Pakistan Journal of Health Sciences

The Rise of E-Cigarettes and Vaping: Health Risks and Policy Implications

2025-04-03T10:08:34+00:00

The use of e-cigarettes and vaping devices has increased exponentially in recent years, primarily affecting teenagers and young adults. These products have been widely accepted as safer alternatives to traditional smoking, often marketed as aids for smokers looking to avoid the tar and toxins associated with regular cigarettes. However, despite their popularity, e-cigarettes pose serious health risks, necessitating stronger public policies to mitigate their dangers. The recent surge in vaping, particularly among young people, has raised significant health concerns. According to the 2024 National Youth Tobacco Survey (NYTS) conducted by the CDC, e-cigarette use among youth remains a severe public health threat. The survey found that 5.9% of middle and high school students—equivalent to 1.63 million individuals—reported current use of e-cigarettes in 2024. Alarmingly, 38.4% of these users reported frequent use, while 26.3% reported daily use, indicating signs of nicotine addiction.

Although e-cigarettes are perceived as less harmful than conventional cigarettes, they are not entirely safe. Users are exposed to dangerous substances such as nicotine, heavy metals, and volatile organic compounds. Most e-cigarette products contain nicotine, the primary addictive component, which can lead to dependence. The health risks associated with e-cigarette use include worsening asthma symptoms, increased frequency of bronchitis, and a higher risk of lung infections. Additionally, nicotine raises heart rate, increases blood pressure, and may irritate blood vessels. A particularly concerning issue is E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), which emerged as a serious health condition in 2019. Symptoms of EVALI include cough, difficulty breathing, chest pain, nausea, and fatigue. The rising prevalence of adolescent e-cigarette use underscores the urgency of addressing this public health crisis.

Governments worldwide are taking action to combat the e-cigarette epidemic. For instance, the UK government has introduced legislation to ban the sale of single-use vapes starting June 1, 2025. This initiative aims to reduce environmental impact and curb the growing youth vaping trend. Policymakers must take stronger measures to mitigate the associated health risks. Strict regulations on the marketing and sale of e-cigarettes are essential, as these products often target underage individuals through misleading advertisements. Flavored e-cigarettes, which appeal to younger users, should be banned entirely. Additionally, only adult smokers seeking to quit should have access to e-cigarettes, with stricter age verification measures ensuring compliance. Public health campaigns play a crucial role in educating both young people and adults about the risks of vaping. These initiatives should focus on dispelling the myth that e-cigarettes are risk-free and emphasize the potential for nicotine addiction and long-term health consequences. Raising awareness about the dangers of vaping is vital to preventing the next generation from developing nicotine dependency.

While e-cigarettes may have a place in harm reduction strategies for adult smokers, their widespread use—especially among youth—poses significant public health challenges. A comprehensive approach involving stricter regulations, targeted education, and ongoing research is necessary to mitigate the risks associated with e-cigarette use and prevent a new generation from becoming addicted to nicotine.

Assessing the Etiology and Pathogenesis of Pyogenic Granuloma in Gingival Tissues

2025-04-03T10:09:20+00:00

Pyogenic granuloma is a benign, rapidly growing vascular lesion commonly found on mucous membranes. Although its demographic distribution is well documented, the specific etiology and pathogenesis of pyogenic granuloma in gingival tissues remain poorly understood. Objectives: To evaluate the etiology and pathogenesis of pyogenic granuloma in gingival tissues. Methods: Databases including PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched from January 2009 to February 2024. Prisma guidelines were followed and 20 studies meeting the criteria were included in the systematic review. Results: These results indicate the significant role of etiological factors such as poor oral hygiene, trauma, local irritation, and hormonal factors in the development of pyogenic granuloma. Patients with pyogenic granuloma showed gingival inflammation, thick bundles of collagen fibers, proliferating endothelial cells, overexpression of vascular molecules and CD4+ cells, and a plethora of neutrophils. Conclusions: It was concluded that pyogenic granuloma in gingival tissues is predominantly associated with local irritants, poor oral hygiene, chronic trauma, and hormonal imbalances. These factors trigger inflammatory responses and vascular proliferation, suggesting that targeted interventions such as enhanced oral care and management of hormonal levels could improve prevention and treatment outcomes for gingival pyogenic granuloma.

Assessment of the Efficacy and Safety of Enhanced Recovery After Surgery (ERAS) Protocols in Patients Undergoing Bariatric Surgery: A Meta-Analysis

2025-04-12T05:51:42+00:00

In modern era bariatric surgeries, the use of several tools of the Enhanced Recovery after Surgery (ERAS) protocols are highly accepted and associated with reduced peri-operative rate of complications and robust recovery. Objectives: To evaluate the impact of application of ERAS protocols in bariatric surgeries, with relevance to postoperative recovery period, postsurgical complications, length of hospital stay and cost effectiveness. Methods: Various randomized controlled trials (RCTs), reviews and observational studies implementing ERAS protocols in bariatric surgeries were included in this meta-analysis after performing a comprehensive search over databases up to August 2024. Results: This meta-analysis affirmed that ERAS protocols significantly reduced the post-operative length of hospitalization by an average of 1.5 days, reduced opioid consumption by approximately 30.7%, and also led to a decreased incidence of major complications (mean 4.16%). The readmission rates remained low (mean 4.16%) in the ERAS group, and overall complication rates were also reduced in studies implementing an increased number of ERAS protocol elements. Subgroup analysis revealed that Sleeve Gastrectomy (SG) was associated with shorter recovery period and fewer complications when compared to Roux-en-Y Gastric Bypass (RYGB). Conclusions: It was concluded that this meta-analysis favors the implementation of ERAS principles in improving outcomes in bariatric surgeries, including shorter hospital stays, reduced recovery period, less need of opioid analgesia and increased patient satisfaction.

Comparison of Lignocaine with Ondansetron for Attenuation of Propofol-Induced Pain in Adult Patients Undergoing Laparoscopic Cholecystectomy

2025-04-03T10:08:40+00:00

Intravenous administration of propofol causes pain that impacts anesthesia procedures. Objective: To compare the efficacy of intravenous Lignocaine and Ondansetron in reducing propofol-induced pain, hemodynamic stability and assess the occurrence of associated adverse effects during induction using a pain scale. Methods: It was a Quasi-Experimental study and conducted for six months from Sep 2024 to Jan 2025 at the Anesthesia department at Islam Medical College, Sialkot. To measure pain effects at laparoscopic cholecystectomy among adult patients. The patients were received 0.5mg/kg Lignocaine through the vein or 8mg Ondansetron before they received propofol treatment. Medical staff evaluated patients' pain levels on a standard scale while recording their vital signs. Data were analysed by SPSS 21.0. The categorical data was analysed through chi-square and evaluated continuous values with an independent t-test at a significance level of 0.05. Results: Lignocaine brought better pain relief from propofol than Ondansetron at a statistical significance of p < 0.001. People in the Lignocaine group reported 15% of bad pain while 32% of patients in the Ondansetron group felt the same pain level. Ondansetron caused short-lived drops in blood pressure and heart rate but the application of Lignocaine generated mild skin issues. Conclusions: The study proved Lignocaine worked better than Ondansetron at stopping propofol pain effects. Despite its merits Ondansetron still serves as a good treatment option and medical staff should monitor heart-related side effects. Additional medical trials must test the effectiveness of using both drugs together as a pain treatment option.

Biochemical Profiles and Clinical Correlates of Hyperkalemia and Metabolic Acidosis in Acute Kidney Injury Patients: A Cross-Sectional Analysis

2025-04-03T10:09:03+00:00

Acute Kidney Injury (AKI) is often complicated by biochemical disturbances, including hyperkalemia and metabolic acidosis. Objective: To examine the biochemical profiles and clinical consequences of hyperkalemia and metabolic acidosis in patients with AKI, with the goal of identifying correlations and prognostic markers to improve management strategies. Methods: The study analyzed 130 geriatric AKI patients with hyperkalemia and metabolic acidosis, assessing clinical outcomes through multivariable regression. Results: In 130 AKI patients with hyperkalemia and metabolic acidosis (mean age: 68.5 ± 10.2 years, 60% males), hypertension (45%) was the most common comorbidity. ICU admission was required in 25%, with an average hospital stay of 8.4 ± 4.5 days. Biochemical markers showed elevated serum potassium (6.2 ± 0.8 mEq/L), creatinine (3.5 ± 1.2 mg/dL), and reduced bicarbonate (18.5 ± 3.5 mEq/L). Serum creatinine (r = 0.80) and potassium (r = 0.67) correlated strongly with dialysis need, while lower blood pH (r = -0.50) was linked to ICU admission. Multivariable analysis identified serum creatinine (OR = 3.00, p < 0.001) as the strongest predictor of severe hyperkalemia and acidosis, with hypertension (OR = 2.15, p = 0.015) and advancing age (OR = 1.05, p = 0.003) also increasing risk. Conclusions: Hyperkalemia, metabolic acidosis, and elevated serum creatinine in acute kidney injury patients are strongly linked to worse outcomes, highlighting the need for early intervention.

Attitude Towards Tele-Medicine Among Caregivers of Pediatric Patients

2025-04-03T10:09:18+00:00

Telemedicine is a vital constituent of digital health-care, particularly stating the deliverance of medical facilities over remote areas by means of Information and Communication Technologies (ICT). The swift progress of mobile applications has improved support for health-care experts, rationalization responsibilities such as time organization, communication, and policymaking. Objective: To assess attitudes of parents having children aged between one to twelve years towards telemedicine. Methods: The cross-sectional study employed an online survey with the sampling strategy as convenience method for recruitment of eligible parents. A self-administered questionnaire was employed to gather sociodemographic data, child-related information, and participants' technological profiles. Attitudes toward telemedicine were measured using a 5-point scale, evaluating the perceived usefulness of various telemedicine services and associated advantages. Data analysis included descriptive statistics to summarize sociodemographic variables and item prevalence, while excluding any missing values. Results: A total of 120 families participated in the study, with caregivers averaging 47.4 years in males, 43.1 in females and children 7.5 years old. The majority of caregivers were female (68.3%), and most children were male (53.3%). Technological profiles indicated high smartphone availability (93.3%) and moderate use of social media accounts. Attitudes toward telemedicine showed significant perceived usefulness, particularly for scheduling medical visits (54.1% rated it as moderate/much) and telemonitoring services (49.1%). Participants recognized advantages of telemedicine, highlighting time efficiency (44.1%) and financial savings (46.6%) as key benefits. Conclusion: Families of pediatric patients demonstrated a strong willingness to engage in telemedicine programs. They showed positive attitude towards usefulness of telemedicine.

