Pakistan Journal of Health Sciences

Targeting the Substance P/Neurokinin-1 Receptor Axis: A Novel Avenue in Overcoming Cancer Resistance

2025-08-15T11:38:51+00:00

The role of the Substance P (SP)/Neurokinin-1 Receptor (NK-1R) system in cancer biology has gained growing recognition. Recent literature consistently supports its implication in cancer promotion, progression, resistance, and inflammation [1]. SP is a peptide of the tachykinin family involved in multiple pathophysiological mechanisms, including nociception, inflammation, and immune modulation. However, its pathological role particularly through its preferred receptor, NK-1R has become increasingly evident in several malignancies [2].

Numerous studies have shown that SP and NK-1R is overexpressed in human cancer cells and NK-1R is essential for the viability of cancer cells. Activation of NK-1R, either constitutively or through SP binding, promotes cancer cell proliferation, antiapoptotic, survival, Warburg effect, angiogenesis, invasion and migration for metastasis [1]. Furthermore, this pathway contributes significantly to the establishment of a pro-inflammatory microenvironment, which sustains tumor progression. In head and neck cancers—especially laryngeal and oral squamous cell carcinomas the SP/NK-1R system has been implicated in the transition from chronic inflammation to preneoplastic and neoplastic lesions [3, 4]. Beyond its role in cancer progression, the SP/NK-1R axis is also associated with resistance to oncologic treatments. Overriding or malfunctioning NK-1R signaling appears to interfere with treatment response through modulation of signaling cascades and cross-talk with other receptor systems, potentially affecting immune escape and chemoresistance. This has opened the door to drug repurposing strategies involving NK-1R antagonists [5, 6].

Aprepitant, a well-known NK-1R antagonist currently approved for chemotherapy-induced nausea and vomiting, has shown potential in preclinical studies as an antitumor drug. It exhibits antiproliferative, pro-apoptotic, anti-Warburg effect, antiangiogenic, prevent invasion and migration, and has anti-inflammatory effects in cancer models [1, 6]. Importantly, aprepitant’s established safety profile and widespread availability make it a promising candidate for repositioning in oncology [1, 6]. The current evidence suggests that combining NK-1R antagonists with existing therapies could improve treatment response and potentially overcome resistance in multiple cancer types [3, 6]. Despite this progress, more precise characterization of NK-1R’s role across different tumors is needed. NK-1R signals through various pathways, and its full and truncated isoforms may exert distinct functions. Understanding these nuances will be critical for optimizing the clinical use of NK-1R-targeted therapies. Moreover, the availability of selective antagonists and the emerging potential for biased ligands based on receptor structural states present exciting research and therapeutic opportunities [6].

In conclusion, the SP/NK-1R system represents a multifaceted target in cancer biology. Its involvement in carcinogenesis, inflammation, and resistance mechanisms positions it as a valuable focus for novel cancer therapies. Future research should seek to translate these findings into clinical strategies, which could transform cancer care through these new drugs. In addition, the drug aprepitant and other similar drugs should be repurposed as antitumor drugs in cancer therapy.

The Role of Peer-Assisted Learning in Enhancing Medical Students' Academic Performance

2025-08-04T11:56:57+00:00

Peer-assisted learning (PAL) has gained recognition as an innovative and interactive educational strategy in medical education. Objectives: To evaluate the impact of PAL on the academic performance and satisfaction of undergraduate medical students. Methods: A comparative quasi-experimental study was conducted at Rawal Institute of Health Sciences, Islamabad, over six months. A total of 106 students participated, including 76 who attended PAL sessions and 30 who did not. Pre- and post-tests were administered to assess academic performance. PAL sessions were conducted twice weekly for four weeks and were led by trained senior students. Student satisfaction was measured using a structured questionnaire. Data were analyzed using SPSS version 25.0. Independent-samples and paired-samples t-tests were used to assess between-group and within-group differences. A p-value of less than 0.05 was considered statistically significant. Results: Pre-test scores were similar between groups. However, PAL participants achieved significantly higher post-test scores (Mean ± SD = 73.81 ± 9.00) and greater improvement (Mean = 18.95%) compared to non-participants (Mean = 6.82%, p = 0.001). Satisfaction levels were notably high among PAL participants, with over 90% reporting an enhanced understanding, increased exam preparedness, and increased academic confidence. Conclusions: It was concluded that PAL had a positive impact on both academic performance and student satisfaction. These findings support the integration of PAL as a complementary educational approach within medical curricula.

Hematological and Biochemical Alterations in Patients with Recurrent Aphthous Stomatitis

2025-08-04T11:57:09+00:00

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by painful, recurring ulcers. Its etiology remains multifactorial, with potential links to hematological and biochemical imbalances. Objectives: To compare the hematological and biochemical profiles of adult patients with and without recurrent aphthous stomatitis (RAS) attending the outpatient department of a teaching hospital in Hyderabad, Pakistan. Methods: A total of 130 participants were enrolled using a non-probability convenience sampling method, with 65 individuals in the RAS group and 65 healthy controls. Standardized clinical oral examinations were conducted to evaluate the presence, number, and location of ulcers in RAS patients, while controls were examined to confirm the absence of oral mucosal lesions. Under sterile conditions, 6 mL of blood was collected from each participant for hematological and biochemical analyses, including serum levels of cortisol, ferritin, iron, folic acid, and vitamin B12, measured using an auto-analyzer. Results: Independent t-tests revealed significantly higher cortisol levels in RAS patients (459.2 ± 49.6 nmol/L) compared to controls (232.4 ± 119.4nmol/L, p=0.001). Conversely, ferritin, iron, and folic acid levels were significantly lower in the RAS group (p=0.001). Hemoglobin (12.9 ± 2.1g/dL vs 14.0 ± 1.4g/dL, p=0.001) and hematocrit (37.88 ± 8.14% vs 40.85 ± 5.81%, p=0.018) were also significantly lower in RAS patients, while differences in RBC, WBC, and platelet counts were not statistically significant. Conclusions: These findings suggest potential connections between RAS and altered specific biochemical and hematological markers, including cortisol, ferritin, iron, folic acid, hemoglobin, and hematocrit.

A Comparison of Urine Dipstick Test with Spot Urine Protein–Creatinine Ratio and 24-Hour Protein Excretion in Women with Pre-Eclampsia

2025-08-04T11:58:09+00:00

Pre-eclampsia is a major obstetric complication marked by hypertension and significant proteinuria after 20 weeks of gestation, posing serious maternal and fetal risks. Early and accurate detection is critical for effective management. Objectives: To assess the diagnostic accuracy, sensitivity, and specificity of the spot urine protein–creatinine ratio (UPCR) in detecting significant proteinuria in pre-eclamptic women, compared to 24-hour urine protein excretion. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tertiary Care Hospital, Bahawalpur, from November 24, 2022, to May 23, 2023 (Approval No. 1516/Trg/2022). The study included 202 pregnant women diagnosed with pre-eclampsia. Spot UPCR and 24-hour urine protein were measured, and dipstick testing was performed. A UPCR cutoff of 0.3 was used to evaluate diagnostic accuracy. Results: The mean UPCR was 1.47 ± 1.05 mg/g, and the mean 24-hour urine protein excretion was 1475.35 ± 1099.87. mg. Spot UPCR showed a strong correlation with 24-hour urine protein (r = 0.974, p<0.001). ROC analysis revealed an AUC of 0.971. At the 0.3 cutoff, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 84.2%, 83.3%, 98.8%, and 25.0%, respectively. Conclusions: It was concluded that spot UPCR is a reliable and efficient alternative to 24-hour urine collection for detecting significant proteinuria in pre-eclampsia. Its integration into routine antenatal care may enhance early diagnosis and improve maternal and fetal outcomes.

Comparison of Alignment Efficiency of Steel Versus Elastomeric Ligatures in Lower Anterior Teeth: A Randomized Clinical Trial

2025-08-04T11:57:07+00:00

Ligature type influences orthodontic treatment speed, but conclusive evidence comparing alignment time between steel and elastomeric ligatures is limited. Objective: To compare the treatment time required by elastomeric ligatures and steel ligatures, in days, to achieve complete alignment of the lower anterior teeth. Methods: This randomized clinical trial was conducted at Khyber College of Dentistry, Peshawar, involving 180 participants (90 in each group: steel and elastomeric ligatures). The study included patients aged 12 to 18 years undergoing fixed orthodontic treatment with lower premolar extractions and a Little's Irregularity Index of 3-9 mm. Exclusion criteria included systemic conditions, specific dental conditions, and poor periodontal health. Participants were randomly assigned to either the steel or elastomeric ligature group, and the time to reach alignment in the lower arch was recorded. A Student's t-test was used for comparison. Results: The age (p = 0.86), gender distribution (p = 0.21), and age groups (p = 0.73) were similar across both groups. The steel ligature group required less time (218.39 ± 10.02 days) compared to the elastomeric group (224.64 ± 9.39 days) (p < 0.001). This trend was consistent across gender, with both females and males showing significant differences (p < 0.001 and p = 0.004, respectively). The 12–15 years age group also showed a significant difference (p < 0.001), while the 16–18 years group demonstrated a smaller but still significant difference (p = 0.016). Conclusion: Stainless steel ligatures required less time to achieve optimal alignment.

