Pakistan Journal of Health Sciences

The Intersection of Robotic Surgery and AI: Revolutionizing Healthcare

Muhammad Ayaz Anwar — 2025-02-28

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

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

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

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

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

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

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

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

Shabina Saifullah — 2025-02-28

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

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

Mubarak Ali Jakhrani — 2025-02-28

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

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

Shahzad Ahmad — 2025-02-28

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

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

Abdul Ahad — 2025-02-28

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

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

Nagina Shahzadi — 2025-02-28

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

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

Muhammad Aslam Rind — 2025-02-28

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

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

Ammara Chaudhry — 2025-02-28

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

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

Mohi Ud Din — 2025-02-28

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

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

Ahmad Danyal — 2025-02-28

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

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

Muhammad Obaidullah — 2025-02-28

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

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

Muhammad Shoaib Nawaz — 2025-02-28

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

Evaluation of Nutrition Awareness of Rural Women Concerning Cardiovascular Disease

Anam Saeed — 2025-02-28

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

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

Syeda Masooma Hussain — 2025-02-28

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

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

Syed Kashif Raza — 2025-02-28

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

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

Ismaa Gul — 2025-02-28

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

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

Hamad Ur Rehman — 2025-02-28

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

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

Shumaila Shabbir — 2025-02-28

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

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

Amir Bashir — 2025-02-28

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

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

Laila Khalid — 2025-02-28

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

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

Maria Tariq — 2025-02-28

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