The Correlation between Glycemic Control and Microvascular Complications in Type 1 Diabetes Mellitus Patients

2025-04-03T10:09:09+00:00

Type 1 Diabetes Mellitus (T1DM) is a chronic condition that destroys pancreatic beta cells, leading to persistent hyperglycemia. Prolonged high levels resulted in an increased risk of microvascular complications. Glycemic control, indicated by HbA1c, plays a critical role in reducing these risks. Objective: To examine the strength of the relationship between HbA1c levels and the severity of microvascular complications in individuals with T1DM. Methods: A cross-sectional study was conducted on 30 patients with T1DM at Liaquat University Hospital, Hyderabad, from December 2024 to February 2025. HbA1c levels were recorded, and microvascular complications were evaluated using KDIGO criteria for nephropathy, ETDRS for retinopathy, and TCNS for neuropathy. Data were analyzed using descriptive statistics and inferential methods, including Spearman’s correlation and linear regression, through SPSS version 22.0. Results: The average age of participants was 24.23 ± 3.45 years, with a mean HbA1c level of 7.65 ± 1.15%. Retinopathy was the most frequent complication (73.3%), followed by neuropathy (63.3%) and nephropathy (40%). Combined complications were present in 40% of cases. HbA1c levels were significantly correlated with the severity of all microvascular complications, showing positive associations with KDIGO (r=0.839), ETDRS (r=0.864), and TCNS (r=0.870). HbA1c values also progressively increased with complication severity (p<0.001). Conclusions: It was concluded that poor glycemic control was strongly associated with the presence and severity of microvascular complications in T1DM patients. These findings highlight the importance of maintaining optimal HbA1c levels to mitigate complications. Further longitudinal studies are warranted to explore these associations in greater depth.

Assessment of Periodontal Health in Patients with Alzheimer's disease in Karachi, Pakistan

2025-04-03T10:08:57+00:00

Alzheimer's disease (AD), causes permanent loss of neurons and neural connections. Objective: To assess the periodontal health status of Alzheimer's disease (AD) patients by assessing plaque index, gingival condition, probing pocket depth, attachment levels, and bleeding on probing, and to correlate these findings with cognitive impairment levels as determined by Mini-Mental State Examination (MMSE) scores. Methods: A cross-sectional study, was conducted at Medicare Hospital between July and October 2024. Total 60 patients were recruited in the study. Hence plaque index, gingival condition, probing depth, attachment levels, and bleeding on probing were used to assess periodontal health, whereas MMSE scores were used to classify cognitive impairment. For statistical analysis, ANOVA and unpaired t-test analyses are carried out using SPSS version 24.0. All of the findings were deemed statistically significant if P was less than 0.05. Results: The study results revealed that the demographic and neurological parameters such as age, the distribution of genders, and the number of teeth of those patients suffering from Alzheimer’s disease. Hence, MMSE scores were significantly lower, indicating substantial cognitive impairment (P < 0.001). As the severity of AD increases, there is a trend for all recorded variables to get worse (p < 0.01). PPD and CAL reveal more periodontal tissue loss in patients with severe AD, while PI and GI show more plaque accumulation and gingival inflammation. Conclusions: This study highlighted a strong link between worsening periodontal health and Alzheimer's severity, emphasizing the need for proactive dental care to improve patient well-being.

Effect of Maternal Nutrition and Micronutrient Supplementation on Neonatal Birth Weight and Health

2025-04-03T10:08:38+00:00

Maternal nutrition significantly influences fetal growth, birth weight, and neonatal health. Deficiencies in iron, calcium, folic acid, and vitamin D increase the risks of preterm birth, low birth weight, and neonatal complications. Objective: To assess the impact of maternal micronutrient supplementation on neonatal birth weight and health outcomes. Methods: A quasi experimental study was conducted at Health Net Hospital, Peshawar. A total of 110 pregnant women were recruited (59 supplemented, 51 non-supplemented). Data on maternal dietary intake, weight gain, and micronutrient consumption were collected. Neonatal birth weight, gestational age, NICU admissions, and morbidity were recorded. Statistical analysis was performed using SPSS version 25.0, with independent t-tests and chi-square tests (p<0.05 considered significant). Results: Neonates in the supplemented group had significantly higher birth weights (3343.54 ± 407.90 g vs. 2825.63 ± 322.46 g, p<0.001). NICU admissions were lower in the supplemented group (6.8% vs. 43.1%, p<0.001). Neonatal morbidity, including infections, jaundice, and respiratory distress, was significantly lower in the supplemented group (p<0.001). Conclusions: Micronutrient supplementation during pregnancy improves neonatal birth weight and reduces neonatal morbidity. These findings highlight the need for targeted maternal nutrition strategies to improve neonatal outcomes, particularly in resource-limited settings.

Effects of the COVID-19 Pandemic on Treatment Outcomes of Drug-Resistant Tuberculosis Patients in Twin Cities of Pakistan

2025-04-03T10:09:15+00:00

Pakistan is the world's fifth-highest Drug-Resistant Tuberculosis burden region. However, it is difficult to evaluate the setback of COVID-19 when concurrent tuberculosis is excluded in patients from Pakistan, where the national burden of tuberculosis and drug-resistant tuberculosis is substantial and rising despite management efforts. The COVID-19 pandemic is prevalent in countries where tuberculosis, notably drug-resistant tuberculosis is high. Objectives: To compare the pre and para-pandemic favourable and unfavorable outcomes of drug-resistant tuberculosis treatment in PMDT Units of Islamabad and Rawalpindi. Methods: A retrospective cross-sectional study was conducted. The study included Pre and Para-COVID-era drug-resistant tuberculosis patients (n=670) in three sites of Rawalpindi and Islamabad from 2016-2021. A non-probability consecutive sampling technique was applied. A validated structured questionnaire was administered to compare the treatment outcomes of drug-resistant tuberculosis patients. Results: Results show that pre-COVID n=240 (35.82%) and Para-Covid era drug-resistant tuberculosis patients n=226 (33.73%) had favourable treatment outcomes. Unfavorable outcomes before and during the pandemic were 128 (18.35%) and 82 (12.2%) respectively. COVID-19 has affected drug-resistant tuberculosis treatment outcomes, both favourable and unfavorable, which are far behind the treatment success targets set by WHO End-tuberculosis. Conclusions: It was concluded that this study compared drug-resistant tuberculosis treatment outcomes pre- and post-COVID-19, showing success rates surpassing WHO-End tuberculosis targets. Key factors included residential status, gender, and occupation.

Assessment of Changes in Corneal Endothelial Characteristics in Primary Open-Angle Glaucoma

2025-04-03T10:08:48+00:00

Patients with glaucoma undergo significant changes in corneal endothelial characteristics due to chronically elevated Intraocular pressure (IOP). Objectives: To compare endothelial cell density between primary open-angle glaucoma (POAG) patients and age-matched non-glaucomatous controls. Also to explore the relationship between endothelial cell density and Intraocular pressure. Methods: This case-control study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. It included 41 eyes of patients with POAG aged between 35-70 years and 41 eyes of age-matched non-glaucomatous subjects were taken as controls. The POAG was diagnosed based on Intraocular pressure, optic disc changes, and visual field defects. All participants went through a comprehensive ocular evaluation, that included slit-lamp examination, gonioscopy and Intraocular pressure assessment. The endothelial cell density was assessed via specular microscopy. SPSS version 26.0 was utilized to perform statistical analysis. Results: The average corneal endothelial cell density in healthy control subjects was 2484.51 ± 286.44 cells/mm², but those with POAG showed a statistically significant decline, measuring 2345 ± 270.29 cells/mm² (p=0.02). A notable decrease in endothelial cell density was seen in patients using dorzolamide 2262.00 ± 287.15 relative to patients not using dorzolamide 2451.28 ± 209.56 (0=0.02). Endothelial cell density and the average Intraocular pressure revealed a weak inverse correlation (r= -0.204, p=0.06). Conclusions: It was concluded that POAG patients show reduced corneal endothelial cell density. It also suggests that endothelial cell density declines with higher Intraocular pressure and increased disease severity, making it a possible biomarker of disease progression in POAG.

Outcome of Low Molecular Weight Heparin Use in Pregnant Women with Oligohydramnios at A Tertiary Care Hospital

2025-04-03T10:08:46+00:00

Oligohydramnios refers to an antenatal condition in which the amniotic fluid volume is abnormally low and has poor fetal consequences. This research strives to elaborate on the convoluted connections between oligohydramnios and the associated maternal and fetal risks. Objectives: To find out the frequency of pregnancy outcomes in pregnant women with oligohydramnios using low molecular weight heparin (LMWH). Methods: The prospective cohort study was conducted at the Obstetrics Department of Nishtar Hospital, Pakistan from November 2024 to January 2025. One hundred and twenty-two women fulfilling the inclusion criteria were included. Patients were given 40 mg LMWH subcutaneously once a day. The patients were followed till delivery to determine outcomes including live birth, preterm delivery, weight at birth, admission to the Neonatal Intensive Care Unit (NICU) and pre-eclampsia. SPSS version 26.0 was employed to analyze the data. Results: Out of 122 participants, 120 (98.4%) resulted in live births while 2 (1.6%) were intra-uterine deaths. Among all births, 21 (17.2%) were delivered preterm while 101 (82.8%) were delivered at term. 108 (88.5) weighed >2.5 kg. Among 120 live births, 23 (19.2%) were admitted to the NICU for observation or treatment. Conclusions: It was concluded that the study results support the use of LMWH in oligohydramnios as a proportion of adverse perinatal outcomes was low in our study. LMWH was found to be efficacious, authentic and safe in oligohydramnios to achieve desired clinical outcomes and decrease the burden of associated morbidities and mortalities in the targeted population.

Competency-Based Medical Education: An Analysis of Implementation Challenges in Resource-Limited Settings

2025-04-03T10:08:44+00:00

Competency-Based Medical Education (CBME) employs a systematic outcome-based strategy to enhance the practical and clinical competencies of the graduates. CBME faces challenges particularly in low-resource areas due to differences in faculty and institutional support, as well as institutional and learning resource availability. Objective: To determine the conditions that affect CBME readiness among academic staff and to determine what may obstruct its effective execution. Methods: A cross-sectional study was completed over 6 years (September 2024 - January 2025) with a total of 110 faculty members. The participants were divided into 2 groups using a validated assessment tool aimed at targeted differences in CBME readiness. Subjects filled out questionnaires which were analyzed through chi-squar and independent t-tests. Results: The factors affecting readiness towards CBME age, faculty experience, and student-patient ratios were not significant. Access to digital resources, government funding, and institutional support were significantly associated with higher levels of readiness. Faculty who participated in the simulation-based training and the competency evaluation showed higher levels of readiness for CBME. The training of faculty members did not impact the level of readiness to any significant degree, which points to the necessity of continuous mentoring and practical work. Conclusions: For the adoption of CBME, institutional support, the presence of digital tools, and access to competency-based evaluations are essential. All three of these factors can enhance faculty’s willingness to participate and subsequently improve the effectiveness of medical education. Investing in structured faculty training and technological resources will help a smoother transition to CBME

Frequency of Low Birth Weight Neonates in Mothers with Low Serum Ferritin Levels

2025-04-03T10:09:01+00:00

Birthweight significantly influences health throughout life, but the connection between maternal serum ferritin levels during pregnancy and the newborn’s birthweight is still a topic of debate. Objective: To investigate the prevalence of underweight infants born to the mothers with low blood ferritin concentrations at term delivery. Methods: A descriptive cross-sectional study was conducted for a period of six months from November 2019 to April 2020. A total of 151 participants with reduced serum ferritin concentrations at full-term delivery were included in this study. Demographic details were taken including blood sample for serum hemoglobin and ferritin levels were checked and noted in a questionnaire. Data stratification was performed to eliminate other effect modifiers and to statistically test the significance of low birth weight of neonates in mother with low serum ferritin levels, with the help of chi-square test. Results: The typical age of the patients was 25.50 ± 4.08 years. Incidence of Low Birth Weight newborn in mother with reduced serum ferritin levels at term delivery was observed in 33.11% (50/151). Conclusions: Low birth weight, a prevalent issue in Pakistan, is a significant contributor to perinatal morbidity and mortality. Correction of anemia, consuming a diet with a proper nutrient balance and accessing maternal care during pregnancy are anticipated to decrease the incidence of underweight infants and lower perinatal death rate. This study suggests that mothers should receive counselling on prevention of teenage marriages and pregnancies, maintaining a birth interval of 3 years, iron supplementation during pregnancy and avoiding consanguineous marriages.

