Pakistan Journal of Health Sciences

The Intersection of Robotic Surgery and AI: Revolutionizing Healthcare

2025-03-04T08:17:34+00:00

Integrating robotic technology and advanced intelligence systems in surgery into a suite of precision, efficiency and improvement in patient outcomes represents a new era in surgery. Surgical procedures are undergoing these developments that are changing the procedures and have great potential for innovation in techniques and protocol streamlining.

In particular, modern robotic surgical platforms help surgeons during complex procedures including minimally invasive surgery. Because of how precise, dexterous and minimally invasive these systems are, they not only shorten patient recovery time, but there is reduced blood loss and smaller incisions. The da Vinci system is certainly one of the Halls of Movers. Computational intelligence takes these systems to the next level by broadening their capabilities and conceiving new space in the field of surgical practice.

Real time assistance for robotic surgery is gained by intelligence based systems which led to increase in robotic surgery efficacies. Extensive data is processed by advanced algorithms, patterns are found, and suggestions are provided to guide surgeons around operating table.

For instance, these systems can use medical imaging to generate three-dimensional visualizations of organs and tissues with great detail and thus help surgeons plan surgery more accurately. When the surgery is on, the technology follows the surgical field to suggest the best instrument position and to minimize risks. These algorithms also can find potential complication earlier, so surgeons can perform remedial procedures.

Advanced computing and robotic surgery promises tremendous advance in patient care. Together these technologies minimize invasive approaches and decrease the risk of infection, scarring, and protracted recovery periods. Less pain, shorter hospital stays and faster recoveries for daily activities are typical for patients. Beyond that, the systems learn and get better, getting increasingly more precise and personal with each procedure.

Whilst robotic surgical systems currently have a high cost, this does so far prevent wider spread adoption in resource constrained settings. However, as more and more computational help becomes a fundamental piece of the surgery puzzle, it is necessary to think about data privacy, algorithmic bias and etc that can ensure ethical activity.

However, the future of robotics and intelligent endo surgery seems bright. While these technologies are not just helping to refine surgical capabilities, they are revolutionizing patient care making procedures safer, more precise and less invasive. This integration will certainly have an impact on our modern era of medicine.

Role of Serum and Dietary Vitamins A and E in Pulmonary Function and Chronic Obstructive Pulmonary Disease: A Systematic Review

2025-03-04T08:17:37+00:00

Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, significantly affecting quality of life and healthcare systems. Oxidative stress plays a critical role in COPD pathogenesis. Vitamins A and E, as fat-soluble antioxidants, are believed to support pulmonary health, but studies report conflicting findings. Objectives: To evaluate associations between serum and dietary concentrations of vitamins A and E with pulmonary function parameters and COPD risk or severity, this systematic review was conducted. Methods: A systematic search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Library. Of 150 screened studies, 22 met the inclusion criteria, comprising cross-sectional, cohort, case-control, and interventional designs. Studies assessing serum or dietary levels of vitamins A and E and their relationships with pulmonary function parameters (FEV₁, FVC, FEV₁/FVC) were included. Results: Higher serum and dietary vitamin A levels were linked to improved FEV₁ and FVC and reduced COPD prevalence. Vitamin E intake was associated with a lower risk of COPD, though its effects on lung function varied. Supplementation studies showed mixed results, with vitamin E benefits observed mainly when combined with other antioxidants. Effects were more pronounced in smokers and individuals with systemic inflammation. Conclusions: Vitamins A and E, particularly vitamin A, may support pulmonary health and slow COPD progression. However, inconsistencies highlighted the need for well-designed trials to confirm their role in COPD management.

A Rare Case of Metachromatic Leukodystrophy (MLD)

2025-03-08T06:36:22+00:00

Metachromatic Leukodystrophy (MLD) is a rare hereditary lysosomal storage disorder affecting white matter, often leading to progressive motor and cognitive decline. This case presents a 30-month-old child from a consanguineous family who was in good health four months prior but initially exhibited mild symptoms of diarrhea and a chest infection before rapidly deteriorating neurologically. The delayed diagnosis highlights the challenges of early recognition in resource-limited settings. MRI findings, coupled with genetic testing, confirmed the diagnosis, emphasizing the importance of integrating neuroimaging with molecular diagnostics. This case underscores the critical need for prenatal and newborn genetic screening, particularly in populations with a high prevalence of consanguinity, to facilitate timely interventions and improve disease management. Early recognition and a multidisciplinary approach, including genetic counseling, can enhance outcomes and inform future preventive strategies for at-risk families.

Patterns of Asthma Control among Asthmatic Patients Presenting at Tertiary Care Hospital, Larkana

2025-03-04T08:18:13+00:00

Asthma is the most prevalent pediatric chronic condition and the leading cause of preventable pediatric hospitalization. Despite its prevalence, asthma is a poorly managed condition. Effective therapies to enhance and sustain asthma control are required. Objective: To determine the frequency of patterns of asthma control among asthmatic patients presenting at a tertiary care hospital, Larkana. Methods: Cross-sectional research was conducted at the Children's Hospital in Larkana between January 21 and June 23. Quantitative and qualitative data were gathered, presented, and evaluated. Effect modifiers were controlled via stratification to determine their impact on the result variable. The chi-square test was used after post-stratification, with a p-value of ≤0.05 considered significant. Results: The study involved 143 patients, with an average age of 7.14 ± 3.49 years and a duration of 25.72 ± 10.24 months, with 72 (50.3%) men and 71 (49.7%) women. Of the 143 patients, 45.5%, 30.1%, and 24.5% had well, partially, and poorly controlled asthma, respectively. Conclusions: It was concluded that 45.5% achieved well-controlled asthma, 30.1% exhibited partial control, and 24.5% had poorly controlled asthma. These findings highlight the need for personalized interventions, emphasizing the importance of exploring factors influencing suboptimal control.

Demographic Analysis of Ophthalmic Surgeries in a Tertiary Care Center in Khyber Pakhtunkhwa, Pakistan

2025-03-04T08:17:55+00:00

Different age groups and genders have unique needs when it comes to eye surgeries. Understanding these trends can help improve eye care services in resource-limited areas. Objectives: To study the types of eye surgeries performed in a tertiary care center in Khyber Pakhtunkhwa, Pakistan, and examine their link to age and gender. Methods: This retrospective observational study reviewed records of 3,016 patients. Data on age, gender, and procedures were analyzed using Chi-square tests, with p<0.05 considered significant. Results: The most common surgeries were intraocular lens (IOL) implantation (18.0%), primary repair surgeries (12.0%), phacoemulsification (11.6%), and extracapsular cataract extraction (10.4%). Older patients mostly underwent cataract-related surgeries, while younger patients had intraocular lens implantation and squint correction. Male patients had more cataract surgeries, while females had more primary repair surgeries. Conclusions: It was concluded that significant associations between age, gender, and surgical procedures were found, underscoring the need for more focused resource allocation and easier access to ophthalmic care, especially for women and older adults.

Prevalence and Correlates of Hyperuricemia in Patients with Hypertension: A Cross-Sectional Study from a Tertiary Care Hospital in Pakistan

2025-03-04T08:18:52+00:00

The link between Serum Uric Acid (SUA) and hypertension debated among researchers. Objective: To determine the prevalence and correlates of hyperuricemia in patients with hypertension. Methods: This cross-sectional study was conducted at the General Medicine Department, Saidu Teaching Hospital, Swat (October 2023–April 2024), analyzing hypertensive patients aged 30–60 years. SUA was measured via an automated micro lab, with hyperuricemia defined as SUA >7.0 mg/dl (men) and >6.0 mg/dl (women). Chi-square tested categorical data, while Pearson correlation assessed SUA relationships with SBP, DBP, and BMI (p<0.05 significant). Results: In a total 266 patients, 136 (51.1%) were male. The mean age, BMI were 45.41 ± 25.92 years, and 27.28 ± 3.25 kg/m², respectively. The obesity was noted in 72 (27.1%) patients. Dyslipidemia was found in 42 (15.8%) patients. There were 54 (20.3%) patients who were newly diagnosed cases of hypertension. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP) were 141.76 ± 8.24 mm Hg, and 91.36 ± 8.45 mm Hg, respectively. The mean SUA level was 6.03 ± 1.13 mg/dl, and the frequency of hyperuricemia was noted in 61 (22.9%) patients. Obesity (p=0.033), and known diagnosis of hypertension (p<0.001) were significantly linked with hyperuricemia, Scatter plot revealed positively linear and significant correlation of SBP (r=0.261, p<0.001), and DBP (r=0.319, p<0.001) with SUA levels. The BMI was also found to have positively linear and significant relationship with SUA levels (r=0.122, p=0.047). Conclusion: Hyperuricemia (22.9%) in hypertensive patients correlated with blood pressure and BMI, indicating its role in complications.

