significant predictor of peripheral blood eosinophilia in patients with COPD.

Correlation Between Spot Urinary Protein-Creatinine Ratio and 24-Hour Urinary Protein Excretion in Patients with Type 2 Diabetes Mellitus

Sat, 31 Oct 2026 00:00:00 +0000

Diabetic kidney disease is a significant complication of type 2 diabetes mellitus (T2DM), and chronic proteinuria is a significant indicator of renal damage. Although the quantification is generally done by 24-hour urinary protein estimation, which is rather convenient, it is subject to collection errors. Objectives: To identify the relationship between spot urinary protein-creatinine ratio (PCR) and 24-hour urinary proteinuria in T2DM patients. Methods: The study was a cross-sectional study, which was carried out at the Department of Medicine, Shaikh Zayed Hospital, Rahim Yar Khan, between August 2024 and February 2025. Non-probability consecutive sampling was done to enroll 190 patients aged 30-65 years with T2DM over 5 years. Measurement and Pearson correlation coefficient were used to measure 24-hour urinary protein and spot urinary PCR. The p-value of less than 0.05 was regarded as significant. Results: The average age was 47.24/10.75 years old, and 53.7 percent of the respondents were men. Mean 24-hour urinary protein excretion was 1011.26 ± 466.17 mg/day, while mean spot PCR was 1.25 ± 0.66 mg/mg. There was a high positive correlation between spot PCR and excretion of urinary protein in 24 hours (r = 0.805, p=0.001). There were significant positive relationships between demographic and clinical subgroups as well. Conclusions: The spot urinary PCR significantly correlated with 24-hour urinary protein excretion and could be used as an alternative to a regular evaluation of proteinuria in T2DM patients.

Evaluation of Hearing Improvement After Type I Tympanoplasty in Tubotympanic Chronic Suppurative Otitis Media: A Prospective Observational Study

Allah Noor, Ijaz Ahmad, Hamza Nawaz, Ali Khan, Muhammad Arif — Sat, 31 Oct 2026 00:00:00 +0000

Chronic suppurative otitis media (tubotympanic type) commonly causes tympanic membrane perforation and conductive hearing loss. Type I tympanoplasty aims to close the perforation and improve hearing outcomes. Objective: To evaluate hearing improvement following Type I tympanoplasty by comparing pre-and postoperative air conduction thresholds and air–bone gap at 3 and 6 months using pure tone audiometry. Methods: This prospective observational study was carried out in the Department of Otorhinolaryngology, Hayatabad Medical Complex, Peshawar, between January 2023 and June 2025. A total of 115 patients with Type I tympanoplasty were included. Preoperative and postoperative hearing were evaluated using pure tone audiometry. Preoperative hearing was assessed before surgery, and postoperative hearing was evaluated at 3 and 6 months after Type I tympanoplasty using pure tone audiometry. Results: There were 62 (53.9%) males and 53 (46.1%) females with a mean age of 29.6±9.4 SD years. Graft uptake in 106 patients (92.2%) was successful. Preoperative air-bone gap was significantly enhanced (29.2 ± 6.5 dB) to 15.1 ± 5.4 dB after the operation (p<0.001). Hearing improvement was seen in 80% of the patients, and the mean improvement in hearing was 12.9 ± 5.8 dB. Conclusions: Type I tympanoplasty showed a high graft success rate and led to a large improvement in hearing, while the clinical outcome is poor for tubotympanic chronic suppurative otitis media. The surgery is still a dependable surgical method of restoring hearing in selected cases.

End Stage Renal Disease and Its Effects on Periodontal Health, Salivary pH, and Flow Rate

Sat, 31 Oct 2026 00:00:00 +0000

End-stage renal disease (ESRD) is the final stage of chronic kidney disease and is associated with several systemic complications that may affect oral health. Additionally, renal impairment can alter salivary pH and reduce salivary flow rate, which may further influence oral and periodontal conditions. Objectives: To evaluate the periodontal status (using plaque index and gingival index), salivary pH, and salivary flow rate in patients with end-stage renal disease (ESRD) in comparison to systemically healthy controls. Methods: A cross-sectional group comparative study with a total of 100 participants, 50 diseased ESRD patients, and 50 systemically healthy controls. were assessed. The oral health status was assessed using the Gingival Index and the Plaque Index. Unstimulated saliva was measured using the Spitting Method. The pH of the saliva was assessed by pH Indicator Strips. Results: Participants were 60% males and 40 % females. 63% participants brushed daily, and only 28% brushed twice. The brushing time reported by 51% participants was 1-2 minutes. 51% reported never visiting the dentist. Significant positive association was found between ESRD and systemically healthy controls in change of salivary pH (p=0.004), PI status (p =0.010), and salivary flow rate (p <0.001). However, gingival status showed no association with ESRD (p=0.066). Conclusions: Patients with end-stage renal disease (ESRD) demonstrated poorer periodontal status and altered salivary pH and flow rate compared to systemically healthy controls.