Association between Temporomandibular Joint dysfunction and Stress in Undergraduate BDS Students of Rawalpindi/Islamabad

2025-04-03T10:09:11+00:00

Temporomandibular Joint Dysfunction (TMJD) is a condition linked with psychological factors like stress. Dental students experience high academic stress which makes them an ideal candidate to investigate the relationship between TMJD and stress. Objective: To investigate the association between TMJD and stress in undergraduate BDS students in Rawalpindi and Islamabad. Methods: A cross-sectional study was conducted among 346 BDS students using convenience sampling. Participants completed structured questionnaires, including Fonseca's Anamnestic Index for TMJD and the Perceived Stress Scale. Data analysis was performed using SPSS version 21.0, employing chi-square tests for categorical data and correlation analysis for continuous variables. he study was conducted in two dental institutes namely Margalla Institute of Health Sciences and Foundation University College of Dentistry and Hospital. Results: Out of 346 participants, 264 (76.30%) were females and 82 (23.70%) were males, with a mean age of approximately 20.7 years. The result of the chi-square test for the association between gender and TMJD was a statistically significant relationship (p = 0.00033), with females showing higher rates of mild and moderate TMJD compared to males, whereas the chi-square test for the association between the year of study and TMJD also indicated a significant relationship (p = 0.023). Conclusions: This study found a significant association between stress and Temporomandibular Joint Dysfunction (TMJD) among undergraduate BDS students.

Incidence and Causes of Early Hospital Readmissions after Cardiac Surgery. One Year Experience at Tertiary Care Hospital, Multan

2025-04-03T10:09:07+00:00

The increased costs, morbidity, and mortality associated with readmissions after cardiac surgery pose a substantial issue for the healthcare system. Objective: To observe the incidence, causes, and outcome of hospital readmissions within two months of discharge after cardiac surgery. Methods: An observational descriptive cohort study was conducted at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan. From September 2023 to August 2024, 1406 patients undergoing cardiac surgery were observed for readmission in the hospital within two months after discharge. Patients who were operated at other facility and those who admitted after 2month were excluded from the study. Perioperative data, reasons for readmission, and outcomes were recorded and analyzed using SPSS version 25.0. Descriptive statistics were applied to continuous and categorical variables. Results: The incidence rate of readmission was 7.5% (n=106). 85.8% readmissions occurred within 30 days after discharge. Common causes of readmission were anticoagulation-related issues (23.6%), wound infections (21.7%), pleural effusion (15.1%), pericardial effusion (9.4%), and sternal dehiscence (6.6%). Surgical intervention was required in 35.8% of readmitted patients. The mean length of readmission hospital stay was 4 ± 2.80 days. Mortality in readmitted patients was 4.7% (n=5). Conclusions: Nearly every 13^th patient needs hospital readmission. Early hospital readmission is most common in patients who needs anticoagulation after valve replacement surgery. Early readmission after cardiac surgery, adversely impacts patient outcomes. Improved anticoagulation management, infection control, and postoperative diuretics, are critical for reducing incidence of hospital readmission

Breast Lump Patterns Across Different Age Groups Among Female Patients Presenting to Surgical Outpatient Department of a Tertiary Care Hospital in District Malir Karachi

2025-04-03T10:08:53+00:00

The number of patients presenting with different types of breast lumps has been on the rise in the Malir district. Many females are being diagnosed with breast cancer. Objectives: To determine the pattern of breast lumps in different age groups in the outpatient department of Al-Tibri Medical College hospital in District Malir, Karachi. Methods: It was a descriptive cross-sectional study conducted at the Department of General Surgery, Al-Tibri Medical College Hospital, Karachi, from 1st November 2022 to 31^st October 2024. Patients presenting in the Surgical Outpatient Department with breast lumps were included in the study. Age at presentation, symptoms, clinical features, investigations, biopsy reports, and operation notes (if operated) were recorded and submitted for analysis. Results: The commonest lesions were fibro-adenoma (33.6%), inclusion cyst of the breast (19%), and breast abscess (18.5%), followed by Carcinoma breast (17.7%). 51.7 % of cases were associated with pain. Among carcinomas, 43% presented with pain. The highest peak of presenting with malignant lesions was from 39 to 43 years, and 2^nd peak was from 49 to 58 years. Most benign lesions presented between 24 to 28 years. The chi-square test showed a strong association between age range and pain (p-value<0.001), age range and type of lump (p-value <0.001), and marital status and type of lump (p-value<0.001). Conclusions: It was concluded that fibro-adenoma is the most common breast disease. Inflammatory lesions are also present frequently in the reproductive age group. Carcinoma breast presented in middle and later age groups, predominantly in married females in our district.

Diagnostic Accuracy of Optical Coherence Tomography to Detect Cystoid Macular Edema (CME) In Patients with Diabetes Mellitus (DM) Taking Fundus Fluorescein Angiography (FFA) As Gold Standard

2025-04-03T10:09:14+00:00

Macular thickening, known as Cystoid Macular Edema (CME), is brought on by fluid buildup in the inner nuclear and outer plexiform layers of the retina as a result of leaking from peri-foveal retinal capillaries. Objective: To determine the OCT's ability to identify cystoid macular edema in individuals with diabetes mellitus, compared to the gold standard of fundus fluorescein angiography. Methods: The Lahore General Hospital's Ophthalmology Outpatient Clinic served as the study's setting. From the Outpatient Department, 143 patients who met the inclusion criteria were randomly selected. Informed consent was obtained from patients before imaging. An indirect biomicroscope was used to evaluate all of the subjects. After completing fundus fluorescein angiography and optical coherence tomography, was diagnosed with cystoid macular edema according to the standardized criteria. A data collection proforma was developed. IBM SPSS version 25.0 was used to analyze the data. Results: In this study, 76 males (53.1%) and 67 females (46.9%) participated. The average age was 47.7 ± 10.3 years and diabetes duration was 5.4 ± 2.9 years. Optical Coherence Tomography (OCT) showed a sensitivity of 88.3%, specificity of 38.5%, PPV of 93.3%, NPV of 25.0%, and an overall accuracy of 84.6% compared to Fluorescein Angiography (FFA) in detecting cystoid macular edema. Conclusions: Diagnosing DME with OCT and FFA is very successful, it ensures early detection and treatment. For Diabetic Mellitus (DM) patients to avoid eyesight loss, accurate and easily accessible diagnostic strategies are essential.

Serum Bicarbonate Changes Among Patients on Thrice Weekly Maintenance Hemodialysis (HD): A Single-Center Study

2025-04-03T10:08:42+00:00

Metabolic acidosis in hemodialysis significantly affects morbidity and mortality. Understanding bicarbonate fluctuations is key to optimizing supplementation and dialysis protocols. Objectives: To determine the inter-dialytic and intra-dialytic changes in serum bicarbonate level among patients undergoing maintenance hemodialysis. Methods: This quasi-experimental study was conducted at the Nephrology Department, Fatima Jinnah Medical University (FJMU)/Sir Ganga Ram Hospital, Lahore, after taking synopsis approval from the CPSP from August 2024 to January 2025. After taking consent, 60 patients on maintenance haemodialysis thrice weekly who met the selection criteria were enrolled. Inter-dialytic and intra-dialytic changes in serum bicarbonate levels were determined. Data were analyzed using SPSS version 26.0. Numerical values were presented as mean ± SD, and continuous variables were analysed using frequency and percentages. Inter-dialytic and intra-dialytic changes in bicarbonate levels were compared using a paired t-test; p≤0.05 was taken as significant. Results: Pre-hemodialysis mean bicarbonate level was 18.65 ± 1.11 mEq/L, increased to 22.18 ± 0.85 mEq/L post-hemodialysis, and by the next hemodialysis session, the mean pre-HD bicarbonate level reduced to 18.78 ± 1.02 mEq/L. Intra-dialytic change showed a mean increase of 3.53 ± 1.19 mEq/L, p-value<0.001 and inter-dialytic change demonstrated a decrease of 3.40 ± 1.18 mEq/L, p-value<0.001. Conclusions: It was concluded that hemodialysis temporarily raises bicarbonate levels, but they drop before the next session, highlighting the need for optimized supplementation or dialysis adjustments to maintain stability.

Polycystic Ovary Syndrome (PCOS): A Biochemical and Physiological Perspective on a Common Gynaecological Disorder in a Local Hospital of Peshawar

2025-04-03T10:08:36+00:00

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive and metabolic health. It is characterized by hormonal imbalances, insulin resistance, dyslipidemia, and chronic inflammation, increasing long-term health risks. Objective: To compare biochemical, metabolic, and ultrasound markers in women with and without PCOS. Methods: A comparative cross-sectional study was conducted at Health Net Hospital, Peshawar, over six months. In total, 110 participants were recruited and divided equally into 2 groups, with each group considered as PCOS (n=55) and Non-PCOS (n=55). PCOS was diagnosed using the Rotterdam Criteria. Hormonal, metabolic, and inflammatory markers, including luteinizing hormone, Follicle-Stimulating Hormone, testosterone, Dehydroepiandrosterone Sulphate, Anti-Müllerian Hormone, fasting glucose, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), lipid profile, C-reactive protein, Malondialdehyde, and Total Antioxidant Capacity (TAC), were analyzed. Ultrasound findings assessed ovarian morphology, endometrial thickness, and stromal resistance index. Data were analyzed using SPSS. Results: PCOS patients had significantly higher BMI, insulin resistance, and androgen levels. Luteinizing hormone/Follicle-Stimulating Hormone ratio and Anti-Müllerian Hormone were elevated, while Follicle-Stimulating Hormone was lower. Metabolic markers showed increased fasting glucose, HOMA-IR, and dyslipidaemia, with higher LDL and triglycerides and lower HDL. Inflammatory and oxidative stress markers (C-reactive protein, Malondialdehyde) were significantly elevated, while TAC was reduced. Ultrasound findings showed increased endometrial thickness and ovarian stromal resistance in PCOS. Conclusions: It was concluded that PCOS is associated with significant hormonal, metabolic, and inflammatory disturbances. Elevated androgens, insulin resistance, and oxidative stress highlight the need for early screening and a multidisciplinary approach for Effective Management.