Clinical and Pathological Spectrum of Wilson Disease in Children at a Tertiary Care Hospital of Faisalabad, Pakistan

2025-03-04T08:18:11+00:00

Wilson disease is a genetic disorder related to copper metabolism that follows an autosomal recessive pattern. Objectives: To document the clinical and pathological spectrum of Wilson disease at a tertiary setting in Punjab, Pakistan. Methods: This cross-sectional study was conducted at the Department of Pediatric Gastroenterology, Children's Hospital, Faisalabad, Pakistan, from December 2019 to October 2024. A total of 60 children of both genders aged below 18 years, and presenting with Wilson disease were analyzed. Physical and clinical examinations were performed and medical history was taken in all Wilson disease cases. Demographic and clinical characteristics were noted, and relevant laboratory investigations were done. Results: In a total of 60 children with Wilson disease, 42 (70.0%) were boys. The mean age was 10.25 ± 3.10 years. The most frequent signs and symptoms were Jaundice, hepatomegaly, ascites, and coagulopathy, noted in 53 (88.3%), 41 (68.3%), 36 (60.0%), and 24 (45.0%) children respectively. Kaiser Fischer ring was noted in 16 (26.7%) children. The mean Wilsons index score was 9.77 ± 2.98 while 31 (51.7%) children had scores ≥10. The mean ceruloplasmin and 24-hour urinary copper levels were 7.03 ± 7.51 mg/dl and 746.03 ± 451.06 µg. Conclusions: It was concluded that hepatic manifestations are the most common among children with Wilson disease. The most frequent signs and symptoms among children were Jaundice, hepatomegaly, and ascites. There is a need to identify factors that contribute to early diagnosis and prompt treatment, thereby preventing severe brain damage and liver failures in affected patients.

Comparative Analysis of Serum Vitamin D Levels in Newly Diagnosed Tuberculosis Patients versus Healthy Individuals

2025-03-04T08:18:08+00:00

Vitamin D deficiency has been implicated in the susceptibility to tuberculosis due to its crucial role in immune regulation and host defense mechanisms. Objectives: To compare serum Vitamin D levels between newly diagnosed TB patients and healthy individuals and assess their association with the nutritional-inflammatory profile. Methods: This comparative cross-sectional study was conducted over 1 year from Dec 2021 to Dec 2022. A total of 224 participants, comprising 112 newly diagnosed tuberculosis patients as cases and 112 healthy individuals as controls, were recruited. Cases included patients aged over 18 years with confirmed tuberculosis diagnosis GeneXpert MTB/RIF assay. Controls were individuals without tuberculosis symptoms and with serum vitamin D levels available. Results: Vitamin D levels were found to be lesser in TB patients with median levels of 14.35 ng/mL (interquartile range (IQR): 8.65–25.48) versus 19.08 ng/mL (IQR: 13.92–26.17; p=0.029) in normal people. A higher proportion of TB patients exhibited severe deficiency (<10 ng/mL) at 35.7% compared to 13.4% in controls (p=0.002). Similarly, deficiency (10–20 ng/mL) was more prevalent among tuberculosis patients (42.9%) than controls (26.8%). Vitamin D levels in tuberculosis patients had a positive correlation with BMI and albumin levels. Conclusions: It was concluded that tuberculosis patients exhibited poorer nutritional status, with lower BMI, albumin, hemoglobin, and Vitamin D levels compared to healthy controls with a significantly higher proportion of tuberculosis patients having severe Vitamin D deficiency.

Knowledge, Attitudes, and Practices towards Early Childhood Caries among Affluent Parents of Lahore

2025-03-04T08:18:16+00:00

Parents influence oral hygiene practices and children's health behaviours as young ones lack the comprehension and dexterity to maintain oral health. Objectives: To evaluate the knowledge, attitudes, and practices about early childhood caries among affluent parents of Lahore. Methods: A cross-sectional study was conducted from August 2024 to October 2024 using non-probability sampling with 203 participants. Revalidated questionnaires inquiring about knowledge, attitude, and practice were distributed to parents with children under 5 years old, enrolled in affluent schools within the city. Frequency and percentage distributions were obtained for each qualitative variable and mean, and standard deviation were acquired for quantitative variables. The differences between genders were analyzed using chi-squared statistics. A p-value of less than 0.05 was considered statistically significant. Results: Among 203 participants, the majority were mothers 56.2% and the sample comprised of most male children in age group 3-5 years. Among the participants, more than half of the parents had graduated from university; some had graduated from high school. Only a few had completed their primary-level education. The overall mean knowledge score was 52.77 ± 21.59, whereas the mean score for attitude and practice was 61.24 ± 25.49 and 65.61 ± 26.66 respectively. Mothers had significantly greater overall knowledge (p=<0.001), better attitudes (p=0.164), and practices (p-value=0.112) towards early childhood caries as compared to fathers. Conclusions: It was concluded that although affluent parents of 5-year-old children had good knowledge regarding the Early Childhood Caries, their attitude and practices were still lacking in keeping up with the recommended standards.

Exploring the Impact of Academic, Environmental, and Psychosocial Stressors on the Mental Well-Being of Medical Students

2025-03-04T08:18:01+00:00

Exploring the multifaceted impact of academic, environmental, and psychosocial stressors on students’ overall mental well-being is necessary, identifying key areas for intervention and support. Objectives: To see the prevalence of different stressors in medical students. Also, to assess their mental well-being and the correlation of different stressors with it. Methods: An analytical cross-sectional study in a private medical college was done from July 2024 to December 2024. A questionnaire was developed through Google Forms and distributed through social media platforms, and quota non-purposive sampling was done. Stressors were assessed through the Likert scale, and mental well-being through the Kessler scale. Chi-square and independent sample T-tests were employed. P-value <0.05 was taken as significant. Results: Mild to moderate effects of academic, environmental, and psychosocial stressors were observed. Mostly, students were having severe mental distress, and an equal percentage were likely to be well. A moderate positive correlation between mental well-being and stressors was observed with significant p-values between mental well-being and academic stressors (r=0.497, p=<0.001), environmental stressors (r=0.432, p=<0.001), and psychosocial stressors (r=0.489, p=<0.001); depicting increased distress were associated with higher prevalence of stressors among participants. Conclusions: It was concluded that female, and students of final year MBBS were having more mental distress. Stressors were having a mild to moderate effect on participants. Establishing an academic culture that provides a haven for all, normalizes seeking help, and promotes collaboration over competition would go a long way toward alleviating some of the stressors that medical students face

Distribution of Radial Root Position of Maxillary Central Incisors on Cone Beam Computerized Tomography

2025-03-04T08:18:43+00:00

Knowledge about the radial root position before possible replacement of central incisors for immediate implant is of pivotal importance to clinician. It varies among different populations. Objective: To determine distribution of radial/sagittal root position in maxillary central incisors in patients reporting to 2 tertiary care hospitals of Lahore, Pakistan using CBCT. Methods: Sample size of 110 individuals between 20-50 years, strictly falling in inclusion criteria was used. Cross sectional study with non-probability consecutive sampling technique was applied in Department of Periodontology at Fatima Memorial Hospital and University college of Medicine and Dentistry, from Jan 2023 to Sep 2023. The position of maxillary central incisor roots was determined using CBCT. Chi-square test was used for stratification based on age and gender. Results: The mean age was 33.67 ± 8.68 and sample consisted of females 50 (45.45%) and males 60 (54.55%). The most common root position was class I, 79 (71.82%), followed by class II, 20 (18.18%), then class IV, 7 (6.36%) and least was class III, 4 (3.64%). The difference among genders (p=0.272) and age (p=0.161) were insignificant statistically. Conclusions: Most common incidence of radial root spatial position for maxillary central incisor is buccal (class 1), followed by II (middle) but class IV and III also existed and must analyzed CBCT to determine the radial root position before any immediate implant in esthetic zone for optimal esthetic and functional outcome.

Effect of Hemodialysis on Intraocular Pressure (IOP) and Ocular Perfusion Pressure (OPP)

2025-03-04T08:19:01+00:00

Hemodialysis is a routine procedure in patients on renal replacement therapy. It carries risk of intraocular pressure and ocular perfusion pressure derangement. With proper monitoring of IOP and blood pressure, visual impairment can be minimized. Objective: To study the effect of hemodialysis on intraocular pressure (IOP) and ocular perfusion pressure (OPP). Methods: Cross sectional observational study after getting ethical approval was carried out in a Tertiary Care Hospital Rawalpindi from Aug 2021 to Apr 2022. Sixty patients with CKD on HD were included. A pneumotonometer was used to measure IOP twice at every time point. IOP was measured Pre-HD, during HD, and Post-HD. After measuring IOP and BP the value of OPP, MAP, SOPP and DOPP were calculated. Statistical analysis was done using SPSS version 21.0. Results: The value of IOP at pre-HD was 18.82 ± 0.57, during HD was 20.73 ± 0.55 and post-HD was 21.55 ± 0.60. Similarly, the value of MAP at pre-HD was 93.48 ± 4.26, during HD was 88.25 ± 4.71 and post-HD was 84.63 ± 5.20. The value of OPP at pre-HD was 74.70 ± 4.23, during HD was 67.50 ± 4.80 and post-HD was 63.13 ± 5.19. Pre-HD to post-HD the value of IOP increased significantly to 2.73 mmHg, MAP decreased significantly to -8.85 mmHg and OPP decreased significantly to -11.57 mmHg. Conclusions: During HD, there is a significant rise in IOP and reduction in OPP, both of which enhance the risk of glaucoma progression and development. Even when IOP is effectively managed, clinicians must evaluate HD history in patients with glaucoma progression.

