Pakistan Journal of Health Sciences

Obesity and Life-Related Disorders

2025-06-05T09:37:34+00:00

Obesity has turned into a global public health emergency with its impact on millions and causing a mass increase in life-style diseases encompassing type 2 diabetes, cardiovascular diseases, hypertension and others cancers.

This pandemic is not only a personal health crisis, but also a societal issue that requires a holistic intervention that goes beyond effective cure and strong preventive strategies.

Managing obesity and the related disorders demands a multi-faceted strategy. For the most severe, medical therapies (e.g, bariatric surgery) can achieve great weight loss and result in improvements of conditions including diabetes. In fact, progress has been made in the area pharmacotherapy with drugs like GLP-1 receptor agonists providing hope to treat a weight and metabolic health derangements. But, these therapies are expensive and don’t reach all especially in the low-income regions. At present, lifestyle interventions such as diet modifications and increased physical activity are the mainstays of obesity management. A few programs such as nutritional counseling integrated with exercise regimens have delivered sustainable results, although retention is a problem due to time constraints, loss of motivation, or socioeconomic disadvantages.

Treatment is important above all, and prevention should be the number one goal to stop this obesity epidemic. Awareness-driven public health campaigns may increase knowledge of healthy eating and active living, but they need to be combined with systemic shifts. The government should set some policies to for example tax sugar-sweetened beverages and mandate clear nutritional label, subsidize fresh produce. Schools have a critical role by embedding nutrition education and physical activity into curriculums that encourage lifelong habits. Walkable cities, and access to recreational spaces through improving urban planning can also facilitate movement.

Harmful social determinants of health are also addressed by community-based initiatives such as cooking or fitness groups that reach people who do not have the benefit of stronger support systems.

Addressing basic factors of health will attend to social determinants of obesity. Obesity, exacerbated by poverty stress and poor healthcare access. Targeted community-level interventions, such as providing free or reduced-cost health screenings, can bring attention to and alleviate the problem prior to full-blown disease. For example, technology such as wearables and remote patient monitoring are being used to track health indicators and wellness behaviors.

Obesity is a multifaceted problem that involves biology, environment and culture. Maybe treatments can, to some degree, decrease incidence but prevention driven policy and education with equitable access to resources has to be the answer if we want to stop this from dramatically increasing. Societies can reduce obesity and noncommunicable disease epidemics through health-promoting, empowering cultures that enable healthier lives.

Association of Glycated Hemoglobin and Microalbuminuria with Renal Function Parameters in Type 2 Diabetic Patients

2025-06-05T09:37:56+00:00

One of the most serious complications of type 2 diabetes (T2DM) is diabetic nephropathy, which can eventually lead to kidney failure. While microalbuminuria is commonly used to detect early kidney damage, relying on it alone may not be enough. Additional markers could help improve early detection and timely treatment. Objectives: To look at how HbA1C levels, a key indicator of blood sugar control, relate to microalbuminuria in people with T2DM. Also, to explore how HbA1C correlates with other markers of kidney function, including the albumin-to-creatinine ratio (ACR), serum urea, creatinine, fasting blood sugar (FBS), and random blood sugar (RBS). Methods: The study included 250 participants: 200 patients with T2DM and 50 healthy individuals matched by age and sex. Those with hypertension, kidney disease, urinary tract infections, or other health issues were excluded. Blood and urine samples were collected. Hemoglobin A1C was measured using high-performance liquid chromatography (HPLC), and A1C was calculated. Data were analyzed using SPSS-20, and correlations were assessed with Pearson’s coefficient. Results: Compared to healthy controls, diabetic patients had significantly higher levels of FBS, RBS, HbA1C, serum urea, creatinine, and microalbuminuria. Higher HbA1C levels were linked with worse kidney function, suggesting that poor blood sugar control may signal early kidney damage. Conclusions: It was concluded that monitoring both HbA1C and microalbuminuria offers a better chance of catching kidney problems early in T2DM patients. Adding both markers to routine screenings could help delay or prevent serious kidney issues.

Comparison of Operative Outcomes of Open Thyroidectomy with Electrothermal Bipolar Vessel Sealer versus Conventional Hemostasis for Benign Thyroid Swelling in Adults Population

2025-06-05T09:37:45+00:00

Precise dissection and effective hemostasis are crucial for safe thyroid surgery. The bipolar vessel sealer, a first-generation electrosurgical instrument, is widely used in thyroidectomies to improve hemostasis, reduce tissue trauma, shorten surgery time, and eliminate the need for sutures. Objective: To compare the operative outcomes of electrothermal bipolar vessel sealer in total thyroidectomy. Methods: At the Department of Surgery, Sir Ganga Ram Hospital, from August 2024 to January 2025, a quasi-experimental study was carried out, involving 80 patients undergoing total thyroidectomy. Exclusion criteria included patients with significant comorbidities, bleeding disorders, or renal and liver dysfunctions. The study participants were divided into two groups: Group A (bipolar vessel sealer) and Group B (clamp-and-tie technique). Primary outcomes included surgery duration, intraoperative blood loss, and hospital stay. Data were entered and analyzed by SPSS version 25.0. Results: The average age of patients was 35.5 ± 4.9 years. Group A had 70% female and 30% male, while Group B had 77.5% female and 22.5% male. Group A had significantly shorter hospital stays (3.8 ± 1.2 days) compared to Group B (5.2 ± 2.3 days, p=0.000). Intraoperative blood loss was significantly lower in Group A (109.7 ± 7.3 mL) compared to Group B (154.3 ± 6.7 mL, p<0.000). Surgery duration was longer in Group A (121.3 ± 13.1 minutes) than in Group B (94.3 ± 11.3 minutes, p<0.05). Conclusions: It was concluded that the bipolar vessel sealer in total thyroidectomy for benign thyroid swelling is effective, and results in shorter hospital stays without increasing complications or costs.

Reliability of Mandibular Plane in Determining Gonial Angle on Lateral Cephalogram

2025-06-05T09:37:48+00:00

Gonial angle is an essential cephalometric indicator used in orthodontic diagnosis and treatment planning. The precise evaluation of the gonial angle is vital for understanding mandibular growth patterns and formulating efficient treatment strategies. Objectives: To assess the mean gonial angle according to the three mandibular planes, Tweed's, Steiner's, and Down's, on lateral Cephalogram and panoramic radiograph for Orthodontic Diagnosis and Treatment Planning. Methods: The Descriptive Cross-Sectional Survey was performed in the Orthodontics Department, Lahore Medical and Dental College (LMDC). Lateral Cephalogram and Ortho-pantomography (OPG) of 100 patients were used. The Gonial angle was assessed on the OPG by drawing a tangent to the lower border of the mandible and the most distal point of the ascending ramus and condyle. On the Lateral Cephalogram, however, the Gonial angle was measured by drawing a tangent to the posterior border of the ramus and making three mandibular planes according to Down, Tweed, and Steiner analysis. The Gonial angle assessed on the lateral Cephalogram was compared to that on OPG to evaluate which plane provides the gonial angle value closest to that obtained on OPG. All data were collected and recorded on a Performa. Results: The mean gonial angle on lateral Cephalogram was 123.06 ± 6.80º, 121.5 ± 6.40, and 123.77 ± 6.43 using Tweeds, Steiner's, and Downs mandibular planes, respectively, and on OPG, the mean gonial angle was 123.45 ± 6.89. Conclusions: It was concluded that Down’s mandibular plane provides the Gonial angle reading that is closest to that found on OPG.

Frequency of Diabetic Nephropathy among Patients of Type 2 Diabetes Mellitus

2025-06-05T09:38:07+00:00

Diabetic Nephropathy (DN) is a predominant consequence of Type 2 Diabetes Mellitus (T2DM), contributing to chronic renal disease. Objective: To determine the frequency of diabetic nephropathy and its correlation with glycemic control. Methods: A cross-sectional study was conducted at the Nephrology and Diabetic OPD of Lahore General Hospital from July to November 2024. A total of 282 type 2 diabetic patients were enrolled. Clinical evaluation, fundoscopy, neurological examination, and laboratory tests were performed. Diabetic nephropathy was diagnosed based on albuminuria and eGFR. Statistical significance was set at p < 0.05. Results: Out of 282 patients, 150 (53.2%) were males and 132 (46.8%) females. The majority (43.3%) were aged 50–59 years. Microalbuminuria and macroalbuminuria were present in 20.9% and 32.3%, respectively. Mean serum creatinine and eGFR were 1.16 ± 0.53 mg/dL and 68.15 ± 24.58 mL/min/1.73m². Mean HbA1c and FBS levels were 8.40 ± 1.84% and 137.03 ± 19.19 mg/dL. Hypertension was noted in 41.5%. Diabetic nephropathy was significantly more prevalent in those with FBS >140 mg/dL (29.1%) and HbA1c >7.5% (32.6%) compared to those with lower values (p < 0.05). Declining eGFR was also significantly associated with nephropathy, with most cases found in those with eGFR <60 mL/min/1.73m² (p < 0.001). Conclusion: The study revealed a high frequency of diabetic nephropathy in type 2 diabetes, linked to poor glycemic control, declining eGFR and complications.

Identification of Genetic Polymorphism of Centrosomal Protein 290 to Assess Its Role as A Novel Diagnostic and Prognostic Biomarker for Ovarian Cancer

2025-06-05T09:38:05+00:00

Ovarian cancer (OC) is one of the most lethal gynecological malignancies, with the dilemma of diagnosing at an advanced stage due to the lack of sensitive early detection markers. Centrosomal protein 290 (CEP290) is important for various functions within cellular processes, and its genetic changes may contribute to tumor development and progression. Identifying polymorphisms in the CEP290 gene could provide valuable insights into its potential as a novel diagnostic and prognostic biomarker for OC. Objective: To identify genetic polymorphism of CEP 290 in ovarian cancer and to determine its role as a novel prognostic and diagnostic biomarker for OC. Methods: A genetic profiling methodology was utilized to detect single-nucleotide polymorphisms (SNPs) within the CEP290 gene in patients diagnosed with ovarian cancer. Techniques such as polymerase chain reaction (PCR) and DNA sequencing were implemented to ascertain these genetic variations, followed by statistical analysis to evaluate their association with disease susceptibility and prognosis. Results: Two potential SNPs, CXCR2 C+785T and VEGF C+936T, were identified in the CEP290 gene. These polymorphisms may be linked to ovarian cancer pathogenesis, influencing tumor growth, angiogenesis, and immune response mechanisms. Conclusions: It was concluded that this study highlights CXCR2 C+785T and VEGF C+936T as potential SNPs within the CEP290 gene, suggesting their role in ovarian cancer diagnosis and prognosis. Further research with larger cohorts is necessary to validate these findings and discover their clinical utility as predictive biomarkers.

