Pakistan Journal of Health Sciences

Anatomical Variations of the Circle of Willis and Their Clinical Significance: A Systematic Review

2026-07-02T08:01:28+00:00

The Circle of Willis (CoW) is the principal intracranial collateral network connecting the anterior and posterior cerebral circulations. Anatomical variations of the CoW are common and may influence cerebral hemodynamics, collateral capacity, ischemic stroke outcomes, and aneurysm development. However, contemporary imaging-based evidence regarding their clinical significance has not been systematically synthesized. Objectives:
To systematically review recent human imaging studies (2020–2025) evaluating anatomical variations of the Circle of Willis and their reported clinical associations. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted following PRISMA 2020 guidelines. Original human studies assessing CoW anatomy using computed tomography angiography (CTA), magnetic resonance angiography (MRA), or conventional angiography were included. Data extracted included study design, population characteristics, imaging modality, prevalence of major variants, and clinical associations. Risk of bias was assessed using a qualitative domain-based approach. Due to methodological heterogeneity, findings were synthesized narratively. Results: Eighteen imaging-based studies were included. Incomplete CoW configurations and posterior communicating artery hypoplasia/aplasia were the most frequently reported variants, with incomplete configurations reported in 30–70% of participants. Several studies demonstrated associations between incomplete configurations and poorer ischemic stroke outcomes, vulnerable intracranial plaque features, and increased odds of intracranial aneurysm. Fetal-type posterior cerebral artery and A1 segment asymmetry were linked to distinct hemorrhagic and aneurysmal patterns. Conclusions: Anatomical variations of the Circle of Willis are highly prevalent and clinically relevant. Standardized reporting of CoW configuration may enhance cerebrovascular risk stratification and inform neurovascular decision-making.

A Preventable Crisis: Overhauling Healthcare for Pakistan's Scorching Future

2026-07-01T08:01:05+00:00

The mercury is rising, and so is the loss of life among humans. The current and future seasons of Pakistan are not only a meteorological event, but a systemic failure that has been revealed. Today, the healthcare system lacks adequate resources and funds, and is in short supply, as the temperature regularly exceeds 49°C in cities such as Karachi and Peshawar, and this is the final line of defense in survival. This heatwave crisis needs more than a seasonal warning; it's a call for a swift and drastic restructuring of public health systems, ranging from the emergency ward to urban design [1].

The numbers put on a dark picture of an approaching collapse. In the past one season, thousands of patients with heatstroke have been reported and admitted at hospitals in Sindh and Punjab, which have been unable to cope with huge number of patients as they were overrun by the number of patients and lacked basic facilities for quick cooling [2]. A study on heat stroke in Karachi revealed that a total of over 6 thousand heat strokes had been reported, but this is a conservative estimate, given that only 5% of deaths are registered officially in the country [3]. No heat-related illness (HRI) ward or special cooling areas are available in KP, and up to 60 patients are brought to major public hospitals every day for heat-related illness, and critical patients are treated in general emergency bays. It is not because patients don't have resources; it's because patients don't prioritize them [4].

The effects of this lack of preparation are deadly, especially for the most vulnerable. Those who are elderly, children, pregnant women, and workers in the open fields, who have no other way to make a living except under the hot sun, are severely affected [5]. Chronic power shortages (otherwise known as load-shedding) and acute water scarcity combine to make homes into furnaces and people into dehydrated individuals in the fight for survival, with acute kidney injuries being just one of the many life-threatening illnesses that result. A new Amnesty International report revealed that the deaths of victims of heatwaves are often not recorded in official statistics, meaning that they are not registered as heatstroke victims. One resident of Karachi reported that his 65-year-old father died after his body overheated during a power outage when he was not able to go to an overcrowded hospital [6].

So, what is the solution? It begins with acknowledging that this is not a natural disaster but a public health emergency that demands systemic change.

First, hospitals must be engineered to be heat-resilient. This is not limited to the provision of IV fluids and ORS. There should be dedicated heatstroke wards in all major public hospitals with A/C cooling centres and crash carts that have all the necessary intubation equipment for heatstroke. Water and electricity are two critical infrastructures in hospitals that are in short supply and must be taken as an emergency failure since cooling is crucial for hospitals to operate and maintain life-saving systems. A recent advisory issued by the National Institutes of Health (NIH) for "dedicated heatstroke centres" is a positive move, but it needs to be followed by fast funding and implementation.

Second, frontline staff must be empowered with the right knowledge. Heat-related illness has long been a marginal problem in the medical curriculum. A recent study of undergraduate medical programs in Pakistan identified no dedicated courses on climate-health connections. Emergency physicians must learn to recognize and treat heatstroke in a proactive rather than a reactive manner. In Karachi, the "Heat Emergency Awareness and Treatment" (HEAT) intervention proved that a structured training program greatly enhanced the diagnosis rate and management practices. This blueprint needs to be scaled up nationally.

Third, prevention must start long before a patient reaches the emergency room. Effective public health measures involve creating early warning systems and conducting awareness-raising campaigns in the community to educate citizens about the signs and symptoms of heat exhaustion, including dizziness and confusion. The relief camps set up by the local administration in Sukkur, where ORS and chilled water were distributed, should be replicated in all cities. Moreover, long-term resilience needs urban greening: planting trees and using reflective surfaces to counteract the so-called “urban heat island” effect.

Pakistan is on the front lines of the climate change crisis, but its healthcare system is still in reactive mode. Heatwaves remained alarming during 2024 and 2025. Pakistan cannot afford to wait for another crisis to act. The decision is stark: invest in a health system built to withstand the climate crisis, or keep tallying preventable deaths. It's essential to the health of this country.