Serum Ferritin Dynamics in Maternal Anemia Management: Implications for Preterm Birth Risk

Annam Ijaz, Yasmeen Akhtar, Zainab Zaib — Sat, 31 Oct 2026 00:00:00 +0000

Preterm birth is one of the major factors that lead to neonatal morbidity and mortality, and maternal iron-deficiency anemia (IDA) has been described as a key but treatable risk factor. There is little evidence of the most commonly practiced approaches to the management of IDA, particularly in low- and middle-income countries (LMICs). Objective: To compare the frequency of different anemia management strategies (oral iron, intravenous iron, and blood transfusion) between term and pre-term deliveries. Methods: This comparative cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Ayub Teaching Hospital, Abbottabad. A total of 150 anemic women aged 15 to 40 years admitted for term or pre-term delivery were compared for anemia management strategies in terms of oral, intravenous iron, and blood transfusion. Results: A total of 150 were studied, 78(52.0%) were term and 72 (48.0%) were pre-term. The mean age in the term group was 38.6 ± 1.2 weeks and 35.0 ± 1.4 weeks in the pre-term group. Overall, 95 (63.3%) received oral treatment, 40 (26.7%) IV, and 15(10.0%) blood transfusion. In the term group, 49 (62.8%) received oral compared to 46 (63.9%) in the preterm group, while IV iron was administered to 21 (26.9%) and 19 (26.4%) patients in the term and preterm groups, respectively (p=0.985). Conclusions: Anemia management techniques are similar for both term and preterm patients, with oral iron remaining the most common. Treatment choices seem to be predominantly influenced by the degree of anemia and socioeconomic circumstances.

Association between Stress and Gastroesophageal Reflux Disease (GERD) Among Undergraduate Students in Peshawar: A Cross-Sectional Study

Sat, 31 Oct 2026 00:00:00 +0000

Gastroesophageal reflux disease (GERD) and stress are growing health concerns among undergraduate students, especially in high-pressure academic settings. However, limited data exist regarding their prevalence and associated factors among students in Peshawar. Objective: To determine the association between Stress and GERD and identify its associated risk factors among undergraduate students in Peshawar. Methods: A cross-sectional study was conducted among 384 undergraduate students in Peshawar using convenience sampling. Data were collected through a structured questionnaire incorporating the validated GERD-Q and Cohen’s Perceived Stress Scale (PSS-10). Results: Of the 384 students, 88% were medical, and 12% were non-medical.PSS-10 scores showed 15.4% low stress, 71.1% moderate stress, and 13.5% high stress. Perceived stress was significantly associated with gender (p= 0.021) and academic performance (p= 0.011). Smoking was associated with GERD (p=0.030), with smokers showing a higher moderate-to-severe GERD. Frequent fast-food consumption was also significantly associated with GERD (p=0.014), and weekly or daily consumers had 79%-89% likelihood of GERD. Spearman’s correlation showed a weak but statistically significant association between perceived stress levels and GERD severity (p=0.014). Conclusions: This study revealed a high burden of moderate to high stress and significant GERD prevalence among undergraduate students in Peshawar. Stress was strongly associated with greater GERD severity and was more common in females and lower academic performers. GERD was significantly associated with smoking, frequent fast-food intake, early academic years, limited physical activity, and NSAID use. College-based interventions focusing on stress management, smoking cessation, healthy eating, and physical activity are recommended.

Efficacy of Nebulized Magnesium Sulphate with Salbutamol versus Salbutamol Alone in Pediatric Patients with Moderate to Severe Asthma Exacerbations: A Comparative Cross-Sectional Study

Sat, 31 Oct 2026 00:00:00 +0000

Acute asthma exacerbation is a leading cause of pediatric emergency. β2-agonists and systemic corticosteroids remain the cornerstone of management and necessitate adjunct therapies such as magnesium sulphate. Objective: To compare the efficacy of nebulized magnesium sulphate combined with salbutamol versus salbutamol alone in reducing asthma severity among pediatric patients presenting with moderate to severe asthma exacerbations. Method: This quasi‑experimental study was conducted in the Pediatrics Department at Sharif Medical City Hospital, Lahore. 60 children aged 2–15 years with moderate to severe asthma exacerbations were allocated to receive either nebulized salbutamol with magnesium sulphate (n=30) or salbutamol with placebo (n=30). Asthma severity was assessed using the Pediatric Respiratory Assessment Measure (PRAM) score at baseline, 60 minutes, and 120 minutes. Efficacy was defined as a reduction of at least 3 points in PRAM score at 120 minutes. Data were analyzed using SPSS version 28.0, with p ≤ 0.05 considered statistically significant. Results: Baseline characteristics and PRAM scores were comparable between groups (7.17 ± 2.17 vs. 8.03 ± 2.31; p>0.05). At 60 minutes, mean PRAM scores were significantly lower in the magnesium sulphate group (4.10 ± 2.80) compared to the placebo group (6.57 ± 2.74; p<0.05), with further improvement at 120 minutes (2.37 ± 3.18 vs. 5.20 ± 3.15; p<0.05). Conclusions: Nebulized magnesium sulphate is an effective and safe adjunct to salbutamol in the management of moderate to severe acute asthma exacerbations in children, particularly among younger age groups.

Frequency and Knowledge of Halitosis Among Students of Khyber Medical University-Institute of Dental Sciences and Khyber Medical University-Institute of Medical Sciences, Kohat

Sat, 31 Oct 2026 00:00:00 +0000

Common oral malodor, halitosis, may damage social relationships, self-confidence, and quality of life. Oral health education is demanded of university students, especially medical and dentistry students. Objective: To determine the frequency and knowledge of halitosis among the students of Khyber Medical University, Institute of Medical/Dental Sciences, Kohat. Methods: A standardized, self-administered questionnaire was used to gather data. The survey included data on demographics, self-perceived halitosis, oral hygiene habits such as brushing teeth, wiping the tongue, and using mouthwash, as well as knowledge on the causes, effects, and treatment of halitosis. Results: 300 students in all took part in the research; 150 (50%) came from Kohat's KMU Institute of Dental Sciences (KMU-IDS) and 150 (50%) from KMU Institute of Medical Sciences (KMU-IMS). The mean age of the participants was 21.8 ± 2.1 years, with ages ranging from 18 to 25 years. Among the respondents, 168 (56%) were female, and 132 (44%) were male. Conclusion: Medical and dental students have different types of awareness regarding halitosis, which is a common problem among students nowadays.