Comparative Efficacy of Occlusal Splint Therapy and Conservative Physiotherapy in the Treatment of Temporomandibular Joint Pain: A Longitudinal Study

2025-03-04T08:18:46+00:00

Temporomandibular joint disorders significantly impact patients' quality of life. Occlusal splint therapy and conservative physiotherapy (Transcutaneous Electrical Nerve Stimulation (TENS) and Electrical Muscle Stimulation (EMS)) are common treatments for temporomandibular joint disorders. However, their comparative long-term efficacy remains unclear. Objectives: To compare the efficacy of occlusal splint therapy and conservative physiotherapy (TENS and EMS) in improving mouth opening and reducing pain in temporomandibular joint disorder patients over six months. Methods: A longitudinal quasi study of 12 months was conducted with 112 patients randomly assigned to occlusal splint therapy (n=56) or conservative physiotherapy (n=56). Pre-operative and post-operative mouth opening and Visual Analog Scale (VAS) pain intensity scores were measured at 3 weeks, 6 weeks, 12 weeks, and 6 months. Independent sample t-tests and repeated measures Analysis of Variance (ANOVA) were used for statistical analysis. Results: Both groups showed significant improvements in mouth opening and visual analogue scale scores over time. The occlusal splint group demonstrated superior long-term outcomes, with greater improvements in mouth opening and pain reduction at 12 weeks and 6 months. RM-ANOVA revealed significant time effects for both treatments. Conclusions: It was concluded that occlusal splint therapy provides greater long-term improvement in mouth opening and pain reduction compared to TENS and EMS. These findings suggest the importance of considering treatment duration and follow-up in managing temporomandibular joint disorders.

Evaluation of Nutrition Awareness of Rural Women Concerning Cardiovascular Disease

2025-03-04T08:19:03+00:00

Cardiovascular disease is the leading component of non-communicable diseases. Atherosclerotic and hypertensive diseases, mostly ischemic heart disease and stroke together with heart failure are the main Cardiovascular disease entities and signify threats to population health. In Pakistan, the incidence of Cardiovascular disease is more common among female as compared to male. The ratio of male to female patients is 1:3. Nutrition plays a significant role in the development and prevention of heart diseases. Objective: To evaluate of Nutrition Awareness of Rural Women Concerning Cardiovascular Disease. Methods: A descriptive cross-sectional study was carried out to assess the nutritional knowledge and health-related behaviour regarding cardiovascular disease of rural women aged 35 to 45. The research was a survey based with a well-established interview-based questionnaire was used to collect data. The sample was selected using random sampling and comprised of 300 respondents. Results: The results revealed rural women had little knowledge regarding good nutrition practices like consumption of high fat, low fiber, high amount of red meat, full-fat milk, and low amount of fruits and vegetables can lead to heart disease. Conclusions: It was concluded that assessment of nutritional knowledge regarding Cardiovascular disease of rural women age 35 to 45 gave statistical evidence of increasing risk factors for heart diseases. Results were useful in the development of gender-specific messages to increase awareness about heart disease and to promote lifestyle behaviours to decrease risk.

Association of Different Formulation with Oral Contraceptive Agents in Lipid and Carbohydrates Metabolism in Women

2025-03-04T08:18:05+00:00

Oral contraceptives impact lipid and carbohydrate metabolism differently based on formulation. Objectives: To assess the association between Ethinylestradiol-Levonorgestrel, Ethinylestradiol-Norgestimate, and Progestin-Only contraceptives and key metabolic markers, including lipid profile and carbohydrate metabolism, in women using these formulations. Methods: A cross-sectional study recruited women aged 18–45 using one of these contraceptives for at least 6 months. Exclusion criteria included metabolic disorders, cardiovascular disease, and recent medication use affecting metabolism. Demographic and health data (BMI, blood pressure, waist-to-hip ratio) were collected. Metabolic markers—including cholesterol, LDL, HDL, triglycerides, Apolipoproteins A1/B, fasting glucose, fasting insulin, HOMA-IR, OGTT, and HbA1c were measured. Statistical tests included One-Way ANOVA, Kruskal-Wallis, and Tukey’s post-hoc (p<0.05). Results: Significant metabolic differences were observed. Ethinylestradiol-Levonorgestrel users had higher total cholesterol (p=0.002) and increased insulin resistance (HOMA-IR, p=0.019), suggesting a potential long-term cardiovascular risk. Ethinylestradiol-Norgestimate users exhibited higher Apo-lipoprotein A1 levels (p=0.005), indicating a possible cardio-protective effect in reducing atherosclerosis risk. HOMA-IR was also higher in Progestin-Only users compared to Ethinylestradiol-Norgestimate (p=0.006). No significant differences were found in fasting glucose or HbA1c. Conclusions: It was concluded that Ethinylestradiol-Norgestimate may have a more favourable metabolic profile, with lower cholesterol and insulin resistance. Tailored contraceptive selection could reduce metabolic risks, particularly in women with cardiovascular concerns. Further research is needed to assess long-term effects. However, the exclusion of women with pre-existing metabolic disorders limits the generalizability of these findings. Future studies should include these subgroups to provide a broader understanding of metabolic responses to oral contraceptives.

Analysis of Hematological and Biochemical Parameters in Rheumatoid Arthritis Patients from Faisalabad, Punjab

2025-03-04T08:18:55+00:00

Rheumatoid Arthritis (RA) is a long-term autoimmune disease that causes inflammation and joint degeneration. It can lead to significant impairment and a loss in quality of life for millions of people worldwide. When diagnosing and treating RA, hematological and biochemical indicators are frequently assessed. These data are essential for monitoring the disease's progression, identifying organ involvement, and making treatment decisions. Objectives: To come up with some significant differences in hematological and biochemical indicators between patients with RA and healthy controls for the diagnosis of RA. Methods: Three hundred blood samples were taken in total from the population of Faisalabad City; 150 blood samples were drawn from people who have been confirmed diagnosed with RA, and 150 blood samples were collected from healthy people without any disease. The significant levels between the two groups were ascertained by calculating descriptive statistics and statistical comparisons using independent t-tests for continuous variables. Results: Among assessed parameters, erythrocyte sedimentation rate (ESR) and white blood cells (WBCs) were hematological parameters found to be highly elevated in RA patients, whereas hemoglobin (Hb) and alkaline phosphatase (ALP) are biochemical parameters that have been demonstrated significantly low in RA patients as compared to healthy. Conclusions: Deferentially expressed parameters ESR, WBCs, Hb, and ALP can be used for the diagnosis of RA.

Frequency of Subclinical Hypothyroidism (SCH) among Patients of Polycystic Ovarian Disease (PCOD) Presenting in Outpatient Department of Tertiary Care Hospital

2025-03-04T08:18:03+00:00

Subclinical hypothyroidism is a prevalent endocrine disorder, often associated with polycystic ovarian disease both of which share a complex interplay of hormonal imbalances, contributing to significant metabolic and reproductive disturbances. Objectives: To determine the frequency of subclinical hypothyroidism among patients of polycystic ovarian disease presenting in an outpatient setting. Methods: This descriptive cross-sectional study was conducted at the Obstetrics and Gynaecology Department of Fatima Memorial Hospital, Lahore, from December 2022 to June 2023. 155 female having polycystic ovaries were enrolled using non-probability consecutive sampling. Blood samples of the patients were sent to the pathology lab for measurement of serum thyroid-stimulating hormone (TSH) level and frequency of subclinical hypothyroidism (thyroid-stimulating hormone>5mIU/L despite normal serum free thyroxin (0.8 to 1.8 ng/dL) was noted. Data were entered and analyzed using SPSS version 26. Results: In the current study mean age and BMI of participants having polycystic ovarian disease were calculated as 28.31 ± 7.7 years and 29.5 ± 5.8 kg/m2, respectively. Among 155 participants 43.2% were married and most of them belonged to the urban population and middle socioeconomic class. Subclinical hypothyroidism was found in 14.8% of female suffering from polycystic ovarian disease. Conclusions: It was concluded that this study underscores the high prevalence of subclinical hypothyroidism among patients with polycystic ovarian disease, highlighting the need for routine thyroid function screening in this population. Early detection enables timely interventions and supports a comprehensive approach to managing polycystic ovarian disease and its related comorbidities.