Role of Epoetin-α in the Management of Anemia in Chronic Kidney Disease (CKD) Patients

2026-07-01T08:04:05+00:00

Anemia in chronic kidney disease (CKD) contributes to morbidity, increased transfusion requirements, and cardiovascular risk, and is mainly caused by insufficient erythropoietin (EPO) synthesis. Erythropoietin-stimulating agents (ESAs) are a crucial therapy for managing anemia associated with CKD. Before the introduction of ESAs, blood transfusions were primarily used to manage anemia in these patients. Epoetin-α was the first erythropoietin analog to be used clinically. Objective: To find the efficacy of epoetin-α in increasing hemoglobin in chronic kidney disease patients. Methods: A cross-sectional study was conducted at Pakistan Air Force Hospital Mushaf, Sargodha, including 189 CKD patients. All patients received Epoetin-α at a dose of 4000 IU subcutaneously once weekly. Baseline complete blood count (CBC) was recorded before treatment, and a follow-up CBC was performed after one month. Data were collected through a questionnaire and analyzed using SPSS version 24.0. Results: The study included 189 patients, of whom 121 were male and 68 were female. The mean age was 58.7 ± 14.39 years. The mean hemoglobin before Epoetin-α therapy was 7.5 ± 0.76 g/dL, which increased to 8.9 ± 1.28 g/dL after one month. Erythropoietin was found effective in 82% of patients, while 18% showed an insufficient response. Post-treatment chi-square analysis revealed statistically significant associations for age, baseline hemoglobin, and duration of dialysis (p<0.001), whereas gender was not significantly associated (p=0.202). Conclusions: Epoetin-α stands as a cornerstone in managing CKD-related anemia. Despite the efficacy, optimal dosing strategies, long-term safety profiles, and personalized treatment algorithms necessitate further research.

Comparison Between Serum Electrolyte Levels in Full-Term Healthy Neonates Versus Neonates with Hypoxic Ischemic Encephalopathy

2026-07-01T08:03:20+00:00

Hypoxic ischemic encephalopathy (HIE) is a major cause of neonatal mortality and neurological disability. Hypoxia leads to multisystem involvement, causing electrolyte disturbances such as hyponatremia, hyperkalemia, and hypocalcemia, causing adverse clinical outcomes. Most studies assess these abnormalities after 24 hours of life. Detection within the first 12 hours may help reduce complications and long-term disability. Objectives: To compare serum sodium, potassium, and calcium levels in full-term healthy neonates versus those with HIE. Methods: This cross-sectional study was conducted at King Edward Medical University from June 2025 to November 2025 (IRB letter no. 512/RC/KEMU). Patients presenting to Mayo hospital over six months period were evaluated to determine the frequency of hypoxic-ischemic encephalopathy (HIE). After taking informed consent, 228 eligible subjects were identified, comprising 114 HIE and 114 non-HIE patients. Serum sodium, calcium, and potassium levels were measured within the first 12 hours of life and were compared between the two groups. Data were analyzed using SPSS version 27.0, and an independent t-test and Chi-square test were applied with a p-value <0.050. Results: The frequency of neonates diagnosed with HIE was 9.7%. Hyponatremia (32.3%), hyperkalemia (22.8%), and hypocalcemia (8.8%) were significantly more common in neonates with HIE. These differences were statistically significant (p<0.001). Conclusions: Compared to healthy neonates, neonates with HIE demonstrated significantly higher rates of electrolyte abnormalities. Identification of these electrolyte abnormalities is crucial, as timely detection and correction can play an important role in preventing further neurological damage, thereby enhancing clinical outcomes in affected neonates.

Comparative Efficacy of Hypertonic Versus Normal Saline Nebulization in Acute Bronchiolitis in Infants at a Tertiary Care Hospital

2026-07-01T08:03:47+00:00

Acute bronchiolitis is a leading cause of hospitalization in infants and is managed mainly with supportive care. Nebulized 3% hypertonic saline (HS) has been used in some settings, but evidence from routine-care practice remains variable. Objectives: To compare short-term clinical outcomes of nebulized 3% hypertonic saline versus 0.9% normal saline administered as routine care in infants hospitalized with acute bronchiolitis at Mardan Medical Complex. Methods: This was a prospective quasi-experimental comparative cohort study to compare the outcomes between infants receiving 3% hypertonic saline and those receiving 0.9% normal saline. Participants were actively followed for up to 72 hours to assess clinical response, with treatment allocation based on routine clinical decisions made by the treating pediatrician. Efficacy was predefined as a ≥2-point reduction in the Respiratory Distress Assessment Instrument (RDAI) score within 72 hours or discharge without supplemental oxygen. Results: Treatment response occurred in 27/30 (90%) in the 3% HS group versus 15/30 (50%) in the 0.9% NS group (p<0.001). Mean oxygen-therapy duration was shorter (17.3 ± 4.2 vs 26.8 ± 5.6 hours; p<0.001), and hospital stay was shorter (2.6 ± 0.8 vs 3.5 ± 1.0 days; p<0.001) in the 3% HS group. Conclusions: In this routine-care setting, nebulized 3% hypertonic saline was associated with a higher treatment-response rate and shorter oxygen-therapy duration and hospital stay than 0.9% normal saline.

Comparison of Rivaroxaban Versus Warfarin in Resolution of Left Ventricular Thrombus After Acute Anterior Wall Myocardial Infarction: A Prospective Cohort Study

2026-07-01T08:03:38+00:00

There is emerging evidence that direct oral anticoagulants like rivaroxaban are a more effective alternative for thrombus resolution after acute myocardial infarction. Objective: To compare the rate of left ventricular thrombus resolution between rivaroxaban and warfarin after acute anterior wall myocardial infarction. Methods: This prospective cohort study was conducted in the Department of Cardiology at Sheikh Zayed Hospital, Rahim Yar Khan, from May to November 2025. A total of 290 participants with left ventricular thrombus after acute anterior wall myocardial infarction were enrolled in the study. The unexposed group consisted of patients treated with warfarin, with the dose adjusted to maintain an INR of 2.0-3.0. The exposed group received rivaroxaban (20 mg daily; 15 mg if creatinine clearance was 30–50 ml/min/1.73m²). Echocardiography was performed at baseline and repeated after three months to assess thrombus resolution. Data were analyzed through SPSS version 25.0. Descriptive statistics were run, and an independent sample t-test was used for numerical comparison and a chi-square test for categorical comparison. Results: The mean age was 60.4 ± 6.4 years, with 73.4% males. Baseline demographics were comparable between the groups. Thrombus resolution at three months was achieved in 52.4% overall, significantly higher in rivaroxaban versus warfarin (61.4% vs. 43.4%, p-value=0.002; RR: 1.4, 95% CI: 1.1–1.8). Diabetes, hypertension, and thrombus size ≥1 cm were associated with lower thrombus resolution rates. Conclusions: Rivaroxaban demonstrated better efficacy over warfarin for thrombus resolution in post-myocardial infarction patients. Comorbid diabetes, hypertension, and larger thrombosis size were significant negative predictors of resolution.