Diagnostic Role of Fine Needle Aspiration Cytology (FNAC) in Oral and Maxillofacial Masses: A Descriptive Cross-Sectional Study

Maryam Mughal, Jehan Alam, Honey Rajpal, Waiza Batool, Shaane Sehar, Ruqaya Shah — Sat, 31 Oct 2026 00:00:00 +0000

Oral and maxillofacial swellings comprise a wide spectrum of inflammatory, benign, and malignant conditions that often present with overlapping clinical and radiological features. Objectives: To determine the diagnostic accuracy of fine needle aspiration cytology in oral and maxillofacial swellings using histopathology as the reference standard. Methods: The research is a descriptive cross-sectional study that was undertaken at the Department of Oral and Maxillofacial Surgery, Jinnah Post-Graduate Medical Centre, Karachi, within a period of four months from December 2025 to March 2026, after receiving the consent of the IRB. Non-probability consecutive sampling was used to select a total of 139 adult patients who had palpable oral and maxillofacial swellings. FNAC was done in aseptic conditions, and cytological results were compared to histopathology, which was taken as the reference standard. The results of FNAC were compared to the histopathological results based on a 2x2 contingency table. Results: A total of 139 patients with oral and maxillofacial swellings were analyzed, predominantly middle-aged males from urban areas, with most lesions present for ≤6 months. FNAC showed strong diagnostic performance against histopathology, with overall sensitivity of 89.7%, specificity of 93.0%, and diagnostic accuracy of 91.4%. Performance was highest in inflammatory lesions, followed by malignant and benign lesions. Cytological features showed typical biphasic epithelial and myoepithelial patterns without malignancy in benign cases, supporting FNAC as a reliable diagnostic tool. Conclusions: Fine needle aspiration cytology is a reliable first-line diagnostic tool for oral and maxillofacial swellings, demonstrating high accuracy in distinguishing inflammatory, benign, and malignant lesions.

Predictors and Clinical Outcomes of Acute Renal Failure in Patients with Plasmodium falciparum Malaria: A Prospective Cohort Study

Sat, 31 Oct 2026 00:00:00 +0000

ARF is considered a serious complication of Plasmodium falciparum malaria and a major indicator of morbidity and mortality. Currently, there are no prospective studies from Pakistan investigating the prevalence and risk factors of ARF. Objectives: To ascertain the prevalence of ARF in adults suffering from Plasmodium falciparum malaria and to determine its predictors and clinical outcomes. Methods: A prospective cohort study was undertaken in the Department of Nephrology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. 230 patients, aged between 18 and 60 years, suffering from microscopically confirmed P. falciparum malaria, constituted the study population. ARF was defined using KDIGO 2012 criteria. The renal function was assessed upon admission and on the second and seventh day of admission. The measured outcomes included the requirement for RRT, in-hospital mortality, length of hospital stay, renal recovery, and CKD. The statistical analyses were done with the help of SPSS version 26. Results: Prevalence of ARF was 18.3%. The prevalence of ARF requiring hemodialysis and exhibiting KDIGO stage 3 kidney dysfunction accounted for 52.4%. Higher in-hospital mortality was observed in patients with ARF as compared to patients without ARF. While amongst survivors, most showed renal recovery, some developed CKD. Conclusions: 18.3% of the studied adults admitted with P. falciparum malaria developed ARF. Mortality rate was significantly higher in patients with ARF, by almost ten times, and at a higher risk of developing CKD. Some preventable causes contributing to ARF are cardiovascular disorders, metabolic disorders, and delayed presentation in hospitals.

Association of Inflammatory Hematological Indices (NLR, NMR, PLR, and MLR) with Gestational Diabetes Mellitus: A Case–Control Study

Aisha Allauddin, Afreen Bhatty, Habiba Sharaf Ali, Aliya Irshad Sani — Sat, 31 Oct 2026 00:00:00 +0000

Gestational Diabetes Mellitus is a metabolic disorder affecting approximately 7-14% of pregnant women and is associated with adverse maternal and fetal outcomes. Low-grade chronic inflammation plays a role in the pathogenesis of GDM. Complete blood count parameters related to inflammatory indices, such as the “neutrophil-to-monocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio,” have emerged as accessible and cost-effective biomarkers. Objective: To find out the association of Inflammatory Hematological Indices (NLR, NMR, PLR, and MLR) with GDM in pregnant females. Methods: This case–control study was conducted at Ziauddin Hospitals, Karachi, from July 2025 to December 2025. A total of 110 pregnant women were enrolled, comprising 51 women diagnosed with GDM and 59 non-GDM controls. GDM was diagnosed on World Health Organization (WHO) criteria, based on oral glucose tolerance test. CBC was obtained, and inflammatory indices were subsequently calculated. Results: GDM patients showed significantly higher fasting, 1-hour, and 2-hour plasma glucose levels compared to the control group (p<0.001). Highly significant differences were observed in NMR and MLR, and a significant difference in NLR. GDM was significantly associated with NLR and MLR. After adjusting for NMR, PLR, and MLR, the multivariate regression analysis showed that NLR association (OR = 5.32, p=0.008) with low discriminative ability. Conclusion: Among the inflammatory indices, NLR and MLR were found to be associated with GDM with low discriminative ability. However, it can be used as an adjunctive inflammatory marker.