Comparison of Single Port Laparoscopic Ingulinal Hernia Repair versus Open Herniotomy in Term of Recurrence and Postoperative Scrotal Hematoma

2025-03-04T08:17:39+00:00

Hernia repair is common surgical procedures, with techniques evolving to improve outcomes. Comparing laparoscopic and open approaches is crucial for determining the optimal method to reduce complications such as recurrence and postoperative scrotal hematoma. Objective: To compare the frequency of hematoma and recurrence in laparoscopic assisted inguinal hernian repair versus open herniotomy. Methods: This quasi experimental study was conducted after approval from CPSP (Ref No: CPSP/REU/PSG-2017-068-339, REU 37362) at Pediatric Surgery Department Services Hospital, Lahore, from October 2020 to March 2021 on 254 patients. Patients were divided into two equal groups; Group-A (single port needle assisted laparoscopic repair) and Group-B, (open repair). Patients were assessed after 24 hours to see scrotal hematoma and regular follow up for 3 months to see the recurrence. Data were analyzed using SPSS version 26.0. Independent sample t-test and chi square was applied to compare quantitative and qualitative variables between groups; p-value ≤0.05 as significant. Results: Postoperative hematoma formation was found among 2 patients (1.6%) of Group-A and in 13 patients (10.2%) of Group-B, (p=0.003). Postoperative recurrence between two groups was comparable and statistically insignificant (Group A 6.3% vs Group B 4.0%, p=0.393). (p=0.393). Conclusions: In conclusion, laparoscopic-assisted hernia repair and open herniotomy demonstrate comparable recurrence rates. However, laparoscopic-assisted repair is associated with a significantly lower incidence of postoperative hematoma. These findings indicate that laparoscopic repair may be a safer option with fewer postoperative complications, making it a favorable choice for pediatric inguinal hernia surgery.

Association of Possible Developmental Delays with Emotional and Behavioral Disorders, and Risk Factors in Children Under Six in Karachi, Pakistan: A Cross-sectional Study

2025-03-04T08:17:45+00:00

Developmental delays refer to a child not reaching expected milestones. They are linked to various factors and, if unaddressed in early childhood, can lead to long-term consequences in adulthood. Objectives: To determine the association of developmental delays with emotional and behavioural disorders and other risk factors in children less than six years of age. Methods: This cross-sectional study was conducted at a primary healthcare center in a Karachi slum from October 2020 to July 2021. Using non-probability consecutive sampling, 425 participants (parents of children aged 1-5½ years) were selected. Data were collected using the validated Survey of Well-being of Young Children tool and analyzed in SPSS version 23.0. Logistic regression assessed associations between outcomes and risk factors. Results: Of 425 participants, 161 (37.9%) had possible developmental delays. No association was found with emotional/behavioural disorders (p=0.30). Binary logistic regression linked delays to male gender, uneducated parents, unemployed mothers, low income, domestic violence, and tobacco/drug exposure at home (p<0.05). After adjustment, significant associations remained with the mother’s education (aOR=1.785, CI: 1.040-3.065, p=0.036), income (aOR=3.361, CI: 1.197-9.434, p=0.021), and domestic violence (aOR=2.603, CI: 1.055-6.423, p=0.027). Conclusions: It was concluded that the prevalence of developmental delays in slum-dwelling children is high. No association was found with emotional/behavioural disorders. Socioeconomic factors, such as the mother’s education.

Lactate Dehydrogenase as a Prognostic Biomarker in Severe Sepsis in Intensive Care Unit

2025-03-04T08:18:58+00:00

Sepsis ranks as one of the principal death-causing conditions in present-day society. The medical community identifies lactate dehydrogenase (LDH) as a potential tool to assess sepsis severity. Objectives: To assess how LDH blood concentrations relate to severe sepsis progression. Methods: A retrospective examination took place within the intensive care unit (ICU) at Shahida Islam Medical Complex. Data of patients of both genders, aged between 18-75 years, and who were admitted to the intensive care unit with sepsis. Biochemical data, including necessary laboratory investigations, infection areas, and comorbidities, were documented. The study subjects were analyzed concerning LDH ≤230 U/L (n=41) and LDH >230 U/L (n=55). Univariate Cox regression analysis for 21-day mortality was also carried out. Results: The records of 96 patients as per inclusion and exclusion criteria were considered for this study. There were 61 (63.5%) patients who were male. The overall mean age was 54.2 ± 12.6 years. LDH ≥230 U/L was found to have a significant association with findings that included significantly higher CRP (p=0.0001) and LDH levels (p=0.0001) in patients with LDH ≥230 U/L compared to LDH <230 U/L. A significant association high SOFA score (p=0.002), and APACHE-II score (p=0.001) was found with LDH≥230 U/L. Strong associations of the biochemical levels, which included LDH levels (HR=1.006, p=0.010), lactate levels (HR=1.498, p=0.002), and creatinine levels (HR=1.483, p=0.005) were seen with mortality. Conclusions: It was concluded that elevated LDH levels were associated with increased disease severity and adverse clinical outcomes, including higher mortality rates, in severe sepsis patients.

Assessment of Predictors for Placental Weight and Birth Weight Ratios from Deliveries Conducted in Pakistani Tertiary Care Hospitals

2025-03-04T08:17:52+00:00

Anomalous placental morphology is associated with obstetric complications. To date, published data is not available regarding placental weights from Pakistan. The aim of the study was to obtain a reference value for placental weights in the Pakistani population and examined the predictors of birth weight to placental weight ratio an indicator of placental efficiency. Objective: To assess the predictors for placental weight and birth weight ratios in singleton pregnancies delivered at a tertiary care hospital in Pakistan. Methods: Data were collected prospectively for the study cohort at a tertiary care hospital unit in Islamabad, Pakistan. Placental and birth weight obtained and documented immediately post-delivery. Information about maternal factors was obtained from medical records. A linear regression model was employed to predict the effects of various risk factors on BW:PW. Results: Fetal weight varied from 2 to 4.5 kg with a mean of 3.016 ± 0.445 kg whereas mean placental weight was 0.667 kg (SD = 0.175). Fetal placental weight ratio (FPWR) existed in the range of 2.54 to 7.91 (mean = 4.732 ± 1.082). Anemia, p < 0.001 and pregnancy-induced hypertension p=0.001, can influence the weight of the placenta. Conclusion: The average placental weight reference values obtained represented the diverse multi-ethnic population residing in Islamabad, Pakistan. The correlation between placental weight and the birth weight to placental weight ratio offered valuable insights into how the placenta adapted to the various challenges posed by the various stages of pregnancy

Prevalence of Awareness in Total Intravenous Anesthesia: A Cross-Sectional Study

2025-03-04T08:17:42+00:00

reaction to stimuli, and the establishment of a tranquil surgical environment. Objective: To determine the prevalence of total intravenous anesthesia (TIVA) among patients in a tertiary care hospital. Methods: The research was a descriptive cross-sectional study. Total intravenous anesthesia was performed on 217 male and female patients aged 18–60 year. The patient's history in the first two post-operative days revealed intraoperative consciousness. Data were gathered, from 17^th June, to November 30^th, 2022. Statistical analysis was performed using SPSS version 23.0. Results: The study found that the prevalence of awareness during total intravenous anesthesia (TIVA) was 15.7%, with a higher occurrence in patients with metabolic equivalent test scores ≤4 (45.4%, p < 0.001) and those with a previous history of awareness (80.0%, p < 0.001). Gender (16.4% in males vs. 14.1% in females, p = 0.654), age (15.2% in ≤45 vs. 16.0% in >45 years, p = 0.865), BMI (17.2% in ≤23.0 vs. 13.9% in >23.0 kg/m², p = 0.494), diabetes (13.3% in diabetics vs. 16.6% in non-diabetics, p = 0.558), alcoholism (25.0% in alcoholics vs. 15.1% in non-alcoholics, p = 0.360), and ejection fraction (20.0% in ≤40% vs. 14.7% in >40%, p = 0.403) did not show statistically significant associations with awareness prevalence. Conclusions: Metabolic equivalent scores and a prior history of awareness were significant predictors of intraoperative awareness during TIVA, highlighting the importance of tailored preoperative evaluations.

Impact of Antioxidants in Preventing Dental Caries and Erosion

2025-03-04T08:18:49+00:00

Dental erosion and caries are common oral health problems with serious consequences. Due to the increased intake of acidic foods and beverages, dental erosion is becoming more widely acknowledged as a serious oral health concern. Objectives: To assess the anti-oxidant (green tea extract, vitamin C, and vitamin E) efficaciousness in reducing dental caries and erosion. To look for changes in the scores for the DMFT (Decayed, Missing, and Filled teeth) and BEWE (Basic Erosive Wear Examination). Methods: A quasi-experimental study with groups (using green tea extract, vitamin C, and vitamin E, respectively) were formed from the 120 participants. BEWE, DMFT, and baseline demographics were noted. Salivary samples were examined for oxidative stress markers and antioxidant levels, and patients receiving certain treatments were assessed for changes in scores. A paired t-test was used to assess significance statistically. Results: All therapy groups showed significant declines in BEWE. DMFT scores slightly increased in all therapy groups as compared to the control group. The DMFT for Group A (vitamin C) increased from 4.2 ± 1.3 to 4.3 ± 1.1, Group B from 4.0 ± 1.4 to 4.0 ± 1.2, and Group C from 4.1 ± 1.2 to 4.2 ± 1.0, all with p-values of <0.001. The treatment groups saw almost similar BEWE scores as compared to the control group. Conclusion: It was concluded that antioxidants are helpful in the prevention of dental caries and erosion.