Role of Foley’s Catheter as Intra-Uterine Balloon Tamponade in Controlling Primary Post-Partum Hemorrhage after Vaginal Delivery

2025-06-05T09:39:34+00:00

One of the leading causes of maternal morbidity and mortality is primary post-partum hemorrhage (PPH). The utilization of intrauterine balloon tamponade has drastically reduced this deadly complication. In low-resource areas, the balloon of a 24-French Foley catheter is used for the same purpose. Objectives: To determine the safety and success rate of 24 Fr Foley’s catheter as intra-uterine balloon tamponade in controlling Primary Post-Partum Hemorrhage after vaginal delivery. To determine the amount of bleeding at 15 and 30 minutes after the Foleys insertion to predict failure. Methods: This cross-sectional study included 140 consecutive women with PPH after failed medical treatment. A 24-French Foley catheter was placed in the uterine cavity, and the balloon was filled with 100 ml of normal saline. Bleeding was observed for the next 15 and 30 minutes. Results: The Foley Balloon tamponade was successful in controlling hemorrhage in 125 (89.2%) patients. While 15 (9.8%) patients had failed balloon tamponade. Patients with failed balloon tamponade had a higher rate of anemia, coagulopathy, and more bleeding after delivery, after 15 minutes, and after 30 minutes of Foley balloon placement. The positive predictive value for 150 ml and 200 ml was 0.60 and 0.80, respectively. Conclusions: It was concluded that the 24 Fr Foley is effective in controlling primary post-partum hemorrhage. A blood loss of ≥200 ml after 15 minutes of Foley balloon placement should alert the physician to adopt a more aggressive approach to control bleeding.

Awareness and Knowledge for Risk Factors, Screening, Control of GDM and its Effect among Pregnant Women Visiting Gynae Outpatient Department at Tertiary Care Hospital Bahawalpur

2025-06-05T09:39:36+00:00

This study explores the disparities observed in knowledge and awareness of Gestational Diabetes Mellitus (GDM) among pregnant women attending a military hospital. Objective: To determine the awareness and knowledge on GDM among pregnant mothers during antenatal visit, to identify factors that can influence such knowledge (demographics) population. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Tertiary Care Hospital Bahawalpur during November 24, 2022 till June 23, 2023. The data were collected via face to face interview employing a pretested structured questionnaire and it aimed the risk factors of GDM, history and lifestyle with regard to GDM screening/management. Statistical analysis involved the chi-square tests and ANOVA to investigate associations among demographic variables with knowledge of GDM. Results: Total 196 pregnant women were selected. The pre-pregnancy, mean BMI was 25.00 ± 4.384, mean age was 31.42 ± 8.215 years, and the average fasting glucose level was 96.71 mg/dL (SD = 15.588). Significant associations were found between family history and GDM knowledge (p = 0.004), as well as previous history of GDM and screening awareness (p < 0.001). Conclusions: There was a notable gap in GDM knowledge among pregnant females, influenced by demographic factors. Enhanced targeted educational programs are necessary to improve awareness and management of GDM.

Level of Patient Satisfaction with Mandibular Acrylic Removable Partial Dentures (RPDS) for Different Kennedy Classes

2025-06-05T09:39:54+00:00

Tooth loss affects facial profile, speech, and mastication, limiting social activities. Maintaining oral health involves using prostheses like implants, bridges, and partial dentures, with acrylic polymers being widely used. Various classifications are used for partially edentulous arches, among them Edward Kennedy's classification being the most often accepted. Objective: To assesses patient satisfaction for two months about mandibular Removable Partial Dentures (RPDs) utilizing the Short Assessment of Patient Satisfaction (SAPS) scale from the University of Wollongong's Centre for Health Service Development. Methods: A Cross-sectional observational study was conducted at Outpatient Department (OPD) of prosthodontics, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad. Fifty three patients were selected on Non-probability convenient sampling. Data on comfort, speech, chewing ability, and prosthesis aesthetics were collected at insertion and after two months. The outcomes were categorized using the 5-point rating scale, The Short Assessment of Patient Satisfaction (SAPS). Results: SAPS was significantly differentiated among Kennedy Classifications at the time of insertion, out of 53 patients who were categorized into class 1 to class 4. The mean age of the patients was 39.6 years, 22 patients were very satisfied, 16 satisfied, and 15 not satisfied, with 25 males and 28 females this studies revealed that female patients are more likely to suffer from tooth loss and manage with partial dentures. Conclusion: The majority of patients were satisfied with Mandibular Removable Partial Dentures, with significant differences in SAPS among Kennedy Classifications at insertion and after two months.

Analytical Study of Beneficial Effects of Magnesium Sulfate for the Neuroprotection in Pre-Term Babies in Tertiary Care Hospital Bahawalpur

2025-06-05T09:39:38+00:00

Neonatal morbidity and mortality are greatly influenced by preterm birth. Magnesium sulfate (MgSO4) has been suggested as a neuroprotective therapy to reduce the negative consequences on neurodevelopment in preterm infants. Objective: To investigate how MgSO4 works to reduce the incidence of cerebral palsy as well as other neurodevelopmental impairments in preterm infants. Methods: This quasi experimental study was conducted at Tertiary Care Hospital Bahawalpur in the Department of Obstetrics and Gynecology from September 30, 2022 to March 29, 2023. This research involved 312 preterm infants. The infants were divided to a group of treatment with MgSO4 or compared with a group without MgSO4 exposure. The incidence of intraventricular hemorrhage (IVH), need for mechanical ventilation, neonatal mortality, as well as cerebral palsy were also measured and compared between the groups using Chi-square and T-tests. Results: The administration of MgSO4, dramatically reduced the rate of IVH (6.4%, 16%, p = 0.007 respectively treatment and control group) and neonatal mortality (3.2%, 10.3%, p = .013). It did not significantly affect the need for mechanical ventilation. This proved to be effective in reducing cerebral palsy by 21.8 percentage points (4.5% vs 26.3%, p<0.001). Conclusion: MgSO4 administration antenatally greatly decreases the risks of IVH and neonatal mortality while decreasing the incidence of cerebral palsy in preterm infants, thereby resulting more to be a 'gold standard' neuroprotective strategy in prenatal care.

Etiology of Short Stature in Children Presenting At a Tertiary Care Hospital

2025-06-05T09:37:41+00:00

Short stature is frequently a rationale for consultation with pediatric endocrinology departments. It may arise from a multitude of origins, encompassing both physiological variations and pathological conditions. Objective: To ascertain the prevalence of various etiologies of short stature in pediatric patients attending a tertiary care medical facility. Methods: This cross-sectional study was carried out within the Pediatric Department of Shalamar Hospital, Lahore from August 2024 to February 2025. Subjects comprised 180 children exhibiting short stature as per operational definition, height falling beneath the 3rd percentile or two standard deviations below the mean corresponding to age and gender, included via non-probability consecutive sampling. Comprehensive history taking, physical assessments, anthropometric evaluations, and pertinent diagnostic tests were conducted. Data were analyzed using SPSS version 25.0 and various etiologies of short stature were presented as percentages and frequencies. Data were stratified by age, gender, residence, and socioeconomic status. Results: Familial Short Stature (FSS) constituted the predominant diagnosis among the pediatric population, impacting 20.6% of the subjects, followed closely by Constitutional Delay of Growth and Maturation (CDGM) and Primary Malnutrition, each accounting for 16.1%. Growth Hormone Deficiency (GHD) was identified in 15.6% of cases, while Hypothyroidism was present in 11.1%. Less prevalent etiologies included Celiac Disease (8.3%), Type 1 Diabetes Mellitus (T1DM) (7.8%), and Turner Syndrome, which affected 4.4% of the cohort. Conclusions: The main causes of short stature in children are familial and constitutional growth delay, along with endocrine disorders like hypothyroidism and growth hormone deficiency. Timely intervention is essential for optimal growth potential.

Prevalence of Vitamin D Deficiency in Newly Diagnosed Multiple Myeloma Patients

2025-06-05T09:38:00+00:00

Multiple Myeloma (MM) is a plasma cell disorder with skeletal complications. Vitamin D deficiency may contribute to these complications. Objective: To check vitamin D levels and determine the prevalence of Vitmain D deficiency in newly diagnosed MM patients. Methods: A prospective cross-sectional study was conducted from July 2024 till February 2025 at Liaquat National Hospital, Karachi, including 85 newly diagnosed MM patients. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Demographic and laboratory data, including hemoglobin, calcium, creatinine, LDH, uric acid, and serum protein electrophoresis, were collected. Blood samples for vitamin D analysis were collected in red-top tubes. All the data analysis was done by IBM SPSS Version 22.0. Results: A total of 85 newly diagnosed MM patients (mean age: 55 ± 8.6 years) were evaluated for vitamin D deficiency. Males comprised 54 (63.5%) patients, while females accounted for 31 (36.5%). The mean vitamin D level was 21.79 ± 7.2ng/mL. 56 (65.9%) of the patients had Vitamin D deficiency (<20ng/mL), 22 (25.9%) had insufficiency (20–29ng/mL), and only 7 (8.2%) had sufficient levels (≥30ng/mL). Urban residents had significantly lower vitamin D levels than rural residents (p = 0.03). Conclusions: Vitamin D insufficiency was prevalent in newly diagnosed MM patients and may contribute to skeletal complications. Variations in vitamin D levels based on patient residence suggest further investigation into potential contributing factors.

Comparison of Cut-Off Value of Neutrophil to Lymphocyte Ratio in the Diagnosis of Non-Perforated Versus Perforated Appendix

2025-06-05T09:38:03+00:00

Neutrophil-To-Lymphocyte Ratio (NLR) gives diagnostic clue about non-perforated and perforated appendixes. However, there are many variations in its cut-off values in diagnosis of non-perforated and perforated appendixes, and there is no single value to differentiate severity of appendicitis. Objective: To determine the optimal NLR cutoff value for diagnosing perforated vs. non-perforated appendicitis in patients presenting with acute appendicitis. Methods: This cross-sectional analysis was carried out at Surgical Department of Mayo Hospital, Lahore from July 2022 to January 2023. Total 105 patients with acute appendicitis undergoing open appendectomy were enrolled after written informed consent. The patients were grouped according to perforated and non-perforated appendicitis, and NLR value was compared in both groups. Continuous and categorical variables were presented as mean ± SD and frequency (%). Results: Non-perforated appendix group comprised 84 (80%) patients, whereas perforated appendix group comprised 21 (20%) patients. Mean NLR in perforated appendicitis group was higher as compared to non-perforated group (14.7 ± 12.6 vs. 7.36 ± 8.93, p = 0.01). Cut-off point for NLR was obtained at 5.71, with sensitivity and specificity noted was 66.7 % and 62%, respectively. Conclusions: The study highlighted the potential of NLR as predictive marker for distinguishing between perforated and non-perforated appendicitis. Its clinical utility is supported by identified cut-off value of 5.71, suggesting its role in aiding timely intervention and reducing complications. The findings reinforce the importance of NLR, particularly in identifying patients at higher risk of appendiceal perforation.