Comparison of Frequency of Postpartum Haemorrhage in Augmented Versus Spontaneous Labour

2025-08-25T07:08:32+00:00

Postpartum haemorrhage (PPH) remains a major cause of maternal morbidity and mortality. Labour augmentation is commonly practiced but may increase the risk of excessive bleeding. Objectives: To determine the frequency of PPH and compare its occurrence in spontaneous versus augmented labour. Methods: A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Mardan Medical Complex, from August 2023 to January 2024. A total of 151 women aged 18–40 years with singleton pregnancies at ≥36 weeks were enrolled using non-probability consecutive sampling. Data on age, parity, gestational age, hypertension, socioeconomic and residential status, labour type, and PPH were collected through a structured proforma. PPH was defined as blood loss >500 ml within 24 hours of vaginal delivery. Data were analyzed using SPSS version 25.0, and associations were tested using Chi-square and Fisher’s exact tests. Results: The frequency of PPH was 13.2%. PPH occurred more frequently in spontaneous labour (15.7%) compared to augmented labour (10.3%), though this was not statistically significant (p=0.333). A significant association was found between hypertension and PPH (p=0.017), with hypertensive women showing a higher risk. Conclusions: It was concluded that Hypertension was significantly associated with postpartum haemorrhage, underscoring the importance of careful monitoring. Labour augmentation did not significantly increase PPH risk. Ongoing evaluation of maternal risk factors is crucial for improving outcomes.

Comparative Cardiovascular Impact of Early-Onset Type 1 and Type 2 Diabetes and Associated Risk Factors in Pediatric and Adult Patients

2025-08-04T11:57:05+00:00

Cardiovascular disease is a leading cause of morbidity and mortality among individuals with diabetes, with early-onset cases posing unique risks. Objective: To evaluate and compare the cardiovascular impact of early-onset type 1 and type 2 diabetes mellitus in paediatric versus adult patients and to identify associated clinical, biochemical, and sociodemographic risk factors in a low-resource Pakistani setting. Methods: This was an observational, comparative, cross-sectional study conducted at the Department of Paediatrics, Quaid-e-Azam Medical College, Bahawalpur, from March 2024 to March 2025. A total of 260 participants were enrolled using non-probability consecutive sampling, comprising 130 diabetic patients (aged 10–40 years) with early-onset diabetes mellitus (diagnosed ≤25 years) and 130 age- and gender-matched healthy controls. Data were collected through structured clinical examination, laboratory investigations (including HbA1c, lipid profile, serum creatinine, urinary albumin-creatinine ratio), electrocardiography, and echocardiography. Statistical analysis was performed using SPSS version 26.0. Results: Diabetic patients demonstrated significantly higher prevalence of left ventricular hypertrophy (36.9% vs. 10.8%; adjusted OR: 5.01; 95% CI: 2.51–9.99; p = 0.0001), CIMT ≥0.9 mm (44.6% vs. 16.2%; OR: 4.49; 95% CI: 2.44–8.26; p = 0.0001), and diastolic dysfunction (24.6% vs. 6.9%; OR: 4.25; 95% CI: 1.83–9.89; p = 0.0003). Significant associations were found between cardiovascular complications and poor glycaemic control (HbA1c ≥7%), LDL ≥100 mg/dL, triglycerides ≥150 mg/dL, low socioeconomic status, and sedentary lifestyle. Conclusion: Early-onset diabetes mellitus is strongly associated with adverse cardiovascular outcomes in young Pakistani patients.

Hyperglycaemia and ABO Blood Groups: An Investigative Analysis among Young Adults of Hyderabad, Sindh, Pakistan

2025-08-04T11:58:01+00:00

Serious health problems include nerve damage, renal failure, and an increased risk of cardiovascular disease can result from chronic hyperglycemia. Objective: To investigate the relationship between hyperglycemia and ABO blood types in young adults from Hyderabad, Sindh. Methods: 582 randomly selected healthy individuals, 281 females and 301 males, aged 18 to 40, were recruited from various institutions for this cross-sectional study, which took place between January 2, 2021, and January 31, 2022. The data was gathered using the basic random approach. All participants gave their informed consent prior to recruitment. Descriptive statistics including mean, standard deviation, and frequency distributions were computed using the Chi-square test. Data collection was analyzed using SPSS version 20.0. Results: This study included 582 participants. In male individuals, the mean age was 27.83 ± 5.478, and in females, 22.27 ± 4.730. The mean BMI was 25.81 ± 5.08 in males and 24.00 ±4.90 in females. The 207 B blood group individuals were found to be obese, comprising 112 males and 95 females, followed by 195 individuals with blood group O, 128 individuals with blood group A, and 52 individuals with blood group AB. People who are Rh-positive and have blood group B were shown to be more likely to experience elevated hyperglycemia. Conclusion: Blood group B and Rh-positive status may be linked to higher hyperglycemia risk in young adults from Hyderabad, suggesting blood typing as a potential screening tool.

Histopathological Diversity in Hysterectomy Specimens at Jinnah Sindh Medical University Lab

2025-08-04T11:57:08+00:00

Hysterectomy is common but often overused in Pakistan, with rising cases in cities like Dera Ghazi Khan. Fibroids and abnormal uterine bleeding are the top causes, though many effective non-surgical treatments exist. Experts urge prioritizing medical management and preserving fertility through alternatives like myomectomy before resorting to surgery. Objective: To determine the spectrum of hysterectomies’ lesions in histopathological analysis at Jinnah Sind Medical University Lab (JSMU lab). Method: This retrospective study was conducted in the setting of the JSMU diagnostic lab in Karachi, from January 2023 to December 2024. The sample size included the hysterectomy samples received during the two years mentioned before. The sampling technique was non-probability consecutive sampling. A proforma was designed to collect data from the records of the JSMU lab. This included the age of the patients, Indication of surgery, and outcome/diagnosis after histopathological examinations. Results: This study included 147 hysterectomies with a mean age of 44.11 years, and the Individuals aged between 40 and 49 years comprised the largest proportion, making up half of the total participants. Heavy menstrual bleeding was the most frequent clinical finding, present in 44% of cases. Histopathologically, 50% of cases showed leiomyoma, followed by adenomyosis, with almost all patients having chronic cervicitis and nabothian cysts. Conclusions: It was concluded that hysterectomy was most common in women aged 40–49 years, primarily for heavy menstrual bleeding. Leiomyoma was the leading histopathological finding, followed by adenomyosis, with chronic cervicitis and nabothian cysts in most cases.

Assessment of Thickness of Macular Edema on Optical Coherence Tomography in Diabetic Patients Treated with Anti-Vascular Endothelial Growth Factor

2025-08-04T11:57:19+00:00

Diabetes is becoming more commonplace worldwide with potential causes. Diabetic retinopathy is a serious ocular complication that affects working-age adults and causes moderate to severe vision loss. Objective: To determine the outcome of anti-VEGF by optical coherence tomography (OCT) in DME thickness. Methods: A prospective (interventional) study was carried out at the Chandka Medical College Hospital's Department of Ophthalmology at SMBB Medical University, Larkana. The study included all individuals over the age of 15 who had diabetes mellitus of any kind. SPSS version 26 was used for data analysis. Result: Patients were 64.8 ± 14.2 years old on average, had a BMI of 33.56 ± 7.85 kg/m2, and had been on DME for an average of 8.06 ± 4.23 years. There were 17 (34%) female patients and 33 (66%) male patients out of 50. The most common risk factor among 50 patients was hyperlipidemia, 45(90%) followed by hypertension 43 (86%), anemia 42 (84%), insulin dependent, 37 (74%), obesity31(62%), chronic renal failure, 28 (56%) and smoking, 26 (52%). Conclusion: OCT can be used to accurately measure retinal thickness brought on by DME. OCT can therefore be a helpful technique in predicting the functional outcome and assessing how well anti-VEGF medication works for individuals with DME. Anti-VEGF therapy results in rapid and sustained thickness reduction on OCT, generally correlating with improvements in visual acuity. The outcome of anti-VEGF therapy in diabetic macular edema (DME), as measured by OCT, typically shows a significant reduction in central retinal thickness (CRT) or central subfield thickness (CST).

Effect of Dexamethasone on Perioperative Lactate Levels in Donor Hepatectomy

2025-08-04T11:57:20+00:00

The use of intravenous dexamethasone intraoperatively has been advocated for analgesia, prevention of nausea and vomiting, post-operative sore throat and inflammation. Hyperlactinemia associated with dexamethasone is a concern in patients undergoing hepatectomy. There is limited evidence to support safety or adversity of dexamethasone in terms of hyperlactinemia. Objective: To evaluate the effect of dexamethasone administration on perioperative lactate levels in living related donors undergoing liver donor right hepatectomies. Methods: The 60 patients who had donor hepatectomy appointments in total were divided into two groups at random. After the induction of anesthesia, Group B (n=30) got dexamethasone at a dose of 8 mg while Group A (n=30) received a placebo. Perioperative lactate levels were assessed at various time points, and statistical comparisons were made between the two groups' mean lactate levels. Results: The patients' mean age was 25.68 years, and their mean BMI was 21.48 kg/m2. At every time point, Group B displayed significantly higher mean lactate levels than Group A (p=0.000). Additionally, there were statistically significant differences between the groups, an hour after drug administration, and after graft extraction (p=0.000). The perioperative mean glucose level climbed steadily in both groups. Conclusion: The administration of dexamethasone in patients undergoing right living related donor hepatectomy was associated with significantly higher perioperative lactate levels compared to patients receiving placebo.