Prevalence of Skin Changes and Their Management After Bariatric Surgery: A Prospective Study at International Metabolic and Bariatric Center

2025-03-04T08:17:49+00:00

Numerous skin disorders, including ulcerated necrobiosis lipoidica diabeticorum, hidradenitis suppurativa, intertrigo, and psoriasis, have shown improvement post-bariatric surgery. On the other hand, there have been reports of the occurrence of unfavourable skin disorders, most of which are related to nutritional deficiencies, such as those of iron, folic acid, vitamins, and trace elements. Objectives: To determine the prevalence of skin changes and diseases following bariatric surgery at our centre and their management strategies. Methods: This longitudinal study was carried out from April 2021 to March 2023. Patients were eligible for inclusion if they were aged 18 years or older, and had undergone one of the following bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, or mini gastric bypass. Baseline clinical and demographic information was documented, At frequent follow-up intervals postoperative data were collected to record any new onset or changes in skin problems. Results: A total of 1656 patients who had undergone bariatric surgery were included. During the 12-month follow-up period, 1292 (78%) of patients experienced skin changes. Excess skin was the most prevalent type of skin alteration, affecting 1026 (62%) of patients, especially in the arms 745 (45%) and abdomen 1159 (70%). Conclusions: It was concluded that significant dermatological challenges are faced by patients post bariatric surgery and a holistic and multidisciplinary approach should be incorporated in managing these issues. By addressing both aesthetic and functional concerns, healthcare providers can enhance patients’ overall satisfaction and quality of life.

Weight Changes in Mandibular Fracture Patients After Maxillomandibular Fixation

2025-03-04T08:17:57+00:00

Maxillofacial injuries, frequently caused by accidents or violence, often result in mandibular fractures. Treatment options include open and closed reduction, the latter utilising maxillomandibular fixation. Although maxillomandibular fixation is a cost-effective method, it may restrict normal dietary intake, leading to weight loss and potential malnutrition that can negatively impact recovery. Objective: To assess weight changes in mandibular fracture patients following maxillomandibular fixation. Methods: A comparative cross-sectional study was conducted at the Pakistan Institute of Medical Sciences from November 2023 to April 2024, enrolling 75 adult patients (ages 18-50) undergoing maxillomandibular fixation for mandibular fractures. Weight measurements were recorded preoperatively and at one and four weeks postoperatively. Statistical analysis was performed using SPSS Version 27.0. Results: The mean age of participants was 26.4 years, with 92% being male. The average preoperative weight was 63.08 kg, decreasing significantly to 58.57 kg after one week and 57.57 kg after four weeks (p<0.001). This weight loss was attributed to dietary restrictions and discomfort from jaw immobilisation. Conclusions: It was concluded that this study reveals significant weight loss post-maxillomandibular fixation, indicating a need for targeted nutritional support during recovery. These findings emphasize the importance of developing effective intraoperative and postoperative care protocols to meet nutritional needs, potentially enhancing recovery outcomes and quality of life for patients. Future research should explore the long-term effects of weight changes and interventions to mitigate weight loss during recovery.

Efficacy of Intravenous Ferric Carboxymaltose Versus Iron Sucrose in the Treatment of Iron Deficiency Anemia of Pregnancy

2025-03-06T09:26:06+00:00

Iron deficiency anemia (IDA) during pregnancy is a widespread disease associated with adverse effects on both the mother and fetus. Objectives: To determine the effectiveness of intravenous ferric carboxymaltose (FCM) versus iron sucrose (IS) for improving hematological parameters in pregnancy-related iron deficiency anemia. Methods: This Quais experimental study was conducted over six months from January 2024 to June 2024 at Rai Medical College Sargodha. A total number of participants was n=120 pregnant IDA women (Hb<10.5 g/dL), gestational age (GA) 16 to 34 weeks), were seen and randomly assigned to either group A or group B. Iron sucrose was given as 200 mg intravenously in 200 ml of normal saline over 15-20 minutes on alternate days, with a maximum dose of 1000 mg per week. Ferric Carboxymaltose was given in a single dose, diluted in normal saline over 15-20 minutes, with a maximum of 1000 mg per day or per week. Assessment of Serum Ferritin and Hemoglobin levels at Baseline, 4th Weeks, and 8th Weeks Post-treatment, and adverse events. Results: There was a significant difference in mean Hb values between Group 1 and Group 2 in 4th week (p<0.05). Serum ferritin also improved significantly in the FCM group. When comparing FCM with IS, FCM was safer, with fewer adverse events. Patients in the FCM group also had higher rates of satisfaction and adherence and had fewer missed doses. Conclusions: It was concluded that FCM has quickly restored iron levels in pregnant women, significantly increasing Hb and ferritin levels over the 8th week with minor side effects.

Knowledge Attitude and Practice of Nutritional Management of Acute Pancreatitis among General Surgery Residents of Tertiary Care Hospital

2025-03-06T09:25:56+00:00

Nutritional management is a critical component in the treatment of acute pancreatitis, yet its integration into clinical practice among surgical residents remains suboptimal. Objectives: To evaluate the knowledge, attitude, and practice of general surgery residents regarding nutritional management in a tertiary care hospital. Methods: A descriptive, cross-sectional study was conducted among 106 general surgery residents at the District Headquarters Teaching Hospital, Narowal. Residents with a minimum of six months of clinical experience who provided informed consent were included. Data were collected using a structured, validated questionnaire comprising three sections: knowledge (multiple-choice questions assessing evidence-based nutritional practices), attitude (Likert scale responses on perceptions and confidence in nutritional management), and practice (self-reported adherence to guidelines and barriers faced). Descriptive statistics summarized participant characteristics, while inferential analysis assessed correlations, with p<0.05 considered statistically significant. Results: The mean knowledge, attitude, and practice scores were 72.3% ± 12.4%, 80.7% ± 10.2%, and 68.5% ± 15.3%, respectively. While most residents acknowledged the importance of early enteral nutrition (84.9%), only 36.8% adhered to evidence-based guidelines in practice. Significant barriers included resource limitations (64.2%) and inadequate training (52.8%). A positive correlation was observed between knowledge and attitude scores (r=0.48, p<0.01). Conclusions: It was concluded that this study highlights discrepancies between knowledge, attitude, and practice in the nutritional management of acute pancreatitis. Despite healthcare providers demonstrating positive attitudes, adherence to evidence-based guidelines remain suboptimal due to resource limitations and insufficient training. Implementing targeted education and structured training programs can enhance compliance with best practices and improve patient outcomes

Knowledge and Practices of Nurses Regarding Prevention of Surgical Site Infections in Tertiary Care Hospitals Peshawar

2025-03-06T09:25:59+00:00

Surgical procedures have many complications of which the leading one is post-surgical site infection (SSI), which can be prevented by following appropriate guidelines. SSI may lead to loss of body parts, septicemia and increase hospital bed occupancy. Objective: To assess nurses’ knowledge and practices regarding the prevention of surgical site infections in tertiary care hospitals in Peshawar. Methods: Descriptive cross-sectional study was conducted among 172 nurses recruited through convenient sampling. Study settings were two tertiary care hospitals in Peshawar. Data was collected through an adopted, self-administered questionnaire and were analyzed by SPSS version 26.0. Results: Findings of the study revealed that the knowledge level of the nurses was poor about the prevention of SSI, while their practice levels were also average. A significant difference was found in the knowledge level of the study participants on the basis of their gender with a p value; 0.001, qualification with a p value; 0.000. Years of experience with a p value; 0.007, and attending infection control courses with a p value; 0.03. In addition, a significant difference was found among the practices of nurses regarding the prevention of SSI on the basis of their gender with a p value; 0.012. Conclusion: The study’s findings revealed that nurses had a poor level of knowledge about SSI, while their practices were average according to arbitrary.

Reamed Versus Unreamed Intramedullary Interlocking Nail for Gustilo and Anderson Type II and IIIA in Open Fractures of Shaft of Tibia

2025-03-06T09:26:02+00:00

Open fractures of the tibial shaft, particularly Gustilo and Anderson Type II and IIIA fractures, present a unique and challenging scenario in orthopedic trauma care. Objectives: To compare the outcomes of reamed versus unreamed intramedullary nailing in the management of Gustilo and Anderson Type II and IIIA open tibial shaft fractures. Methods: This prospective cohort study study was conducted at Gajju Khan Medical College/ Bacha Khan Medical Complex, Swabi from May 2023 to December 2023. Data were collected from 129 patients. All surgeries were performed under general or spinal anesthesia by experienced orthopedic trauma surgeons. The standard anterolateral approach was used for tibial nailing. Results: 129 patients were enrolled in the study, with 64 patients in the reamed group and 65 patients in the unreamed group. The mean age of patients in the reamed group was 36.4 ± 9.2 years, and in the unreamed group, it was 37.2 ± 8.7 years. The mechanisms of injury were also comparable, with both groups experiencing similar proportions of motor vehicle accidents (58%), falls from height (34%), and industrial accidents (8%), with p-values all greater than 0.05, indicating no significant differences between the groups. The Reamed Group had significantly better outcomes compared to the Unreamed Group. Conclusions: It was concluded that reamed intramedullary nailing is superior to unreamed nailing in the treatment of Gustilo and Anderson Type II and IIIA open tibial shaft fractures. The reamed group demonstrated higher union rates, faster healing times, lower infection rates, and better functional outcomes.