Comparison of Video Laryngoscopy Versus Conventional Laryngoscopy in Anticipated Difficult Intubation in Patients Undergoing Thyroid Surgery

2026-07-01T08:03:11+00:00

Anticipated difficult airway in thyroid surgery is associated with failed intubation, hypoxia, and airway trauma, despite structured preoperative assessment. Objectives: To compare video laryngoscopy with conventional direct laryngoscopy in adult patients undergoing elective thyroid surgery with anticipated difficult intubation in terms of first- attempt and overall tracheal intubation success, glottic visualization, intubation time, and immediate oropharyngeal injury. Methods: A randomized controlled trial was conducted in the Department of Anesthesia, Sheikh Zayed Hospital, Rahim Yar Khan, from January 2025 to June 2025. Sixty patients (18–60 years) undergoing elective thyroidectomy with anticipated difficult intubation (ASA I–II, ≥1 airway predictor) were enrolled by non-probability consecutive sampling and randomized (1:1) to conventional laryngoscopy or video laryngoscopy. All intubations were performed by experienced anesthetists. Results: Among 60 randomized patients, baseline age (44.47 ± 7.66 vs 44.60 ± 8.02 years) and gender distribution (46.7 % vs 40.0 % males) were comparable between conventional and video- laryngoscopy groups. Video laryngoscopy improved Cormack–Lehane grade I view frequency (60.0% vs 13.3%, p=0.002) and increased first-attempt intubation success (93.3% vs 60.0%, p=0.002). Overall success was 100.0% with video laryngoscopy versus 93.3% with direct laryngoscopy (p=0.150). Mean intubation time was longer with video laryngoscopy (45.13 ± 8.38 vs 39.20 ± 9.83 seconds, p=0.015). Immediate oropharyngeal injury was numerically lower with video laryngoscopy (6.7% vs 20.0%, p=0.129). Conclusions: In anticipated difficult airways during thyroid surgery, video laryngoscopy significantly improved first-attempt intubation success and glottic visualization, while overall success remained similarly high in both groups.

Role of Pre-Operative Single Dose Versus Double Dose Antibiotic in Prevention of UTI in Patients Undergoing Ureteroscopy with Negative Urine Culture

2026-07-01T08:02:53+00:00

Ureteroscopy (URS) is a minimally invasive procedure for ureteral stones, strictures, and tumors. Though generally safe, it carries a risk of postoperative urinary tract infections (UTIs), particularly with instrumentation or residual fragments. The optimal prophylactic antibiotic strategy remains debated. Objectives: To compare single- versus double-dose intravenous Ceftriaxone for preventing post-URS UTIs in patients with sterile preoperative urine. Methods: A prospective cohort study was conducted from 12 June to 11 December 2025, including 86 patients aged 18–60 years undergoing URS for ureteric calculi (0.5–2.0 cm) with negative urine cultures. Patients were allocated to two equal groups: Group A received a single 2 g intravenous Ceftriaxone dose at anesthesia induction, and Group B received two doses, 24 hours preoperatively and at induction. Exclusion criteria included uncontrolled diabetes or hypertension, positive culture, and cephalosporin allergy. Data were collected by a standardized proforma. Postoperative UTI was defined clinically (fever >100°F, TLC >10×10⁹/L, pulse >100/min) and confirmed by urine culture. Statistical analysis was performed using SPSS version 22.0; p<0.05 was considered significant. Results: Baseline characteristics (age, BMI, gender) were comparable between groups (p>0.05). UTIs occurred in 11 patients (12.8%), with no significant difference between Group A (16.3%) and Group B (13.9%) (p=0.74). Isolated organisms included E. coli, Enterococcus faecalis, Proteus mirabilis, and Enterobacter. No significant associations were found with stone location, URS side, stenting, or diabetes. Conclusions: Single- and double-dose Ceftriaxone equally prevent post-ureteroscopy UTIs in sterile urine patients. Single-dose is a cost-effective, stewardship-friendly option. Further trials needed.

Knowledge, Practices, and Barriers Related to Informed Consent Among Postgraduate Medical and Surgical Residents in Peshawar

2026-07-01T08:02:18+00:00

Informed Consent is well-established and standard protocol in clinical practice, ensuring that patients are autonomous in making decisions and know about the benefits, risks, and alternatives to the procedure. Objectives: To determine the knowledge, practices, and barriers of informed consent among medical and surgical postgraduate residents of the tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan. Methods: An analytical cross-sectional study was conducted from June 2025 to August 2025 among 294 medical and surgical postgraduate residents in public and private hospitals in Peshawar through a self-structured questionnaire, using convenience sampling, and analyzed by SPSS version 27.0. Results: 65% of postgraduate residents were aware of informed consent, especially legal requirements and ethical principal 92.9% and 91.8% respectively, while lower for assessing decision capacity (36.7%) and voluntariness (21.4%). Practice levels were lower than the knowledge level, despite the frequent use of standardized forms and verification of understanding. Language barriers (74.1%) and time constraints (58.5%) were key obstacles in obtaining informed consent. Knowledge significantly correlated with department (p=0.018), while practice significantly correlated with formal training in informed consent (p=0.010), but not age. Barriers showed no significant associations with department or training year. Conclusions: Regardless of the high knowledge of informed consent among residents, it was moderately practiced in hospitals, with a weakness in assessing decision-making and voluntariness. Language barriers and time constraints embarrass the practice of informed consent. Structured training and barrier mitigation could bridge this knowledge-practice gap and strengthen the practice of informed consent.

Informed Consent is well-established and standard protocol in clinical practice, ensuring that patients are autonomous in making decisions and know about the benefits, risks, and alternatives to the procedure. Objectives: To determine the knowledge, practices, and barriers of informed consent among medical and surgical postgraduate residents of the tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan. Methods: An analytical cross-sectional study was conducted from June 2025 to August 2025 among 294 medical and surgical postgraduate residents in public and private hospitals in Peshawar through a self-structured questionnaire, using convenience sampling, and analyzed by SPSS version 27.0. Results: 65% of postgraduate residents were aware of informed consent, especially legal requirements and ethical principal 92.9% and 91.8% respectively, while lower for assessing decision capacity (36.7%) and voluntariness (21.4%). Practice levels were lower than the knowledge level, despite the frequent use of standardized forms and verification of understanding. Language barriers (74.1%) and time constraints (58.5%) were key obstacles in obtaining informed consent. Knowledge and practice significantly correlated with gender, hospital, and department (p<0.001), but not age. Barriers showed no significant associations with department or training year. Conclusions: Regardless of the high knowledge of informed consent among residents, it was moderately practiced in hospitals, with a weakness in assessing decision-making and voluntariness. Language barriers and time constraints embarrass the practice of informed consent. Structured training and barrier mitigation could bridge this knowledge-practice gap and strengthen the practice of informed consent.