The Knowledge, Experiences, and Barriers Associated with Male Involvement in Family Planning at Tehsil Lal Qila, District Dir (Lower), KPK, Pakistan

2025-06-05T09:39:50+00:00

Pakistan is one of the world’s most populous countries, with a high growth rate affecting the country’s socioeconomic progress negatively. Family Planning (FP) can reduce fertility rates, enhance maternal and child health. With the use of FP, mothers will have a low risk of pregnancy-related complications, and the best care can be provided to a child. Moreover, FP has a significant role in accelerating the Sustainable Development Goals (SDGs). Investing in FP will lower poverty and improve economic stability. Objectives: To explore the knowledge, experiences, and barriers associated with male involvement in family planning in Tehsil Lal Qila, Dir Lower, KPK. Also, to propose strategies to promote male participation in FP through improved awareness, accessibility, and inclusion in reproductive health programs. Methods: A qualitative exploratory design was used with a total of 12 in-depth interviews with male clients using a purposive sampling technique. The data were analysed using content analysis. Results: Myths and misbeliefs about FP, the unavailability and unaffordability of contraceptives, pressure from intimate partners and relatives, lack of proper FP services, and gender discrimination were significant barriers to the use of FP. Conclusions: Collaborative efforts among various stakeholders, for instance, community-level awareness campaigns, accessible and affordable FP services, male involvement in healthcare initiatives (alongside females), and improved communication skills among healthcare providers working in FP programs can promote the use of FP.

Assessing Medical Students’ Interest in Community Medicine/Public Health as a Career Path: A Cross-Sectional Study at Sahiwal Medical College, Sahiwal, Pakistan

2025-06-05T09:39:44+00:00

Public health should be the priority of underdeveloped countries like Pakistan to have better management plans for combating diseases. But it was observed that medical students are less interested in a career as a public health specialist, and they are less inclined towards community medicine. Objectives: To determine the preferences of the undergraduate medical students towards the choice of subject for specialization and to determine their attitude towards community medicine as a future career. Methods: A cross-sectional questionnaire-based study was conducted at a public sector medical college of Punjab using a convenient sampling technique. After receiving approval and having informed consent from the 315 study participants, we shared the questionnaire via WhatsApp in the form of Google Forms. The data were then analyzed using SPSS version 26.0. Results: Out of the total 315 participants, 170(54%) were females and 145 (46%) were males. The majority (96%) of the students were inclined towards opting for clinical sciences after graduation. Surgery 139 (44.1%) and Medicine 84 (26.6%) were the most preferred fields for specialization, only 9(2.8%) students preferred community medicine (p-value=0.001). When asked for the reason for not choosing community medicine, the majority, 189 (60%), said that they are not impressed by this subject. Career dissatisfaction was identified as the second main reason (14.6%) for not opting for this subject as a future career path. Conclusions: It was concluded that appropriate teaching methodology should be adopted and the curriculum should be designed in such a way that it may increase students’ interest in community medicine.

Comparative Effectiveness of Duloxetine and Pelvic Floor Exercises for Stress Urinary Incontinence in Postmenopausal Women: A Quasi-Experimental Study in a Secondary Care Setting, Islamabad

2025-06-05T09:37:53+00:00

Stress urinary incontinence has great impact on female daily activities, emotional well-being, and overall quality of life; hence the need of most effective treatment is mandatory. Objective: To evaluate the effectiveness of Duloxetine and Pelvic Floor Muscle Training (PFMT) in the management of Stress Urinary Incontinence (SUI) in postmenopausal women. This study also aims to estimate symptom reduction, adherence rates, quality of life, and associated factors. Methods: Sample consist of 100 participants who were randomly assigned to two groups: Duloxetine (n=50) and PFMT (n=50). Reduction in weekly incontinence episodes over the period of 12 weeks was considered as the primary outcome. Improvement in quality of life, adherence rates, strengthening pelvic floor muscle and reduction in adverse effects was considered as the secondary outcome. Results: A considerable reduction in the weekly incontinence episodes was seen in both groups and no statistically significant difference (p = 0.08) was found among two groups. Similarly, quality of life scores was also improved significantly (p < 0.001), post intervention with PFMT group exhibiting a marginal advantage. Only the PFMT group exhibited significant pelvic floor muscle strengthening (p < 0.001). Mild adverse effects, including nausea and fatigue, were reported in 12% of participants in the Duloxetine group, while PFMT had no reported side effects. Conclusions: Both Duloxetine and PFMT effectively reduced SUI symptoms and improved quality of life. However, PFMT had advantages in adherence, safety, and pelvic floor muscle strengthening, making it the preferred first-line treatment.

Single Dose Intravenous Tranexamic Acid Efficacy in Reducing Blood Loss in Total Hip Replacement

2025-06-05T09:39:45+00:00

Total Hip Replacement is a commonly performed procedure for Hip joint degeneration. Despite its hazards, blood transfusion has to be performed due to significant perioperative blood loss. The effects of pre-operative intravenous single-dose tranexamic acid in our population have been presented in this study. Objectives: To compare the mean blood loss during and after total hip replacement for hip osteoarthritis with or without a single dose of tranexamic acid. Methods: This quasi-experimental study was performed in the Orthopedic Surgery Department Unit II, Nishtar Medical University Hospital, Multan, from October 2022 to March 2024. In the experimental group, tranexamic acid (20mg/kg) was administered intravenously ten minutes before skin incision, while in the control group, no such drug was given. Preoperative and postoperative Hematocrit data were collected. THA was done as per standard protocol. The operative blood loss and blood transfusions were recorded and compared with the controls. Results: Among 60 patients, the mean age was 54.85 ± 12.23 years. Male were 19 (31.7%) and female were 41 (68.3%). BMI was 26.04 ± 3.48 Kg/m². Mean age (p=0.746), mean BMI (p=0.633), age (p=0.417), gender (p=0.781) and BMI (p=0.749) were comparable in both groups. The estimated total loss of blood was significantly less in patients receiving intravenous tranexamic acid (1169.10 ± 191.92ml vs. 1730.07 ± 203.62ml; p<0.001) as compared to the control group. Conclusions: It was concluded that a pre-operative intravenous single dose of tranexamic acid decreased blood loss during surgery significantly in patients having total hip arthroplasty regardless of gender, age and BMI.

Physical Activity among Middle-aged Adults After Total Hip Arthroplasty Following One Year

2025-06-05T09:39:55+00:00

Total hip arthroplasty is one of the common surgical procedures that is used to treat the diseases of the hip joint and improve mobility and physical activity. Evaluating the physical after total hip arthroplasty is critical to understanding recovery and outcomes for long-term effectiveness. Objective: To evaluate physical Activity after total hip arthroplasty following one Year. Methods: The questionnaire-based descriptive case series included 50 subjects (27 Male and 23 Female) after total hip arthroplasty. The sample size was collected using the WHO calculator. Physical Activity and pain were evaluated using the Harris Hip Score. The data were analyzed using SPSS version 20. Results: Middle-aged patients aged 55-65 years were evaluated using the Harris Hip Score. Physical Activity was gradually fair to good in patients with total hip arthroplasty following one Year. In 50 patients of THA, the grades of total Harris hip score were with 14 patients (28%) in Poor grade (˂70), 17 patients (34%) in Fair grade (70-79), 18 patients (36%) in Good grade (80-89) and one patient (2%) in Excellent grade (90-100). Conclusions: It was concluded that the majority of middle-aged adults, after total hip arthroplasty, presented with fair to good (34 % & 36 %) physical activity following one Year.

Efficacy of 0.25% Bupivacaine Alone vs. with Dexmedetomidine for Ultrasound-Guided Supraclavicular Block in Upper Limb Surgery

2025-06-05T09:39:41+00:00

The pain after upper limb surgeries can be intense. The brachial plexus block is an effective and commonly used method to manage this pain, reduce opioid use, and facilitate smoother recovery. Objective: To see the effect of combining bupivacaine with dexmedetomidine in upper limb surgeries. Methods: Quasi-experimental research was carried out at Islam Medical College, Sialkot. 100 patients undergoing upper limb surgeries who were aged between 25 to 65 years. All the patients who were comprised allergies to study drugs, severe organ impairment, coagulopathy, neurological disorders affecting pain perception, and pregnancy were excluded and divided to receive either 0.25% bupivacaine alone or with dexmedetomidine. The outcome variables included pain, analgesia duration, sensory/motor block onset, and 24-hour analgesic consumption. Data were analyzed by SPSS version 23.0. The comparison of quantitative data was done by an independent sample t-test and chi-square test for insightful comparisons between qualitative variables, with the significance level at p-value<0.05. Results: The average age of patients was 40.1 ± 11.5 and 39.8 ± 10.5 years in Group I and Group II, respectively. Male were more in both groups. Group II showed significantly longer analgesia duration (12.7 vs. 5.3 hours), faster sensory/motor block onset, and lower analgesic consumption (p<0.001). There were no significant differences in adverse effects. Conclusions: It was concluded that combining dexmedetomidine with bupivacaine significantly extended analgesia, quickened sensory and motor block onset with a reduction in overall consumption of analgesia. Although sedation was more frequent, no major adverse events were observed.

Assessing the Effects of Metformin on Lipid Metabolism in Women with PCOS

2025-06-05T09:37:57+00:00

Polycystic ovary syndrome (PCOS) is a prevalent hormonal imbalance condition that is linked with insulin resistance and abnormal lipid metabolism. Metformin is a common drug given in the management of PCOS; the impact on the lipid profile and the role of adherence to therapy are not established. Objectives: To assess the therapeutic effects of Metformin on lipid profile, hormonal status, and insulin resistance in PCOS while exploring the influence of patient adherence on overall treatment response. Methods: One hundred and ten women with a diagnosis of PCOS in Health Net Hospital, Peshawar, were given Metformin (1500 mg/day) for six months. The assessments for the study included lipid profile, glucose, insulin level, HOMA-IR, and hormonal profiling both at baseline and after the treatment. Treatment adherence was evaluated with pill count and attendance to follow-up visits. Pre- and post-comparisons were done using paired t-tests, while group differences were examined using independent t-tests and chi-square tests. Results: Metformin significantly reduced total cholesterol (199.43 to 167.60 mg/dL, p<0.001), LDL-C (131.71 to 111.20 mg/dL, p<0.001), triglycerides (178.15 to 149.66 mg/dL, p<0.001), and VLDL-C (35.72 to 30.03 mg/dL, ‘p<0.001’), while HDL-C increased (39.70 to 45.24, p<0.001)’. Insulin resistance and androgen levels also improved, with greater benefits observed in adherent participants. Conclusions: It was concluded that metformin positively impacts lipid metabolism, hormonal levels, and insulin responsiveness in patients with PCOS. Adherence significantly enhances therapeutic outcomes, emphasizing the need for strategies that promote consistent medication use.