Frequency of Hyperthyroidism in Patients Diagnosed with Atrial Fibrillation

2025-08-04T11:58:05+00:00

The global prevalence of hyperthyroidism in patients with atrial fibrillation (AF) ranges between 10% and 20%, with lower and higher rates in developed countries to regions with iodine deficiency and health care settings with limited resources, respectively. Demographic variations, such as age, the severity of hyperthyroidism, or differences in AF detection methods, may lead to additional disparities. Hence, the study was planned to help clarify these variations and facilitate more accurate global comparisons. Objective: To evaluate the prevalence of hyperthyroidism in patients diagnosed with AF. Methods: This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Department of Cardiology, from July 1, 2023, to December 31, 2023. 119 male and female participants in the age range of 30 to 60 years diagnosed with atrial fibrillation were enrolled. The patients were analyzed for hyperthyroidism. Serum TSH levels of blood test <0.1 mU/L and FT₄ >1.5 ng/dL by laboratory were considered confirmatory for hyperthyroidism. Results: The Mean age of participants was 41.84 ± 8.376 years. Male participants were 79 (66.4%). Hyperthyroidism was found in 35 patients (29.4%). The p-value for the association between hyperthyroidism and hypertension was statistically significant (p-value=0.025). Conclusions: Our study revealed a higher frequency of hyperthyroidism-induced AF when compared to global reports. Iodine disorder, delayed diagnosis, multiple medical conditions, and economic inadequacies could be the underlying reasons. Female patients with atrial fibrillation, aged more than 45 years, with a history of hypertension, were more likely to have hyperthyroidism.

Efficacy and Safety of Dapagliflozin Monotherapy in Patients with Insulin Resistance Syndrome and Relative Insulin Deficiency

2025-08-04T11:58:02+00:00

Type 2 diabetes mellitus had different subtypes. Some patients had insulin resistance syndrome, while others had relative insulin deficiency. Dapagliflozin helped in both subtypes. It reduced blood sugar, weight, and improved heart health. It works with independent of insulin. Objective: To evaluate efficacy and safety of dapagliflozin monotherapy in patients with insulin resistance syndrome and relative insulin deficiency. Methods: This Prospective Quasi-Experimental Study Design was conducted at Bolan Medical College and Jhalawan Medical College Hospital between January 2024 and December 2024. A total of 180 T2DM patients (aged 30-70 years) received 10mg dapagliflozin monotherapy. Age, HbA1c, weight, glucose, and blood pressure were recorded at baseline and after three months. Patients were classified patho-physiologically as insulin resistance syndrome and relative insulin deficiency. Results: The most common age group was 41–50 years (65, 36.1%). The mean age was 54.3 ± 2 years. Males were 100 (55.6%) and females were 80 (44.4%). At baseline, HbA1c was 7.8 ± 0.5% and 8.3 ± 0.4%, glucose 158 ± 15.2 and 162 ± 14.5. At the 3-month follow-up, both groups showed reductions in HbA1c (−1.2 ± 0.4% in IRS vs. −1.0 ± 0.3% in RID), fasting plasma glucose (−22 ± 5.1 mg/dL vs. −18 ± 4.8 mg/dL), and body weight (−3.5 ± 1.0 kg vs. −2.2 ± 0.8 kg). Conclusion: Dapagliflozin improves glycemic control and weight control by reducing sugar in the urine in both insulin resistance syndrome and renal insufficiency disease patients.

Assessment of Myometrial Invasion of Endometrial Carcinoma Using Fusion of T2WI and DWI Taking Histopathology as Gold Standard

2025-08-04T11:57:15+00:00

Precise evaluation of myometrial invasion in endometrial carcinoma is crucial. MRI; especially combination of T2WI and DWI has shown great potential as non-invasive method for this assessment. Objective: To determine positive predictive value of T2WI and DWI fusion in diagnosis of deep myometrial invasion of endometrial carcinoma taking histopathology as gold standard. Methods: This cross sectional study was piloted on 71 patients recruited from Radiology and Gynaecology departments of SGRH, Lahore. All histologically confirmed cases of endometrial carcinoma underwent pelvic MRI, including T2WI and DWI were included. The fused T2WI-DWI images were evaluated for presence and depth of myometrial invasion. Final histopathology reports post-surgery were used as gold standard to determine the PPV of the fused approach. Results: The positive predictive value of T2WI-DWI for detecting deep myometrial invasion calculated is 94.4%. Conclusions: Current findings suggest that, fusion of T2WI and DWI proved to be highly effective tool in diagnosing deep myometrial invasion in cases of endometrial carcinoma, taken histopathology as gold standard. The results indicate that this combined imaging approach offers strong PPV and overall accuracy, supporting its use as reliable, non-invasive method for preoperative evaluation.

Morphological Features and Ki67 Immunohistochemical Analysis in Trophoblastic Diseases: A Five-Year Retrospective Study

2025-08-04T11:57:14+00:00

Gestational trophoblastic disorders (GTDs) are characterized by aberrant trophoblastic growth, with entire moles, partial moles, and hydropic abortions looking identical, making diagnosis difficult. Ki67 immunohistochemistry quantifies cellular proliferation, improving diagnosis and disease progression prediction. Objectives: To investigate the morphological features of prenatal trophoblastic disorders and test the diagnostic accuracy of Ki67 immunohistochemistry in distinguishing between whole moles, partial moles, and hydropic abortions during a five-year period. Methods: A retrospective descriptive study examined 50 GTDs, including complete, partial, and hydropic abortions. Morphological examination was done on Hematoxylin and Eosin-stained sections, while Ki67 immunohistochemistry assessed proliferation. To assess Ki67 expression and clinical outcomes, descriptive statistics, ANOVA, and regression models were used. Results: Complete moles exhibited the highest Ki67 levels (mean: 3.8 ± 0.6), significantly differing from partial moles and hydropic abortions in terms of villous hydrops and trophoblastic proliferation (p<0.001). Ki-67 expression was strongly associated with the progression of chronic trophoblastic disease, with 60% of high Ki-67 cases advancing to persistent disease (p<0.05). Conclusions: Ki67 immunohistochemistry proves effective in diagnosing and prognosticating GTDs, particularly in distinguishing between subtypes. Incorporating Ki67 into routine diagnostic practices can improve accuracy and patient care, though further multicenter studies are needed to confirm these findings and address limitations, such as the small sample size.

Genotypic Strain Determination of Multi-Drug Resistance (MDR) and Extended Drug Resistance (XDR) in Acinetobacter Baumanii from Tertiary Care Hospitals in Lahore

2025-08-04T11:57:12+00:00

Antibiotic resistance in Acinetobacter baumannii poses a major future challenge, with a sharp rise in drug-resistant infections significantly limiting treatment options. Objectives: To determine the frequency of multidrug-resistant (MDR) and extended drug-resistant (XDR) Acinetobacter baumanii and the frequency of blaOXA-23, blaOXA-24, blaOXA-51, and blaOXA-58 among all other resistance genes responsible for resistance in Acinetobacter baumanii.

Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, King Edward Medical University, Lahore. Specimens were collected from the (Neonatal ICU, ICU, CCU) of Mayo Hospital, Lahore, and were processed at the hospital laboratory. Acinetobacter baumannii was identified on CHROMagar based on colony morphology and growth conditions, confirmed by biochemical tests. Antimicrobial sensitivity was assessed using the disc diffusion method, and PCR was performed for genotypic identification, with primer details in the data collection procedure. Results: Out of 67 samples, 19 (23.36%) were positive for Acinetobacter baumannii. Among these, blaOXA-23 (57.89%) was the most common resistance gene, followed by blaOXA-51 (47.36%). All 19 had the OXA-58 strain. The isolates showed 100% resistance to Penicillin, Ceftazidime, Cefepime, Imipenem, Levofloxacin, Doxycycline, and Septran. The most effective antibiotics were Ampicillin + Sulbactam (42.11%) and Piperacillin + Tazobactam (26.32%). Conclusions: The frequency of Acinetobacter baumanii was 28.36%. according to the study results. Among these positive isolates, carbapenem-resistant genes blaOXA-23 (57.89%) and bla-OXA-58 (47.36%) were the most frequent drug-resistant genes which were isolated. Regarding antimicrobial susceptibility, very few drugs showed sensitivity for Acinetobacter baumanii, which poses a major challenge for clinicians.

Factors affecting Menstrual Hygiene Management Practices among Women Visiting a University Hospital of Lahore: A Cross-Sectional Study

2025-08-04T11:58:08+00:00

Menstrual practices are considered taboo in various spheres of our lives, serving as an impediment to the provision of adequate resources to women. Objective: To determine factors affecting menstrual hygiene practice (MHMP) in the population visiting a Tertiary Care Hospital. Methods: A Quantitative descriptive study was conducted at Lady Willingdon Hospital from July to December 2024. 382 female were included in the study after seeking informed consent and approval from ERB. The inclusion criteria for this study were female aged 18-45 years with regular menstrual cycles. Female who were pregnant or with irregular menstrual cycles were excluded. The data were analyzed by using SPSS version 21.0. Results: In this study age significantly influenced hygiene practices, with younger females (12-17 years) more likely to engage in unsafe practices (p=0.005). Maternal secondary education was a key factor in promoting safe hygiene practices (p=0.009). Awareness about menarches and the primary source of information were strongly associated with better hygiene practices (p<0.001). Sanitary pad usage was prevalent (99%) and linked to safer practices (p = 0.0032), while access to water and sanitation facilities improved hygiene (p=0.005). Conclusions: This study highlights the crucial role of socio-demographic factors and access to sanitation facilities in influencing menstrual hygiene management practices. Promoting education, increasing awareness, and improving access to sanitary products and sanitation facilities are essential to enhance safe menstrual hygiene practices.