Frequency of Cardiogenic Shock in Post-Myocardial Infarction Patients with Diabetes: A Descriptive Cross-Sectional Study

Abdus Salam, Jabar Ali, Mushtaq Ahmad, Sibtain Nisar, Anwar Jamal Khan — Sat, 31 Oct 2026 00:00:00 +0000

To enhance risk classification and enable more rapid and proactive surveillance and response, the study sought to ascertain the precise incidence of cardiogenic shock among this vulnerable cohort. The results would aid in addressing this potentially fatal issue, with the goal of lowering mortality and enhancing post-infarction outcomes for diabetes patients. Objective: To determine the frequency of cardiogenic shock in post-myocardial infarction patients with diabetes. Methods: This descriptive cross-sectional study was conducted at the department of cardiology, LRH Peshawar. A total of 132 post-myocardial infarction (MI) diabetic individuals aged 30 to 60 years were evaluated for the presence of cardiogenic shock. Data analysis was carried out using SPSS version 26.0. Results: The mean age of the participants was 47.8 ± 8.1 years, with the majority of participants in the age group 41 – 50 years, 49 (37.1%). Male participants were more frequent, 71 (53.8%). STEMI was the most common recorded MI, 73 (55.3%), and 57 (43.2%) had anterior wall MI. Cardiogenic shock was recorded in 13 patients (9.8%). Conclusions: Cardiogenic shock was observed in a significant number of diabetic post-myocardial infarction patients. No significant associations were found with demographic or chronic diabetes-related variables.

Piecing Together the Puzzle: The Interplay of Malocclusion, Dental Caries, and Oral Health Status in Special Needs Children

Sat, 31 Oct 2026 00:00:00 +0000

Children with special needs are at greater risk of oral health challenges due to physical, cognitive, and sensory limitations that hinder oral hygiene practices. Such children face oral health challenges due to functional limitations, leading to dental caries, tooth loss, poor hygiene, and malocclusion. Objectives: To assess the association between types of children's disability with dental caries, oral health status, and malocclusion among children attending Falah Foundation, Lahore. Methods: A cross-sectional study was conducted in children with special needs in which oral examinations were performed. Dental caries was measured by the DMFT index, malocclusion using Angle’s molar classification, oral hygiene using the Plaque Index, and the Gingival Index, while associations were assessed by using the Chi-square test. Results: Most participants were mentally disabled (49.5%) and had higher caries severity among mentally and physically disabled children. Physically disabled children showed the highest abundance of plaque accumulation (38.1%), while severe gingival inflammation was observed in blind (40.0%), followed by physically disabled children (31.0%). Conclusions: Oral health status, dental caries experience, and malocclusion patterns vary significantly by type of disability among Special healthcare need children. Targeted preventive strategies, improved caregiver education, and enhanced access to dental services are fundamental to addressing the oral health disparities in this vulnerable population. Moreover, parental education is also very important to help reduce oral diseases in this group.

Assessment of Various Factors Responsible for Hospital Admission in Patients of Chronic Liver Disease at Chandka Medical College Teaching Hospital, Larkana – An Analytical Cross-Sectional Study

Sat, 31 Oct 2026 00:00:00 +0000

Chronic liver disease (CLD) is a major cause of hospital admission and in-hospital mortality in Pakistan, where chronic viral hepatitis is highly prevalent. Objectives: To assess factors responsible for hospital admission in CLD patients and their association with in-hospital outcome (Discharge vs Death). Methods: This analytical cross-sectional study was conducted in the Department of General Medicine Unit-III, Chandka Medical College Teaching Hospital, Larkana, from 5^th January 2026 to 5^th March 2026.. Seventy patients aged 18–60 years with CLD ≥6 months and decompensated cirrhosis (Child–Pugh A, B, or C) were enrolled by consecutive sampling after informed consent and IRB approval (IRB/96). The primary admission factor and in-hospital outcome (Discharge or Death) were recorded. Data were analysed in SPSS version 26.0 using the chi-square test; p≤0.05 was significant. Results: Mean age was 44.43 ± 11.23 years; 45 (64.3%) were male. HCV was the leading aetiology (57.1%), and 33 (47.1%) had Child–Pugh Grade C disease. Commonest admission factors were ascites (31.4%), hepatic encephalopathy (14.3%), and variceal bleeding (11.4%). In-hospital mortality was 10/70 (14.3%). Variceal bleeding was the only factor significantly associated with mortality (40.0% vs 6.7%; p=0.012). Conclusions: Decompensation complications, such as ascites, hepatic encephalopathy, and variceal bleeding, drove CLD admissions, and variceal bleeding was the only factor significantly associated with in-hospital death. Findings warrant larger multi-centre studies.

Radio-Pathological Concordance in Ultrasound-Guided Core Needle Biopsies of Breast Lesions: A Retrospective Study

Uzma Azmat, Sadaf Nasir, Abdul Qayoom Rakhshani — Sat, 31 Oct 2026 00:00:00 +0000

Breast cancer is the leading malignancy among women in Pakistan, often presenting at advanced stages. Accurate, minimally invasive diagnostic methods such as ultrasound-guided core needle biopsy (CNB) are critical in optimizing care and resource allocation. Objectives: To see the diagnostic accuracy of ultrasound-guided core needle biopsy (CNB) in breast lesions, assess radio-pathological concordance and discordance, and improve standards of clinical care and resource utilization. Methods: This retrospective study included female outpatients and walk-in patients aged 15–80 years who underwent ultrasound-guided CNB for breast lesions at the Department of Radiology, Memon Medical Institute Hospital, Karachi, between 1 August 2024 and 31 July 2025. Data were retrieved from the electronic health records and analyzed for demographic characteristics, lesion features, histopathological findings, and radio-pathological concordance. Data were analyzed using RStudio. Results: One hundred and eleven ultrasound-guided core-needle biopsies were analyzed (mean age 44.7 ± 14.5 years). Lesions were almost evenly split between the right (50.5%) and left (49.5%) breasts; 88 lesions (79.3%) measured >2 cm. Histopathology showed 55 benign (49.5%), 46 malignant (41.4%), and 10 inadequate (9%) cores. Among the 101 cases with complete radiological–histopathological pairing, concordance was 89.1% for benign lesions and 95.7% for malignant lesions, resulting in an overall concordance of 92.1% (sensitivity, 95.7%; specificity, 89.1%). Conclusions: Ultrasound-guided core needle biopsy is an indispensable, effective, less invasive, and cost-effective tool for accurate and early diagnosis, significantly reducing the need for unnecessary surgical interventions; excisional or incisional biopsy for diagnosis, while providing crucial histological and molecular data for treatment decisions.