Frequency and Risk Factors Associated with Postoperative Sore Throat (POST) in Adults Undergoing General Anesthesia during ENT and Eye Surgery: A Cross-Sectional Study

2025-06-05T09:39:52+00:00

Postoperative Sore Throat and hoarseness are two common complications after intubation during general Anesthesia. It is crucial to understand the frequency and associated risk factors of POST to improve patients’ outcomes and reduce its incidence in patients of ENT and eye surgeries undergoing General Anesthesia (GA). Objectives: To emphasize the frequency and risk factors of POST after endotracheal intubation in patients undergoing GA for elective ear, nose, throat (ENT) and eye surgeries. Methods: A DHQ Hospital hosted this cross-sectional study from August 2024 to October 2024. The number of participants was 215. A consecutive non-probability sampling technique was used for patient selection. The ASA tool was used to assess the health status of patients undergoing GA. All participants were observed perioperatively, including for 10 minutes in the Post Anesthetic Care Unit (PACU). This was not a blinded study. Results: In this study, female subjects comprised 62.8% of the total sample. Complications included sore throat in 102 patients (47.4%) and hoarseness in 25 (24.2%). After the surgeries lasting for 31-60 minutes (51 cases, p=0.01) and in throat surgeries (89 cases, p=0.006), the sore throat was more common. Conclusions: Sore throat and Hoarseness are two common complications reported postoperatively with high frequency. The problem may arise more frequently during long surgical procedures; other factors may include the type of surgery, use of an NG tube, and large diameter ETT size. Knowing these hazards makes it clear that the best airway management techniques are required to reduce patient discomfort and enhance recovery.

Outcomes in Conservative Versus Surgical Treatments in Ludwig’s Angina Cases: A Comparative Study

2025-06-05T09:38:10+00:00

Rapid airway impairment brought on by Ludwig's angina may require careful antimicrobial treatment or surgery. Objective: To compare the airway compromise and hospital stay in conservative versus surgical approach in cases with Ludwig's Angina. Methods: This experiment was conducted at Liaquat University using a non-probability consecutive sampling technique to recruit 76 patients, aged 18 to 40, diagnosed with early-stage Ludwig’s angina without airway obstruction. Quasi-experimental study. There were 38 patients in each group, and participants were randomized to either the surgery group or the conservative treatment group. Outcomes such as airway compromise and length of hospital stay were recorded and compared between groups using t-tests and Fisher’s exact tests. Findings: The conservative group's mean age was 30.58 ± 5.52 years, while the surgical group's was 31.34 ± 5.92 years. There were 11 females (28.95%) and 27 males (71.05%) in the conservative group and 8 females (21.05%) and 30 males (78.95%) in the surgical group. There was a statistically significant difference (p < 0.001) in the length of hospital stay between the surgical group (6.97 ± 1.10 days) and the conservative group (5.05 ± 0.89 days). Five patients (13.16%) in the surgical group and three patients (7.89%) in the conservative group experienced airway impairment; however, this difference was not statistically significant (p = 0.706). Conclusion: Conservative treatment, being less invasive, can be effective in mild cases, leading to shorter hospital stays and a reduced risk of airway compromise.

Comparison between Oral Nifedipine and Intravenous Labetalol in Managing Severe Preeclampsia

2025-06-05T09:37:51+00:00

Hypertensive disorders contribute to significant maternal morbidity and mortality in pregnancy. Immediate treatment is required to avoid serious complications. Objectives: To compare the mean time taken to achieve the target BP with oral nifedipine versus intravenous labetalol in patients with severe preeclampsia. Methods: This quasi-experimental study was conducted at Lady Willington Hospital, Lahore, over six months after taking approval from CPSP, involving 100 patients diagnosed with severe preeclampsia. Participants were divided into two equal groups: Group oral nifedipine and IV labetalol. Study outcome time taken to reach target BP <140/90 mmHg was compared among groups using an independent sample test, with a p-value≤ 0.05 as significant. Results: Target BP was achieved earlier at 43.96 ± 5.93 minutes with oral nifedipine compared to IV labetalol at 48.60 ± 6.80 minutes (p<0.001). Conclusions: It was concluded that the findings strongly support the use of nifedipine as a more effective option for rapidly lowering blood pressure compared to labetalol. Its faster onset of action makes it the preferred choice for achieving timely blood pressure control in patients with severe preeclampsia.

Primary Cesarean Section: A Gateway to Repeat Surgery

2025-06-05T09:38:02+00:00

The rising rate of Cesarean Sections (CS) is a significant concern globally. While C-sections are lifesaving in many cases, an increasing number of unnecessary procedures pose risks to both mothers and babies. It has been found that the most common indication of CS is previous CS. Objective: To assess the indications and the factors leading to primary CS. Methods: The study was conducted at a tertiary care hospital of Pakistan employing non-probability consecutive sampling. A detailed history of participants revolving around their first CS was taken including indication and the associated demographics. All the information was entered on a specific proforma. Data analysis was conducted using SPSS software version 26.0. The primary outcome variable was the indication for primary cesarean section, while the secondary variables included factors contributing to the procedure. Results: A total of 264 women who had CS for at least one of their pregnancy were considered. The vast majority (n=195, 73.9%) were primigravida, had 4-6 antenatal visits (n=174, 65.9%) and underwent CS at term (180, 68.2%). There were more emergency CS (n=140.53%) performed at private clinics/hospitals (n=201. 57.4%). Regarding the indications of primary CS, the most prevalent was failed progress of labour, followed by oligohydramnios, breech presentation/transverse lie, fetal distress, reduced fetal movements and maternal request. Conclusion: It is need of time to scrutinize the indications of primary CS and to adopt potential strategies to minimize its number with the aim to lower overall CS rate.

Perceptions of Artificial Intelligence in Medical Education: A Cross-Sectional Study Among Students and Faculty at HBS Medical and Dental College, Islamabad

2025-06-05T09:37:39+00:00

As artificial intelligence (AI) continues to transform healthcare, its integration into medical education is increasingly critical. However, many institutions lack formal AI curricula, leaving students and faculty underprepared for the digital demands of clinical practice. Objectives: To assess awareness, familiarity, perceived benefits, and concerns regarding AI among medical students and faculty, and to explore training preferences and barriers to AI integration in academic settings. Methods: A descriptive cross-sectional survey was conducted at a HBS Medical and Dental College, with a total of 100 participants (76 students and 24 faculty). A questionnaire assessed demographic characteristics, AI familiarity, perceived benefits and concerns, and interest in formal training. Chi-square tests and logistic regression were used to analyse group differences and predictors of training interest. Results: Most participants (60%) were under 25 years old, and 76% were students. While 68% had heard of AI, only 43% reported basic familiarity. Interest in AI training was high (87%). Commonly cited benefits included faster knowledge access and personalized learning, while concerns focused on ethical issues and misinformation. A significant association was found between academic role and perceived lack of training (p=0.041). Logistic regression showed a non-significant trend linking prior AI exposure with interest in training (p=0.125). Conclusions: It was concluded that there is strong enthusiasm for AI in medical education among both students and faculty. However, limited familiarity and perceived barriers highlight the need for structured training and targeted curriculum reforms to build digital competence in future healthcare professionals.

Hepatitis B and C Infections in Pregnant Women Undergoing Chorionic Villus Sampling in Pakistan (2023–2024)

2025-06-05T09:39:33+00:00

Pregnant women with high viral loads of HBV and HCV are at increased risk of vertical transmission and long-term complications. Objectives: To determine the disease burden of hepatitis B and C infections in pregnant women who underwent chorionic villus sampling (CVS). Methods: A comparative cross-sectional study was done in MINAR Cancer Hospital, Multan, from January 2023 to June 2024 for eighteen months using a non-probability purposive sampling technique. 1000 pregnant ladies who were scheduled for CVS were included after fulfilling the exclusion and inclusion criteria. Participants were divided into two age groups: 16–25 years and 26–50 years. Blood samples were taken and tested for HBV and HCV infections using commercial kits. The data were recorded and explored using SPSS version 24. Results: The participants had an average age of 27.78 ± 4.93 years (range: 16–46 years). HBV DNA was detected in 21 women (2.1%), while 66 (6.6%) tested positive for HCV RNA, leading to a total infection rate of 8.7%. Participants were divided into two age groups: 16–25 years (n=370) and 26–50 years (n=630). HBV infection rates were 1.6% and 2.38% in younger and older groups, respectively (P=0.418), while HCV infection rates were significantly higher in the older group (7.77% vs. 4.59%, p=0.04). Conclusion: It was concluded that the study highlights a significant prevalence of HBV and HCV infections in pregnant women undergoing CVS, emphasizing the need for routine screening and preventive strategies to reduce vertical transmission.

Causative Organisms and Antimicrobial Sensitivity Pattern in Patients with Urinary Tract Infection

2025-06-05T09:37:43+00:00

Patterns of pathogens in urinary tract infection (UTI) and antibiotic sensitivity have been scarcely studied in the recent past in local settings. Hence, the study has been planned to address the knowledge gap arising from the non-availability of recent data. Objectives: To evaluate the causative organisms and antimicrobial sensitivity patterns in patients with urinary tract infections. Methods: This descriptive cross-sectional study was carried out at the Medicine Department of Khyber Teaching Hospital, Peshawar, during the period 1^st July 2022 till 31^st December 2022. Male and female patients aged 20 to 80 years with culture-proven urinary tract infections were enrolled. Pathogens isolated were noted their sensitivity to antibiotics was assessed. Data were analyzed using SPSS version 26.0. Results: The majority of study participants were aged more than 50 years (n=92, 51.4%). 109 patients (60.9%) were male, and 85 patients (47.5%) were diabetic. 89 patients (49.7%) were enrolled from the Outpatient Department. The most common pathogen was E coli, recorded in 48 patients (26.8%). Isolates in 154 (86.0%) out of 179 participants were susceptible to nitrofurantoin, followed by meropenem in 151 (84.3%). Conclusions: It was concluded that people of all ages can be affected by urinary tract infection. The most common bacterial cause of UTI is E coli. Nitrofurantoin and meropenem are the most effective antibiotics against uropathogens.

Investigating Motorcycle Accident Risk Factors among Educated Riders: Associations with Driver Behaviour, Road Conditions, and Vehicle Safety Concerns

2025-06-05T09:37:50+00:00

Motorcycle accidents pose a significant threat to public health and often present as serious medicolegal challenges, particularly in developing countries. Objectives: To identify and analyze key risk factors, over speeding, poor driving sense, lighting defects, and mirror faults, associated with motorcycle accidents among an educated population comprising students and faculty. Also, to explore the association of these factors with demographic characteristics and varying road conditions. Methods: A cross-sectional study was conducted using a self-administered questionnaire to gather data on participants' demographics, motorcycle usage patterns, self-reported safety concerns, and perceived road hazards. Chi-square tests were used to assess associations between variables. Results: Over-speeding emerged as the most frequently reported safety concern, especially among younger riders and during peak traffic hours. Although notable trends were observed across different age groups, professions, and road conditions, none of the associations reached statistical significance (p>0.05). Conclusions: It was concluded that although over-speeding was consistently reported as the most frequent safety concern among students and faculty, statistical analysis revealed no significant associations between reported concerns and demographic or road condition variables. These findings suggest that motorcycle safety risks are broadly distributed across rider categories. Institutional interventions such as safety awareness programs, infrastructure improvements, and strict enforcement of traffic laws may still be beneficial in promoting safer riding practices within the academic community.