Antibiotic Prescription Practices among Dentists After Extractions in Lahore

2025-03-08T06:36:25+00:00

Antibiotics, discovered by Sir Alexander Fleming in 1929, have significantly advanced medical therapeutics. However, the rising antibiotic resistance has been the result of its overuse in the past few decades. Objective: To evaluate the antibiotic prescribing practices after dental extractions of house officers in Lahore. Methods: A study was conducted with a sample size of 127 house officers/interns from March to June 2024, from various dental hospitals in Lahore. These participants were asked to complete an anonymous questionnaire that explored their knowledge, attitudes, and practices related to prescribing antibiotics following tooth extractions. The data collected were analyzed using SPSS version 25.0 to identify trends and gaps in their understanding. Results: The participants had an average age of 23.77 years, with slightly more females than males. A vast majority (92.1%) prescribed antibiotics when a patient had a periapical abscess with a fever, while fewer (18.9%) did so simply because a patient requested it after a routine extraction. A significant knowledge gap among house officers in classifying antibiotics, with 81.1% incorrectly identifying Azithromycin as a broad-spectrum antibiotic and 64.6% misclassifying narrow-spectrum antibiotics. Conclusions: This study highlighted that while there is a general awareness of antibiotic resistance among house officers, there is still a significant gap in their adherence to proper guidelines when prescribing antibiotics after tooth extractions. The findings suggested a need for multi-prog strategies and their application to ensure that antibiotics are used judiciously, thereby helping to combat the growing problem of antibiotic resistance.

Knowledge, Attitudes and Practices of Basic Life Support among University-Enrolled Undergraduate Medical Students in Karachi

2025-03-20T04:43:53+00:00

Basic Life Support (BLS) involves a core set of skills necessary to preserve life during medical emergencies. Both practical abilities and knowledge are crucial for managing life-threatening situations. Objectives: To assess the knowledge, attitudes and practices of BLS among undergraduate students enrolled in the medical program at a university in Karachi. Methods: The cross-sectional study was carried out from February 2022 to May 2022 at the Jinnah Sindh Medical University, Karachi, and included medical students of both genders from the first to the fifth year of the academic program. Data were gathered through a self-administered organized questionnaire. Data were analyzed using SPSS version 22.0. Results: Out of 310 medical students, 54.2% were female, and 45.8% were male. The study revealed that only 22.3% had taken the BLS course. 55.3% of medical students had adequate theoretical knowledge, while their practical skills in BLS were weak. The majority of the students, 73.4% were not confident in performing Cardiopulmonary Resuscitation (CPR), and only 8.7% had performed BLS on patients. 4% stated that they could use Automated External Defibrillators (AEDs). The attitude of medical students toward BLS was largely supportive, with 94% believing that BLS is essential for all medical students and should be integrated into the academic curriculum. Conclusions: It was concluded that Undergraduate medical students possess sufficient theoretical knowledge of BLS (CPR), while there is a significant gap in their practical skills. For this, continuous hands-on training in critical life-saving techniques should be included in the undergraduate program throughout their medical education.

Exploring Artificial Intelligence Role in Enhancing Medical Education for Future Physicians

2025-03-20T04:43:37+00:00

Artificial intelligence (AI) has the potential to completely transform medical education by improving learning outcomes through data-driven insights, simulation, and individualized instruction. Objectives: To determine the impact of Artificial Intelligence on Medical Education and medical students' willingness and readiness to use it. Methods: An analytical cross-sectional study was conducted among medical students at a private medical institute. Ethical approval and informed consent were taken. The questionnaire was distributed through social media platforms. Mann-Whitney U test was performed, mean + SD was taken and Pearson correlation was used to assess mean rank distributions, higher means among variables, and significant associations. A p-value of <0.05 was considered statistically significant. Results: Higher mean ranks by the Mann-Whitney U test in all perception-related questions indicated a tendency for higher values in males than females. The mean + SD of perception score was 3.63 ± 0.66 and the willingness was 3.48 + 0.69 which showed a positive perception and willingness to use AI. ANOVA was employed with the most significant association, enabling doctors to make correct decisions. Pearson correlation between readiness for AI and their perceptions, and willingness to use AI showed a strong positive correlation between them with p values significant at <0.01 level. Conclusions: It was concluded that AI could revolutionize medical education by enhancing learning, and clinical decision-making, and supplementing traditional teaching methods. A significant positive correlation was found between AI readiness, perceptions, and willingness to use it, recognizing its role in shaping future medical practice.

Precision in Diagnosis of Factors in Female Infertility Through Diagnostic Laparoscopy Insights from Lady Reading Hospital Peshawar

2025-03-20T04:43:35+00:00

Infertility afflicts millions worldwide and often stems from female factors. The World Health Organization reports that 60-80 million couples struggle with infertility due to blocked fallopian tubes, polycystic ovary syndrome, or endometriosis. Understanding the intricacies of infertility is paramount to addressing this prevalent issue. Objective: To determine factors in female infertility through diagnostic Laparoscopy. Methods: A cross-sectional study was conducted from Nov 2020 to April 2021 in the Gynecology Unit of Lady Reading Hospital, Peshawar. No longitudinal elements were involved; the analysis was purely observational. We included 90 infertile women aged 18-45 with normal male partner semen analysis. Exclusion criteria consisted of contraceptive use or no intercourse in a year. Participants were divided into primary (n=62) and secondary (n=28) infertility. Diagnostic laparoscopy investigated the cause. Data were analyzed by SPSS version 26.0. Results: Tubal blockage emerged as the leading cause at 33.3%, followed by polycystic ovaries at 21.1% and endometriosis at 13.3%. Other etiologies comprised fibroids at 6.7%, ovarian cysts at 4.4%, and pelvic inflammatory disease at 3.3%. Laparoscopy proves integral to identifying occult pathologies driving infertility. It facilitates clinical management and improves reproductive outcomes for women presenting with fertility complications. Conclusions: It was concluded that tubal blockage was the most common cause (33.3%). In 33.3% of cases, polycystic ovaries were found, in 13.3% endometriosis, in 6.7% fibroids, in 4.4% ovarian cysts, and in 3.3% pelvic inflammatory disease (PID).

Assessing the Correlation between Hearing Loss and Diabetic Retinopathy Severity in Patients at A Tertiary Care Hospital in Pakistan

2025-03-20T04:43:45+00:00

Diabetes frequently results in sensorineural hearing loss (SNHL), although little is known about its root causes and risk factors. Objectives: To evaluate the association between the severity of diabetic retinopathy and sensorineural hearing loss in patients with type 2 diabetes mellitus. Methods: Data were collected from 150 patients with type 2 diabetes between June and August 2024. Participants were recruited via consecutive sampling. Audiological assessments were conducted using pure-tone audiometry, and the severity of diabetic retinopathy was graded by the Early Treatment Diabetic Retinopathy Study scale. Statistical analysis was performed using the Kruskal-Wallis test to assess the association between diabetic retinopathy severity and sensorineural hearing loss. Results: 33.3% of participants had normal hearing, while 37.3% had mild sensorineural hearing loss, 20% had moderate sensorineural hearing loss, and 9.3% had severe sensorineural hearing loss. Hypertension prevalence increased with DR severity (p=0.002), and a longer duration of diabetes was associated with more severe retinopathy (p<0.001). Significant differences were found in albumin, creatinine, and HbA1C levels (p<0.05), indicating worsening metabolic control with disease progression. sensorineural hearing loss severity showed a significant correlation with retinopathy stages (χ²=25.47, p<0.001), with the highest prevalence of severe sensorineural hearing loss in proliferative diabetic retinopathy. Conclusions: It was concluded that this study demonstrates a significant association between diabetic retinopathy severity and sensorineural hearing loss, with increased sensorineural hearing loss severity in more advanced stages of diabetic retinopathy.

Dental Caries Prevalence among Undergraduate Students Attending Medical and Dental College

2025-03-20T04:43:40+00:00

Dental caries is a chronic and widespread infectious disease that affects billions of people worldwide. The most prevalent chronic illness is one that, if left untreated, becomes worse over time. Objective: To determine the prevalence of the dental caries in the undergraduate student in medical and dental college of Jamshoro. Methods: With permission from Liaquat University of Medical and Health Science's Ethical Committee vide number ERC-19/2024/11, this observational cross-sectional study was carried out between April 2024, and November 2024. All students of Medical and Dentistry who were willing to participate in the study were included with 17–25 age range. Epi Info Software was used to calculate the sample size. 500 of the students were included as per the sample size calculation. Results: 300 (60%) of the participants were day scholars. The first, second, third, and fourth/final years were represented by students 105 (21%), 90 (18%), 175 (35%) and 130 (26%) respectively. 97 students (19.4%) had no DMFT score, whereas 403 students (80.6%) had dental caries with a DMFT score (>1). The test-takers' DMFT scores were as follows: 97 (19.4%) for a score of 0 and 139 for a score of 1 (27.8%). The DMFT scores were 102 (20.4%) for a score of 2, 136 (27.2%) for a score of 3, and 26 (5.2%) for a score of 4. Conclusion: This study demonstrated that the population's prevalence of dental caries was relatively low.