Comparative Evaluation of Classical Inferior Alveolar Nerve Block and Gow-Gates Nerve Block for Surgical Removal of Mandibular Third Molar

2026-07-01T08:03:29+00:00

Effective anesthesia is essential for the surgical removal of mandibular third molars. While the classical inferior alveolar nerve block is widely used, its success may be limited by anatomical variations. The Gow-Gates technique is considered a potential alternative offering broader mandibular anesthesia. Objectives: To evaluate and compare the classical inferior alveolar nerve block and Gow-Gates nerve block for surgical removal of mandibular third molars in terms of Anesthetic success rate, Onset and duration of anesthesia, and patient-reported pain using a visual analog scale. Methods: A quasi-experimental, comparative study was performed in which a total of 160 patients were selected and randomly allocated to receive Gow-Gates (GG) nerve block or inferior alveolar nerve block (IANB) for the extraction of mandibular molars. Onset time, pain levels, and volume of anesthesia were recorded as data. SPSS statistical analysis version 26.0 was used for data analysis. Results: Regarding gender, females were counted more, 87, comprised 54.43 % of the sample, whereas 73 men accounted for 45.57 %. The onset time of the Gow-Gates group took 6.16 minutes, which is slower than IANB, 2.78 minutes; however, the success rate of both techniques is about the same, 87.5%. Furthermore, the mean volume of local anesthesia used to anesthetize tissues was higher in the IANB group than in the GG group. Conclusions: Both methods are useful in mandibular anesthesia, and Gow-Gates has a high rate of success and less chance of aspiration, though IANB has a quicker onset. Patient and clinician factors determine the technique to be used.

Frequency of Human Immunodeficiency Virus, Hepatitis B, and Hepatitis C Among Antenatal Women at a Tertiary Care Hospital

2026-07-01T08:04:23+00:00

Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) are major blood-borne infections. In Pakistan, the prevalence of HCV is predicted to range from 8% to 15%, while the combined frequency of HBV and HCV affects 7.6% of the population. Prenatal HIV screening is recommended to prevent mother-to-child transmission. Objectives: This study aimed to determine the frequency of HIV, HBV, and HCV among antenatal patients at a tertiary healthcare facility. Methods: A descriptive cross-sectional study was carried out at the Civil Hospital Karachi Obstetrics and Gynecology unit 3 over 6 months, from October 7, 2022, to April 8, 2023. Pregnant women aged between 15-49 years, with a gestational age >20 weeks, presenting for routine antenatal care were enrolled using non probability consecutive sampling. All participants were screened for HIV, HBV, and HCV. Data were analyzed using SPSS version 25.0. Results: Among 187 women, the mean age was 32.29 ± 3.91 years, and the mean gestational age was 22.87 ± 1.34 weeks. The prevalence rates of HIV, HBV, and HCV were 13 (7%), 23 (12.3%), and 43 (23%), respectively. Conclusions: Among antenatal patients, the prevalence of HIV, HBV, and HCV was 13 (7%), 23 (12.3%), and 43 (23%), respectively. This underscores the need for regular screening during pregnancy. Regular screening during pregnancy is mandatory to prevent these infections from being transferred from the mother to the child.

Frequency and Types of Seizures among Patients Presenting with Stroke

2026-07-01T08:02:27+00:00

Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. Post-stroke seizures represent an important neurological complication that may occur early or late after the event. However, limited data are available regarding their frequency and characteristics in the local population. Objective: To determine the frequency and types of seizures among patients presenting with stroke. Methods: This analytical cross-sectional study was conducted in the Department of Emergency Medicine, Lady Reading Hospital, Peshawar, over six months from May 2023 to November 2023. A total of 177 patients aged 20–80 years with radiologically confirmed stroke were enrolled using non-probability consecutive sampling. Patients with prior epilepsy or metabolic derangements known to precipitate seizures were excluded. Post-stroke seizures were classified as early (≤14 days) or late (>14 days to 3 months). Data were analyzed using SPSS version 26.0. Frequencies, percentages, chi-square tests, and logistic regression were applied, with p < 0.05 considered statistically significant. Results:
The mean age was 49.7 ± 18.1 years, and 61.0% were male. Ischemic stroke occurred in 73.4% of patients. Post-stroke seizures were observed in 14.1% (n=25). Among these, 48.0% were early, and 52.0% were late seizures. No statistically significant associations were found between seizures and stroke subtype (p=0.197), gender (p=0.150), or age category (p=0.320). Conclusions: Post-stroke seizures occurred in 14.1% of patients, with nearly equal early and late distribution. Structured surveillance during acute and subacute phases is warranted.

Frequency of Pneumonia in Children Presenting with Measles at DHQ Hospital, Dera Ismail Khan

2026-07-01T08:01:41+00:00

Measles remains a significant cause of pediatric morbidity and mortality worldwide, particularly in low- and middle-income countries. Pneumonia is one of the most frequent and serious complications of measles, contributing substantially to adverse outcomes in affected children. Objectives: To determine the frequency of pneumonia among children presenting with measles at DHQ Hospital, Dera Ismail Khan, and to assess associated demographic and clinical factors. Methods: This cross-sectional analytical study was conducted in the Department of Pediatrics, District Headquarters Hospital, Dera Ismail Khan, from September 2024 to January 2025. A total of 169 children aged 2–15 years with laboratory-confirmed measles were enrolled using consecutive non-probability sampling. Pneumonia was diagnosed based on clinical findings and radiographic confirmation. Data on age, gender, vaccination status, nutritional status, socioeconomic status, and residence were collected using a structured proforma. Statistical analysis was performed using SPSS version 25.0. Associations were evaluated using chi-square and Fisher’s exact tests, and multivariable logistic regression was conducted. Results: Among 169 children, 54 (32.0%) developed pneumonia. Pneumonia was significantly associated with malnutrition (p<0.001), younger age (p<0.001), rural residence (p=0.028), and lack of immunization (p<0.001). No pneumonia cases were observed among immunized children. Conclusions: Pneumonia was observed in approximately one-third of children with measles. Malnutrition, younger age, and non-immunization were associated with higher pneumonia frequency.