Association of Chronic Psoriasis with Syndrome X

2025-08-04T11:58:10+00:00

Psoriasis is a chronic skin disorder and has been associated with a number of chronic inflammatory conditions. Syndrome X, which is commonly seen in our population and is responsible for major cardiovascular events, has been found to be linked with chronic skin disorders. Objective: To find out the link between Syndrome X and chronic plaque psoriasis in our population, to estimate the disease burden and plan the management strategies accordingly. Methods: This study included 130 participants selected through consecutive sampling including 65 patients as diagnosed cases of chronic plaque psoriasis and rest of 65 were controls. Data collection involved measuring body size, blood pressure, and lab investigations with lipids panel, complete blood counts and fasting sugar levels. For the diagnosis of Syndrome X, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria was applied. Results: The study results revealed that Syndrome X was common in the psoriasis patients (41.5%) than the other group (23.1%) with a p value of 0.035. The majority of psoriasis patients were obese, had hypertension, sugar levels were elevated, higher triglycerides, and low HDL cholesterol. The bivariate analysis indicated that psoriasis was associated with the high tendency of developing syndrome X (p value of 0.021). Conclusion: The study findings highlighted that appropriate treatment of syndrome X in patients with chronic psoriasis can reduce the cardiovascular complications.

Incidence of Fungal Pneumonia in Children with Acute Myeloid Leukemia Taking Oral Antifungal Prophylaxis

2025-08-04T11:57:11+00:00

Acute leukemia is common in children, with acute lymphoblastic leukemia (ALL) making up 80-85% and acute myeloid leukemia (AML) 10-15%. Objective: To determine the incidence of fungal pneumonia in children with acute myeloid leukemia taking oral antifungal prophylaxis. Methods: In this single-center retrospective study done in a tertiary care hospital, the study analyzed 276 pediatric AML cases from July 2022 to June 2024. The diagnosis of fungal pneumonia was made on the basis of CT scan findings. Demographic and AML subtype data were also analyzed. Results: Among the 276 AML patients enrolled in this study, the mean age of the patients was 8.4 years (range 1-16 years), and there was a male predominance (157 male vs. 119 female). The most common AML subtype was M2 (34.1%), followed by M4 (16.7%) and M5 (8.3%). Out of 276 patients with AML, 69 (25.0%) had CT findings suggestive of fungal pneumonia. M2 and M4 subtypes were the most commonly affected, accounting for about 50% of cases. Conclusions: Children with AML taking oral primary antifungal prophylaxis have a 25% incidence of fungal pneumonia. These findings highlight the importance of vigilant imaging surveillance and targeted interventions in high-risk subgroups (M2 and M4).

Treatment-Related Mortality in Pediatric Acute-Lymphoblastic and Myeloid Leukemia: Experience from A Low- and Middle-Income Setting

2025-08-04T11:57:16+00:00

Treatment-induced complications are challenging to manage in low-middle-income country (LMIC) settings, leading to higher mortality rates. Objectives: To ascertain the frequency, causes, and risk factors leading to treatment-related mortality (TRM) in children with acute leukemia (ALL and AML) in our setup. Methods: A Retrospective descriptive cohort study was done at the Hematology Oncology Department of the Children’s Hospital, Lahore. Using non-probability consecutive sampling, data of pediatric acute leukemia patients (<16 years of age) who experienced TRM during the study period were recorded. Results: Among TRM 136 (75%) had Acute-Lymphoblastic-Leukemia, and 45 (25%) had Acute-Myeloid-Leukemia. Median age of expiry 7.0 years (1–15years) with a Male-to-Female ratio 1.5:1. Underlying causes of TRM were Infection-related mortality in 168 (93%), Hemorrhage in 10 (5.5%), and Drug toxicity in 3 (1.5%). Under-nutrition (<10th centile) was found in 111 (61%) and 120 (67.4%) patients who were on active chemotherapy. Median hospital stays 10 days (1–45days) and median distance of residence to medical facility 222km (41–995km). Median values of hematological parameters at death: hemoglobin 8.0g/dl (2.6–14.7g/dl), WBC 0.57x103/mm3 (0.0-500), platelets 15x103/mm3 (0-503), and CRP 149mg/L(0.1–193mg/L). Significant factors associated were platelet counts (p=0.009), hemoglobin (p=0.001), and CRP (p=0.017). Conclusions: The Major cause of TRM in children with acute leukemia is infection. Noteworthy factors were male gender, residents of rural areas, cytopenia, high CRP, under-nutrition, and ongoing chemotherapy sessions. The majority of deaths occurred during Induction chemotherapy. Infection prevention/control and enhanced supportive care can result in decreasing TRM in acute leukemia.

Recurrence Rates and Postoperative Complications Following Colorectal Cancer Surgery: A 5-Year Study at a Tertiary Care Hospital in Peshawar

2025-08-04T11:57:03+00:00

Colorectal Cancer (CRC) is a leading cause of cancer related morbidity and mortality in the world. In low- and middle-income countries like Pakistan, delayed diagnosis, lack of access to specialist care, and irregular post-operative surveillance make things worse for a successful outcome. Objective: To evaluate the five-year recurrence rates and postoperative complications among patients undergoing colorectal cancer surgery at a tertiary care center in Peshawar, KPK, Pakistan. Methods: This retrospective cohort study was carried out in the department of General Surgery, Hayatabad Medical Complex, Peshawar, from March 2020 to February 2025. Patients presenting with metastatic disease at the time of surgery, palliative or bypass procedures, patients with missing follow-up data and patients lost to follow-up within 12 month following surgery were excluded from the study. Results: In terms of tumor stage, 14.4% had stage I, 28.5% had stage II, 46.8% had stage III, and 10.3% had stage IV. The majority of the patients (61.5%) underwent open surgery, while 38.5% underwent laparoscopic surgery. Postoperative complications were recorded in 122(39.1%) patients. Anastomotic leakage occurred in 6.7%, while surgical site infections (SSI) were observed in 12.2% of cases. Conclusions: A 26.9% recurrence rate and a high burden of postoperative complications were observed among colorectal cancer patients. Advanced stage, open surgery, anastomotic leaks, and older age were significantly associated with increased recurrence risk.

Adjunctive Brivaracetam Therapy in Epilepsy: A Prospective Clinical Study

2025-08-04T11:58:06+00:00

Epilepsy is one of those primary illnesses that affect the brain, and the population is estimated to be around 50 million people. Objective: To evaluate the efficacy and safety of adjunctive Brivaracetam therapy in adult patients with epilepsy. Methods: This observational, non-interventional, single-center study assessed the use of adjunctive Brivaracetam (BRV) in patients aged ≥16 years over six months (October 2023–March 2024). Eligible participants had stable antiepileptic drug (AED) regimens for at least one month before BRV initiation. Demographic data, seizure type, frequency, and intensity were documented at baseline, 3 months, and 6 months. The primary endpoint was the change in seizure frequency. Secondary outcomes included ≥50% seizure reduction, seizure freedom, and adverse events. Data were analyzed using SPSS version 23.0. Results: A total of 168 patients (mean age: 25.1 ± 12.9 years) received adjunctive BRV therapy. Partial seizures and comorbid depression were the most common indications for BRV use. Mean seizure frequency decreased from 5.26 ± 0.29 at baseline to 2.41 ± 0.24 at 3 months. All patients achieved seizure freedom by 6 months. Reported adverse effects were generally mild: somnolence 12 (7%), headache 10 (6%), and dizziness 9 (5%). Conclusions: Adjunctive BRV therapy demonstrated significant efficacy in reducing seizure frequency and achieving seizure freedom, with a favourable safety profile. These findings support BRV as a promising treatment option for patients with epilepsy unresponsive to conventional AEDs.

Innovative Pedagogies: Exploring Effective Teaching and Learning Methodology from Students’ Perspective

2025-08-04T11:57:22+00:00

In recent years, educational institutions have integrated innovative methods such as interactive learning, digital tools, and student-centered approaches into traditional teaching to enhance understanding and engagement. Evaluating their effectiveness requires insight into students' perceptions is crucial. Objectives: To evaluate innovations in traditional teaching and learning methodology from the students’ perspective of a public institution. Methods: A cross-sectional study was conducted at a Public Sector College, with a sample size of 282 students recruited through non-probability convenience sampling. Medical and dental undergraduates aged 18-24 years from both genders were included, while graduates and faculty members were excluded. Data collection involved a questionnaire filled out by undergraduate students using "Google Forms." Data were analyzed on SPSS version 25.0. Results: Among 82 participants, 41.8% were MBBS students and 58.2% were BDS students. Most students (37.6%) had limited knowledge of non-traditional teaching methods, yet 86.9% believed that specific learning outcomes should be included for each topic. Interactive lectures were favoured over traditional ones (46.8%), and students preferred 45-minute lectures followed by 15 minutes of revision. Nearly half (49.3%) favoured audiovisual learning over rote textbook study. Additionally, 42.2% felt the grading system needs improvement, and 64.5% highlighted the importance of interactive student-teacher strategies. Many preferred knowledge-based activities and e-learning, with 47.9% favoring e-learning over textbooks. Conclusions: It was concluded that transforming learned concepts into applied knowledge is more beneficial for students. Therefore, enhancing medical education is crucial for developing more competent and skilled physicians in the future.