Exploring the Relationship between Achievement Emotions and Academic Performance in Dental College

2025-03-20T04:44:41+00:00

Achievement emotions, such as anxiety, enjoyment, and confidence, significantly influence students' academic performance. Understanding these emotions can enhance educational strategies and student outcomes, especially in high-stress environments like dental colleges. Objective: To investigate the achievements and emotions effects on academic performance in Pakistani dental colleges. Methods: A cross-sectional study was conducted at Islamic International Dental College, using convenient sampling across all professional years. Students scoring 50% or higher were classified as "pass," while those below 50% were labeled as "fail." Achievement emotions were measured using the Achievement Emotions Questionnaire, and logistic regression was used to analyze their impact on performance. Data were processed using Jaffery Amazing Statistical Package (JASP). Results: The study included 212 students (average age 21.25 years, 73.6% female). Females had higher average scores (375.64 vs. 342.79) and pass rates (75.6% vs. 67.9%) compared to males. Day scholars outperformed hostilities (377.70 vs. 358.41). Anxiety was common, with 60.9% of students experiencing moderate to high levels. While 35.8% disliked exams, 34.4% felt moderate pressure, and 54.2% were moderately confident. Concerns about grades were prevalent, with 36.3% worrying about poor grades and 47.2% caring about good grades. Negative emotions significantly reduced the likelihood of passing (p = 0.040), whereas positive emotions did not have a significant effect (p = 0.367). Conclusion: Negative emotions significantly decreased the likelihood of passing exams, while positive emotions did not have a significant impact.

Comparison of “Mucopexy with Haemorrhoidal Artery Ligation with Open Hemorrhoidectomy in Terms of Effectiveness and Outcome

2025-03-20T04:44:32+00:00

Traditional haemorrhoidectomy techniques are effective in the treatment of haemorrhoids but are associated with an increased risk of postoperative bleeding, pain, and longer recovery time. Our study on Mucopexy with haemorrhoidal artery ligation compares the outcomes in both procedures. Objective: To compare operating time, postoperative pain and bleeding, and postoperative urinary retention with both methods. Methods: This randomized control trial was conducted at the Department of General Surgery at the Pakistan Railway Hospital from January 2023 to December 2023. Results: In the hemorrhoidectomy group, the median age was 44.6 ± 14.54 years and the mean age of 50.91 ± 17.23 years for the other group. The mean operating time for the Hemorrhoidectomy group was 56.04 ± 7.52 minutes, while for the Mucopexy group, it was 40.36 ± 6.85 minutes. The difference was significant (p=0.000000000000000078). On the 1^st day, the mean pain score (numerical rating scale for pain) for the Hemorrhoidectomy group was 7.00 ± 1.17, whereas for the Mucopexy group, it was 3.59 ± 1.15 with a significant difference (p=0.000000000000000578). On the 7th postoperative day, the mean score on the numerical rating scale for pain for the Hemorrhoidectomy group was 2.37 ± 1.10, as compared to the mucopexy group, which was 1.07 ± 0.25, (p=0.0000000000258). No statistically significant difference was found for Postoperative bleeding and urinary retention between the two groups. Conclusions: It was concluded that HAL with Mucopexy has shown significant improvement in postoperative pain and operating time as compared to the open haemorrhoidectomy.

Immunohistochemical Demonstration of COX2 in Various Lesions of Oral Cavity

2025-03-20T04:44:49+00:00

Cyclooxygenase enzyme facilitates the conversion of arachidonic acid into pro-inflammatory compounds, resulting in formation of prostaglandins, which contributes substantially to the carcinogenic process. Objective: To analyze the immunohistochemical COX2 enzyme expression in various lesion of oral cavity. Methods: A total of 60 formalin fixed, paraffinized blocks (including 10 healthy oral mucosa cases, 10 cases of leukoplakia. 10 cases of oral sub mucosal fibrosis, 10 cases of dysplasia, 10 cases of well differentiated carcinoma, 10 cases of highly aggressive invasive squamous carcinoma) were randomly selected during the period of Jan, 2022 till Dec, 2023. Immunohistochemistry was done on each case for analyzing COX2 expression. Data was statistically analyzed by using chi square test. P value < 0.05 was taken as substantial. Result: It was found that the expression level was high in invasive carcinoma as compared with other oral lesion. Conclusion: Present study strongly supported the involvement of COX2 in the advancement of precancerous lesions of oral cavity to malignant one.

Diagnostic Accuracy of Chest Ultrasonography in Diagnosing Pneumothorax Taking CT Chest as A Gold Standard

2025-03-20T04:43:28+00:00

Ultrasound of the lung is an emerging diagnostic technique for diagnosing pneumothorax in patients with traumatic injury which is faster, safer, or more accessible than a conventional computed tomography scan. Objectives: To assess the diagnostic accuracy of chest ultrasonography in diagnosing pneumothorax using computed tomography chest as a gold standard. Methods: A cross-sectional validation study was conducted at the Radiology Department of Holy Family Hospital, from Nov 2022 to May 2023. Adult patients of either gender, with clinical suspicion of pneumothorax either traumatic or spontaneous, were included. Patients undergone chest ultrasound and pneumothorax were confirmed by the presence of sonographic features. Plain computed tomography chest imaging was done to confirm the diagnosis and compare it with ultrasound results. Results: There were ninety patients included. The ultrasound technique was found to have 92.8% sensitivity and 91.7% specificity to correctly diagnose pneumothorax as compared to chest computed tomography. The positive and negative predictive values were found to be 94.5% and 88.5% respectively, and overall diagnostic power was 92.2%. Conclusions: It was concluded that the diagnostic accuracy of chest ultrasonography in detecting pneumothorax is comparable to computed tomography Chest gold standard and this technique can be utilized in emergency care settings.

Gender Predilection in Post-Graduation among Dental House Officers in a Public Tertiary Care Hospital

2025-03-20T04:44:46+00:00

Pakistan is characterized as a developing nation with 25000 registered dentists. Confronting issues as the demand and dental needs are rising, so grasping the knowledge for career choices is vital. Objectives: To determine the Post-graduate career choices and factors involved in career selection by gender among dental house officers in a public tertiary care hospital. Methods: This cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, for six months using a convenient sampling technique by Self-administered questionnaire after consenting from the administration and house officers while maintaining privacy and approval from the Ethical Review Board. A sample size of n=82 was calculated at 50% proportion keeping the confidence limit at 10 using Open Epi Software Version 3.01. House Officers were inducted except those who had a gap of more than one year after graduation. Using SPSS version 28.0, the mean and standard deviation for numerical data were calculated for categorical data.Results: There were 11 (13.1%) male and 73 (86.9%) female. Male 10 (90.9%) and female 64 (87.7%) opted for post-graduation. Both genders opted for Oral Surgery and Restorative dentistry. In male, 11 (100%) wanted clinical dentistry while 52 (71.3%) female wanted it, 9 (12.3%) health management, 3 (4.1%) academics, 2(2.7%) business rest were undecided. Conclusions: Clinical dentistry and FCPS exams were chosen irrespective of gender and marital status. Among female Oral Surgery and Restorative Dentistry while in males Oral Surgery, Restorative Dentistry and Orthodontics departments were favoured.

Outcome of Open Versus Closed Reduction of Unilateral Mandibular Sub-Condylar Fracture

2025-03-20T04:44:52+00:00

Condylar fractures are among the most common types in the maxillofacial area, yet their optimal treatment approach remains debated. Objectives: To compare occlusion and mouth opening between open and closed reduction for unilateral mandibular sub-condylar fractures in adults. Methods: This quasi-experimental study was conducted on 68 patients in Jamshoro using a non-probability sampling technique. Patients aged 18–50 years with unilateral non-comminuted sub-condylar fractures within 48 hours and sufficient dentition for fixation were included, while those with bilateral fractures, undisplaced condyles, or other exclusion criteria were excluded. Participants were divided into two groups: Group A underwent closed reduction with maxillomandibular fixation, and Group B underwent open reduction with internal fixation using titanium mini-plates under general anesthesia. Occlusion, range of motion, and mouth opening were evaluated at 3-month follow-ups. Results: Pre-operative assessments showed limited mouth opening (15–20 mm) in 97.1% and 100%, poor occlusion in 100%, and poor range of motion in 100% of patients in both groups. Post-operatively, mouth opening improved to 20–30 mm in 8.8% vs. 67.6% and 30–45 mm in 73.5% vs. 85.3%. Good occlusion improved to 58.8%, 88.2%, and 97.1% in Group A vs. 82.4%, 94.1%, and 100% in Group B over 1, 2, and 3 months, respectively. Range of motion also improved, reaching 94.1% vs. 100% by the 3rd month. Conclusions: It was concluded that open reduction with internal fixation was a superior therapeutic option compared to closed reduction for unilateral mandibular sub-condylar fractures

Association Between Hypertensive Disorder in Pregnancy and Postpartum Depression

2025-03-20T04:44:38+00:00

Gestational hypertension, preeclampsia, and eclampsia are suspected of spontaneously developing and being particularly critical for maternal and infant health. New research indicates that these disorders may also elevate the probability of developing Postpartum Depression (PPD), which remains one of the serious mental health challenges in new mothers. Objective: To evaluate the prevalence of PPD in women with hypertensive disorders during pregnancy and to examine further the association of PPD with hypertensive disorders of pregnancy. Methods: This comparative cross-sectional study was conducted at the Obstetrics and Gynaecology Department, LMH, Kohat. A total of 155 postnatal women between the ages of 15 and 40 between 2-6 weeks postpartum were included. PPD was evaluated using the Urdu translation of Edinburgh Postnatal Depression Scale (EPDS), with depression indicated by scores >10. SPSS version 25 for statistical analysis, Chi-square tests (p < 0.05) were performed. Results: Women suffering from hypertensive disorders showed significantly higher EPDS scores (mean value of 11.85 ± 3.00) in comparison to those of normotensive women (mean value of 8.71 ± 2.03, p = 0.001). Emotional neglect (p = 0.001) and previous depression (p = 0.001) as risk factors were significantly related to PPD. Hypertensive pregnancies were also linked to adverse neonatal outcomes, including lower birth weights (p = 0.001) and increased neonatal admissions (p = 0.001). Conclusions: Hypertensive disorders in pregnancy significantly increase the risk of PPD. Integrating mental health support into prenatal and postnatal care for hypertensive women may improve maternal psychological well-being and neonatal health outcomes.