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in Differentiating Benign and Malignant Causes of Obstructive Jaundice Using Histopathology as the Reference Standard

2026-07-01T08:01:51+00:00

Obstructive jaundice requires accurate differentiation between benign and malignant causes to guide management and prognosis. Magnetic resonance cholangiopancreatography (MRCP) is increasingly used as a non-invasive diagnostic modality; however, local evidence comparing MRCP findings with histopathology remains limited. Objectives: To evaluate the diagnostic accuracy of MRCP in differentiating benign from malignant obstructive jaundice using histopathology as the reference standard. Methods: This retrospective cross-sectional study included 103 patients with obstructive jaundice who underwent MRCP followed by histopathological confirmation between June and December 2025. Biochemical parameters and imaging findings were analyzed. Sensitivity, specificity, predictive values, overall accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results: Histopathology confirmed 54 (52.4%) benign and 49 (47.6%) malignant cases. Total bilirubin, direct bilirubin, ALT, AST, ALP, and CA 19-9 levels were significantly higher in malignant cases (all p<0.001), while duration of jaundice, GGT, and stricture length showed no significant difference (p>0.005). MRCP demonstrated a sensitivity of 95.9%, specificity of 96.3%, positive predictive value of 95.9%, negative predictive value of 96.3%, and overall accuracy of 96.1%. ROC analysis showed excellent diagnostic performance (AUC = 0.961; 95% CI: 0.918–1.000; p<0.001). Conclusions: MRCP demonstrates excellent diagnostic accuracy in differentiating malignant from benign obstructive jaundice and serves as a reliable non-invasive imaging modality for clinical decision-making.

Visual Outcome and Topographic Parameters Stability after Corneal Ring Segment Surgery in Keratoconus

2026-07-01T08:02:00+00:00

Keratoconus is a bilateral, non-inflammatory disease that leads to the bulging outward of a cone-shaped cornea affecting both genders. The major symptoms are blurring of vision, distortion of images, and difficulty in night driving. Objectives: To find the improvement in distance best corrected visual acuity (BCVA) and maximum keratometry (Kmax) from the baseline values up to three months following the implantation of ICRS. Methods: This study was employed as a retrospective consecutive cohort, which included all eligible keratoconus subjects visting Out Patient Department, Fatima Memorial Hospital. All twenty-five cases underwent a comprehensive clinical ocular examination followed by Pentacam corneal topography. Those willing for the Kerrara ring segment implant for visual rehabilitation were enrolled. All surgeries were performed by a single surgeon with Femtolaser technology. Results: A total of twenty-five subjects were implanted with Ferrara Rings. Regarding the visual outcome, a statistically significant improvement in uncorrected visual acuity (UCVA) was observed following implantation of the Ferrara cornea rings (p<0.001). Similarly, the K max values also demonstrated a decreasing trend from 52.88 ± 4.80 preoperatively to 50.42 ± 4.61 postoperatively (p<0.001). Hence, it was documented that a reduction in Kmax values indicates a significant flattening in corneal regularity and topographic stability after Ferrara segment implantation. Conclusions: The results of this observational study showed a significant improvement in visual acuity and a reduction in K max values due to the spacer effects of ICRS, resulting in an overall improvement in the quality of life of Keratoconus patients.

Association of Plasma Fibrinogen Levels with Severity of Postpartum Hemorrhage: A Cross-Sectional Study

2026-07-01T08:01:32+00:00

Postpartum hemorrhage (PPH) significantly contributes to maternal morbidity and mortality worldwide. Identifying women at risk for severe PPH early is essential for timely intervention. Objective: To compare the mean plasma fibrinogen level between women with severe and non-severe postpartum hemorrhage (PPH). Methods: This comparative cross-sectional study was performed after its approval from the ethical committee with approval number Admin/PF/722A in the Department of Obstetrics and Gynecology at Cantt General Hospital, Rawalpindi, from July 3, 2025, to December 30, 2025. A total of 60 women with postpartum hemorrhage were enrolled using a consecutive sampling technique and categorized into non-severe PPH (n=30) and severe PPH (n=30) based on predefined clinical criteria. Plasma fibrinogen levels were assessed at the time of postpartum hemorrhage diagnosis with IBM SPSS version 25.0. A p-value of less than 0.05 was considered statistically significant. Results: Women experiencing severe PPH exhibited significantly lower fibrinogen levels in comparison to those with non-severe hemorrhage. The mean fibrinogen level in the non-severe postpartum hemorrhage group was 4.55±1.06 g/L, but in the severe PPH group it was 3.53±0.66 g/L, indicating a statistically significant difference (p=0.001). The findings demonstrate an inverse association between fibrinogen concentration and the severity of PPH, showing that lower fibrinogen levels are associated with an increased likelihood of severe bleeding. Conclusions: Reduced fibrinogen levels were significantly associated with severe PPH. Early measurement of fibrinogen may assist in identifying patients at increased risk of severe hemorrhage and ensure prompt management.

Investigating the Psychosocial Impact and Quality of Life in Gyne Cancer Survival Patients

2026-07-01T08:01:23+00:00

Gynecologic cancers are on the rise globally. Survivors frequently encounter physical distress aggravated by psychological instability, anxiety, and depression. Quality of life (QoL) includes physical, emotional, social, and functional well-being, rendering it a crucial patient-reported outcome in cancer. Objective: To investigate the psychosocial impact and quality of life in gynaecological cancer survival patients. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Liaquat National Hospital, Karachi. This study comprised 178 women with ovarian, endometrial, and cervical cancer who were undergoing active therapy at the time data were collected. Psychological well-being was measured by using the Hospital Anxiety and Depression Scale and the Distress Thermometer. The collected data were analyzed with IBM SPSS version 27.0. A p-value of ≤ 0.050 was deemed statistically significant. Results: The abnormal anxiety was highly prevalent (110; 61.8%) compared to depression (27; 15.2%). Patients ≤50 years showed significantly higher abnormal anxiety (66.2%) (p-value=0.025) and depression (18.5%). Treatment modality was significant, with combined surgery and chemoradiotherapy showing the highest abnormal depression (32.3%). Patients with abnormal anxiety showed significantly poorer functional status compared with normal anxiety (median FACT score versus 18, with a p-value <0.001). Conclusions: Gynecological cancer survivors face significant psychosocial challenges, with anxiety being more prevalent than depression. Quality of life was markedly impaired, and functional limitations were strongly linked to psychological morbidity.