Role Of Corticosteroid in Treatment of Bronchiolitis Presented to Qazi Hussain Ahmad Medical Complex

2025-08-04T11:56:56+00:00

Acute bronchiolitis is a major cause of hospitalization in infants and young children, most commonly caused by respiratory syncytial virus (RSV). Despite high spontaneous recovery rates, corticosteroids are frequently used, though their efficacy remains uncertain. Objective: To assess the short-term clinical efficacy of oral corticosteroids compared to placebo in infants with acute bronchiolitis. Methods: This quasi-experimental study was conducted at the Department of Pediatrics, Qazi Hussain Ahmad Medical Complex, Nowshera. A total of 234 children aged 3 months to 2 years with clinically diagnosed bronchiolitis were enrolled. Participants were allocated to receive either oral prednisolone (1 mg/kg/dose) or placebo twice daily for three days, alongside standard supportive care, including inhaled salbutamol. A blinded examiner assessed treatment response on day 3 using a validated respiratory distress score. Clinical improvement was defined as a reduction of more than two points in the score. Results: Clinical improvement was observed in 97.4% of the corticosteroid group and 94.9% of the placebo group. The difference was not statistically significant (p=0.308). Subgroup analyses based on gender, maternal education, socioeconomic status, and maternal occupation showed no significant impact on treatment outcomes. Conclusions: Oral corticosteroids did not significantly improve clinical outcomes compared to placebo in infants with mild to moderate bronchiolitis. Given the high rate of natural recovery and the potential for adverse effects, routine corticosteroid use is not recommended. Further research is needed to identify specific subgroups that may benefit from targeted steroid therapy

Fetomaternal Outcome of Pregnant Women with Malaria

2025-08-04T11:57:18+00:00

Malaria during pregnancy is a major public health concern, with devastating implications for both the mother and the unborn child. Objectives: To evaluate the maternal and fetal outcomes in pregnant women infected with Plasmodium falciparum and Plasmodium ovale/vivax. Methods: This descriptive cross-sectional study was carried out in Obstetrics and Gynecology Ward II using non-probability convenience sampling. It included 110 pregnant women diagnosed with malaria, excluding those with underlying health conditions. Data were gathered through interviews, medical records, and laboratory tests. Various maternal and neonatal factors, including hemoglobin levels and birth weight, were recorded. The chi-square test was performed to evaluate the relationship between malaria and fetal outcomes, with p-values<0.05 considered statistically significant. Results: Among 110 pregnant women, 58 (52.7%) were aged 21–30 years. The majority, 69 (62.7%), had 2–5 pregnancies, while 25 (22.7%) were primigravida. Preterm birth and full-term deliveries were equally distributed, 55 (50.0%), while anemia was prevalent in 82 (74.5%) of cases. Low birth weight was observed in 35 (31.8%) of neonates. Among 71 women with P. falciparum infection, 63 (88.7%) developed anemia, which was significantly higher than in the P. ovale/vivax group, where only 19 out of 39 (48.7%) were anemic (p<0.001). Preterm birth, 45 (63.4%) and low birth weight, 34 (47.9%), were significantly greater in falciparum cases (p<0.001). Conclusions: It was concluded that Plasmodium falciparum infection poses a higher frequency of adverse fetomaternal outcomes compared to Plasmodium ovale/vivax, characterized by noticeably greater incidences of hypoglycemia, low weight at birth weight, premature birth, and anemia.

Clinical and Radiological Outcomes of Anterior Column Reconstruction Using Titanium Mesh Cage for Dorsolumbar Spine Pathologies

2025-08-04T11:57:23+00:00

Pathological fractures in the spine, often caused by cancer, infection, or aging, can lead to vertebral compression fractures, resulting in pain, deformity, and neural compromise. Anterior cervical corpectomy with titanium mesh cages is effective for decompression, stabilization, and spinal column restoration in trauma and tumor cases. Objective: To evaluate clinical and radiological outcomes of anterior column reconstruction using cylindrical titanium mesh cage for Dorsolumbar spine pathologies. Methods: A Descriptive Case Series was conducted at the department of Neurosurgery, Fatima Jinnah Medical University/Sir Ganga Ram Hospital. 60 Patients of either gender, aged 12 to 50 years, presenting with dorsolumbar spine pathologies were included. Pre-operative and post-operative plain X-ray, MRI plain film of Spine and CT Spine (wherever required) was All surgeries were performed by a single surgeon having 10 years of post-fellowship experience. Clinical and Radiological outcomes were assessed after 3 months. The data were analyzed using SPSS version 25.0. Results: Total of 60 patients, 36.6% were in age group of 12-30 years and 63.4% were in age group of 31-50 years .There were 60% were male whereas 40% were females. Clinical outcome was excellent in 28.3%, good in 45%, fair in 23.3% and poor in 3.3%. Mean change in intervertebral space height was 1.52±0.19 and mean change in segmental angle was 0.49^o± 0.06^o. Conclusion: In the current investigation it was concluded that the use of titanium mesh cages in patients with spinal disorders is safe and offering significant improvements in both clinical outcomes and radiological parameters.

Predicting Adverse Pregnancy Outcomes in First Time Mothers: The Role of Maternal Body Mass Index

2025-08-04T11:57:06+00:00

Maternal underweight during pregnancy can profoundly "programme" the fetal physiology and metabolism, which may end up in chronic illnesses later in life. including diabetes mellitus, cerebrovascular disease and hypertension. Objective: To figure out the likelihood of untoward events among underweight nulliparous women. Methods: A descriptive cross-sectional study was performed in the Obstetrics and Gynaecology Department, Nishtar Hospital, Multan, for the period of four months from December 2024 to March 2025 using non-probability consecutive sampling. Around 401 women were included after fulfilling the selection criteria. Data were collected through a specialized form and reviewed using SPSS Version 20.0. Results: Mean age was 28.98 ± 4.21 years among the participants. Mean height was 165 ± 7.43 centimeter, and mean weight was 52.21 ± 3.25 kilograms. Mean body mass index (BMI) was 18.11 ± 0.23 kg/m².Cesarean delivery was reported among 73 (18.2%), pre-eclampsia in 57 (14.2%), preterm delivery in 165 (41.1%) and low-birth-weight babies were 126 (31.5%). Conclusions: The results reported an upsurge in the incidence of undesirable pregnancy outcomes such as preterm births and low birth weight babies among underweight first-time mothers. Proper counselling of these cases regarding weight gain before conception can help to lessen these adverse events and can be helpful in subsequent pregnancies.

Enhancing Diagnostic Precision and Clinical Outcomes with FNAC in Parotid Gland Masses

2025-08-04T11:57:04+00:00

Parotid gland tumors present with diverse histopathological profiles, making accurate preoperative diagnosis essential for appropriate management. Fine Needle Aspiration Cytology (FNAC) provides a minimally invasive technique to differentiate between benign and malignant lesions. Objectives: To evaluate the diagnostic accuracy of ultrasound-guided FNAC, categorized using the Milan System, in parotid gland masses by correlating cytological findings with final histopathological diagnoses. Methods: A prospective observational study was conducted over 12 months, involving 100 patients with clinically suspected parotid gland tumors at a tertiary care center. Patients were enrolled based on predefined inclusion and exclusion criteria. Ultrasound-guided FNAC was performed using 22-gauge needles, and aspirates were categorized per the Milan System. All participants subsequently underwent parotidectomy, and histopathology was used as the reference standard. Data analysis was conducted using SPSS version 26.0 to determine sensitivity, specificity, predictive values, and overall diagnostic accuracy. Results: Among the 100 cases, FNAC classified 48 as benign, 12 as malignant, and 5 as non-diagnostic. The most frequent benign and malignant tumors were pleomorphic adenoma (41%) and mucoepidermoid carcinoma (14%), respectively. FNAC demonstrated a sensitivity of 90.4%, specificity of 96.1%, positive predictive value (PPV) of 92.3%, negative predictive value (NPV) of 94.8%, and an overall accuracy of 93.5%. The highest diagnostic concordance was observed in Milan categories IVa and VI. Conclusions: It was concluded that FNAC, when guided by ultrasound and interpreted through the Milan System, demonstrates high diagnostic accuracy for parotid masses. It is a cost-effective first-line diagnostic tool, especially beneficial in resource-limited settings.