Maternal and Neonatal Health Outcomes in Placenta Accreta: Short-Term Morbidity and Long-Term Neurodevelopmental Impacts

2025-03-20T04:44:44+00:00

Placenta accreta (PA) is a serious maternal complication defined by abnormal attachment of the placental trophoblastic tissue to the myometrial wall of the uterus. Objectives: To evaluate the effect of placenta accreta on maternal morbidity and neonatal health outcomes, with an emphasis on long-term neurodevelopmental effects. Methods: This retrospective study was conducted at Social Security Teaching Hospital, Lahore, from October 2022 to March 2023. A total of 231 patient data was gathered for the study, comprising 77 infants delivered after third-trimester bleeding due to placenta accreta and 154 gestational age-matched controls. The maternal outcomes assessed included rates of postpartum hemorrhage, cesarean section, and peripartum hysterectomy. Neonatal outcomes were evaluated by Apgar scores, the incidence of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and hypoglycemia. Long-term neurodevelopmental outcomes, including cerebral palsy (CP) and minor neurodevelopmental abnormalities, were followed up at 2 years. Statistical analyses were conducted using one-way ANOVA and Chi-square test using SPSS-26. Results: Infants born to mothers with PA had lower Apgar scores at 1 minute (24.7% vs. 5.2% in controls; adjusted OR-5.67), higher rates of RDS (40.3% vs. 7.8%; adjusted OR-7.42), and severe IVH (11.7% vs. 1.9%; adjusted OR-6.30). Hypoglycemia occurred in 18.2% of the PA group compared to 3.2% in controls (adjusted OR-6.41). At 24 months, 7.8% of infants with PA had cerebral palsy (adjusted OR-13.5) and 6.5% had severe developmental delays (adjusted OR-10.4). Conclusions: It was concluded that PA is a serious risk factor for maternal and neonatal morbidity and long-term neurodevelopmental impairment.

Indications and Frequencies of Elective and Emergency Cesarean Section in Social Security Landhi Hospital Karachi, Pakistan

2025-03-20T04:43:43+00:00

The cesarean section rate is high in Pakistan as compared with WHO recommendations. It is quite high in the public sector hospitals due to high-risk pregnancies repeat cesarean sections and referrals from private sector hospitals. Objectives: To determine the proportions of indications of elective and emergency cesarean sections. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynecology, Social Security Landhi Hospital, Karachi, from January 1^st, 2023 to December 31^st, 2023. A total of 1150 patients were enrolled with a convenient sampling technique. Performa was filled by patients who delivered by cesarean section and through vaginal delivery. Patients who attended the Obstetrics patient’s department were marked as booked cases and those who were admitted for early labor and later cesarean-section was performed, were marked as un-booked. Cesarean sections through emergency were also included. Patients of ruptured uterus were excluded from this study. Data were entered in SPSS software version 24.0 and analyzed for frequencies and percentages. Results: A total of 770 cesarean sections were done. Overall frequency of cesarean-sections was 66.95%. Frequency of elective and emergency cesarean-section was 485 (62.98%) and 285 (37.01%). Booked cases were 658 (85.45%) while un-booked were 112 (14.54%). The commonest indication was repeat cesarean-section in 150 (19.48%), cervical dystocia in 105 (13.63%), fetal distress in 103 (13.37%), and antepartum hemorrhage were 94 (12.20%) patients. Conclusions: It was concluded that the Cesarean-sections rate was very high as compared to normal vaginal deliveries. The most common indication of cesarean section was repeat cesarean section.

Perspective of Women in Neurosurgery: Quantitative Study Interpreting Journey of Professional Identity Formation in Female Doctors of Low Middle Income Country

2025-03-20T04:43:32+00:00

Globally, there is a shift towards choosing medical and allied specialities over neurosurgery. In Pakistan, where female medical students now outnumber males, this trend has led to a significant gap in the availability of qualified neurosurgeons. Objectives: To assess how the perception of neurosurgery evolves from final year medical school to house job among female doctors focusing on educational adequacy, socioeconomic factors and challenging career choices. Methods: This cross-sectional descriptive study was conducted through a validated questionnaire. This questionnaire encompassed demographic information, and a series of items designed to evaluate students' educational perceptions regarding neurosurgery, their socioeconomic viewpoints on neurosurgery, and their perspectives on neurosurgery training within Pakistan. Results: We received 216 responses from participants, with 115 (53.2%) being final-year students and 101 (46.8%) serving as house officers. 57.9% of participants disagreed to consider neurosurgery as a career option whereas 97.7% considered neurosurgical illnesses challenging and interesting. Neurosurgery involving long operating hours was the strongly agreed question among participants (97.2%). Final-year students were significantly more likely to perceive their neurosurgery education as inadequate (61.7%). Likewise, they reported greater concerns about limited job opportunities compared to house officers (20% vs 7.9%, p=0.012). Conclusions: It was concluded that although there is considerable interest in neurosurgery, enrollment among females remains low due to educational gaps, socioeconomic barriers and gender challenges. Limited teaching resources, the demanding nature of the field, and perceived negative impacts on personal life among female doctors contribute to this trend.

Comparison of Fracture Resistance of Conventional Composite Veneers with Novel Veneer Preparation Design- In Vitro Study

2025-03-27T09:03:26+00:00

The patient's primary concern or need for good and pleasing esthetics of anterior teeth has increased. With the progression in the restorative field, multiple treatment options exist for patients’ complaints. Composite veneering is one of the suitable and an appropriate treatment option with classic properties that is a good mechanical property, bend strength, abrasion resistance, and longevity of direct anterior restoration. Objectives: To compare fracture resistance of conventional and novel veneer preparation (a modified form of feather edge preparation) design in the indirect composite veneer method. Methods: In Vitro, a comparative study was conducted at the Department of Operative Dentistry and Endodontics Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences Karachi time duration of six months by using a non-probability consecutive sampling technique. Data analysis was performed using SPSS version 26.0. The independent sample T-test was applied to compare the fracture resistance between the two procedures. Results: In terms of fracture load performance, the Conventional Veneer group had an average fracture load of 309.7 ± 126.3 N, compared to 335.5 ± 136.14 N in the Novel Veneer group. Although the Novel Veneer group showed a higher mean fracture load, this difference was statistically significant (p=0.005). Conclusion: It was concluded that increasing fracture resistance of the prepared materials with new preparation designs trends in the present study, however, the obtained data were statistically significant (p-value 0.005).

Patient Satisfaction Level and its Various Determinants in a Tertiary Care Hospital of Peshawar, Pakistan: A Cross-Sectional Study

2025-03-26T04:28:59+00:00

Patient satisfaction is a surrogate metric for quality of services provided by healthcare system. Objective: To assess patient satisfaction and associated factors in a major tertiary care hospital. Methods: This cross-sectional study was conducted at the Lady Reading Hospital (LRH), Peshawar, Pakistan. All patients admitted for indoor treatment for at least 2 days were enrolled through multistage sampling technique. Patients admitted to ICU, CCU, psychiatry or oncology wards and COVID-19 positivity were excluded. Patient satisfaction level was assessed with the Patient Satisfaction Questionnaire (PSQ)-18. Likert scale was utilized to evaluate patients’ response, where the scale ranged from 1 (complete dissatisfaction) to 5 (complete satisfaction). Patients with cumulative score of ≥ 50 were classified as satisfied. Results: Of the total 384 patients enrolled, 199 (~52%) patients were older than 45 years of age, while the female to male ratio was 1.25:1. The number of satisfied patients was significantly higher than dissatisfied patients (313 vs. 71: p < 0.01). Highest number of patients were satisfied with the domain D7 (i.e., accessibility and convenience: 72%), followed by domain D6 (i.e., time spent with the doctor: 69%). A minimum number of patients were satisfied with the domain D2 (i.e., technical quality: 53%). Moreover, higher number of patients with age ≥45 years (~86%), female gender (~86%), with bachelor education (~100%) and patient admitted to medical and allied wards (~86%) expressed satisfaction. Conclusion: Overall, the study showed a high patient satisfaction at LRH, Peshawar.