Role of a Teacher in Medical Education: A Faculty’s Perspective from HBS

2025-06-05T09:37:38+00:00

Medical educators are vital in delivering knowledge and shaping students' professional behaviour and critical thinking. However, their effectiveness is influenced by institutional support, teaching training, and the ability to adapt to innovative methodologies. Objectives: To assess faculty members' perceptions, teaching practices, and institutional involvement in medical education and to explore the association between formal training and innovative teaching methods. Methods: A descriptive cross-sectional survey was conducted at HBS Dental College, Islamabad, including 85 faculty members. Data were collected using a structured questionnaire covering demographics, teaching methods, perceptions of educational roles, and barriers faced. Statistical analysis was performed using SPSS version 25.0, applying Chi-square, Mann-Whitney U, and Kruskal-Wallis tests. Results: Lecture-based teaching was universal, while small group teaching (68.2%) and PBL (41.2%) were also common. Only 35.3% of faculty had formal training in medical education. A significant association was found between training and the use of innovative methods (p=0.001). Reflective teaching scores were higher among trained faculty (p=0.049). Lack of time was the most reported barrier (69.4%). Conclusions: It was concluded that faculty with formal training were more likely to adopt innovative and reflective teaching practices. Addressing institutional barriers and investing in structured faculty development can significantly enhance the quality of medical education.

Differences in Depressive Symptoms, Perceived Social Support, and Quality of Life among Patients with Hepatitis C and Psychiatric Patients: A Cross-Sectional Study

2025-06-05T09:37:42+00:00

Hepatitis is a series of viral illnesses that can impact a person's health and social life. Objective: To investigate the differences in depressive symptoms, perceived social support, and quality of life among the normal population, patients with Hepatitis C, and patients with psychiatric disorders. Methods: 402 participants were taken from Faisalabad's different urban and rural areas. The participants 'ages ranged from 25 to 54 years. The sample consisted of married participants (n=189, 47%) and unmarried participants (n=213, 53%). A purposive sampling technique was used to collect the data. The following measures were used to assess the findings: Demographic Form, Patient Health Questionnaire, Multidimensional Scale of Perceived Social Support, and World Health Organization Quality of Life-BREF scale. Results: The findings revealed that patients with hepatitis C and patients with psychiatric disorders perceived a high degree of depression as compared to individuals having no history of medical and psychiatric treatment. Similarly, patients with hepatitis C and patients with psychiatric disorders perceived a low degree of social support and quality of life as compared to individuals having no history of medical and psychiatric treatment. Conclusion: In this study, depression, perceived social support, and quality of life were found to significantly differ between the general population, Hepatitis C patients, and people with a mental health condition.

Comparative Study between Ultrasound Guided Erector Spine Block versus Transversus Abdominis Plane Block for Post-Operative Analgesia in Laparoscopic Cholecystectomy

2025-06-05T09:39:42+00:00

Cholelithiasis is a common condition, and laparoscopic cholecystectomy (LC) is the preferred minimally invasive procedure for symptomatic gallstones. Postoperative pain management is crucial for enhancing recovery. Ultrasound-guided erector spinae plane block (US-ESP) and transversus abdominis plane block (TAP) are two regional anesthesia techniques used for postoperative analgesia. Objective: To compare the mean postoperative numeric rating scale (NRS) scores in patients undergoing LC with US-ESP and TAP blocks. Methods: This observational prospective study was approved by the Institutional Review Board (IRB) of RMI, Peshawar. This observational prospective study included 138 patients (69 in each group) who underwent LC at the Department of Anesthesia, RMI, Peshawar, from October 1, 2021, to April 1, 2023. Group A received US-ESP, and Group B received TAP. Postoperative NRS scores were recorded at 12 hours. All patients provided informed consent before participation. The study adhered to ethical guidelines and was approved by the Institutional Review Board (IRB) of Rehman Medical Institute. Results: The mean postoperative NRS score was significantly lower in Group A (1.521 ± 0.63) compared to Group B (2.304 ± 0.69) (p=0.000). Both groups had similar demographic and procedural characteristics. Conclusions: It was concluded that US-ESP is more effective than TAP in providing postoperative analgesia in LC patients, as evidenced by lower NRS scores.

Association of Gestational Hypertension with Neonatal Cardiovascular Physiology

2025-06-05T09:37:36+00:00

Gestational hypertension (GH) is a common hypertensive disorder of pregnancy associated with increased maternal and neonatal risks. While its impact on maternal cardiovascular health is well-established, its effects on neonatal cardiovascular physiology remain insufficiently explored. Objective: To examine the association between GH severity and neonatal cardiovascular outcomes. Methods: A cross-sectional observational study was conducted at Health Net Hospital, Peshawar, including 150 mother-neonate pairs diagnosed with GH. Participants were categorized into mild, moderate, and severe GH groups per ACOG criteria. Neonatal cardiovascular parameters heart rate, blood pressure, pulmonary artery pressure, LVEF, and CHD, were assessed. One-way ANOVA and Chi-square tests analyzed group differences, while logistic regression identified independent predictors of NICU admission. Results: Of the 150 neonates, 34% required NICU admission, with all severe GH cases admitted (p<0.001, Cramer's V=0.638). One-way ANOVA showed no significant differences in heart rate, blood pressure, or LVEF across GH groups (p>0.05), though LVEF showed a borderline trend (p=0.059). Logistic regression confirmed GH severity as an independent predictor of NICU admission (OR: 0.181, 95% CI: 0.097–0.339, p<0.001), while birth weight was non-significant (p=0.575). Conclusions: It was concluded that the severity of gestational hypertension is significantly associated with adverse neonatal cardiovascular outcomes, particularly NICU admission. GH severity independently predicted NICU requirement, emphasizing the need for close monitoring and early intervention in pregnancies complicated by moderate to severe GH.

Preoperative Total Leukocyte Count: A Key Predictor for Better Optimization and Conversion Risk in Laparoscopic Cholecystectomy for Cholelithiasis

2025-06-05T09:37:59+00:00

Gallstone disease requires laparoscopic cholecystectomy (LC) as the standard of care. Sometimes, the surgeon decides to convert LC to open cholecystectomy (OC) for patient safety. Several factors help us predict preoperatively whether there is any chance of conversion of LC to OC. The role of elevated total leucocyte count (TLC) as a predictor for conversion is being proposed. This study investigates the association between pre-operative TLC levels and conversion rates from LC to OC. Objective: To determine the association between increased TLC and conversion from LC to OC. Methods: This study was conducted at Al-Tibri Medical College Hospital, Karachi, over eighteen months from 1st July 2023 to 31st December 2024. A total of 230 patients were included. We selected 115 patients with TLC above 11.0x10^9/L and 115 patients with non-elevated TLC. All patients underwent LC, and conversions to OC were recorded. Data were analyzed using SPSS version 23.0. Mean and standard deviation were computed for numerical variables, and percentages for categorical variables. The chi-square test was applied to find the association between categorical variables. The relative risk (RR) was calculated to compare the risk of conversion of LC to OC among Elevated and Non-elevated TLC Groups. Results: The average age of patients was 31.82±10.06 years. The conversion risk was 117% higher in the elevated TLC group compared to the non-elevated TLC group (RR=2.17, 95%CI: 1.32-3.56). Conclusions: It was concluded that elevated pre-operative TLC is significantly associated with a higher risk of conversion from LC to OC, indicating its potential as a predictive factor for surgical planning.

Evaluation of Variability in Macular Thickness in Primary Open Angle Glaucoma: A Spectral Domain Optical Coherence Tomography-Based Study

2025-06-05T09:37:47+00:00

Globally, glaucoma, especially primary open-angle glaucoma (POAG), is one of the leading causes of blindness. This disease is connected to damage of the optic nerve head, death of retinal ganglion cells and visual field abnormalities. Objectives: To check the macular thickness and total macular volume using spectral-domain optical coherence tomography (SD-OCT) among patients of POAG and subjects without glaucoma. Methods: The observational case-control study, where 40 participants had POAG and 40 participants the same age did not. Only the right eye or only the left eye from each subject was examined in the study. All subjects had a thorough check of their eyes which included history, eye chart testing, slit-lamp examination, dilated fundus inspection, gonioscopy and measuring intraocular pressure (IOP). Visual fields were assessed using the Humphrey Field Analyzer. Macular thickness (MT) was analyzed with SD-OCT using OCT Spectralis. Parameters evaluated were macular inner thickness (MIT), macular outer thickness (MOT), macular central thickness (MCT) and macular total volume (MTV). Results: Patients with POAG exhibited markedly reduced MTV, MIT and MOT in comparison to healthy controls, with the greatest decline observed in the temporal as well as the inferior quadrants. These observations confirm that structural differences in the macular parameters are correlated with glaucoma and can aid in early diagnosis and monitoring progression. Conclusion: This study emphasizes the diagnostic utility of SD-OCT in determining macular thickness variability in individuals with POAG. Our findings show that macular thickness is much lower in glaucomatous eyes than in healthy controls, with distinct patterns of regional thinning indicating retinal ganglion cell vulnerability.

Hematological Ratios versus Disease Characteristics versus Surgeons’ Experience and Expertise: What Stands Out as Predictor of Conversion to Open Cholecystectomy?

2025-06-05T09:38:08+00:00

Conversion of laparoscopic to open cholecystectomy is often a surprise for the surgeon. Objective: To evaluate predictors like inflammatory ratios, gallbladder wall thickness and surgeons’ experience to see what predicts conversion best. Methods: Retrospective cohort study was done on adult patients diagnosed with acute cholecystitis (Tokyo guidelines) at Surayya Azeem Hospital from 2021 to 2024. Data collected included demographics, CBC findings, surgeons' experience, operation details and ultrasound findings. Patients with chronic cholecystitis, comorbidities and other gallbladder pathologies were excluded. Ratios like NLR, MLR, PLR, SIRI, SII, NLPR and d-NLR were calculated. Chi square, Mann Whittney U, binary logistic regression and ROC analysis were used as per requirement. P-value of less than 0.05 was considered significant. Results: 80% of 475 patients were females. 22 (4.8%) patients underwent conversion. Old age and male gender were associated with adverse outcome. WBC count, NLR, d-NLR, SIRI, SII and NLPR were higher in conversion group. Platelet count, PLR and MLR had no associations. Higher hemoglobin (>12.3 g/dL) and ALC (> 1.8x109/L) were predictive of successful laparoscopic procedure. Highest predictive value for conversion was found for NLR and d-NLR (AUC=0.84) followed SIRI (AUC=0.78) with cut-offs of 4.97, 3.76, and 1.69 respectively. Gallbladder wall thickness of >7mm (AUC=0.64) and inexperienced surgeons (AUC=0.69) also increase the probability of conversion. Conclusion: Systemic inflammatory indices predict conversion better than ultrasound findings and surgeons’ experience. Experienced laparoscopic surgeons should operate on patients with thick gallbladder wall and high inflammatory ratios to minimize the risk of conversion.