Frequency of Septal Perforation in Submucous Resection of Nasal Septum

2025-08-04T11:56:54+00:00

Deviated nasal septum (DNS) is a frequent cause of nasal obstruction and is commonly treated through submucous resection (SMR). Although effective, SMR carries a risk of septal perforation, which can lead to long-term morbidity. Objectives: To determine the frequency of septal perforation following submucous resection (SMR) of the nasal septum using the tunnel-in technique. Methods: This descriptive observational study was conducted at the Department of ENT, Lady Reading Hospital, Peshawar, from September 2024 to February 2025. A total of 203 patients aged 18–60 years undergoing SMR for symptomatic DNS were enrolled through consecutive non-probability sampling. Patients with prior nasal surgery, trauma, or coexisting nasal pathology were excluded. All surgeries were performed by ENT consultants using a standardized technique. Septal perforation was assessed via endoscopy on the 10^th postoperative day. Results: Out of 203 patients, 43 (21.2%) developed septal perforation. The mean age was 38.96 ± 12.74 years; the mean disease duration was 19.52 ± 10.46 months. Perforation showed a significant association with gender (p=0.005) and age group (p=0.025), while no significant link was found with the side of deviation or disease duration. Conclusions: Septal perforation was a relatively common postoperative complication of SMR, with higher occurrence in females and older individuals. Careful patient selection and surgical precision are key to reducing risk.

Assessing the Effect of Hormonal Contraceptives on Oxidative Stress and Lipid Metabolism in Reproductive Age Women

2025-08-04T11:56:53+00:00

Women of reproductive age frequently use hormonal contraceptives for family planning and regulating menstrual cycles. There is growing apprehension, however, regarding the potential long-term metabolic and cardiovascular effects of these contraceptives due to their impact on oxidative stress and lipid metabolism. Objective: To assess the impact of hormonal contraceptive use on oxidative stress markers and lipid profile parameters in reproductive-age women. Methods: This comparative cross-sectional study encompassed 150 women aged 18 to 40 years, evenly split into users and non-users of hormonal contraceptives. From each participant, blood samples were drawn to assess oxidative stress Markers Malondialdehyde (MDA), Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), catalase, Glutathione Peroxidase (GPx), as well as lipid profile parameters such as total cholesterol, triglycerides, LDL-C, HDL-C, and the LDL/HDL ratio. For the analysis, appropriate parametric and non-parametric tests were applied for the statistical comparisons. Results: Hormonal contraceptive users had significantly higher MDA levels and reduced TAC, SOD, GPx, and catalase activity, indicating elevated oxidative stress and impaired antioxidant defenses (p < 0.001). Lipid profile analysis revealed significantly increased total cholesterol, triglycerides, and LDL-C, along with reduced HDL-C and elevated LDL/HDL ratios among users compared to non-users (p < 0.001). Conclusions: Hormonal contraceptive use in reproductive-age women is associated with increased oxidative stress and an unfavorable lipid profile. These biochemical alterations may raise the risk of cardiovascular complications with long-term use. Regular monitoring and preventive strategies, including lifestyle counseling and antioxidant support, may help mitigate these risks.

Frequency of Hypertension in Patients with Intracranial Hemorrhage Presenting to Emergency Department

2025-08-04T11:56:59+00:00

Intracranial haemorrhage is a serious neurological emergency with high morbidity and mortality. Hypertension is a known major risk factor; however, local data regarding its frequency in intracranial haemorrhage patients remain limited. Objectives: To determine the frequency of hypertension among patients with intracranial haemorrhage presenting to the Emergency Department (ED) of Lady Reading Hospital, Peshawar. Methods: This cross-sectional study was conducted at the ED of Lady Reading Hospital from April to September 2023. A total of 182 patients aged 30–70 years, diagnosed with intracranial haemorrhage via CT scan, were enrolled using consecutive sampling. Blood pressure, BMI, demographic data, and socioeconomic status were recorded. Hypertension was defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or self-reported antihypertensive medication use. Data were analyzed using SPSS version 26.0, with the chi-square test (p<0.05 considered significant). Results: Patients had a mean age of 50.24 ± 12.24 years and a mean BMI of 25.74 ± 4.41 kg/m². Hypertension was found in 155 patients (85.2%). There were no significant associations between hypertension and gender (p=0.364), age groups (p=0.817), or socioeconomic status (p=0.613). Conclusions: Hypertension prevalence was high among intracranial haemorrhage patients. This emphasizes the need for improved hypertension management and preventive strategies in the community.

Effects of Home Blood Sugar Monitoring on HbA1c Among Diabetes Mellitus Patients Attending a Tertiary Care Hospital in Peshawar

2025-08-07T06:25:39+00:00

Diabetes mellitus (DM), encompassing both type 1 and type 2, has escalated worldwide over the last twenty years, resulting in elevated death and morbidity rates. Prior research indicates that home blood glucose monitoring enhances metabolic control and aids in alleviating the atherosclerotic effects of type 2 diabetes mellitus. Objectives: To evaluate the effect of home blood glucose monitoring on HbA1c levels among diabetic patients at Lady Reading Hospital (LRH), Peshawar. Methods: This quasi-experimental study was performed over six months in the Department of General Medicine at LRH, Peshawar, including 62 diabetic patients. Participants were directed to assess fasting blood glucose thrice weekly for three months, maintaining their existing medical care. HbA1c was measured before and during the intervention. Means and standard deviations were used to evaluate continuous variables in SPSS version 22.0. A paired t-test was used to compare pre- and post-intervention mean HbA1c levels, with p < 0.05 indicating statistical significance. Results: The mean age of participants was 45 ± 12.29 years, with 61% male and 39% female. The average diabetes duration was 10 ± 5.8 years. Pre-monitoring HbA1c was 9.62 ± 1.87%, which significantly reduced to 8.02 ± 1.19% after three months (mean difference=1.6%, p=0.0001). Significant reductions were observed across all age groups, genders, weight categories, and diabetes durations (p<0.05). Conclusions: Home blood glucose monitoring significantly improves glycemic control in diabetic patients, as evidenced by the reduction in HbA1c levels, consistent across various demographics.

Serum Adiponectin Levels and Their Association with Age, Gender and Waist Circumference: Insights from a Cross-Sectional Study

2025-08-15T11:39:16+00:00

Adipose tissue secretes the adipokine adiponectin, which is essential for insulin sensitivity, cardiovascular health, and metabolic control. Although prior studies suggest that age and waist circumference (WC) influence adiponectin levels, contradictory results indicate the need for further research. Objectives: To evaluate and compare serum adiponectin levels among individuals of different age groups and waist circumference categories. Methods: A cross-sectional study was conducted with 50 individuals. Age, WC, body mass index (BMI), and gender were among the anthropometric information gathered. Spearman's correlation was used to test serum adiponectin levels and their relationships with these factors. The threshold for statistical significance was p<0.05. Results: The average amount of adiponectin in the blood was 5.59 ± 1.94 ng/mL. Adiponectin did not significantly correlate with either WC (r=+0.17, p=0.16) or age (r=-0.06, p=0.60). Furthermore, although somewhat higher in females, adiponectin levels did not significantly correlate with either gender (p=0.47) or BMI (r=+0.10, p=0.37). Conclusion: It was concluded that results show no significant relationships of adiponectin with WC, in contrast to previous research that found an inverse link with WC or an age-related increase in adiponectin. This could be the result of unmeasured confounding variables, including food and lifestyle, sample size restrictions, or demographic characteristics. More extensive research is needed to elucidate these connections and investigate adiponectin's potential as a biomarker for metabolic diseases.

Beyond the Gag Reflex: Understanding Soft Palate Variations for Better Dental Care

2025-08-15T11:38:40+00:00

The gag reflex is a defense process to protect the airway from irritants. In a few patients, exaggerated reflexes jeopardize the dental treatment and compromise the dental procedures. Objectives: To evaluate the potential association of the severity of gag reflex with types of soft palate in patients attending to prosthodontic clinic and to find out the association within gender, age groups. Methods: A cross-sectional observational study included 250 patients of both genders who needed dentures, were selected. Gag reflex was checked by touching the anterior to posterior part of the maxilla and mandible with a dental mirror while taking impressions. Gag Reflex Index (GRI) was used for the assessment of gag response. The reaction of the patients was recorded on V grades. The types of soft palates were classified via house classification as I, II, and III. Results: The soft palate forms frequently observed were soft palate drop type I, 60.0% followed by type II, 31.6 % and 8.0 % patients had type III soft palate drop. The gag reflex grade V was 5.6 %, grade IV was 4.8 %, grade III was 8.4%, grade II was 22.0 % and grade I was 59.2%. The association of gag reflex grades with gender and types of soft palate drop was found to be significant, 0.02 and 0.00. However, with different age groups, insignificant results were obtained, p 0.07. Conclusions: The study concluded that the severity of gagging is found more in female patients and patients with type II and III soft palatal anatomy. Dentists need to evaluate different soft palatal types, especially when dealing with female patients needing prosthodontic treatment.

Impact of Formative Feedback on Skill Acquisition in Simulation-Based Training

2025-08-15T11:38:38+00:00

Simulation-based learning is widely used in healthcare education to teach clinical skills in a safe, structured environment. However, the integration of systematic formative feedback within simulation remains inconsistent, particularly in undergraduate programs. Objectives: To evaluate the impact of structured formative feedback on clinical skill acquisition, self-reported confidence, and learner satisfaction among undergraduate students in medicine, dentistry, and nursing. Methods: A quasi-experimental study was conducted at Rawal Institute of Health Sciences with 72 undergraduate students. Participants were recruited via convenience sampling and randomly assigned to either a feedback group or a control group (n=36 each). Both groups performed the same simulation tasks, but only the feedback group received structured, real-time formative feedback after the initial assessment. Data collection included pre- and post-test knowledge scores, Objective Structured Clinical Examination (OSCE) performance, confidence rating scales, and satisfaction questionnaires. Data were analyzed using SPSS version 26.0. Results: The feedback group showed significantly higher post-test and OSCE scores compared to the control group (p<0.001), with large effect sizes (Cohen’s d >1.5). Improvement scores and post-training confidence ratings were also significantly greater in the feedback group. Learner satisfaction scores in the feedback group were consistently high across all domains. Conclusions: Structured formative feedback in simulation-based training leads to substantial improvements in clinical performance, learner confidence, and satisfaction. These findings support the routine incorporation of feedback into undergraduate simulation curricula, particularly in resource-limited educational settings.