The Role of 8% Branched Amino Acids (BCAA) in Patients with Hepatic Encephalopathy

2025-04-03T10:08:55+00:00

Hepatic Encephalopathy (HE) is a neuropsychiatric disorder caused by liver dysfunction, commonly seen in cirrhosis or acute liver failure. Objective: To address the safety and efficacy of branched-chain amino acids (BCAA) solution in patients with HE. Methods: This retrospective study was performed at the Sheikh Khalifa Bin Zayed Al Nahyan Hospital, CMH Rawalakot, Azad Kashmir, Pakistan. Data from patients fulfilling the eligibility criteria during the study span from February 2022 to August 2024 were analyzed. The inclusion criteria were adults aged 18-70 years, diagnosed cases of cirrhosis of the liver, and admitted with HE. The BCCA group was given 8% BCCA solution administered through intravenous (IV) transfusion. Patients receiving any other treatments were categorized as conventional treatment. Psychometric hepatic encephalopathy score (PHES), serum ammonia levels, duration of hospitalization, treatment-related adverse events, and mortality were documented. Results: 467 patients were analyzed, the median age was 54.00 (48.00-63.00) years, and 280 (60.0%) were male. 315 (67.5%) received IV BCAA, while the remaining 152 (32.5%) received conventional therapy. Patients in the BCAA group showed a significant improvement in PHES scores, (-2.1 ± 1.9 vs. -4.6 ± 2.2, p=<0.001), reduction in serum ammonia levels (45.3 ± 8.1 vs. 56.2 ± 10.8 µmol/L, p<0.001), mean duration of hospitalization (8.9 ± 3.7 vs. 10.1 ± 4.5 days, p=0.002), and mortality (3.8% vs. 9.2%, p<0.001). In the BCAA group, 8 (2.2%) patients experienced mild gastrointestinal discomfort, and 4 (1.3%) patients reported transient dizziness.Conclusions: Intravenous 8% BCAA solution effectively enhances cognitive function, lowers serum ammonia, shortens hospitalization, and reduces mortality in hepatic encephalopathy patients.

Association of Personality Traits and Future Specialty Preference among MBBS Students

2025-04-03T10:08:50+00:00

Different personality traits may have a significant impact on medical students’ choices on future selection of their future specialty selection. Objectives: To determine the most common personality traits among medical students. Also, to establish if there is any association between traits and future specialty preference. Methods: An analytical cross-sectional study was conducted from June 2024 to December 2024. A validated questionnaire was used and distributed through social media platforms, and quota non-purposive sampling was done. The Big Five Inventory (BFI) was used for personality traits assessment. For demographics and specialty choice, frequencies and percentages were calculated. The chi-square test was used to assess the association between gender and choice of specialty. Analysis of variance (ANOVA) was employed to assess the mean comparisons of personality traits with specialty preferences. Post hoc, a Tukey HSD test was done to determine the statistical significance of the association between specialty selection and personality traits. p-value < 0.05 was taken as significant. Results: Between gender and specialty selection, a significant association was seen (p=0.033). The personality profiles of medical students showed a higher Mean + SD in the agreeableness profile (3.77 + 0.52). Significant associations with agreeableness and openness traits (p=0.05) were seen with the specialty chosen. Conclusions: The findings offered important perspectives on the relationship between personality traits and specialty selection among medical students. Future studies should build on these ideas, looking into various dynamic influences that affect specialty choice and the significance of personality traits in this regard

Evaluating the Incidence of Co-Existing Injuries in Anterior Talofibular Ligament Injuries a Magnetic Resonance Imaging Study

2025-04-03T10:09:05+00:00

Ankle lateral ligament injuries are common in everyday life as well as in athletic activities. Ankle injuries most commonly affect the anterior talofibular ligament (ATFL). Due to ATFL's susceptibility, achieving intelligent localization and injury evaluation is extremely important from a clinical standpoint. Objectives: To evaluate the incidence and patterns of co-existing injuries in ATFL damage using Magnetic Resonance Imaging (MRI). Methods: In this cross-sectional study, fifty-five patients undergoing surgical management for ATFL injuries were included. Preoperative MRIs of affected ankles were analyzed to document ATFL integrity and associated injuries. Descriptive statistics were used to summarize findings, with categorical variables reported as frequencies and percentages and continuous variables as means ± SD. Results: The mean age of the patients was 36.8 ± 12.4 years, with 61.8% male and 38.2% female. Associated injuries were observed in 72.7% of patients. ATFL injuries included 30.9% low-grade incomplete, 21.8% high-grade incomplete, and 14.5% complete tears. calcaneofibular ligament (CFL) injuries were common, with 36.4% showing partial tears, and 3.6% complete tears. The deep deltoid ligament was intact in 56.4%, while 43.6% had injuries. The superficial deltoid ligament was intact in 70.9%. The peroneal tendon was intact in 83.6%, with 5.5% having injuries and 10.9% showing tendinosis. Osteochondral Defects (OCDs) were present in 21.8% of cases. Conclusions: It was concluded that ATFL injuries frequently occur with damage to other structures, particularly the CFL and deltoid ligaments. MRI facilitates accurate diagnosis, emphasizing the need for comprehensive assessment and concurrent management of associated injuries during ATFL repair.

Increased First Trimester Serum Uric Acid as A Predictor of Gestational Diabetes Mellitus

2025-04-04T11:01:23+00:00

The gestational period of diabetes type 2 (GDM) is a serious condition that can harm both mothers and newborns throughout pregnancy. Objective: To determine if elevated first-trimester serum uric acid levels lead to gestational diabetes mellitus onset during pregnancy. Methods: A comparative cross-sectional study was conducted between November 2023 and April 2024 at Niazi Medical and Dental College in Sargodha. The study sample consisted of 139 pregnant women separated into two groups: those exhibiting and those absent diabetes in women. The researchers employed independent t-test and Chi-square statistical methods to evaluate age and BMI data, as well as diabetes familial histories and delivery history. Results: Gestational diabetes mellitus patients had higher serum uric acid levels compared to pregnant women without Gestational diabetes mellitus (p<0.001). This study found that uric acid levels above 4.5 mg/dL increased the likelihood of abnormal fasting glucose values by 74.5% (p<0.001). Women with high uric acid levels had a 40% higher risk of developing Gestational diabetes mellitus (OR: 1.40; 95% CI: 1.10-1.80; p=0.02). Conclusions: It was concluded that women who have gestational diabetes mellitus display increased serum uric acid concentrations during their first trimester. Monitoring serum uric acid levels presents an opportunity to detect susceptible pregnant women with gestational diabetes in the early stages, allowing for quick implementation of preventive measures that promote maternal and fetal health.

Frequency of Urinary Incontinence and Its Risk Factors in Patients Attending Gynae Outpatient Department (OPD) of Lady Reading Hospital (LRH) Peshawar, Pakistan

2025-04-04T11:01:25+00:00

Urinary incontinence (UI) is an important health issue acknowledged by the World Health Organization (WHO) that adversely affects the quality of life. Objectives: To find out the occurrence of UI in female presenting to the Gynaecology Out-Patient Department of Lady Reading Hospital and also to find out the frequencies of its risk factors for urinary incontinence in women presenting with UI. Methods: A descriptive cross-sectional design was used to conduct this study. The sample consisted of 163 women who presented to the Gynaecology Out-Patient Department of Lady Reading Hospital for any complaints were included in the study. Results: UI was observed in 15.3% of patients. Moreover, Stress UI was 48%, followed by overflow UI 24%, urge UI 20%, and mixed UI 8%. The leading factors for UI consisted of 3.75% more than three normal vaginal deliveries, 24% chronic cough, 12% history of gynaecological operation, 80% Illiterate, and 56% lower urinary tract infection (LUTI). Conclusions: It was concluded that based on the findings of the current study, UI is 15.3% prevalent in Pakistan which is comparable to that of other Asian nations. Furthermore, normal vaginal delivery more than three times and UTI may develop the key risk issues for the development of UI. The magnitude of UI problems may impact on daily lives and habits of the patients.

Clinical and Biochemical Parameters among Hemodialysis Patients Before and During the Month of Ramadan

2025-04-08T09:31:15+00:00

Ramadan fasting among hemodialysis patients is a complex issue in the Muslim world, with varying opinions and outcomes. Objectives: To evaluate clinical and biochemical parameters in hemodialysis patients before and after Ramadan. Methods: This quasi-experimental study was conducted in a private tertiary care hospital in Karachi from March to April 2024. Patients undergoing hemodialysis for more than three months were included, except those who did not consent. Participants were categorized into three groups: complete fasting, intermittent fasting, and non-fasting. Clinical and biochemical parameters were measured before and after Ramadan, including ultra-filtrate, dry weight, potassium, phosphorus, and albumin. Data were analyzed using SPSS version 27.0, with paired t-tests and significance set at p<0.05. Results: 132 patients participated (56.1% male, 43.9% female). Most (90.9%) did not fast, while 5.3% fasted continuously and 8.3% intermittently. Hypertension was the most common comorbidity (47.7%). Ultra-filtrate levels significantly increased in both male and female. Potassium levels rose significantly in female and in patients on thrice-weekly dialysis. Albumin levels declined across all groups. No significant changes were observed in dry weight or phosphorus levels. Conclusions: It was concluded that increased ultra-filtrate and potassium levels post-Ramadan, with albumin declining in most groups. However, the fasting group showed no significant changes, highlighting the need for group-specific monitoring in hemodialysis patients during Ramadan.

Can Early Orthotic Support and Physical Therapy Improve the Functional Level in Pediatric Burn Patients?