Frequency of Cognitive Impairment in Multiple Sclerosis: Association with Neuro-Imaging Parameters and Disease Duration

2026-07-01T08:03:02+00:00

Cognitive impairment is a frequent but underrecognized feature of multiple sclerosis and contributes to functional decline. Early identification and association with clinical and neuroimaging markers may guide management. Objectives: To determine the frequency of cognitive impairment and its relationship with demographic, clinical, and MRI characteristics in multiple sclerosis. Methods: This cross-sectional study was conducted at the Department of Neurology, Punjab Institute of Neurosciences, Lahore, from May to December 2025. Seventy-one adults aged 18–50 years with multiple sclerosis, diagnosed according to the 2017 Revised McDonald Criteria, were enrolled. Brain MRI on a 3-Tesla system was evaluated for lesion characteristics and atrophy by a radiologist. Cognitive function was assessed using the Montreal Cognitive Assessment. Results: The mean age of participants was 35.08 ± 7.71 years, and the mean disease duration was 6.53 ± 3.24 years. The mean Montreal Cognitive Assessment (MoCA) score was 22.91 ± 5.87, and the mean total MRI lesion count was 16.07 ± 8.98. Cognitive impairment was found in 40.8%, including 21.,1% mild, 12.7% moderate, and 7.0% severe impairment. Relapsing–remitting multiple sclerosis was most common (69.0%), followed by secondary progressive (19.7%) and primary progressive (11.3%). Patients with impairment had older age (p=0.016) and longer disease duration (p=0.012). Cortical lesions and brain atrophy were significantly related to cognitive impairment. Conclusions: Cognitive impairment appeared as a frequent feature of multiple sclerosis and was related to advancing age, longer disease duration, and neuroimaging abnormalities.

Efficacy and Safety of Topical Spironolactone Versus Topical Clindamycin in the Treatment of Acne Vulgaris: A Split-Face Study

2026-07-01T08:01:14+00:00

This study compares the effectiveness and safety of topical Spironolactone 5% versus topical Clindamycin 2% in treating acne vulgaris in the same patient. Objective: To assess the effectiveness and safety of topical spironolactone 5% versus topical clindamycin 2% in the treatment of mild to moderate acne vulgaris in the same patient through a controlled evaluation. Methods: A double-blind, split-face comparative study was conducted at the Department of Dermatology, Ghurki Trust Teaching Hospital (September 2023-August 2024). Participants used 5% Spironolactone on one side of the face and 2% Clindamycin on the other for 12 weeks. Both patients and the assessing dermatologist remained blind. Improvement was measured by Total Lesion Count, Acne Severity Index, and Global Acne Assessment Score (GAAS), with a GAAS score of 0 or 1 indicating treatment success. Results: Both therapies effectively reduced papules, pustules, and comedones in 42 participants over 12 weeks, achieving Total Lesion Count Reductions of approximately 77.5 % for topical Spironolactone and 79.2% for topical Clindamycin (p=0.877). Clindamycin demonstrated faster initial improvement in total lesion count at week 6 (p=0.043) and week 8 (p=0.012), but Spironolactone showed comparable improvement by Week 12; however, the difference was not statistically significant (p=0.057). Clindamycin reduced pustules more efficiently at Week 12 (p=0.007). Conclusions: Both topical spironolactone and clindamycin were effective in treating mild to moderate acne vulgaris. Clindamycin showed a quicker initial improvement, but both treatments had similar results after 12 weeks.

Cleft Lip and Palate: Analyzing the Impact of Family History and Cousin Marriages

2026-07-01T08:04:31+00:00

Cleft lip and palate (CLP) are prevalent birth disorders and have significant impacts on the individuals and their families. Objectives: To identify the trends of cleft lip and palate and to examine the effects of family history and the marriage of cousins. Methods: This cross-sectional study was carried out in the Department of Oral Pathology, University of Health Sciences, Lahore. Four hundred children between the ages of 0 and 20 years were included. The following data were taken: demographic and clinical, such as age, sex, type of cleft, maternal folic acid intake, family history of cleft lip and/or palate or other congenital anomalies, and parental consanguinity. Results: The mean age of the participants was 55.79 ± 54.3 months. Among them, 214 (53.5%) were male, and 186 (46.5%) were female. In terms of cleft pattern, cleft lip and palate were most common, affecting 247 (61.8%) individuals, compared to those with only cleft lip or cleft palate. A positive family history was reported in 89 (22.3%) of the cases. Only 60 (15%) of the mothers had taken folic acid during pregnancy, and cousin marriages were noted among the parents of 309 (77.3%) children. Conclusions: CLP is more commonly observed in individuals with a positive family history and those whose parents are biologically related. A considerable proportion of affected children had parents who were cousins, suggesting that consanguinity may be a contributing factor to CLP. Additionally, a significant number of mothers did not receive folic acid supplementation during pregnancy, which is a modifiable risk factor.

Incidence of Contrast-Induced Nephropathy in Post-Renal Transplant Recipients

2026-07-01T08:02:44+00:00

Contrast-induced nephropathy (CIN) is a widely occurring, although possibly preventable, complication after the use of iodinated contrast media. Objectives: To identify CIN incidence in patients who have undergone renal transplants and also to see the risk factors involved. Methods: The cross-sectional research was carried out at the Sindh Institute of Urology and Transplantation (SIUT), Karachi, within six months after ethical consent of the College of Physicians and Surgeons Pakistan (CPSP). The sample size was 174 renal transplant recipients (aged 18 years and above) with an estimated glomerular filtration rate (eGFR) of over 20 ml/min, and these individuals were pre-exposed to 50 ml of iodinated contrast. Data analysis was done by use of SPSS version 25.0. Associations were evaluated using the chi-square test and multivariate logistic regression, with p≤0.005 being taken as statistically significant. Results: The average age of the interviewees was 44.2 ± 11.6 years old. The mean serum creatinine increased to 1.76 ± 0.49 mg/dl at the end of the experiment and correspondingly decreased to 55.6 ± 12.3 ml/min to 49.8 ± 13.1 ml/min. CIN appeared in 26 patients (14.9%). Its occurrence was much higher among those patients who had diabetes mellitus (23.8%, p=0.021) and hypertension (19.2%, p=0.045). On multivariate analysis, independent predictors of CIN were diabetes mellitus and contrast volume more than 100 ml (p<0.001). Conclusions: CIN is very prevalent among the post-renal transplant recipients. Higher contrast volume and diabetes mellitus are the best independent predictors.