Efficacy of Percutaneous Nephrolithotomy in Pediatric Renal Stone Clearance in Khyber Pakhtunkhwa: A Cross-Sectional Analytical Study

2025-08-15T11:38:37+00:00

Renal stone disease is increasingly recognized in the Pediatric population and poses significant clinical challenges. Timely and effective intervention is essential to prevent long-term complications such as recurrent infections, renal damage, or impaired growth. Percutaneous nephrolithotomy (PCNL) has emerged as a key surgical technique in managing moderate to large renal stones in children, but data on its efficacy and safety in the local context remain limited. Objectives: To assess the effectiveness of PCNL in achieving renal stone clearance in Pediatric patients aged 5 to 15 years presenting to a tertiary care centre in Khyber Pakhtunkhwa. Methods: This descriptive study was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar. A total of 216 children with uncomplicated, single renal stones measuring ≤8 mm, confirmed on a KUB X-ray, were enrolled through consecutive non-probability sampling. Standard PCNL was performed under general Anesthesia, and clearance was assessed postoperatively. Data were analyzed using SPSS version 23.0. Chi-square test was used for associations between stone clearance and variables age, gender, stone size, site, and operative time. Results: Stone clearance was achieved in 78.2% of cases. Clearance was higher in children with smaller stones (≤5 mm) and shorter operative times, though the differences were not significant (p>0.05). No major procedural complications were reported. Conclusions: PCNL is an effective and safe procedure for treating Pediatric renal stones. While factors like stone size and operative duration may influence outcomes, further large-scale studies are warranted to confirm these associations in the Pediatric population of low-resource settings.

Prevalence and Associated Factors of Obesity in Children Aged 2-11 Years at a Tertiary Care Hospital in Islamabad

2025-08-15T11:39:14+00:00

Childhood obesity is a rising health concern globally, with an increasing trend in many low middle-income countries like Pakistan, due to rapid urbanization and lifestyle changes like unhealthy dietary practices and lack of physical activity. Objectives: To find out the prevalence of obesity and some associated variables, such as demographic, socioeconomic, and lifestyle factors, among the children aged 2 to 11 years visiting a tertiary care hospital in Islamabad, Pakistan. Methods: The study was conducted from May 10, 2024, to November 10, 2024, at the Pediatric Department of the Avicenna Medical Complex in Islamabad. 220 children aged 2-11 years were recruited using consecutive sampling. Obesity was defined as a BMI ≥ +2SD on WHO percentile charts, and data related to its associated factors were collected. SPSS version 26.0 was used to analyze data and report descriptive statistics; chi-square tests were performed to determine statistical significance. Results: The prevalence of obesity was 7% (n=15). Among participants, 57% were aged 2-6 years, 59% were male, and 63% resided in rural areas. An insignificant association was found between obesity and age, gender, socioeconomic status, or family history (p>0.05). A higher obesity trend was observed in urban areas (11%) than rural areas (4%), though it was statistically insignificant (p=0.0538). Most of the children were physically active (88%), with high obesity (54%) reported in inactive children. Conclusions: Childhood obesity was low, with no significant associations found with key demographic or socioeconomic factors. However, urban residence and physical inactivity showed trends toward higher obesity risk.

Association of Gastro-Esophageal Reflux Disease with Persistent Cough in Infants

2025-08-15T11:38:41+00:00

Gastroesophageal reflux disease (GERD) is widely recognized, alongside upper airway cough syndrome (also known as postnasal drip syndrome) and eosinophilic airway inflammation, as one of the predominant causes of chronic cough. Numerous global respiratory societies have published cough management guidelines that advocate for the assessment and treatment of GERD as a fundamental aspect of the diagnostic and therapeutic framework for addressing chronic cough. Objectives: To determine the association of gastroesophageal reflux disease with persistent cough in infants. Methods: This case-control study was conducted in the Department of Paediatric Medicine at The Children's Hospital and The Institute of Child Health, Lahore, from August 25, 2022, to February 25, 2023. This study was conducted on infants with complaints of persistent cough and healthy controls. These two groups underwent baseline assessment carried out by physicians and a diagnosis of GERD was made through a barium swallow test. The data were analyzed through SPSS version 25.0. Odds ratio (OR) was calculated to measure the association between persistent cough and GERD. Results: Among case patients, the mean age was 2.92±2.17 months, and 3.67±2.41 months among control patients. By comparing GERD between case and control groups, it was found that the percentage of GERD was 17.6% in case children and 5.9% control children. The difference was significant (p=0.033) and the risk ratio (OR=3.429). Conclusions: The presence of gastroesophageal reflux disease exhibited a notable correlation with the occurrence of chronic cough in the infant population.

Association of Xerostomia with Diabetes a Cross Sectional Study in Subset of Karachi

2025-08-15T11:39:13+00:00

Xerostomia, is a common oral symptom of Diabetic Mellitus (DM). It has a detrimental impact on clinical procedures and outcomes due to decreased saliva. Considering its impact on oral cavity and dental procedures it is important to identify the Association of xerostomia with diabetes. Objective: To identify the prevalence and association of xerostomia in diabetic patients subset of Karachi. Methods: It was a cross sectional study conducted from January 2024 to October 2024. The calculated sample size was 63 which was increased to 75. Patients reporting to OPD with history of diabetes were recruited and they were advised to get their HbA1c and random blood sugar level (RBS) checked. After getting their HbA1c and RBS reports their stimulated salivary flow rate was calculated. Stimulated salivary flow less than 0.7ml/min was considered as low. Chi square and independent t-test was applied for comparison at 95% confidence interval and p value less than 0.05 was considered as significant. Results: The xerostomia was found to be present in 47 (62.66%) participants.The salivary flow was identified as 0.46 ± 0.31 in diabetic patients with xerostomia, compared to female, male diabetic patients had less salivary flow at 7.01 ± 0.62 HbA1c and 220.53 ± 5.12 RBS. Conclusions: There was 62.66% prevalence in diabetic patients in the recruited subset of Karachi. Males had more prevalence than females. Higher HbA1c and RBS levels were associated with the presence of xerostomia.

Head and Neck Cancer Reconstruction with or without Internal Lining Using Various Flaps in a Tertiary Care Hospital

2025-08-25T06:39:05+00:00

Reconstructive surgeries of the head and neck with or without the use of internal lining must be thoroughly evaluated for post-operative complications and functional outcomes unclear phrasing. Objectives: To compare the surgical outcomes, complication rates, and functional outcomes of head and neck cancer reconstruction surgeries performed with or without internal lining using various flap techniques in a Tertiary Care Hospital setting. Methods: This one-year prospective comparative study at Al-Tibri Medical College included 139 head and neck cancer patients undergoing resection and reconstructive surgery with or without internal lining. Data on demographics, tumor, surgical, and postoperative outcomes were analyzed using SPSS version 23.0, applying appropriate statistical tests with significance set at p<0.05. Results: From 139 patients, operative time was significantly longer in Group A (with flap and internal lining) than in Group B (p<0.001). Postoperative complications were more common in Group A, with higher rates of wound infection (15.7% vs. 5.8%, p=0.04) and overall complications (28.6% vs. 11.6%, p=0.01). Functional outcomes favored Group B, with significantly better swallowing (82.6% vs. 55.7%, p=0.007) and speech intelligibility (79.7% vs. 60%, p=0.04). Hospital stays over 7 days were more common in Group A (35.7% vs. 14.5%, p=0.009). The need for secondary intervention was higher in Group A, but not statistically significant. Overall, Group B demonstrated fewer complications and better postoperative functional recovery. Conclusions: Head and neck reconstruction without internal lining resulted in fewer complications, shorter hospital stay, and better functional recovery than reconstruction with internal lining. Careful patient selection can optimize outcomes and surgical efficiency.

Time to Complete Retinal Vascularization After Anti-VEGF Among Preterm Neonates in Pakistan

2025-08-25T06:39:08+00:00

Retinopathy of prematurity (ROP) is a leading cause of preventable blindness in children. Anti-VEGF agents are widely used for treatment, but they pose concerns regarding delayed or incomplete retinal vascularization. There is limited local data on the vascularization timeline in Pakistani preterm neonates following anti-VEGF therapy. Objectives: To determine the time required to achieve complete retinal vascularization after intravitreal anti-VEGF injection in preterm neonates with ROP and to identify clinical predictors influencing this timeline. Methods: This prospective cohort study was conducted over 1.5 years from December 2023 to May 2025 at the neonatal nursery of the Pediatric Ward, Liaquat University of Medical and Health Sciences, Jamshoro. A total of 63 preterm neonates with treatment-requiring ROP received either Bevacizumab or Ranibizumab. Demographic, clinical, and treatment-related data were collected. Time to complete vascularization and postmenstrual age (PMA) at vascularization were recorded. ANOVA was used to assess statistical differences between subgroups. Results: The mean time to complete vascularization was 10.5 ± 2.0 weeks’ post-treatment, with a PMA of 44.5 ± 2.1 weeks. Delayed vascularization (>50 weeks) occurred in 8.5% and reactivation in 6.4% of neonates. Stage 3 ROP, Zone I disease, and Bevacizumab were associated with slightly longer vascularization times, but none of these comparisons were statistically significant (p>0.05). Conclusions: Retinal vascularization typically completes within 10–12 weeks after anti-VEGF therapy. Although not statistically significant, trends suggest extended follow-up is advisable in neonates with more severe disease or ZONE I ROP.