The Effects of Aerobic Training and Moringa oleifera on High-Density Lipoprotein and Cardiac Endurance among Males

2025-06-10T06:25:40+00:00

Aerobic training is a form of physical workout in which heart and lungs work efficiently to supply oxygen to the muscles for improving athletic performance. Objective: To investigate the effect of moderate aerobic training and Moringa oleifera leaf powder (MOLP) on high-density lipoprotein (HDL) and cardiac endurance among males. Methods: One hundred (100) male volunteers of age group 38.9 ± 6.7 years were randomly and divided into four groups i.e. the control group (T₀), the moringa group (T₁), the aerobic group (T₂), and the Combined Group (T₃). Moringa oleifera leaf powder (3 gm) was given to the T₁ and T₃ daily for five days a week for 12 weeks, while the T₀continued a normal diet routine. Results: Results indicate an increase in HDL posttest mean values of three interventional groups T₁ (41.80 ±4.81 mg/dl), T₂ (42.08 ± 1.28 mg/dl) and T₃(43.40 ±1.77 mg/dl) as compared to control group T₀ (36.28 ±1.86 mg/dl). Beep tests mean values of the post-test of interventional groups T₁(10.1 ±1.24), T₂(10.2 ± 1.25) and T₃ (12.0 ± 1 .18) and control group T₀ (7.3 ± .67) were recorded. Conclusions: It was concluded that moderate aerobic training and MOLP have a positive effect on HDL and cardiac endurance among the interventional groups (T₁, T₂, and T₃), with more significant improvement in T₃ and no improvement in the control group.

Urological Complications in Patients Undergoing Hemodialysis and Peritoneal Dialysis

2025-06-05T09:37:54+00:00

Urological complications (UCs) remain a significant concern following kidney transplantation (KT), contributing to both morbidity and mortality. Objectives: To determine the prevalence of urological complications and associated factors in patients receiving hemodialysis (HD) and peritoneal dialysis (PD). Methods: A comparative cross-sectional study was conducted in the Department of Urology at Bacha Khan Medical College and Mardan Medical Complex, Mardan. A tertiary hospital, involving 310 dialysis patients. Data on demographics, comorbidities, and urological complications were collected. Urological complications assessed included urinary tract infections (UTI), bladder dysfunction, nephrolithiasis, hematuria, and urethral stricture. Laboratory tests were used to evaluate renal function parameters. T-tests discover differences between groups, and chi-squares are used for identifying differences in categorical data. If the p-value was less than 0.05, the result regarded as statistically significant. Results: The mean age of participants was 58.7 ± 12.3 years, and the majority were male (58.1%). Diabetes and hypertension were prevalent in 45.8% and 71.0% of patients, respectively. The prevalence of urological complications included UTIs (27.4%), bladder dysfunction (19.4%), LUTS (29.7%), hematuria (15.5%), and nephrolithiasis (11.3%). HD patients had a significantly lower residual urine output compared to PD patients (80 mL/day vs. 200 mL/day, p<0.001). UTI and bladder dysfunction were significantly more common in diabetic patients (p=0.03 and p=0.02, respectively). Patients who received dialysis for longer duration had more LUTS (p=0.03). There was a significant difference in albumin levels between HD patients and PD patients (p=0.04). Conclusions: Urological complications are common in dialysis patients, with significant associations observed with dialysis modality, diabetes, and residual urine output.

Forensic Evaluation of Injury Pattern in Pedestrian Road Traffic Accidents in Karachi

2025-06-10T06:25:18+00:00

Pedestrian-related injuries are among the top of all road traffic-related injuries in Pakistan. Objectives: To determine the pattern of injuries and responsible factors for pedestrian fatality due to road traffic accidents in Karachi. Methods: This retrospective study was carried out at the Department of Forensic Medicine, Karachi Institute of Medical Sciences. Victims involved in pedestrian road traffic accident fatalities, belonging to either gender of any age from three major hospitals in Karachi, were evaluated. Information was recorded in a semi-structured written questionnaire. The multivariate logistic regression analysis was performed for multiple variables simultaneously and reports adjusted odds ratios to determine the independent contribution of each factor to pedestrian mortality. A p-value less than 0.05 was considered statistically significant. Results: A total of 681 deceased pedestrians were examined and evaluated for the patterns and factors. The majority of the deceased were male (81.0%) with a mean age of 34.7 ± 2.9 years. The highest proportion (39.2%) of fatalities due to RTA was reported in the 18-30 years’ age group. Over two-thirds (74.6%) of accidents took place on the main roads of the city. Common injuries that resulted in death included fatal injuries to the brain and associated vessels (64.4%) and thoracic injuries (14.7%). Conclusion: The findings highlight a significant prevalence of male victims, particularly in the 18-30 age group, with brain injuries being the leading cause of death. The analysis also emphasizes the critical role of accident timing, with peak fatalities occurring between 12:00 pm and 4:00 pm, and on main roads.

Factors Affecting Non Compliance to Medication in Epileptic Patients

2025-06-05T09:39:39+00:00

Non-compliance with antiepileptic medications is a significant concern, leading to poor seizure control, increased hospitalization, and higher healthcare costs. Objective: To identify factors contributing to non-compliance among epileptic patients. Methods: A cross-sectional study was conducted at Akhtar Saeed Trust Hospital, Lahore, from July 2023 to March 2024, including 200 epileptic patients aged 18-60 years identified as non-compliant using the Morisky Medication Adherence Scale (MMAS-4) Patients with psychiatric illnesses, hearing problems, or those pregnant/lactating were excluded. Data on demographics and contributing factors (e.g., high costs, forgetfulness, unemployment) were collected via structured proformas. Statistical analysis using SPSS version 25.0 included descriptive statistics and stratified analyses to explore relationships between factors and demographics, with significance at p < 0.05. Results: Of 200 patients, 67.5% were male. High cost (57.5%) was the leading factor, followed by forgetfulness (55.0%), prolonged treatment duration (32.5%), unemployment (29.5%), and medication complexity (16.5%). Monthly household income significantly influenced these factors; high costs and prolonged treatment duration were predominant in low-income groups (p < 0.001). Forgetfulness was uniformly reported across socio-economic strata (p = 0.094). Conclusions: High medication costs and forgetfulness are primary contributors to non-compliance among epileptic patients. Strategies like cost reduction, simplified regimens, and reminder interventions are essential to enhance adherence and improve clinical outcomes.

Comparison of Micro Needling with Topical Tranexamic Acid and Mesotherapy with Intradermal Tranexamic Acid in Treatment of Melasma

2025-06-10T06:25:45+00:00

Melasma is a common hyperpigmentation disorder that poses therapeutic challenges due to its recurrent and resistant nature. Microneedling showed superior and faster pigmentation reduction, with significant MASI score improvement and no adverse effects. Objective: To compare the effectiveness of intradermal Tranexamic Acid (TA) via mesotherapy versus topical TA delivered through microneedling in the treatment of melasma. Methods: In this prospective comparative study, 100 patients were divided into two equal groups. Group A received intradermal injections of TA (100 mg/mL), and Group B was treated with the same concentration of TA via microneedling using the Dr. PEN A6 device. Each group received three treatments at two-week intervals. Outcomes were assessed at Weeks 4, 8, 12, 16, and 20 using the Melasma Area and Severity Index (MASI) and standardized clinical photography. Statistical analysis was performed using repeated measures ANOVA, with a significance threshold of p ≤ 0.05. Results: The mean age was 37.7 ± 6.1 years. Group B showed greater improvement in MASI scores compared to Group A, with a 32.5% vs 18.4% reduction at Week 4 (p = 0.17). Group B consistently showed statistically significant improvement at Weeks 12, 16, and 20 (p < 0.05), and a strong trend by Week 8 (p = 0.001). No adverse events were reported. Conclusion: TA is an effective treatment for melasma. Microneedling significantly enhances its efficacy, providing faster and greater pigmentation reduction with minimal side effects.

Urological Carcinomas in Patients Presented with Gross Hematuria

2025-06-10T06:25:42+00:00

Gross hematuria is a common urological symptom associated with both benign and malignant conditions. It is often a presenting feature of urological carcinomas, necessitating timely evaluation and diagnosis to improve outcomes. Objectives: To determine the prevalence of urological carcinomas and assess their association with demographic and clinical variables among patients presenting with gross hematuria. Methods: This descriptive cross-sectional study was conducted at the DHQ Teaching Hospital Mardan (KP) from July 2024 to January 2025. A total of 209 patients presenting with gross hematuria were included. Detailed demographic and clinical data, including age, gender, family history of cancer, anticoagulant use, urinary tract infections, history of stones, and prior urological surgeries, were recorded. All patients underwent urine cytology, ultrasound, X-ray KUB, computed tomography (CT) scan, and cystoscopy when required. Data analysis was performed using SPSS-25, and the Chi-square test was applied to determine associations. Results: Urological carcinoma was diagnosed in 41 (19.6%) patients. Higher prevalence was observed in older age groups (24.6% in 60–80 years) but showed no significant association with gender (p=0.333) or other clinical variables such as urinary tract infections (p=0.527) and anticoagulant use (p=0.997). Benign causes, including urinary tract infections (17.8%) and trauma, were common. Conclusions: It was concluded that urological carcinomas were prevalent in patients with gross hematuria, particularly in older age groups, highlighting the need for structured diagnostic evaluations. Early imaging, cytology, and cystoscopy are recommended to differentiate malignant from benign causes and improve outcomes.

Evaluation of Functional Results and Local Recurrence in Enbloc Resection of Campanacci Grade 3 Giant Cell Tumor of Distal Radius and Wrist Arthrodesis Using Ulnar Translocation Technique

2025-06-10T06:24:52+00:00

Reconstruction following en-bloc resection of a distal radius GCTB of Campanacci grade 3 can be difficult. Objective: To examine the outcomes of patients who had ulnar translocation correction and wrist arthrodesis for Campanacci grade 3 distal radius GCTBs. Methods: This retrospective study was comprised of 22 patients. After obtaining informed written consent detailed demographics were recorded. A follow-up clinical evaluation was conducted to determine the functional status and any problems. The MSTS and DASH scores, which measure impairments in the musculoskeletal system, were used to assess the functional outcomes. The MSTS and DASH scores were compared before and after the operation using paired t-tests. At a significance level of P less than 0.05, statistical differences were recorded. Results: The included cases had mean age 30.7±6.28 years. The majority 15 (68.2%) were females and 7 (31.8%) cases were males. Mean follow up was 33.25±9.38 months. Mean length of tumor resection was 8.97±5.79 cm. Before surgery, mean MSTS was 10.84±3.35 and after surgery mean MSTS was 26.01±3.19 p value <0.05. At admission, the mean DASH score was 40.14±14.66 and after surgery decreases to 8.91±12.51 with p value <0.05. Frequency of recurrence rate was 3 (13.6%) and radioulnar synostosis was found in 2 (9.1%) cases. Conclusion: It was found that ulnar translocation in conjunction with wrist arthrodesis is an easy reconstructive technique that preserves function, produces outstanding results, and has few problems.