Mean Length of Femoral Shortening Required in DDH Patients

Shahan Raza, Asad Amin, Haseeb Hussain, Umair Ahmed, Jawad Ul Haq, Shuaib Amin — Sat, 31 Oct 2026 00:00:00 +0000

Walking-age children with developmental dysplasia of the hip (DDH) frequently exhibit severe dislocation and soft tissue contractures, making concentric, tension-free reduction difficult. However, it is still unclear exactly how much femoral shortening is necessary and what factors influence it. Objectives: The goal is to ascertain the average length of femoral shortening needed for open reduction in pediatric patients with DDH and to find radiographic and clinical indicators of the extent of shortening. Methods: From February to August of 2025, a descriptive observational cohort study was carried out. There were 46 kids (52 hips) with IHDI grades III–IV DDH. Standard anterior open reduction with routine soft tissue releases was performed, and femoral shortening was applied intraoperatively when reduction under excessive tension was observed. Postoperative outcomes were assessed. Results: The mean femoral shortening required was 2.34 ± 0.56 cm (95% CI: 2.18–2.50). Grade IV dislocations required significantly greater shortening (2.51 ± 0.49 cm) than grade III (1.92 ± 0.41 cm, p = 0.001), and children older than 36 months required more shortening (2.63 ± 0.45 cm) compared to younger children (1.98 ± 0.44 cm, p<0.001). Age, side, and IHDI grade IV were independent predictors. Conclusions: In children aged 1–8 years with IHDI III–IV DDH, the mean femoral shortening required for stable, tension-free reduction was 2.34 cm, with older age and higher-grade dislocations predicting greater shortening. Tailored, intraoperative determination of shortening length achieves excellent short-term outcomes with minimal complications, supporting its selective use in pediatric DDH surgery.

Prevalence of Gastro-esophageal Reflux Disease in Hemodialysis Versus Non-Hemodialysis Chronic Kidney Disease Patients in a Tertiary Care Hospital of Rahim Yar Khan

Muhammad Ali, Abid Hussain, Javed Iqbal, Shanzah Javed, Ahmad Raza — Sat, 31 Oct 2026 00:00:00 +0000

Gastroesophageal reflux disease (GERD) is frequently reported among patients with chronic kidney disease (CKD), particularly those undergoing hemodialysis. GERD contributes to upper gastrointestinal morbidity, affecting quality of life and clinical outcomes. However, data from South Asian populations remain limited. Objectives:
To determine the prevalence of GERD symptoms among CKD patients and to identify clinical, biochemical, and lifestyle factors associated with GERD in both hemodialysis and non-hemodialysis groups in a Pakistani tertiary care setting. Methods: An analytical cross-sectional study was carried out among 182 CKD patients, with 70 on hemodialysis and 112 not on hemodialysis, using a non-probability consecutive sampling approach. Sociodemographic, clinical, biochemical, and lifestyle details were gathered via structured questionnaires along with lab records. Results: GERD symptoms were reported in 38.5% of participants, with a higher prevalence in the hemodialysis group (47.1%) compared with non-hemodialysis patients (33.0%; χ² = 4.98, p=0.026). Heartburn and regurgitation occurring ≥2 times per week were significantly more frequent in hemodialysis patients. Proton pump inhibitor use was also more common in this group (p=0.014). Logistic regression showed that hemodialysis status (OR 1.78; 95% CI 1.03–3.07; p=0.038) and late-night eating (OR 2.12; 95% CI 1.19–3.76; p=0.011) were independent predictors of GERD. Conclusions: GERD symptoms are common among CKD patients in Pakistan, particularly those undergoing hemodialysis. Hemodialysis treatment and modifiable lifestyle factors such as late-night eating are associated with increased GERD risk.

Comparative Diagnostic Accuracy of Risk of Malignancy Index Versus International Ovarian Tumor Analysis Model in Predicting Malignancy in Adnexal Masses: An Analytical Comparative Cross-Sectional Study

Sat, 31 Oct 2026 00:00:00 +0000

Correct pre-surgical discrimination between benign and malignant adnexal lesions is critical for appropriate operative decision-making. Risk of Malignancy Index (RMI) and international ovarian tumor analysis (IOTA) models combine clinical and ultrasound findings to assess ovarian tumor malignancy risk. However, evidence comparing their diagnostic accuracy remains limited. Objectives: To determine the comparative diagnostic performance of standalone RMI versus an integrated RMI–IOTA approach for preoperative detection of malignancy in adnexal lesions. Methods: This analytical comparative cross-sectional study was conducted at the Pakistan Institute of Medical Sciences from 1 February 2023 to 30 August 2023. A total of 49 women with adnexal masses ≥5 cm scheduled for surgical intervention were enrolled using non-probability consecutive sampling. The women with measurable serum, complete ultrasonographic, and IOTA evaluation were included. Pregnant women, conservatively managed cases were excluded. All participants underwent transabdominal and/or transvaginal ultrasonography, serum CA-125 testing, and risk stratification using RMI and IOTA Analysis models. Histopathology served as the reference standard. Results: Only 1 (2.0%) had a borderline tumor, 13 (26.5%) malignant, and 35 (71.4%) benign. The RMI identified 10/13 malignant cases (sensitivity 76.9%) and 31/35 benign cases (specificity 88.5%). The ultrasound score showed sensitivity of 76.9% (10/13) and specificity of 74.2% (26/35). The IOTA classified 5/49 (10.2%) as malignant, 25/49 (51.0%) as benign, and 19/49 (38.7%) as inconclusive. Conclusions: RMI demonstrated more reliable diagnostic performance than the IOTA model for preoperative assessment of adnexal masses. So, the RMI can be continually used as an effective tool for guiding clinical decision-making and surgical planning.