Acceptance of Post-Partum Intrauterine Contraceptive Device During Cesarean Section

2025-08-25T06:39:09+00:00

The world population is increasing, and approximately 115 million women have unmet needs for family planning. Institutional deliveries are increasing. Institutional deliveries and cesarean sections provide an excellent opportunity to provide women with a long-term, safe, effective and reversible method of contraception in the form of Post-Partum Intrauterine Contraceptive Device (PPIUCD). Objective: To assess the acceptability of PPIUCD as a method of family planning. Methods: A descriptive cross-sectional study was conducted on patients undergoing elective or emergency cesarean sections (C-section) in the Department of Obstetrics and Gynaecology, Social Security Teaching Hospital, Multan Road, Lahore. 116 women were counselled, and in those who opted for it, an IUCD was placed inside the uterus after delivery of the placenta during C-section. This study set 95% confidence (Z=1.96) expected prevalence p from prior literature/pilot, and a conventional margin of error d=0.05 (typical range 0.03–0.05). Where applicable, the study applied finite population correction, then inflated for design effect (if clustered) and 10% nonresponse. Results: Total acceptance rate was 38.79%. The majority of the patients belonged to the age group 19 to 30 years, and the mean age was 30.42 ± 5.28 years. Parity was >2 in 56.9% patients, while in 43.1% parity was ≤2. 24.14% clients were uneducated, and 76.72% belonged to a poor socio-economic group. Conclusions: PPIUCD as inserted during cesarean section is an effective, acceptable and safe method of contraception, with the rate of acceptance of 38.79 %. Previous cesarean history and proper counselling enhance acceptance.

Frequency and Pattern of Congenital Heart Disease in Term Neonates Presenting in Respiratory Distress at Tertiary Care Hospital, Larkana

2025-08-25T06:39:06+00:00

Congenital heart disease (CHD) is a leading cause of infant morbidity and mortality. This is particularly the case in resource-limited settings where diagnosis is commonly delayed. Objectives: To assess the frequency and pattern of CHD among term neonates who presented with respiratory distress at a tertiary care hospital in Larkana, Pakistan. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan, from December 1, 2024, to June 7, 2025. A total of 105 term neonates presenting with respiratory distress were enrolled. Each neonate underwent detailed clinical examination and echocardiographic evaluation to identify structural heart defects. Demographic and perinatal data were also collected to explore associations with different CHD types. Statistical analysis was performed using SPSS version 22.0. Results: CHD was diagnosed in 41.9% of the neonates. The most common defect was a ventricular septal defect (24.8%), followed by an atrial septal defect (15.2%) and patent ductus arteriosus (12.4%). Cyanotic defects were less frequent, with tetralogy of Fallot identified in 6.7% and transposition of the great arteries in 2.9%. No statistically significant associations were found between CHD and neonatal age, gender, or mode of delivery. Conclusions: A significant proportion of term neonates with respiratory distress had underlying CHD, with acyanotic lesions being more common. These findings support the incorporation of routine echocardiographic screening and timely specialist referral for symptomatic neonates, particularly in resource-constrained healthcare settings.

Clinical Profile and Predictors of Posterior Reversible Encephalopathy Syndrome at Tertiary Care Hospital, Peshawar

2025-08-25T06:39:11+00:00

Posterior Reversible Encephalopathy Syndrome is an acute neurological condition characterized by reversible subcortical vasogenic edema, often presenting with seizures, headache, visual disturbances, and altered mental status. Objectives: To evaluate the clinical profile, risk factors, radiological findings, and outcomes of Posterior Reversible Encephalopathy Syndrome patients at a tertiary care hospital in Peshawar. Methods: This prospective cohort study was conducted at Northwest General Hospital and Research Center, Peshawar, from January 2023 to March 2025. Ninety patients diagnosed with Posterior Reversible Encephalopathy Syndrome through clinical presentation and Magnetic Resonance Imaging confirmation were enrolled using non-probability consecutive sampling. Data on demographics, risk factors, symptoms, imaging, outcomes, and length of hospital stay were collected and analyzed. Descriptive analysis of the study was performed through SPSS version 25.0. Results: Among 90 patients, 61 (67.8%) were females, 29 (32.2%) were males. The mean age was 35.92 ± 3.16 years. Seizures (70%), headache (56.7%), and altered mental status (54.4%) were the most common symptoms. Hypertension (53.3%) and postpartum eclampsia (50.8% of females) were the leading risk factors. Magnetic Resonance Imaging showed parieto-occipital/cerebellar involvement in 74.4% and bilateral lesions in 96.7%. Most patients (92.2%) recovered and were discharged, while 7.8% passed away. Conclusions: Posterior Reversible Encephalopathy Syndrome is more prevalent in young females with underlying hypertension or postpartum complications. Early recognition and management can result in favorable outcomes. This study highlights the importance of timely diagnosis to prevent irreversible damage.

Level of Integration in Modular System Curriculum in Medical Colleges of KPK, Pakistan

2025-08-25T06:39:33+00:00

Integrated medical education links basic sciences with clinical exposure, enhancing critical thinking. The World Federation of Medical Education (WFME) standards now require integrated teaching for graduates seeking US residency. KPK implemented Harden’s Ladder integration in 2018, but the extent of its integration is unknown. Objective: To assess the integration level using Harden's Ladder of Integration of medical colleges in KPK and examine variations across institutions, faculty profiles, and demographic data. Methods: A cross-sectional study was conducted from October 2024 to February 2025 across 13 public and private medical colleges within KPK. Faculty members received a validated questionnaire based on Harden's Ladder, which was distributed through convenience sampling. The study employed Chi-square and Fisher's exact tests to investigate the relationship between faculty demographics and levels of integration. Results: 99 faculty members participated. All faculty members reported full implementation of Step 5, which represents temporal coordination, whereas Steps 7-11 showed implementation in ≤50% of colleges (7 colleges). Senior faculty members with >3 years of experience observed better integration levels. The statistical analysis revealed significant institutional differences (p < 0.05) that were evenly distributed across colleges. Conclusions: Temporal coordination (Step 5) is fully implemented, but advanced integration is inconsistent. Faculty/institutional factors significantly influence outcomes, potentially compromising WFME accreditation requirements for US residency eligibility. Targeted interventions are recommended to bridge this gap.

Multi-Epigenetic Landscapes of Schizophrenia

2025-08-04T11:57:01+00:00

Schizophrenia is a debilitating neurodevelopmental disorder affecting approximately 1% of the global population. Traditional genetic models have provided limited insight into its complex etiology. This review synthesizes recent advances in epigenetic research related to schizophrenia, focusing on dynamic and reversible genome modifications. The study analyzed multi-omics and epigenomic profiling studies published between 2020 and 2025 that explore DNA methylation, histone modifications, non-coding RNAs and gene–environment interactions in schizophrenia. Epigenetic mechanisms, including DNA methylation, chromatin remodeling and non-coding RNAs, mediate environmental influences during critical neurodevelopmental periods, contributing to long-term gene expression changes associated with schizophrenia. These findings integrate genetic liability with environmental exposures and highlight potential biomarkers and therapeutic targets. Understanding schizophrenia through the lens of epigenetics may inform novel diagnostic and treatment approaches, advancing precision psychiatry.

Nutritional Knowledge and Health Behaviour Related to CVD, Narrative Review

2025-08-04T11:58:04+00:00

Cardiovascular disease is the leading cause of death worldwide. A person's diet plays a critical role in their cardiovascular health and is linked to the progression of heart-related diseases. Several scientific researchers have demonstrated an association between dietary habits, lifestyle, and Cardiac diseases. This narrative review aims to demonstrate the present state of scientific evidence on nutritional knowledge and health behaviour related to CVD (Cardiovascular Diseases). The review focuses on the impact of dietary patterns and lifestyle on the risk factors of CVD, summarizing facts from surveys, population-related scientific trials, observational research, and meta-analyses. Unhealthy dietary behaviours and lifestyle, for instance, high consumption of saturated fatty acids, red and processed meat, refined carbohydrates, sugar-sweetened beverages and excessive salt, have been related to an amplified possibility of CVD. On the contrary, increasing consumption of a plant-centred diet, such as food fiber, fruits, vegetables, and nuts, has been shown to reduce CVD risk-related factors. The Mediterranean diet is considered to be a well-supported dietary pattern for prevention. This review offers novel understandings into diet-related factors that are either harmful or beneficial in the context of CVD and suggests potential strategies for improving cardiovascular health. The implications of these findings put forward a need for healthcare providers to enhance their discussions with female patients about CHD, providing targeted education on its prevention.