Acute Systemic Organ Injury in Term Infants with Perinatal Asphyxia

2025-06-10T06:25:03+00:00

Perinatal asphyxia is a major contributor to neonatal morbidity and mortality. This leads to multiple organ dysfunction (MODS). Objectives: To assess the extent of acute organ system injury in term newborns with perinatal asphyxia, focusing on clinical and biochemical markers indicative of MOSD. Methods: This descriptive cross-sectional study involved 50 term newborns diagnosed with perinatal asphyxia. Clinical manifestations and biochemical markers, including renal and liver function tests, were analyzed to evaluate the extent of organ dysfunction. Fifty term newborns diagnosed with perinatal asphyxia were enrolled through non-probability convenience sampling. Clinical assessments included evaluations of the neurological, cardiovascular, respiratory, renal, and hepatic systems. Biochemical tests measured serum creatinine, serum ALT, and CKMB levels to assess kidney, liver, and myocardial function, respectively. Data were analyzed using descriptive statistics and Chi-square tests to examine the relationship between perinatal asphyxia and multi-organ injury, with a significance level of p≤0.05. Results: The severity of perinatal asphyxia was significantly correlated with the incidence of organ damage. Serum creatinine levels were elevated in 18 (36%) neonates, ALT levels were elevated in 20 (40%) neonates, and CKMB levels were elevated in 23 (46%) neonates. In some cases, early intervention was linked to improved neurological outcomes. Conclusions: This study emphasizes the critical need for early diagnosis and prompt intervention to prevent extensive organ damage in newborns with perinatal asphyxia. The severity of organ dysfunction is closely related to the degree of asphyxia, highlighting the importance of comprehensive monitoring and targeted treatment strategies. Further research is essential to develop better protective interventions for these infants.

Efficacy and Safety of Endoscopic Papillary Large Balloon Dilatation (EPLBD) for the Extraction of Common Bile Duct Stones

2025-06-10T06:25:44+00:00

Endoscopic Papillary Large Balloon Dilatation (EPLBD) is an endoscopic technique which combines limited endoscopic sphincterotomy followed by balloon dilation, leading to increased stone extraction rate with minimum complications of Endoscopic Biliary Sphincterotomy (EBS), Endoscopic Balloon Dilatation (EBD) alone and more advanced Mechanical (ML) and Laser Lithotripsy. Objectives: To evaluate the efficacy and safety of EPLBD procedure by using balloon size of 12-20 mm to remove difficult CBDS of ≥15mm. Methods: A total of 105 patients fulfilling the inclusion criteria underwent ERCP with EBS at the Endoscopy Department, Lahore General Hospital, Lahore. EPLBD was done with gradual balloon expansion from 12 to 20 mm till the disappearance of the waist under fluoroscopy. Technical success was recorded as complete stone removal. Patients were observed for 24 hours post-procedure for any complications. The data were processed on SPSS version 23.0. Descriptive statistics were employed to calculate means and standard deviation for age, size and number of stones, bilirubin level, CBD size and size of EPLBD in mm and time of balloon inflation in seconds. Success rate and complications were expressed in percentages. Results: Data of total 105 patients were collected. The mean age of patients was calculated to be 52.28 years, with female gender predominance (F=62, M=43). The average size of the balloon used was 15.32 ± 1.93mm. The overall success rate for stone extraction, irrespective of the number of sessions or the use of ML, was 95 (90.5%). Post EPLBD complications percentage was 7 (6.7%) (3.8% Bleed, 1.9% pancreatitis, 1% perforation). Conclusion: EPLBD is a safe and effective method for the removal of large bile duct stones of >15 mm.

Comparative Analysis of Clinical and Pathological Characteristics of Breast Cancer among Premenopausal and Postmenopausal Women

2025-06-13T04:22:15+00:00

Breast cancer shows distinct clinical and pathological characteristics between premenopausal and postmenopausal women, potentially affecting disease progression and treatment outcomes. Understanding these differences is essential for optimizing management strategies. Objectives: To compare the clinical and pathological characteristics of breast cancer among premenopausal and postmenopausal women. Methods: This retrospective study was conducted at the Department of Histopathology, Quaid-e-Azam Medical College, Bahawalpur, from January to December 2024. A total of 188 breast cancer patients (94 premenopausal, 94 postmenopausal) were included. Clinical variables such as age at diagnosis, family history, tumor laterality, clinical stage, lymph node involvement, and metastasis were analyzed, along with pathological features like histological type, tumor grade, molecular subtype, and hormone receptor status. Data were analyzed using a t-test and a chi-square test. Results: The mean age at diagnosis was significantly lower in premenopausal women (46.96 ± 5.29 years) compared to postmenopausal women (65.87 ± 10.82 years) (p<0.001). A positive family history was more common among premenopausal patients (37.2% vs. 23.4%, p=0.039). Lymph node involvement was higher in premenopausal women (73.4% vs. 59.6%, p=0.045). Tumor laterality, clinical stage, metastasis, histological type, tumor grade, molecular subtype, and hormone receptor status were similar between groups (p>0.05). Conclusions: It was concluded that premenopausal women presented at a younger age, with more frequent family history and lymph node involvement, suggesting a potentially aggressive disease course. However, pathological tumor characteristics were comparable. Early detection and genetic risk assessment are crucial, particularly in younger women.

Comparison of Pain, Cosmetic Outcomes and Early Restoration of Breast Feeding in Multiple Percutaneous Needle Aspiration Vs Incision and Drainage for Small Breast Abscess Management

2025-06-14T04:38:15+00:00

Breast abscesses disrupt postpartum women's well-being, hindering breastfeeding and affecting cosmetic outcomes. Traditional incision and drainage (ID) often causes significant discomfort and suboptimal aesthetics. Multiple percutaneous needle aspiration (MPNA) offers a minimally invasive alternative with potentially better outcomes. Objectives: To compare pain, cosmetic satisfaction, and breastfeeding restoration between MPNA and ID for breast abscess treatment. Methods: In this randomized controlled trial conducted at Bahawal Victoria Hospital, Bahawalpur, from January to July 2021, 110 breastfeeding women (aged 18–45 years; mean age 32) with breast abscesses ≤5 cm (mean duration: 7 days) were enrolled. Participants were randomized into two groups: MPNA (n=55) and ID (n=55). Outcomes, including pain (via a standardized scale), cosmetic satisfaction (patient surveys), and breastfeeding restoration, were assessed at baseline, one week, and one-month post-treatment. Results: The MPNA group reported lower mean pain scores (2.3 vs. 5.6 in the ID group). Cosmetic satisfaction was higher in the MPNA group, with 80% reporting "Highly Satisfactory" outcomes compared to 40% in the ID group. Additionally, 85% resumed breastfeeding within one-week post-treatment in the MPNA group, compared to 60% in the ID group. Conclusion: It was concluded that MPNA is a viable, less invasive alternative to ID for small breast abscesses in breastfeeding women, with significantly reduced pain, better cosmetic outcomes, and quicker breastfeeding restoration. MPNA should be considered a preferred first-line treatment in appropriate cases.

Factors Affecting Parental Satisfaction with Ponseti Treatment in Children with Clubfoot

2025-03-29T09:45:01+00:00

Clubfoot, also known as congenital talipes equinovarus (CTEV), is a common lower-limb developmental disorder. Objectives: To assess the factors affecting parental satisfaction with Ponseti treatment in children with clubfoot presenting at a tertiary care hospital. Methods: It was a cross-sectional study carried out in the Department of Orthopaedics, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, from January 2024 to December 2024. We enrolled the 150 parents (either mother or father of children aged more than 18 years) of children diagnosed with clubfoot and who were undergoing Ponseti treatment. Parents were interviewed, and data were collected on socio-demographic factors, and their satisfaction level was assessed using a modified orthotics prosthetics user survey. Data were analysed using SPSS version 23. Results: The median age of the parents was 39 years, and most were female (54%). 59.3% of the parents were satisfied with the Ponseti clubfoot treatment, and 40.7% were unsatisfied. The multivariate analysis revealed female gender (AOR=17.90, 95% CI=6.05-53.29), duration of treatment ≥8 months (AOR=8.30, 95% CI: 2.88-23.93), being employed (AOR=8.76, 95% CI=2.65-29), primary education (AOR=5.69, 1.49-21.62), intermediate education (AOR=7.35, 1.84-29.35) and graduate level education (AOR=10.80, 95% CI=2.52-46.19) were identified as major factors for parental satisfaction for ponseti treatment in children with clubfoot. Conclusions: It was concluded that factors such as being a father, children with short duration of treatment, having no job and education are significantly associated with parental dissatisfaction. Therefore, appropriate educational interventions should be devised to improve treatment results and adherence rates.

Frequency of Osteoporosis in Patients Presenting with Chronic Liver Disease at Tertiary Care Hospital Karachi

2025-06-14T05:47:06+00:00

Osteoporosis is a disease of low bone mass and micro-architectural deterioration of bone tissue, resulting in bone fragility and an increased risk of fractures. Because osteoporosis suddenly manifests with fractures at multiple skeletal sites, most often at the spine, hip, or wrist, it is termed "silent disease". This becomes even important in CLD patients. Objective: To determine the frequency of osteoporosis in patients presenting with chronic liver disease (CLD) at Al Tibri Medical College and Hospital, Karachi. Methods: A Total of 120 CLD patients of either gender were included. Data like age, gender, residence, and duration of CLD were recorded and followed by a study of bone mineral density (BMD) in the distal forearm of the non-dominant hand using dual-energy X-ray absorptiometry (DEXA). If BMD <–2.5 SD, then osteoporosis was positive. SPSS version 23.0 was used for analysis. Descriptive statistics were calculated. Effect modification was controlled through Chi-square. p-value<0.05 was considered significant. Results: The mean age was 39.49 ± 8.12 years. Mean CLD duration was 5.93 ± 2.29 years. Male were 68.3%. A total of 31.7% of patients with CLD had a BMD score <–2.5 SD and were observed as osteoporosis. The frequency of osteoporosis decreased with increasing age, but not statistically significant. Numerically, male was more affected than female, however, with an insignificant association. The duration of CLD was an effect modifier insignificantly. Conclusion: Almost every third patient of CLD has osteoporosis. The current study recommends screening of all such patients.

Comparing the Learning Experience of Student LED CBL (S-CBL) and Instructor Led CBL (I-CBL) in BDS Clinical Years

2025-06-11T04:07:53+00:00

Literature suggests that in instructor led CBL, where clinical cases are delivered by the facilitators, student’s ability to view the authentic context of oral diseases from multiple sources of real world is hampered. Objective: To compare the level of satisfaction regarding instructor led CBL (I-CBL) and student led CBL (S-CBL) of dental students in their clinical years and the test exam score of dental students gone through instructor led CBL (I-CBL) and student led CBL (S-CBL). Methods: Comparative cross-sectional study was carried out at Bahria Dental College Karachi for 1 year after approval of synopsis. Non-probality Sampling Technique was used for sample collection. Inclusion criteria included dental students in five clinical rotations for two months and students who provided consent to participate in study. Data were analyzed using SPSS version 25.0 and chi square test was applied. Results: Among total subjects 22% were females and 78% were males. Both S-CBL and I-CBL received high ratings for satisfactory sessions, but S-CBL participants (69%) experience was slightly higher, that indicated a preference for the student-led approach. Prioritized teaching method using it was recommended by 65% of the students, especially in clinical years of dentistry. Conclusions: It also brought students and faculty together to create a healthy communication flow. A strong preference for CBL as a better learning strategy especially for clinical knowledge was found among many dental institutions by dental undergraduates. PBL was also recommended by many students in problem solving, communication skills and sharpening critical thinking.