Relationship between the Duration of Symptoms and Operative Findings in Pediatric Patients Undergoing Appendectomy for Acute Appendicitis

Amna Choudry, Anwar Arian, Romila Mazhar, Mahrukh Nasir, Ali Abbas — Sat, 31 Oct 2026 00:00:00 +0000

Acute appendicitis is a common surgical emergency in children. The relationship between duration of preoperative symptoms and severity of intraoperative findings remains debated. Objective: To compare the duration of preoperative symptoms between pediatric patients with complicated and uncomplicated intraoperative findings undergoing appendectomy for acute appendicitis. Methods: This analytical cross-sectional study was conducted at the Department of Pediatric Surgery. A total of 171 children aged 2–12 years with acute appendicitis were recruited through non-probability consecutive sampling. Intraoperative findings were categorized as uncomplicated or complicated appendicitis, and duration of preoperative symptoms was categorized as ≤48 hours or >48 hours. Data were analyzed in SPSS version 26.0 using chi-square and t-tests (p ≤ 0.05). Results: Among 171 patients, 65 (38.0%) presented within ≤48 hours and 106 (62.0%) after >48 hours. Complicated appendicitis was observed in 126 (73.7%) patients, and uncomplicated appendicitis in 45 (26.3%). In the complicated group, 46 (36.5%) presented within ≤48 hours and 80 (63.5%) after >48 hours; in the uncomplicated group, 19 (42.2%) presented within ≤48 hours and 26 (57.8%) after >48 hours. The distribution of symptom duration did not differ significantly between the complicated and uncomplicated groups (p=0.498). Older age (10.29 ± 1.79 vs. 8.95 ± 2.62 years; p<0.001) before appendicitis (19.8%vs.4.4%; p=0.009) was significantly associated with complicated findings. Conclusion: Complicated appendicitis was the most frequently observed intraoperative finding. Increased age and a prior history of appendicitis were significantly linked to complicated disease, whereas the duration of symptoms before surgery was not significantly related to disease severity.

Association of Screen Time Exposure with Developmental Delay in Communication and Problem-Solving Skills among Children Under 5 Years of Age Presenting at Children's Hospital: An Analytical Cross-Sectional Study

Sat, 31 Oct 2026 00:00:00 +0000

Excessive screen exposure in early childhood has been increasingly associated with adverse neurodevelopmental outcomes. Objectives: To determine the association of screen time exposure with developmental delay in communication and problem-solving skills among children under five years of age presenting at a tertiary care hospital in Pakistan. Methods: This analytical cross-sectional study was carried out at Children's Hospital Multan. A total of 236 children aged 1 to 5 years were included using consecutive sampling. Information about children's screen use was collected from parents through a structured questionnaire. Child development in communication and problem-solving was assessed using the Ages and Stages Questionnaire (ASQ-3). Associations between screen exposure and developmental delays were evaluated using chi-square analysis and multivariable logistic regression. Results: More than half of the children (58.1%) were using screens for more than 2 hours per day. Communication delay was found in 34.3% of children, while 29.7% had delay in problem-solving skills. After adjusting for potential confounders, children who used screens for more than 2 hours daily had approximately 2.4 times higher odds of communication delay (AOR=2.41; 95% CI: 1.42–4.08; p=0.001) and 2.1 times higher odds of problem-solving delay (AOR=2.08; 95% CI: 1.19–3.64; p=0.010). Conclusion: Children under five who spend more time on screens were more likely to have speech delay, understanding, and problem-solving skills. Because of these findings, children should be screened regularly for development, and parents should receive advice about healthy screen habits. Parents spending time while talking, playing, and interacting with children may help to improve child development.

Comparison of Serum Calcium-Magnesium Ratio in Women with and without Preeclampsia

Sat, 31 Oct 2026 00:00:00 +0000

Preeclampsia remains a major cause of maternal and perinatal morbidity, and altered calcium and magnesium balance may contribute to its pathophysiology. Objective: To compare serum calcium, serum magnesium, and the calcium-to-magnesium ratio between women with preeclampsia and normotensive pregnant women. Methods: A comparative cross-sectional study was conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital from July to December 2025. Using non-probability consecutive sampling, 52 women at or beyond 24 weeks’ gestation were enrolled. Cases were diagnosed with preeclampsia, and controls were normotensive with negative urine protein. Serum calcium and magnesium were measured to calculate the calcium-to-magnesium ratio. Results: Fifty-two pregnant women were analyzed, including 26 with preeclampsia and 26 normotensive controls. Maternal age was similar between groups (28.96 ± 2.76 vs 29.54 ± 3.00 years, p=0.474), and gestational age did not differ (33.04 ± 2.16 vs 32.92 ± 3.01 weeks, p=0.874). Body mass index was higher in preeclampsia (28.57 ± 4.86 vs 24.27 ± 4.38 kg/m², p=0.002). Systolic and diastolic pressures were higher in preeclampsia (p<0.001 each). Serum calcium, magnesium, and the calcium to magnesium ratio were lower in preeclampsia (p<0.001, p=0.015, and p=0.002), supporting altered mineral balance in affected pregnancies. Conclusion: Women with preeclampsia showed lower serum calcium, serum magnesium, and a reduced calcium to magnesium ratio compared with controls. Consequently, a low serum calcium to magnesium ratio could be a risk factor for preeclampsia.