2025-04-08T09:31:42+00:00

Physiotherapy prevents contractures and aids mobility in pediatric burn patients. Objective: To evaluate the potential benefits of implementing early orthotic interventions and physiotherapy programs in pediatric patients with burn injuries. Methods: This quasi experimental study was conducted on 27 children at Department of Physical Medicine and Rehabilitation (PM and R), The Children Hospital and University of Child Health Sciences, Lahore between August 2022 and August 2023. The sample size included 27 pediatric burn patients. Convenient sampling technique was used to collect data. Children under age of 16 years with burn were included in the study. ROM (measured via a goniometer), muscle tone (assessed using the Ashworth scale), and muscle strength (evaluated via the Oxford scale MMT) was systematically assessed. Related pre-treatment questionnaire was filled first, they were undergoing the burn rehabilitation protocol (anti-contracture positioning, ROM, casting, splinting, stretching) followed by verbal questionnaire filling after 3months. Wilcoxon Signed Rank Test was used to measure difference before and after the intervention. Results: Muscle tone of majority of patients was tested which was possible against gravity was possible now against some resistance. Result suggest that Physical activities like carrying an object and other ADLs which were severe difficult after burn were improved. ROM which was limited before orthotic intervention and physiotherapy protocol was now partially limited. Conclusions: In conclusion, the amalgamation of physiotherapy and orthosis represented a pivotal cornerstone in the comprehensive care paradigm for burn patients, yielding a myriad of positive effects that significantly enhance their rehabilitation journey.

Role of Diagnostic and Prognostic Immunohistochemical Markers in Hepatocellular Carcinoma

2025-04-08T09:31:17+00:00

As the primary cause of cancer-related death globally, Hepatocellular Carcinoma requires accurate diagnostic and prognostic markers. Immunohistochemical indicators have been identified as promising instruments to improve the precision of hepatocellular Carcinoma diagnosis and forecast patient outcomes. Objectives: To evaluate the relationships between clinicopathological characteristics associated with hepatocellular carcinoma, such as tumor grade, vascular invasion, and patient characteristics, and the expression of immunohistochemical markers. Methods: A cross-sectional study was conducted for six months from Feb 2024 to Jul 2024 in the Department of Pathology at a tertiary care hospital. There were 323 patients with Hepatocellular Carcinoma diagnoses in all. Immunohistochemical was used to examine specimens of tissue for the markers Ki-67, CK19, Glypican-3, alpha-fetoprotein (AFP), HepPar-1, and CD34. Kaplan-Meier survival analysis, t-tests, and chi-square tests were used to evaluate correlation with clinicopathological characteristics and survival results. Results: High percentages of positive expression were seen for CD34 (88.2%), Glypican-3 (75.9%), and HepPar-1 (82.7%). There were noteworthy associations discovered between tumor size, vascular invasion, and serum AFP levels and IHC markers. Notably, HepPar-1 positive predicted a better prognosis (HR 0.72, p=0.032), but Glypican-3 (HR 1.58, p=0.001) and Ki-67 (HR 2.10, p=0.002) were linked to poor overall survival. Conclusions: It was concluded that the significant associations between specific immunohistochemical markers (e.g., HepPar-1, Glypican-3, and Ki-67) and clinicopathological characteristics, as well as their impact on prognosis in Hepatocellular Carcinoma patients.

Screening Student Behavior: Exploring the Impact of Daily Screen Time on Sleep Quality, Mental Distress, and Academic Performance in Students

2025-04-08T09:31:13+00:00

The pervasive influence of technology, particularly screen usage, on daily routines and its implications for sleep quality, mental health, academic performance, and physical activity has become an increasing area of concern. Objective: To evaluate the daily screen time of students from different fields of study and to assess its association with demographic variables, sleep quality, psychological symptoms, physical activity, and academic performance. Methods: This study was performed at Isra University, Hyderabad from February 2024 to August 2024, with 152 participants. Data on demographics, sleep quality (PSQI), mental distress (DASS-42), academic performance, and screen time were collected after informed consent. Statistical analysis, conducted using SPSS version 25.0, determined correlations between daily screen time, PSQI, and DAS scores. Results: The participants had a mean age of 20.59 ± 2.16 years, with most residing in urban areas (87.5%) and being day scholars (74.34%). Average daily screen time was 5.85 ± 1.14 hours, significantly higher among those with GPAs below 2.5 and low physical activity levels (p<0.05). Mean scores for depression, anxiety, stress, and PSQI were 13.34 ± 12.01, 11.17 ± 9.41, 15.32 ± 11.09, and 6.45 ± 3.48, respectively. Screen time positively correlated with depression (r = 0.81, p<0.01), anxiety (r = 0.78, p<0.01), stress (r = 0.83, p<0.01), and PSQI (r = 0.75, p<0.01). Conclusion: Increased screen time was linked to poorer sleep quality, elevated mental distress, and reduced academic performance, particularly in urban populations and individuals using screens for recreation.

Femoral Condyle Measurements in Anterior Cruciate Ligament Injury: 1 Tesla Magnetic Resonance Imaging Analysis

2025-04-08T09:31:11+00:00

Orthopedic injury of Anterior Cruciate Ligament (ACL) remains an increasingly frequent issue that primarily affects athletes with permanent complications as a result. The modern Magnetic Resonance Imaging (MRI) technology enables better accuracy when measuring femoral condyles. Objective: To investigate the dimension analysis of the femoral condyles regarding ACL injuries alongside their implications for both surgical procedures and preventive management. Methods: Descriptive cross-sectional study from September 2023 to August 2024 in the Orthopedic department. The study enrolled 385 participants between 18 to 60 years old. All subjects completed scanning with a 1 Tesla MRI and the researchers recorded femoral condyle dimensions. Data analysis occurred with SPSS version 26.0. while linear regression and ANOVA. Results: The research analysis involved 385 participants whose mean age equaled 34.7 ± 6.95 years. The majority were male (70.6%). Mean measurement of Lateral Condyle AP was 6.28 ± 0.43 cm while Medial Condyle AP recorded 6.11 ± 0.46 cm, and Trans-epicondylar Axis reached 7.96 ± 0.53 cm. ANOVA analysis found significant measurement distinctions in knee joints that occurred between different age groups (p<0.001). The results from independent t-tests showed knee measurement discrepancies between men and women signify statistical significance at p<0.001. Conclusions: This research demonstrated that the dimensions of femoral condyles act as major factors that determine risk for ACL injuries. Preventive strategies alongside treatment plans for ACL injuries need to adopt age- and sex-specific considerations according to the research results.

Comparison of Analgesic Effectiveness of Tapentadol and Tramadol in Relieving Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia

2025-04-08T11:55:43+00:00

Various pharmacological interventions have aimed to address postoperative pain, however the search for optimal preemptive analgesic continues. In this assessment, it was sought to evaluate tapentadol and tramadol as preemptive analgesic, in order to identify the more effective option for managing postoperative pain. Objective: To compare the analgesic effectiveness of tapentadol and tramadol in relieving postoperative pain in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: This quasi experimental study was conducted at Anesthesia Department of Mayo Hospital, Lahore from 30-11-2022 to 30-05-2023 after taking ethical approval from IRB. 60 individuals were enrolled after taking written informed consent, who were planned for laparoscopic cholecystectomy under general anesthesia. Patients were assigned to either group A (tramadol) or group B (tapentadol). Analgesic effectiveness was assessed in terms of time to first rescue analgesia, total rescue analgesic consumption in 24 hours, and VAS score at different interval postoperatively. Results: Mean time to 1^st analgesia requirement calculated was 1.667±0.365 hours for group A and 4.46±1.45 hours for group B; p <0.0001. Mean total rescue analgesic (injection nalbuphine) consumption in group A and group B was 17.06±5.16mg and 8.4 ± 2.59mg, respectively (p <0.001). Mean of VAS score at different intervals noted was less in group B as compared to group A postoperatively, p <0.001. Conclusions: The findings of this study demonstrate that tapentadol 75 mg is more effective than tramadol 50 mg as preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

Association of Partial Edentulism with Signs and Symptoms of Temporomandibular Disorders

2025-04-12T05:51:37+00:00

Temporomandibular Joint (TMJ) is a complex joint and occlusal disharmony affects the joint health and result into temporomandibular joint dysfunction syndrome. Objective: To assess the signs and symptoms of temporomandibular joint disorders in partially edentulous patients and find out the association between TMD’s and edentulous span, tooth loss quadrant and occlusal support. Methods: 200 partially edentulous patients selected by non-probability purposive sampling and TMJ were examined for maximum mouth opening, joint deviation, tenderness of muscles of mastication and joint pain with clicking. The sample was grouped into 3 characteristics i.e.; number of partially lost teeth, number of dental quadrants with posterior teeth loss and the numbers of Occlusal Support Zones (OSZ) based on Eichner Classification system. Results: TMJ muscle pain existed in 8.0% and joint pain was 23.0%. Many patients had missing teeth in 2 quadrants 30.0% and had 5-8 numbers of missing teeth 42.5%. A3 support zone was frequently found 29.5%. Significant association of gender was found for TMJ pain, and maximum mouth opening. The tooth loss quadrant, number of partially lost teeth and occlusal support zones had significant association with muscle pain, TMJ pain with clicking and maximum mouth opening. Conclusions: It can be concluded that the partially edentulous patients frequently develop one or more signs and symptoms of TMJ disorders and number of teeth lost, number of quadrants with missing teeth and loss of occlusal support disturb the joint function and associated stomatognathic system.

Frequency of Vaginal Birth after C-Section and Factors Associated with Successful Trial of Vaginal Birth after C-Section

2025-04-12T05:52:09+00:00

A repeat cesarean section is often a more favorable and comfortable option for women who have previously undergone a cesarean section. Objective: To determine the prevalence and the maternal and obstetric factors influencing the likelihood of a successful vaginal birth after cesarean (VBAC) among women attempting a trial of labor. Methods: This descriptive case series was conducted at the Gynecology Unit 3 of Sir Ganga Ram Hospital, Lahore, from August 2023 to February 2024. A total of 158 women with a history of one prior lower-segment cesarean section were enrolled through a non-probability sampling technique. Labor progression was monitored using the WHO labor guide, which guided the decision for either a repeat cesarean section or a vaginal birth. Data on factors associated with a successful VBAC were collected and analyzed by comparing their frequency between successful and unsuccessful cases. Results: Among the women undergoing a trial of labor, 115 (72.78%) achieved a successful vaginal delivery. When comparing maternal and obstetric factors between successful and unsuccessful groups, the following differences were observed: maternal age below 30 years (55.65% vs. 39.53%), gestational age under 40 weeks (59.13% vs. 48.84%), BMI less than 25 kg/m² (57.39% vs. 30.23%), and an inter-delivery interval exceeding two years (80.0% vs. 60.47%). Conclusions: This study found that the success rate of vaginal delivery in women with a prior cesarean section undergoing a trial of labor was 72.78%. Several maternal and obstetric factors were associated with an increased likelihood of successful VBAC.