Unveiling Pelvic Organ Pathologies: A Laparoscopic Exploration of Female Infertility at a Tertiary Care Hospital

2025-06-16T10:17:42+00:00

The World Health Organization (WHO) estimates the global prevalence of infertility at 17.5% with little discrimination among regions, lifetime prevalence coming to 17.8% in high-income countries and 16.5% in low- and middle-income countries. In Pakistan, no large-scale multicenter studies have been conducted to assess the prevalence of infertility. The United Nations Population Fund (UNFPA) estimated it to be around 22% in 2003. No studies other than small-scale cross-sectional studies have been done. Objective: To investigate the causes of unexplained infertility in Pakistani women undergoing diagnostic laparoscopy. Methods: A cross-sectional study was conducted at Shalamar Medical College and Teaching Hospital from October 2023 to June 2024. All patients >18 years of age, who had a complete infertility workup (ultrasonography (USG), endocrine markers and male partner semen analysis negative or equivocal, resulting in no diagnosis, were included in this study. Results: Primary infertility (73%) was more frequent than secondary infertility (27%). The most common diagnoses for primary infertility were polycystic ovaries (22%) and endometriosis (16.4%). Tubal blockages (52.5%) were the most frequent tubal pathology. Laparoscopy confirmed the diagnosis of unexplained infertility and provided valuable information for treatment planning. Conclusions: This study suggests a high prevalence of primary infertility with delayed diagnosis in Pakistan. Traditional delays in seeking treatment and limited access to laparoscopy highlight the need for improvement in infertility care. Laparoscopy provides a panoramic and magnified view of the pelvic organs. It is a reliable tool to identify the causes of infertility that are usually missed on a non-invasive work-up.

Antibiotic Resistance: Investigating the Prevalence of Antibiotic Resistance in E. Coli Infections among Patients Treated with Ciprofloxacin versus Amoxicillin

2025-06-17T04:30:37+00:00

Among all gram-negative organisms that cause bacteremia, the most frequent one is Escherichia coli. Objectives: To determine the prevalence of antibiotic resistance towards E. coli infections in patients treated with ciprofloxacin and amoxicillin. Methods: This cross-sectional descriptive study was carried out at the Shahida Islam Medical College and Hospital for six months from July 2024 to December 2024. Isolates of specimens from various samples, such as blood, urine, stool, pus of the ear and skin were included. Isolates positive for Escherichia coli were included, while isolates from other organisms were excluded. Antibiotic sensitivity towards Ciprofloxacin and Amoxicillin was tested. SPSS version 25.0 was used for data analysis. Chi-square test was applied for statistical analysis, keeping p<0.05 as statistically significant. Results: The study analyzed 208 E. coli isolates, mostly from patients over 55 years and presenting with outpatient infections. Antibiotic resistance was significantly higher to amoxicillin (68.75%) compared to ciprofloxacin (41.35%) (p<0.001). Only 9.62% of isolates were sensitive to amoxicillin, while 44.71% were sensitive to ciprofloxacin. These findings highlight a concerning prevalence of resistance, particularly against amoxicillin, among E. coli infections. Conclusions: The results of this study reported a higher prevalence of antibiotic resistance to Amoxicillin when compared with the resistance towards Ciprofloxacin. Further, multicenter studies with a greater sample size would be better able to authenticate the findings observed in this research.

Prevalence of Leg Ulcers in Sickle Cell Disease and Their Association with Disease Severity, Inflammatory, and Oxidative Stress Markers

2025-06-10T04:26:51+00:00

Leg ulcers are a devastating problem of sickle cell disease (SCD) and are associated with elevated inflammation and oxidative stress. Understanding their prevalence, severity, and biochemical associations is essential for improved management. Objective: To determine the prevalence and severity of leg ulcers in sickle cell disease and evaluate their association with oxidative and inflammatory stress markers, addressing the gap in the literature regarding biochemical correlates of ulcer development in SCD patients. Methods: This cross-sectional study was carried out at Gujranwala Teaching Hospital, Gujranwala Medical College. A total of 323 genetically confirmed SCD patients were enrolled. Clinical data, including leg ulcer characteristics and SCD severity, were documented. Serum levels of Tumor Necrosis Factor Alpha (TNF-α), Interleukin-6 (IL-6), Total Antioxidant Capacity (TAC), and Total Oxidative Stress (TOS) were quantified using ELISA. Statistical analysis was completed using SPSS-25. Results: The prevalence of leg ulcers was 30.0% (97/323; 95% CI: 25.1%–35.3%), increasing with SCD severity (p<0.001). Ulcerated patients had significantly higher TNF-α (28.5 ± 5.3 vs. 19.6 ± 4.8 pg/mL; 95% CI for difference: 7.3–10.2, p<0.001) and IL-6 (21.2 ± 4.7 vs. 12.9 ± 3.6 pg/mL; 95% CI: 6.9–9.6, p<0.001). TOS was elevated (48.7 ± 9.5 vs. 32.3 ± 7.1 µmol H₂O₂ equiv./L; 95% CI: 13.5–18.2, p<0.001), while TAC was lower (0.82 ± 0.14 vs. 1.27 ± 0.21 mmol Trolox equiv./L; 95% CI: –0.54 to –0.38, p<0.001). Conclusions: Leg ulcers are prevalent in SCD, particularly in patients with severe disease. SCD severity showed significant associations with inflammatory and oxidative stress markers.

Efficacy of Suprachoroidal Triamcinolone Acetonide Injections in Resistant Diabetic Macular Edema

2025-04-09T10:35:36+00:00

Localized drug delivery through the suprachoroidal space can be used for more targeted therapies whilst minimize exposure to the healthy tissues. Objectives: To determine the efficacy of suprachoroidal triamcinolone injection given by the suprachoroidal route in patients with resistant diabetic macular edema. Methods: A quasi-experimental study was done at Al Ibrahim Eye Hospital, Karachi’s Vitreo-retina Department. Duration of research was 6 months (July to December 2024) (ATMC/ERC/13 (01/2023/22). Adult patients attending the vitreo-retinal OPD with resistant diabetic macular edema were included. Data were analyzed using SPSS version 22.0. Discrete variables were reported as mean and standard deviation, and continuous variables as frequencies and percentages. BCVA and CST readings at 4, 8 and 12 weeks were compared with baseline using a paired t-test, with p-value <0.05 statistically significant. Results: Before injection. The pre- and post SCTA BCVA and CST with baseline mean BCVA were 1.1 ± 0.30, which progressively improved at subsequent follow-ups, reaching 0.33 ± 0.18 by the third month post-injection. Conclusions: SCTA injections significantly improve visual acuity and reduce central subfield thickness in patients over a three-month follow-up period. The progressive enhancement in Best Corrected Visual Acuity and consistent reduction in Central Subfield Thickness highlight the efficacy of SCTA

Abdominal Ectopic Pregnancy: Surgical Management in Low-Resource Settings

2025-06-20T06:40:15+00:00

Abdominal ectopic pregnancy (AEP) is a rare and potentially life-threatening condition in which a fertilized ovum implants within the peritoneal cavity outside the uterine structures. It accounts for approximately 1% of all ectopic pregnancies and poses significant diagnostic and management challenges. AEP is a rare but serious obstetric emergency requiring high clinical suspicion for early diagnosis. Prompt imaging and appropriate surgical intervention are crucial in preventing maternal morbidity and mortality. We hereby report a case of a 42-year-old Gravida⁵ Para⁴ Alive¹, a 17-week pregnant woman from a remote rural area presented with shock and sudden lower abdominal pain for 5 hours. Abdominal ultrasound revealed an abdominal ectopic pregnancy with the fetus in the right iliac fossa. Due to hemodynamic instability, an emergency laparotomy was performed, revealing a 17-week male fetus in the peritoneal cavity with 1500 mL of hemoperitoneum. The placenta was attached to the right fallopian tube, necessitating a salpingectomy. Postoperative recovery was uneventful without complications. This case highlights the importance of considering AEP in differential diagnoses of atypical abdominal pain in pregnancy and underscores the role of multidisciplinary management for optimal patient outcomes.

Trimester-Specific Hemodynamic and Blood Volume Adaptations in Pregnancy: A Systematic Review of Normal and High-Risk Populations

2025-06-16T06:54:51+00:00

Pregnancy involves significant cardiovascular adaptations, including increased blood volume, cardiac output (CO), and reduced systemic vascular resistance (SVR), which are essential to support fetal development. While these changes are well established, the timing, magnitude, and variability across maternal risk profiles remain inconsistently reported. Objectives: To synthesize original research from 2015 to 2025 examining trimester-specific changes in maternal hemodynamic and blood volume, with a focus on both normal and high-risk pregnancies. Methods: Systematic searches were conducted in PubMed, Science Direct, Scopus, and Wiley Online Library. Inclusion criteria encompassed original English-language studies involving human pregnancies that assessed maternal blood volume or cardiovascular parameters using validated methods. Extracted data were synthesized across four domains: study characteristics, trimester-wise trends, methodology, and quality. Results: Nine studies met the inclusion criteria. Most reported a rise in CO and plasma volume from early to mid-pregnancy, alongside a reduction in SVR. In contrast, high-risk groups, including those with fetal growth restriction (FGR), preeclampsia (PE), and obesity, demonstrated impaired adaptation, marked by persistently high SVR and reduced stroke volume. Conclusions: It was concluded that trimester-specific hemodynamic adaptation is essential for healthy pregnancy progression. Deviations in high-risk populations may serve as early markers of complications. Incorporating non-invasive cardiovascular monitoring into routine prenatal care may improve risk stratification and outcomes.

Evaluating Preventive Strategies for Bronchopulmonary Dysplasia in Preterm Neonates: A Systematic Review

2025-06-10T07:00:50+00:00

Bronchopulmonary dysplasia (BPD) remains a major complication in preterm neonates, affecting long-term respiratory health and quality of life. Despite advances in neonatal care, identifying consistently effective preventive strategies remains a clinical challenge. Objectives: To evaluate recent evidence on interventions used to prevent BPD in preterm neonates, focusing on identifying effective strategies and addressing current research gaps. Methods: A structured literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science for studies published between January 2016 and March 2025. Eligible studies included randomized controlled trials, prospective cohorts, and observational studies evaluating interventions in neonates born before 32 weeks of gestation or weighing under 1500 grams. Screening and data extraction were performed independently. Methodological quality was assessed using standard tools. Results: Eighteen studies met the inclusion criteria. Interventions evaluated included non-invasive ventilation, minimally invasive surfactant therapy (MIST), pharmacologic agents (melatonin, corticosteroids, intra-tracheal budesonide), and nutritional supplementation (vitamins A and D, fatty acids). MIST, melatonin, budesonide with surfactant, and early vitamin D supplementation consistently reduced BPD incidence. In contrast, vitamin A, maternal DHA supplementation, and systemic hydrocortisone showed limited or inconsistent benefit. Conclusions: Several interventions, particularly MIST, budesonide with surfactant, melatonin, and vitamin D, appear effective in preventing BPD in preterm infants. However, inconsistencies in outcomes from other therapies underscore the need for further high-quality trials to guide clinical practice.