Incidence of Recurrent Laryngeal Nerve Injury While Using LigaSure in Total Thyroidectomy as Compared to Conventional Knot Tying

Sat, 31 Oct 2026 00:00:00 +0000

Recurrent laryngeal nerve (RLN) injury is a recognized complication of thyroid surgery. Although LigaSure enables faster vessel sealing, concerns remain about thermal injury to the RLN. As local randomized evidence is limited, this trial compared LigaSure with conventional knot tying to assess the risk of RLN injury. Objective: To compare the incidence of recurrent laryngeal nerve (RLN) injury between LigaSure and conventional knot tying in patients undergoing total thyroidectomy. Methods: This randomized controlled trial was conducted at Gulab Devi Hospital, Lahore, from July 2025 to March 2026, including 120 patients undergoing total thyroidectomy who were consecutively enrolled and randomly allocated, with allocation concealment, to Group A (conventional knot tying, n=60) or Group B (LigaSure, n=60). RLN injury was assessed postoperatively by clinical examination and laryngoscopy over 6 months of follow-up. Fisher’s Exact Test was used for comparison, with statistical significance defined as p<0.050. Results: The mean age was 36.29 ± 7.63 years, and 75% of patients were female. Multinodular goitre was the most common indication (60%). RLN injury occurred in 1 patient (1.7%) in the conventional group, and 2 patients (3.3%) in the LigaSure group; the overall rate was 2.5%. All injuries were unilateral and temporary, resolving within follow-up, and the difference between groups was not statistically significant (p=1.000). The risk ratio for RLN injury (LigaSure vs conventional) was 2.0 (95% CI 0.2–21.5). Conclusions: Only three RLN injury events occurred, with no significant difference between LigaSure and conventional knot tying during total thyroidectomy.

Depression, Anxiety, and Stress Among Caregivers of Patients with Schizophrenia

Fariha Saeed, Nauman Mazhar, Sanan Saeed, Asma Suleman, Aneel Shafi, Iqra Naeem — Sat, 31 Oct 2026 00:00:00 +0000

Psychological distress in family caregivers of schizophrenia often remains unnoticed in outpatient services. Objective: To determine the frequency and severity of depression, anxiety, and stress among informal family caregivers of patients with schizophrenia, and to identify contributing factors. Method: A cross-sectional study was conducted at the outpatient psychiatry clinic of PIMH, Lahore, from May to December 2025. Consecutive informal primary caregivers aged 18–55 years (n=194) were interviewed. Depression Anxiety Stress Scale 21-item version scores were doubled; clinically significant depression, anxiety, and stress were defined as ≥14, ≥10, and ≥19. Chi-square tests and multivariable models were applied. Results: Caregiver mean age was 41.4 ± 9.6 years. Clinically significant depression, anxiety, and stress were present in 63.4%, 67.5%, and 66.0%. Depression was higher in male caregivers (72.2% vs 54.6%), unemployed caregivers (74.4% vs 54.6%), those with higher education (90.4%), and those with illness duration ≥5 years (75.6%) (p<0.05). Anxiety was higher in female caregivers (78.4%), higher education (82.7%), and illness duration ≥5 years (72.6%) (p<0.05). Stress was higher in males (77.3%), unemployed caregivers (77.9%), higher education (78.8%), and spouses or parents (77.1% and 75.0%) (p<0.05). In adjusted multivariate analyses, caregiver sex remained the most consistent predictor across depression, anxiety, and stress, while higher education independently predicted depression and stress; caregiver relationship to the patient independently associated with stress. Conclusion: Clinically significant distress was present in nearly two-thirds of caregivers, supporting routine screening within outpatient services and the provision of targeted, family-focused psychosocial support.

Frequency of Burrows Under Dermatoscope in Children Suspected of Scabies Presenting at Tertiary Care Hospital Karachi

Faryal Naimat, Reema Mirza, Areeba Rais, . Ekta, Humaira Talat — Sat, 31 Oct 2026 00:00:00 +0000

Scabies is a highly contagious parasitic skin condition that is more common among children in resource-poor environments. The diagnosis is difficult to make due to atypical presentations in the paediatric age group. Dermoscopy is a non-invasive tool that can be used in real time to visualise-scabies-specific structures such as burrows. Objectives: To assess the diagnostic yield of dermoscopy in detecting scabies burrows in children with clinically suspected scabies. Methods: An analytical cross-sectional study was conducted at the Department of Dermatology, Civil Hospital, Karachi, from March to June 2025 (Approval No.: IRB-3811/DUHS/Approval/2025/105). Seventy-one children aged 1–16 years with clinical suspicion of scabies were enrolled by non-probability consecutive sampling. A polarised handheld dermoscope (10× magnification) with ultrasound gel as the interface medium was used. A binary logistic regression was used, and p<0.05 was regarded as statistically significant. Results: The mean age was 7.1 ± 4.3 years; 46 (64.8%) were female. The use of dermoscopy revealed that 36 (50.7%) children had burrows. Statistically significant associations were observed with longer symptom duration (OR = 0.80; 95% CI: 0.648–0.986; p=0.026) and prior scabies treatment (OR = 3.61; 95% CI: 1.324–9.849; p=0.011). Conclusions: The diagnostic yield of dermoscopy in children with clinical suspicion of scabies was around 50%, which was lower than previously reported. The presence of burrows was more likely when symptoms had been present longer and if treatment had been given.