Frequency of Syndrome of Inappropriate Antidiuretic Hormone in Patients with Guillain-Barré Syndrome Presenting at Tertiary Care Hospital, Karachi

2025-04-12T05:51:31+00:00

Guillain-Barré Syndrome (GBS) is a condition that causes inflammation in the nerves and can sometimes lead to a problem called SIADH. SIADH happens when the body makes too much of a hormone that controls water balance, leading to low sodium levels in the blood. Objective: To determine the frequency of SIADH inpatients with GBS presenting at Tertiary Care Hospital, Karachi. Methods: This Cross-sectional study was conducted at Department of Neurology, Civil Hospital, Karachi, from 12-07-19 till 12-01-20. Total 119 GBS patients who met the inclusion criteria were included. A brief history was recorded, and demographic details were noted in the form. Numerical data were summarized using simple descriptive statistics. Categorical data were shown as numbers and percentages. Results: 71 (59.7%) were male and 48 (40.3%) were female. Mean age in the study was 46.78 ± 2.81 years. Whereas, Mean age, duration of symptoms, serum sodium and GC Sinour study was 46.78 ± 2.81 years, 25 ± 10.78 hours, 128.65 ± 7.52 mmol/L and 11.21 ± 3.14 % respectively. Out of 119 GBS patients, 21% had SIADH. Conclusions: This study showed that SIADH is present in significant proportion of patients with GBS. Thus, it is essential to focus on a comprehensive way of management of GBS and its comorbidities rather than primarily treating the neurological symptoms.

The Efficacy and Difficulties of Implementing a Multifaceted of Strategies to Improve Retainer Compliance

2025-04-12T05:51:33+00:00

Orthodontic therapy with both permanent and removable appliances is known to be impacted by poor compliance. Objective: To investigate the barriers affecting orthodontic retainer compliance and to explore the effectiveness of a multifaceted approach in enhancing adherence to retainer wear. Methods: In this mixed-methods study, 100 patients were recruited from Jinnah Medical and Dental College, and treatments improved these patients' retainer compliance. Two groups were made control and intervention in which the control group received orthodontic treatment, and the other group received education, digital tools, and behavioral techniques. For statistical analysis descriptive statistics, logistic regression, and chi-square tests were used, and for qualitative data thematic analysis. Results: The self-reported adherence rates of the control group were higher (78%) as compared to the control group (52%; p < 0.05). The intervention group had higher retention wear adherence than the control group (78% vs. 52%, p < 0.05) which was further confirmed by smart monitoring (6.5 vs. 4.2 nights/week, p = 0.03) and orthodontists (76% vs. 50%, p < 0.05). The impact of digital interventions and behavioral strategies in improving retainer compliance was demonstrated by the compliance-improving techniques that ranked mobile health reminders (82%) as the most effective. Conclusions: A multifaceted approach, such as behavioral approaches, digital technologies, and education, considerably increased retainer compliance. Hence, orthodontic retention regimens that incorporate behavioral techniques and technology may produce improved long-term treatment results.

Effect of Phototherapy On the Serum Calcium Level in Term Neonates with Indirect Hyperbilirubinemia

2025-04-12T05:51:39+00:00

Normal calcium levels in neonates are crucial for preventing hypocalcemia. Phototherapy disrupts melatonin secretion, enhancing cortisol-induced hypocalcemia and urinary calcium excretion. Objectives: To determine the effect of phototherapy on serum calcium levels and its association with the incidence of hypocalcemia in term neonates with indirect hyperbilirubinemia. Methods: A descriptive case series was carried out in the Department of Pediatrics, Islamic Teaching Hospital, Sialkot, between Nov 5, 2023, and April 4, 2024. A total of 134 newborns who met the study's inclusion and exclusion criteria were enrolled. Demographic information, including name, age, sex, weight, and address, was noted. Three milliliters of venous blood were drawn before the commencement of conventional phototherapy and following forty-eight hours of nonstop phototherapy. The sample was subsequently transferred to a laboratory for the measurement of calcium and serum indirect bilirubin levels. All data was collected through a well-designed proforma. Results: A Total of 134 patients, 77 (57.5%) belonged to the age category of 0-15 days, while 57 (42.5%) belonged to the age group of 16-28 days. The mean age of the patients was determined to be 14.32 ± 5.25 days. There were 66 (49.3%) female and 68 (50.7%) male. The percentage of hypocalcemia was 31 (23.1%) in term neonates receiving phototherapy for indirect hyperbilirubinemia. Conclusions: It was concluded that the percentage of hypocalcemia was 31 (23.1%) in term neonates receiving phototherapy for indirect hyperbilirubinemia. Phototherapy effectively reduces serum bilirubin levels but is associated with a significant decline in serum calcium, suggesting a potential risk of hypocalcemia in neonates.

Assessment of Vitamin D Levels and Bone-Related Biochemical Markers in Healthy Adults in Pakistan: Influence of Socio-Demographic and Environmental Factors

2025-04-12T05:52:14+00:00

Vitamin D is an essential nutrient that plays a crucial role in bone health, calcium homeostasis, and immune function. Objectives: To assess the levels of vitamin D by age, gender, sunlight exposure, education level, calcium levels, parathyroid hormone (PTH) levels, and albumin levels. Methods: The cross-sectional study was carried out at the Department of Community Medicine, Niazi Medical and Dental College, Sargodha. This study was carried out over half a year from January 2024 to June of the same year. A total number of responders was n=246. Socio-demographic data were collected on the responder's age, gender, number of family members, occupation, education levels, and house type using a structured questionnaire. Blood samples were collected to assess serum vit D levels, and other biochemical indicators used were albumin, calcium phosphate, and parathyroid hormone (PTH). Results: Vitamin D deficiency was prevalent, especially in female, older individuals, and those with low sun exposure. Male had higher levels (16.5 ng/mL) than female (14.2 ng/mL). Deficient individuals (<12 ng/mL) showed lower calcium and higher PTH levels, indicating secondary hyperparathyroidism. Only 14.6% were sufficient (>20 ng/mL). Vitamin D levels were significantly associated with age, gender, sun exposure, education, calcium, and PTH (p<0.05). Conclusions: It was concluded that there was a significant correlation between vitamin D deficiency with age, gender, sun exposure, education level, calcium, PTH, and albumin levels.

Association between Functioning and Dynamics in Families of Children with ADHD in Pakistani Context

2025-04-12T05:51:26+00:00

Attention-Deficit/Hyperactivity Disorder (ADHD) affects multiple aspects of a child’s development, including family dynamics. Understanding the association between family functioning and ADHD can provide insights into its social determinants. Objectives: To evaluate family functioning and dynamics in families of children with ADHD and compare them with healthy controls. Methods: A comparative cross-sectional study was conducted at the Child Psychiatry Clinic, Liaquat University Hospital, Hyderabad, from August 2024 to January 2025. A total of 120 participants (60 ADHD cases and 60 age-matched controls) were recruited using non-probability consecutive sampling. Family structure, socioeconomic status, parental employment, education, and family discord were assessed through structured interviews. Data were analyzed using SPSS version 25.0. Results: Family dysfunction was significantly associated with nuclear family structure (39.2% vs. 88.9%, p=0.044), lower socio-economic status (41.2% vs. 11.1%, p=0.031), and maternal educational level (33.3% vs. 11.1%, p=0.038). Additionally, a history of parental/family discord was significantly more prevalent in families with dysfunction (52.9% vs. 11.1%, p=0.005). Conclusions: It was concluded that family discord is significantly associated with ADHD, highlighting the need for family-based interventions. Addressing family conflict may help improve outcomes for children with ADHD.

Relationship of BMI with Severity of Chronic Obstructive Pulmonary Disease (COPD)

2025-04-12T05:51:29+00:00

COPD is linked to significant extra-pulmonary manifestations. However, limited research exists on relationship between BMI and COPD severity. Objective: To find frequency of COPD stages and to compare mean BMI in various stages of COPD. Methods: This cross-sectional study was conducted at Chest Medicine Department, Mayo hospital, Lahore from August 2022, to February 2023 after approval of synopsis from CPSP. 160 COPD patients were enrolled, and classification as per GOLD guidelines and BMI was calculated. Data were analyzed using SPSS version 26.0, comparison of BMI across COPD stages was done using ANOVA and post Hoc analysis done, p-value ≤ 0.05 considered statistically significant. Results: Among 160 individuals, 26.2% had COPD Stage I, 23.8% had stage II, while Stage III and IV observed in 25% each. Mean BMI was 24.30 ± 2.71, 25.86 ± 5.77, 20.29 ± 5.39, and 19.50 ± 6.07 in Stage I-IV, P<0.001. Mean BMI difference was statistically significant when comparing Stage, I vs. III (p = 0.003), Stage I vs. IV (p < 0.001), Stage II vs. III (p < 0.001), and Stage II vs. IV (p < 0.001). However, difference between Stage III and IV was not statistically significant (p = 0.900). Conclusions: The distribution of COPD severity was relatively even across all stages, with comparable proportion of patients in each stage. A significant decline in BMI was observed with increasing disease severity. These findings emphasize the importance of regular BMI monitoring in COPD patients, as lower BMI is linked to disease progression and poorer clinical outcomes.

Factors Affecting Sexual Health after Puerperium among Women in Karachi

2025-04-12T05:51:35+00:00

The puerperium phase represents a critical juncture in a woman's reproductive journey, marked by significant physical, emotional, and relational adjustments. Various factors beyond the mere resumption of sexual activity influence sexual well-being during this period. However, discussions surrounding postpartum sexual health remain limited, particularly in low- and middle-income countries like Pakistan. Objectives: To explore postpartum sexual health in Pakistani women, identifying cultural, physical, and emotional factors influencing well-being. Methods: A cross-sectional study was conducted at Fazaia Ruth Pfau Medical College (FRPMC) Hospitals in Karachi from August 2022 to July 2023. Within the first three months’ post-puerperium, 263 women aged 18 to 45 participated. A comprehensive questionnaire, developed and validated through rigorous processes, assessed socio-demographic, obstetric, and sexual health factors. Statistical analyses, including chi-square tests and Kendall’s tau correlation analyses, were employed. Results: Participants exhibited diverse socio-demographic and obstetric profiles, with a notable prevalence of resumption of sexual activity (65.1%) and concerns such as dyspareunia (66.5%) and decreased libido (53.2%). Significant associations were found between various socio-demographic and obstetric factors and postpartum sexual health outcomes. Longer marriage duration was associated with higher libido levels, while the mode of delivery and the last baby's birth weight influenced coital frequency. Age, marriage duration, and parity affected postpartum libido, vaginal dryness, and dyspareunia. Conclusions: It was concluded that this study provides valuable insights into the complexity of postpartum sexual experiences among women in Karachi, Pakistan. The findings underscore the need for comprehensive, culturally sensitive interventions to support women's sexual well-being during this critical period.