Cone Beam Computed Tomography Analysis of the Correlation Between Gingival Biotype and Schneiderian Membrane

2026-07-01T08:02:36+00:00

The Schneiderian membrane plays a critical role in maxillary sinus health and implant planning. Although odontogenic and periodontal factors are known to influence membrane thickening, the role of the gingival phenotype remains unclear. Objectives: To evaluate the relationship between gingival biotype, gingival thickness, and Schneiderian membrane thickness and pathology using cone-beam computed tomography (CBCT). Methods:
This analytical cross-sectional study included 96 CBCT scans obtained from Altamash Institute of Dental Medicine, Karachi. Gingival thickness was measured radiographically and classified as thin or thick biotype. Schneiderian membrane thickness was measured at corresponding posterior maxillary sites and categorized as normal (≤2 mm) or thickened (>2 mm). Sinus pathology was recorded. Independent-samples t-test, chi-square test, and Pearson correlation were applied (p<0.005). Results: Mean gingival thickness was 1.06 ± 0.18 mm, and mean membrane thickness was 2.23 ± 0.85 mm. Membrane thickening was observed in 61.5% of cases, while sinus pathology was present in 29.2%. No significant difference in membrane thickness was found between thin and thick biotypes (mean difference = 0.22 mm; p=0.203). Gingival biotype was not associated with membrane category (p=0.340) or sinus pathology (p=0.107). Gingival thickness showed a weak, non-significant correlation with membrane thickness (r = 0.084; p=0.416). Conclusions: Gingival phenotype was not significantly associated with Schneiderian membrane thickness or pathology. Sinus membrane alterations appear to be influenced predominantly by anatomical and odontogenic factors.

Descriptive Cross-Sectional Study on Menstrual Irregularities in Patients Undergoing Tubal Ligation

2026-07-01T08:04:14+00:00

Menstrual abnormalities continue to be a problematic consequence of tubal ligation, despite conflicting results from pertinent studies. Menorrhagia, metrorrhagia, polymenorrhagia, and dysmenorrhea are common disorders that may require a hysterectomy. Objective: To ascertain how frequently women who had tubal ligation experienced irregular menstruation. Methods: The Department of Obstetrics and Gynecology at Government Maula Baksh Hospital in Sargodha carried out this descriptive cross-sectional study between August 1, 2023, and January 31, 2024. The Institutional Review Board (IRB) of Government Maula Baksh Hospital in Sargodha gave its approval to the study (Reference No. CPSP/ETH/2023/001). Using non-probability consecutive sampling, 303 women between the ages of 20 and 40 who were having tubal ligation were included. Women with gynecological conditions (polycystic ovarian syndrome, endometriosis, adenomyosis, fibroid uterus), diabetes mellitus, hypertension, thyroid or cardiovascular disorders, or thyroid dysfunction were excluded. Tubal ligation was performed by a consultant gynecologist using the standard method. Patients were followed 6 months post-ligation, with menstrual irregularities self-reported via a specially designed proforma and clinically validated through menstrual diaries where possible. Results: This study found oligomenorrhea in 83 (27.4%), abnormal uterine bleeding in 61 (20.1%), dysmenorrhea in 55 (18.2%), and polymenorrhea in 37 (12.2%) post-TL. Conclusion: Oligomenorrhea is the most common menstrual irregularity post-tubal ligation, followed by abnormal uterine bleeding.

Comparison of the Six-Minute Walk Test and the One-Minute Sit-To-Stand Test for Assessing Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease

2026-07-01T08:03:56+00:00

Exercise tolerance assessment plays an important role in the management of chronic obstructive pulmonary disease (COPD). The Six-Minute Walk Test (6-MWT) and One-Minute Sit-to-Stand Test (1-MSTST) are commonly used, although few studies have compared their relative value in COPD. Objective: To compare 6-MWT and 1-MSTST in assessing exercise tolerance in patients with COPD. Methods: This analytical cross-sectional study was conducted in the Department of Pulmonology, Khyber Teaching Hospital, Peshawar, from March 29 to September 28, 2024. 98 participants were included in the study using a non-probability convenience sampling technique. Exercise tolerance was assessed in both tests, using heart rate (beats/min) and oxygen saturation (SpO₂%) measured with a pulse oximeter. Data were analyzed using SPSS version 23.0. Results: Out of the 98 patients with COPD (50 males, 48 females; mean age, 58.98 ± 7.75 years), the 6MWT, pulse rate rose from 88.92 ± 6.84 to 93.15 ± 7.73 bpm, and SpO₂ fell from 93.99 ± 1.97% to 91.24 ± 2.72%. In the 1MSTST, pulse rate increased from 88.38 ± 6.48 to 90.02 ± 6.37 bpm, and SpO₂ declined from 94.01 ± 2.07% to 92.94 ± 2.34%, with changes significant for SpO₂ (p-value<0.001) and modest for pulse rate (p=0.002). The 6MWT induced greater tachycardia and desaturation, reflecting higher cardiopulmonary demand. Conclusions: Both tests effectively assessed exercise tolerance in COPD, but the 6MWT demonstrated greater desaturation, making it more sensitive for evaluating functional limitation.

Clinical Features and Prognosis of Cancer Patients Requiring Intensive Care Unit Admission

2026-07-01T08:02:09+00:00

Cancer patients are at risk of admission to the critical care unit either due to primary illness or as a consequence of treatment. Objectives: To determine clinical features and cancer patients’ prognosis necessitating ICU (Intensive Care Unit) admission. Methods: This cross-sectional analytical study at the critical care unit of Ziauddin Medical University Hospital was done on cancer patients fulfilling eligibility criteria between July 2023 and December 2023. Along with demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and ECOG were reported. SPSS version 23.0 was used for data analysis. For comparing clinical characteristics and outcomes between different subgroups, the t-test and chi-square test were applied, keeping p<0.05 as statistically significant. Results: Patients having hematological malignancy had a significantly lengthier hospital stay before ICU admittance compared to those with solid tumors (p=0.01). Chemotherapy use was significantly more frequent (p<0.01), and sepsis/septic shock was a more common cause of ICU admission (p=0.05). On ICU admission, renal dysfunction (p<0.01), leukocyte count (p=0.04), thrombocyte count (p=0.05), and C-reactive protein levels (p<0.01) showed significant differences between the groups. During ICU stay, sepsis/septic shock remained significantly different between groups (p<0.01). Additionally, overall survival outcomes differed significantly, with higher survival observed in patients with solid tumors (p<0.01). Conclusion: The type of malignancy significantly influenced ICU outcomes, with hematological cancers associated with greater disease severity and poorer prognosis, while solid tumors showed better survival.