Frequency of Antenatal Depressive Symptoms and Their Determinants among Pregnant Women Attending Antenatal Clinic at Northwest General Hospital

Sarah Karim, Sidra Jehangir, Maryam Faseeh, Anam Manan, Maryam Hayat — Sat, 31 Oct 2026 00:00:00 +0000

Antenatal depressive symptoms (ADS) are common and are associated with significant consequences for both mother and fetus. Its burden is particularly high in low- and middle-income countries, yet routine screening remains limited in Pakistan. Objectives: To determine the trimester-wise frequency of antenatal depressive symptoms and their determinants among pregnant women attending a tertiary care hospital in Peshawar through prospective follow-up across pregnancy. Methods: This prospective cohort study was conducted from 01 April 2024 to 01 December 2025 at Northwest General Hospital, Peshawar,.including a complete-case cohort of 384 pregnant women aged ≥15 years (435 screened at baseline). ADS, defined as a PHQ-9 score ≥5 (a screening threshold, not a diagnosis of depression), were assessed in all three trimesters. Data were analyzed using SPSS version 25.0. Descriptive statistics were applied, and associations were evaluated using Chi-square. Repeated measures ANOVA assessed changes in mean PHQ-9 scores across trimesters, and multivariable logistic regression was performed to identify independent predictors of third-trimester antenatal depressive symptoms. (p≤0.05). Results: frequency of ADS increased significantly from 19.3% in the first trimester to 34.4% in the second and 47.4% in the third trimester (p<0.001). Third-trimester ADS were more frequent among women with unplanned pregnancy (64.9%), miscarriage (65.1%), stillbirth (70.8%), non-supportive spouse (79.6%), prior depression (81.3%), and antenatal care dissatisfaction (72.1%) (p≤0.002). Independent predictors of third-trimester ADS included prior depression (AOR=4.5), non-supportive spouse (AOR=3.8), pregnancy complications (AOR=2.9), antenatal care dissatisfaction (AOR=2.6), low socioeconomic status (AOR=2.3), and unplanned pregnancy (AOR=2.1). Conclusions: Self-reported antenatal depressive symptoms are common and increase across pregnancy..Targeted identification of women with these risk factors, using a validated tool such as the PHQ-9 followed by clinical evaluation, may support timely psychosocial care; studies using diagnostic interviews are needed before routine screening is recommended.

Efficacy of Oral Dexamethasone versus Parenteral Dexamethasone in the Management of Mild to Moderate Croup

Sadiq Akbar, Sabir Khan, Abdul Khaliq, Ikram Ullah, Wajid Ali, Sulaiman Shah — Sat, 31 Oct 2026 00:00:00 +0000

Croup is a common cause of upper airway obstruction in children, characterized by a barking cough, stridor, and respiratory distress. While corticosteroids, particularly dexamethasone, are the cornerstone of treatment, the optimal, least invasive route remains debated, especially for mild-to-moderate cases. Objectives: To compare the efficacy of oral versus parenteral dexamethasone in children presenting with mild to moderate croup. Methods: This randomized controlled trial was conducted at the Department of Pediatrics, Khyber Teaching Hospital, Peshawar, from Oct 2024 to Mar 2025. A total of 200 children aged 6 months to 6 years with mild to moderate croup were randomized into two equal groups to receive a single dose of dexamethasone either orally (Group PO) or intramuscularly (Group IM) at 0.15 mg/kg. The primary outcome was improvement in the Westley Croup Score at 4, 8, and 24 hours. Secondary outcomes included respiratory rate, stridor, need for additional interventions, and parental satisfaction. Outcomes were compared between the groups using appropriate statistical tests, with a p-value of <0.05 considered significant. Results: The mean age was 23.5 ± 12.4 months. The Westley Croup Score and respiratory rate were significantly higher in Group PO at 4 hours (p=0.03), but comparable at 8 and 24 hours. No significant differences were noted regarding stridor or requirement for additional interventions. Parental satisfaction was significantly higher in Group PO (p=0.01). Conclusions: Oral dexamethasone is as effective and well-tolerated as intramuscular administration for mild to moderate croup in children under six years, with higher parental satisfaction.

Maternal and Pregnancy Outcomes Following Vaginal Progesterone Use in Threatened Preterm Labour: A Descriptive Case Series

Hira Sial, Huma Afridi, Hafsa Mubashir, Faryal Azhar — Sat, 31 Oct 2026 00:00:00 +0000

Threatened preterm labour is a key contributor to neonatal morbidity and mortality worldwide. Progesterone supplementation has been investigated for its role in prolonging pregnancy and reducing the risk of preterm birth. Objectives: To share insights into pregnancy prolongation among women receiving vaginal progesterone at a tertiary care hospital and to examine how these outcomes vary across demographic and clinical groups. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Imran Idrees Teaching Hospital, Sialkot, from August 2025 to January 2026. A total of 100 pregnant women aged 18–45 years with parity <5 and gestational age between 28 and 36 weeks presenting with threatened preterm labour were recruited using consecutive non-probability sampling. All participants received 200 mg natural micronized progesterone vaginally once daily until delivery. Delivery beyond 36 completed weeks was considered a favorable pregnancy prolongation outcome. Data were analyzed using SPSS version 25.0. Results: The mean maternal age was 32.13 ± 8.41 years, while the mean gestational age at presentation was 32.11 ± 2.22 weeks. Delivery beyond 36 weeks of gestation was observed in 76% of participants (95% CI: 66.6%–83.5%). No significant statistical association was identified between pregnancy prolongation outcomes and “maternal age, body mass index, cervical dilatation, gestational age at presentation”, parity, lifestyle status, anemia, diabetes, hypertension, previous preterm labour, or antepartum haemorrhage (p>0.05). Conclusions: A majority of women receiving vaginal progesterone delivered beyond 36 weeks of gestation. Due to the descriptive single-arm design, causal conclusions regarding treatment effectiveness cannot be established.