Evaluation of Glycated Hemoglobin Levels in Cirrhotic Patients Across Different Child-Pugh Classes

2025-04-12T05:52:11+00:00

Chronic liver diseases can lead to cirrhosis, characterized by structural abnormalities and fibrosis. Diabetes is a significant risk factor for poor prognosis in cirrhotic patients, associated with complications such as ascites, renal dysfunction, and increased mortality. Objectives: To evaluate glycated hemoglobin (HbA1c) levels in cirrhotic patients across different Child-Pugh classes, contributing to better management of chronic liver disease. Methods: Conducted at Liaquat University of Medical and Health Sciences, this descriptive cross-sectional study enrolled 62 cirrhotic patients (aged 18-60) over six months. Exclusion criteria included known diabetes and recent blood transfusions. Data on demographic characteristics and HbA1c levels were collected and analyzed using SPSS version 24.0. Results: The mean age of participants was 52.3 ± 7.5 years, with a mean disease duration of 28.4 ± 12.3 months. The overall mean HbA1c level was 5.3 ± 0.9%. Child-Pugh classification revealed 32% Class A, 40% Class B, and 28% Class C patients. HbA1c levels increased significantly with liver disease severity: Class A (4.9 ± 0.6%), Class B (5.4 ± 0.7%), and Class C (5.9 ± 0.8%), p<0.05. Significant associations were found between HbA1c levels and age, disease duration, but not with gender or BMI. Conclusions: It was concluded that HbA1c levels are influenced by the severity of liver disease and duration, indicating the need for careful interpretation of HbA1c in cirrhotic patients for effective management.

Socioeconomic Determinants of Access to Primary Healthcare in Rural Population of Sindh, Pakistan

2025-04-12T05:51:44+00:00

Pakistan's rural population lacks access to primary healthcare facilities due to various socioeconomic factors. Investigating these factors is essential to improve healthcare delivery to these people. Objective: The Current study explores the socioeconomic determinants that influence the access to primary healthcare services in rural Sindh, Pakistan. Methods: This cross-sectional study was conducted in five districts of Sindh: Hyderabad, Thatta, Badin, Tharparkar, and Larkana. A total of 300 participants were surveyed using a structured questionnaire. Demographic data along with education, occupation, Monthly Income, Access to Utilities, Distance to medical facility, Medical services Costs, Waiting Times, Doctor, medicine, and diagnostic facilities. Descriptive statistics and logistic regression were used to analyze the data. Results: The study found that 46.8% of respondents had no formal education, and 54.5% reported a monthly household income of less than 20,000 PKR. Barriers to healthcare included long distances to healthcare facilities (72%), lack of transportation (60%), high treatment costs (55%), and long waiting times (50%). Logistic regression revealed that education level, income, and proximity to healthcare services were significant determinants of access to healthcare. Conclusions: Socioeconomic factors such as education, income, and geographical distance significantly affect access to primary healthcare in rural Sindh. Targeted interventions, including improving healthcare infrastructure and addressing transportation and affordability issues, are crucial to enhancing healthcare accessibility in these areas.

Histopathological Spectrum of Hysterectomy Specimen in Sonographically Bulky Uterus among Peri and Post-Menopausal Women

2025-04-16T06:21:26+00:00

A common sonographic characteristic in peri- and postmenopausal women is a sonographically bulky uterus, often associated with diverse uterine abnormalities, necessitating histopathological evaluation. Objective: To assess the histopathological changes in hysterectomy samples of peri- and post-menopausal females with sonographically enlarged uterus. Methods: The study participants were 150 postmenopausal women with a bulky uterus by ultrasound. This study was cross sectional and carried out in the Obstetrics and Gynaecology Department of Rashid Latif Meical College, Lahore from February 2022 to January 2024. Histopathological assessment was done on hysterectomy specimens to compare various diseases of the uterus including fibroids, endometrial hyperplasia, endometrial cancer, adenomyosis, and other benign/malignant diseases. Data were analyzed using SPSS version 23.0 and descriptive and comparative analysis methods including chi-square, Fisher exact test and logistic regression. Results: The majority of the participants, 53.33 % were peri-menopausal while 46.67 % were post-menopausal. The symptomatic complaints were abnormal bleeding and pelvic pain with rates of 60% and 33.3%, respectively. Uterine size greater than 12 cm was found to be more common in peri-menopausal women 62.5% compared to post-menopausal women 42.86%; p=0.02. Histopathology assessment showed that endometrial hyperplasia 37.5% vs 14.29%, p=0.02 and fibroid 50% vs 28.57%, p=0.02 were higher in peri-menopausal women. There were no statistically significant differences between the two groups for endometrial carcinoma, adenomyosis, cervicitis or atrophic endometrium. Conclusion: The women in their peri-menopausal period that had sonographically enlarged uteri had a higher rate of fibroids and endometrial hyperplasia than the post-menopausal women.

Comparative Analysis of Serum Uric Acid Levels and Bone Mineral Density Among Elderly Individuals

2025-04-16T06:21:18+00:00

Osteoporosis is a major public health concern, particularly in aging populations. Emerging evidence suggests that serum uric acid (SUA) may influence bone mineral density (BMD) due to its antioxidant properties. However, the relationship between SUA levels and BMD remains controversial. Objectives: To compare BMD among individuals with low and high SUA levels and to determine the association between SUA and osteoporosis prevalence. Methods: This cross-sectional-comparative study was done at Liaquat University Hospital, Hyderabad, from March 2022 to August 2022. A total of 182 participants (≥50 years old) who underwent DEXA scan for BMD assessment were included using a purposive sampling technique. Participants were categorized into low SUA (<5.5 mg/dL) and high SUA (>5.5 mg/dL) groups. BMD at the lumbar spine, total hip, and femoral neck was recorded. Statistical analysis was performed using SPSS v.24, with t-tests, chi-square tests, and Pearson’s correlation applied. A p-value of <0.05 was considered significant. Results: Participants with high SUA levels had significantly higher BMI (p=0.01). Lumbar spine BMD was significantly lower in the high SUA group (p=0.04), but no significant differences were observed for total hip and femoral neck BMD. Pearson’s correlation showed a positive association between SUA and lumbar BMD (r=0.32, p=0.015). Conclusions: It was concluded that higher SUA levels were associated with lower osteoporosis prevalence but paradoxically lower lumbar BMD.

Frequency of Obstetrical Anal Sphincter Injuries in Nulliparous Women Undergoing Normal Vaginal Delivery in Tertiary Care Hospital at Khyber Pakhtunkhwa

2025-04-16T06:21:51+00:00

Obstetric Anal Sphincter injury is one of the most devastating complications of vaginal delivery. The incidence is higher in instrumental deliveries, but OASI can be avoided with proper techniques, such as mediolateral episiotomy, and pre-assessment of fetal head position, such as vertex mal-presentation and progress of labour. Objectives: To find the frequency of Obstetric anal sphincter injury during normal vaginal deliveries in nulliparous female from August 2023 to September 2024. Methods: It was a cross-sectional study conducted in the Gynaecology and Obstetrics Department, Lady Reading Hospital. The study included 162 nulliparous women with Cephalic presentation undergoing Normal Vaginal Delivery, among them the patient with Obstetric Anal Sphincter Injury were identified to find the frequency. The data were collected by a structured questionnaire and analyzed with SPSS version 26.0. Results: Out of the total 162 populations, 6 (3.92%) individual had their OASIs. Five individuals had 3^rd while one individual had a 4th-degree injury. The mean age was 26.33 years with a standard deviation of 4.73. The oldest mother was 38 years old, and the youngest was 18 years old. BMI from 18.5 to 21.9 (Kg/m²) was more frequent in a population of 67. Regarding the presentation of the fetus’s head at birth, 146 presented Cephalic, 5 as transverse and 11 as oblique on presentation. Conclusions: It was concluded that the study shows the frequency of Obstetric Anal Sphincter injuries as 6 out of 162 individuals, having injuries of different degrees.

Maternal Vitamin A Deficiency in Pregnancy and its Relationship with Maternal and Neonatal Haemoglobin Concentration

2025-04-16T06:21:20+00:00

Vitamin A Deficiency (VAD) remains a major nutritional concern, particularly in low-income countries, and is associated with maternal anemia and adverse neonatal outcomes. Objective: To assesses the correlation between maternal Vitamin A levels and hemoglobin concentrations in both mothers and neonates along with its impact on neonatal health outcomes. Methods: A cross-sectional study was conducted at Khyber medical university (Hayatabad Medical Complex, Peshawar), over one year. Pregnant women in their third trimester were recruited based on predefined eligibility criteria. Serum Vitamin A levels were measured using high-performance liquid chromatography (HPLC), and hemoglobin levels were assessed in both maternal and neonatal blood samples. Statistical analyses included t-tests, chi-square tests, and binary logistic regression. Results: Among 121 participants, 84% were Vitamin A deficient (<0.70 µmol/L). Maternal hemoglobin was significantly lower in the deficient group (10.38 g/dL vs. 11.83 g/dL, p = 0.001), as was neonatal hemoglobin (13.40 g/dL vs. 14.31 g/dL, p = 0.001). Low birth weight was more common in the deficient group (31.0% vs. 10.8%), though not statistically significant after Bonferroni correction. Logistic regression confirmed Vitamin A deficiency as an independent predictor of low neonatal hemoglobin (AOR = 3.174, p = 0.043). Conclusions: Vitamin A deficiency is significantly associated with lower maternal and neonatal hemoglobin levels. These findings highlight the importance of maternal nutrition interventions to prevent anemia-related complications.

Exploring the Antimicrobial Potential of Moringa Oleifera Extracts Against Acinetobacter Baumannii

2025-04-16T06:21:54+00:00

Background setups around the world, especially in Asian countries. Published data explained the situation of extreme drug resistance and left patients with very few antibiotic options against this particular pathogen. Plant and their extracts are well known for their antimicrobial properties. Moringa oleifera is one of the prime plants with multiple applications in industries, especially in health care. Objective: To determine the antimicrobial activity of Moringa oleifera plant extracts against Acinetobacter baumannii. Methods: In this experimental study, ethanol extracts of Moringa oleifera root, stem, and leaves were prepared and tested against Acinetobacter baumannii by the well diffusion method and minimum inhibitory concentration method. Four concentrations of all three extracts were prepared as 5mg/ml, 10mg/ml, 15mg/ml, and 20mg/ml. All experiments were tested three times. Results: No inhibition was seen at 5mg/ml, a 6mm zone diameter was observed at 10mg/ml, and 11mm was seen at 15mg/ml. Conclusions: It was concluded that Moringa oleifera showed good inhibition activity against Acinetobacter baumannii. This study does not include the quality analysis of extracts; after quality analysis and precise concentrations could create a huge opportunity in dealing with this extremely drug-resistant pathogen.