Internal Mammary Artery Perforator Flap to Cover Sternotomy Wounds: A Prospective Study

2026-07-02T08:01:21+00:00

The issue of sternotomy wounds is a continued challenge in cardiac and thoracic vascular surgery, especially in patients who have various comorbidities and are infected. Functional morbidity is linked to traditional muscle flaps that are effective. IMAP flap provides an alternative to other conventional flaps and the internal mammary perforator (IMAP) flap, which maintains muscle functionality while also producing well-vascularized tissue. Objectives: To determine the clinical results of the internal mammary artery perforator flap to reconstruct presternal and mediastinal sternotomy wound defects. Methods: This prospective observational study was conducted during the period of August 2024 and February 2025 at the Department of Plastic Surgery, Jinnah Burn Reconstruction Surgery Centre/Allama Iqbal Medical College. Institutional ethical approval was obtained No.6117/ED/JB&RSC. Results: In this study, the mean age of the cases was 56.4 ± 10.8 years. There were 21 (70%) males and 9 (30%) females enrolled. Complete reconstructive success was achieved in 10 patients, partial success was achieved in 15 patients, and non-healing wounds were found in 5 patients. Recurrent infection was found in 5 patients (16.7%), and mortality associated with sepsis was observed in 4 patients (13.3%). Conclusions: IMAP flap is a secure reconstruction of the defects present on the presternal and mediastinal sternotomy wounds, which has a good healing outcome even in high-risk patients. IMAP flap is a better alternative to the conventional muscle flap for chest wound coverage.

Ocular Manifestations in Patients with Facial Seborrheic Dermatitis

2026-07-02T08:01:35+00:00

Seborrheic dermatitis (SD) is a chronic inflammatory disorder, especially including the peri-orbital region, which leads to different types of ocular surface abnormalities. Objective: To assess the prevalence and pattern of ocular manifestations in patients having facial SD and to evaluate its correlation with the severity of disease. Methods: An analytical case-control study was conducted from January 2024 to June 2025 in the Department of Dermatology and Ophthalmology at Al-Tibri Medical College and Hospital. Ninety-one patients with clinically diagnosed facial SD and ninety-one age and sex-matched healthy controls were enrolled in the study. All participants underwent a detailed ophthalmic examination, including TBUT, Schirmer’s test, and slit-lamp evaluation. Data were analyzed by using SPSS version 26.0, and a p-value < 0.05 was taken as statistically significant. Results: Ocular symptoms were reported in 68.1% SD patients compared to 30.8% in controls (p < 0.001). Lid margin telangiectasia (50.5%), conjunctival hyperemia (48.4%), and meibomian gland dysfunction (57.1%) were significantly more common in SD patients (all p<0.001). Mean TBUT (6.2 ± 2.1 s) and Schirmer’s scores (9.5 ± 4.3 mm) were lower in SD patients than in controls (13.1 ± 3.9 s and 14.8 ± 4.5 mm; p < 0.001). Disease severity showed a strong negative correlation with TBUT and Schirmer’s test and a positive correlation with ocular surface staining (p < 0.001). Conclusion: Facial seborrheic dermatitis is frequently associated with significant ocular involvement. Early ophthalmologic evaluation is recommended.

Frequency of Metabolic Risk Factors and Association with Demographic Characteristics in Patients with Non-alcoholic Fatty Liver Disease

2026-07-02T08:01:13+00:00

Non-alcoholic fatty liver disease is a rapidly growing public health concern worldwide and is closely associated with metabolic and cardiovascular risk factors. Objectives: To determine the frequency and demographic associations of metabolic and cardiovascular risk factors among patients with NAFLD. Methods: This analytical cross-sectional study was conducted at the Department of Medicine, Fazaia Ruth Pfau Medical College, Base Faisal, Karachi, from June 2025 to December 2025. A total of 121 patients with NAFLD were enrolled through consecutive sampling. Diagnosis was based on elevated alanine aminotransferase levels and ultrasonographic evidence of fatty liver. Patients with significant alcohol intake, viral hepatitis, or other chronic liver diseases were excluded. Results: The mean age of the patients was 37.18±10.30 years, with a mean BMI of 27.27±4.27 kg/m², and a predominance of males (80.2%). Diabetes mellitus was present in 16.5% of patients, hypertension in 15.7%, and ischemic heart disease in 5.8%. Dyslipidemia was frequently observed, with hypertriglyceridemia in 47.1% and hypercholesterolemia in 27.3%, while obesity was identified in 31.4% of cases. A significant association was observed between age greater than 40 years and the presence of diabetes, hypertension, and ischemic heart disease (p<0.001). Conclusion: NAFLD is strongly associated with metabolic risk factors, particularly dyslipidemia and obesity, with a significant clustering of cardiovascular comorbidities in older individuals.

Relationship of Maternal Education with Malnutrition in Children Under the Age of Five Years Presented to A Tertiary Care Hospital

2026-07-02T08:01:06+00:00

Malnutrition remains a major public health problem among children under five years, particularly in developing countries like Pakistan. Maternal education plays a crucial role in determining child nutritional status through its influence on feeding practices, healthcare utilization, and overall child care. Objective: To determine the association between maternal education and the severity of malnutrition among children under five years of age presenting to a Stertiary care hospital. Methods: This cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, including 282 malnourished children aged 6 months to 5 years. Nutritional status was assessed using WHO Z-scores (WAZ, HAZ, WHZ) and categorized into moderate and severe malnutrition. Maternal education was classified into six levels. Data were analyzed using SPSS version 27.0, and associations were evaluated using Fisher’s Exact tests, with p ≤ 0.05 considered significant. Results: The mean age was 28.4 ± 11.2 months. The prevalence of malnutrition was high, with 54.8% underweight, 48.8% stunted, and 32.4% wasted. Severe malnutrition was common, particularly among children of illiterate mothers, showing significantly higher rates of underweight (65.4%), stunting (75.0%), and wasting (70.0%) (p≤0.002). On multivariable analysis, maternal illiteracy remained a strong independent predictor of underweight (AOR: 4.89), stunting (AOR: 5.73), and wasting (AOR: 4.12), all statistically significant (p<0.001). Higher maternal education showed a protective effect against all forms of malnutrition. Conclusions: Maternal education is associated with reduced severity of childhood malnutrition. Improving female education and implementing targeted nutritional interventions are essential to reduce the burden of malnutrition.