Coronary Angiographic Profile in Smokeless Tobacco Users in Patients Presenting with Acute Coronary Syndrome at A Tertiary Care Cardiac Center

2025-04-16T06:21:22+00:00

Smokeless tobacco users with acute coronary syndrome (ACS) at tertiary care cardiac centers are more likely to develop significant coronary artery disease (CAD). With multi-vessel involvement, highlighting its significant risk factor. Objectives: To determine the frequency of coronary angiographic profiles in smokeless tobacco users with ACS at a cardiac center. Methods: A study involving 159 smokeless tobacco users aged 18-70 with acute coronary syndrome was conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi from Mar 2022 to Jan 2024, recording demographic data such as gender, age, height, and weight. Before an angiography procedure, the patient's medical history, including hypertension, diabetes, family history, and obesity, was reviewed, along with their smokeless tobacco use, recording type, frequency, and duration. Results: A study involving 159 smokeless tobacco users aged 18-70 years, with a mean age of 46.64 ± 10.186, included 134 male (84.3%) and 25 female (15.7%). The study revealed that male accounted for 63 (39.62%) of the total ACS with Single vascular disease (SVD), while unstable angina was typical in 52 (32.70%) cases. The study found a significant association between age groups, ACS type, culprit artery, and tobacco use on the day of ACS (p=0.004, 0.027, 0.044, and 0.024), respectively. However, no significant association was seen between gender, tobacco type, and risk variables. Conclusions: It was concluded that smokeless tobacco significantly contributes to ACS, with a high percentage of single vessel blockage involving RCA, and that duration and number of use also contribute to ACS.

Association of Child Pugh Class with Esophageal Varices and Portal Hypertensive Gastropathy in Patients with Cirrhosis

2025-04-16T06:21:16+00:00

Oesophageal-varices and portal-hypertensive-gastropathy are common in cirrhotic-patients. The Child Pugh-classification, a key measure of liver disease severity, helps assess their association, offering insights into disease progression and management. Objective: To determine the association between Childs PUGH class, oesophageal varices and portal hypertensive gastropathy in patients with cirrhosis. Methods: This Cross Sectional Study was conducted at the Department of Gastroenterology, LUMHS, Jamshoro, Pakistan. Doppler ultrasound was used to diagnose portal hypertension. Following the ultrasound, endoscopy was performed to diagnose oesophageal varices and portal hypertensive gastropathy. The data collected were electronically recorded for research purposes using the provided proforma. Results: Oesophageal varices were noted in 122 (88.4%) patients and portal hypertensive gastropathy in 117 (84.8%) patients. In association of Child-Pugh class with oesophageal varices, class A was noted in 9.4%, class B in 23.2%, and class C in 55.8% of patients resulting in a significant p- value of 0.008 whereas in the association of Child-Pugh-class with portal-hypertensive-gastropathy, class A was noted in 8.0%, class B in 23.9%, while class C had 52.9% resulting in a non-significant p- value of 0.122. Conclusions: This study found a strong association between cirrhosis severity and the presence of esophageal varices, with the highest prevalence observed in Child-Pugh Class C patients (p = 0.008). However, the association between Child-Pugh class and portal hypertensive gastropathy was not statistically significant (p = 0.122).

Efficacy of Combined Intralesional Triamcilone and Cryotherapy for Treatment of Keloid

2025-04-18T07:15:26+00:00

Keloid treatment remains a challenging task due to the high recurrence rates and limited effectiveness of monotherapies. Objective: To determine the efficacy of combining intralesional Triamcinolone Acetonide (TA) with cryotherapy. Methods: A quasi-experimental study was conducted at the Dermatology Department, Nishtar Hospital, Multan, over 6 months from 30^th June 2024, to December 31, 2024. Eighty patients were enrolled using non-probability consecutive sampling. Baseline characteristics, including keloid dimensions, pain, and itching scores, were documented. Patients received cryotherapy followed by intralesional TA (40 mg/mL) injections for up to six sessions. Treatment outcomes were assessed two weeks post-treatment through reduction in keloid height, length, and Visual Analog Scale (VAS) scores. Results: The mean keloid height and length reduced significantly from 4.66 ± 1.37 mm to 1.69 ± 1.18 mm and 6.64 ± 2.23 cm to 2.68 ± 1.79 cm, respectively (p < 0.001) post-treatment. VAS pain scores decreased by 2.86 ± 1.96, and VAS itching scores decreased by 3.53 ± 1.39 (p < 0.001). Efficacy, defined as ≥50% reduction in keloid dimensions, was achieved in 75% of participants. Common adverse effects included blistering (18.8%) and erythema (15%). Conclusions: The combination of cryotherapy and intralesional triamcinolone acetonide demonstrated effective reduction in keloid height and length, with significant improvement in pain and itching scores. Although efficacy varied across demographic and lesion-specific variables, the treatment remains a safe and viable option for keloid management, with manageable adverse effects and promising outcomes.

Determination of Frequency and Risk Factors of Ureteral Stent Encrustations in a Tertiary Care Hospital

2025-04-16T06:21:24+00:00

Ureteral stent encrustation is a common problem, with incidence rates rising from 9% at 6 weeks to over 75% after 12 weeks of indwelling time. Objective: To determine the frequency and associated risk factors of the ureteral stent encrustation in patients with urolithiasis. Methods: This was a prospective descriptive study, conducted at the Department of Urology, JPMC, Karachi, Pakistan. All patients who visited to JPMC and fulfilled the inclusion criteria were included in the study after their consent. Stent duration was grouped into ≥ 6 weeks and < 6 weeks. The stent removal was done under general or local anesthesia. All the collected data were entered into the pre-defined study proforma. Results: Mean ± SD of age was 39.60 ±12.06 years. In the distribution of gender, 43 (58.9%) were male while 30 (41.1%) were female. Ureteral stent encrustation was noted in 11 (15.1%) patients. In the comparison of urinary tract infection and proteinuria, with and without ureteral stent encrustation was noted as 9.6% v/s 5.5% and 11% v/s 4.1%, and the p-value was found to be highly significant i.e., p < 0.0001. Conclusions: This study concluded that ureteral stent encrustation was prevalent in patients with urolithiasis. It is significantly associated with urinary tract infection and proteinuria. However, more prospective and well-controlled trials are needed to validate the current findings.

Outcome of Severe Left Ventricle Systolic Dysfunction Patients After Coronary Artery Bypass Grafting

2025-04-18T07:15:28+00:00

Coronary artery bypass grafting (CABG) has historically been regarded as a high-risk intervention. Objective: To evaluate the short-term outcomes of severe left ventricular (LV) systolic dysfunction in patients after CABG. Methods: This prospective observational cohort study was done at the Department of Cardiac Surgery, Pervaiz Elahi Institute of Cardiology, Bahawalpur, Pakistan, from August 2022 to September 2024. Patients aged 30–75 years, with confirmed coronary artery disease requiring CABG and ejection fraction (EF) ≤30%, were analyzed. Preoperative variables included demographic information, comorbidities, cardiac function parameters and angiographic findings. Postoperative complications and 90-day mortality were noted. Results: In a total of 78 patients, 53 (68%) were male. The mean age was 55.2 ± 9.3 years. The mean baseline EF was 25.4 ± 4.6%. The mean bypass and cross-clamp times were 90.3±16.8 minutes and 51.4 ± 11.6 minutes, respectively. The most common post-surgery complications were arrhythmias, neurological disorders, wound infection, and acute kidney injury, noted in 12 (15.4%), 6 (7.7%), 5 (6.4%), and 3 (3.8%) patients, respectively. At 90 days postoperatively, mortality was reported in 6 (8.7%) patients. Predictors of 90-day mortality included preoperative EF <25% (OR=3.2, 95% CI:1.2–8.5, p=0.014), age ≥65 years (OR=2.8, 95% CI:1.1–7.0, p=0.021), and left main disease (OR=3.6, 95% CI:1.4–9.1, p=0.008). Conclusions: In terms of short-term outcomes, CABG in patients with severe LV systolic dysfunction is associated with significant improvements in functional status and EF. Key predictors of mortality included preoperative EF <25%, advanced age (≥65 years), and left main disease, highlighting the need for careful preoperative risk stratification.

Comparison of Trichoscopic Features of Alopecia Areata before and after Treatment with Intralesional Steroids

2025-04-18T07:15:49+00:00

Alopecia Areata is a common form of non-scarring hair loss. The utility of Trichoscopy lies in diagnosis and monitoring therapeutic response in challenging cases. Objectives: To compare the change in frequency of trichoscopic features of Alopecia Areata before and after treatment with intralesional steroids. Methods: This descriptive longitudinal study was carried out in the Department of Dermatology, Sahiwal Teaching Hospital, Sahiwal. Patients between age 18 to 60 of either sex, having Severity of Alopecia Tool (SALT Score) of less than 50 were enrolled. Intralesional triamcinolone acetate (5mg/ml with lignocaine) was infiltrated at a dose of 0.1 ml /cm² into the dermis. Trichoscopic features were recorded using Heine Delta 30 digital Dermatoscope at baseline and after 12 weeks. Results: Mean age was 28.19 ± 8.54. There was statistically significant decrease in mean of SALT Score before (9.91 ± 6.77) and after (4.94 ± 4.04) treatment. The frequency of black dots, exclamation mark hairs and yellow dots at baseline was 91%, 81% and 23%. After treatment these frequencies reduced significantly to 8%, 7%, and 9% respectively (p-value<0.001). While the proportion of short vellus hair and circle hair at baseline (63%,12%) increased to 99% and 70% after treatment respectively (p-value<0.001). Conclusions: It was concluded that clinical improvement in Alopecia Areata after treatment with intralesional steroids can be demonstrated with disappearance of yellow dots, black dots, exclamation mark hair and appearance of circle and short regrowing hair on Trichoscopy. Thus, highlighting the utility of Trichoscopy as a valuable tool for monitoring therapeutic response in Alopecia Areata.

Determination of Diagnostic Accuracy of ACR-TI-RADS in Detecting Malignancy in Thyroid Nodules On Ultrasonography, Keeping Bethesda Cytological Score at FNAC as Gold Standard

2025-04-18T07:15:51+00:00

Thyroid nodules are a common clinical concern, requiring precise evaluation to differentiate benign from malignant cases. Objective: To compare the diagnostic accuracy of the ACR TI-RADS with the Bethesda System, the gold standard for thyroid cytopathology. Methods: This cross-sectional study was carried out within the Diagnostic Radiology Division of Mayo Hospital Lahore between August and November 2024, and included 224 patients who had thyroid nodules on ultrasonography and were planned for fine needle aspiration cytology (FNAC). A radiologist assessed the ACR-TIRADS scores after data were accumulated employing a standardized case report form. The FNACs were categorized utilizing the Bethesda framework. SPSS version 29.0 was used to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the ACR TI-RADS system. Results: Their study had a total of 224 patients, with a prevalence of female (186, 83.0%). The sensitivity of ACR TI-RADS in identifying malignant nodules was 87.5% (SE=0.049, 95% CI (77.9%, 97.1%)), while specificity was lower at 31.6% (SE=0.039, 95% CI (23.9%, 39.3%)). The PPV and NPV were 33.6% and 86.5%, respectively. Overall, the accuracy of ACR TI-RADS was 47.4%. Conclusions: It was concluded that the ACR TI-RADS system showed excellent sensitivity but low specificity in identifying malignant thyroid nodules. This implies that ACR TI-RADS is more useful for excluding cancer than identifying malignant instances. To improve the ACR TI-RADS system's predictability across a range of populations, more research is required.