Pakistan Journal of Health Sciences

Early Detection of Cardiovascular Risk in Pediatric Populations: Are We Doing Enough Compared to Adult Protocols?

Ussama Munir — 2025-08-31

Cardiovascular diseases, once considered primarily adult health concerns, are increasingly being traced back to risk factors emerging during childhood. Objectives: To evaluate the early detection of cardiovascular risk factors in pediatric populations and compare current pediatric screening practices with established adult protocols in a low-resource setting. Methods: This was a cross-sectional analytical study conducted at the Department of Pediatric Cardiology, Quaid-e-Azam Medical College, Bahawalpur, from March 2024 to March 2025. A total of 341 children aged 5–12 years were enrolled using non-probability consecutive sampling. Data were collected through structured interviews, anthropometric measurements, blood pressure readings, and fasting laboratory investigations, including lipid profile, fasting blood glucose, HbA1c, and serum. Participants were stratified by BMI, lifestyle, and family history. Results: Obesity was observed in 8.2% of participants, and 27.3% had a waist-to-height ratio ≥0.5. Hypertension was identified in 27.0% of children and dyslipidemia in 38.7%. Low HDL (<45 mg/dL) was seen in 46.6%, and triglycerides ≥130 mg/dL in 38.7%. Vitamin D deficiency (<20 ng/mL) was found in 66.6%, with a significant inverse correlation with triglyceride levels (r=–0.41, p<0.001). Obesity (OR 3.67, 95% CI: 2.10–6.41, p< 0.001), sedentary lifestyle (OR 2.34, 95% CI: 1.33–4.12, p=0.004), and family history of CVD (OR 2.26, 95% CI: 1.30–3.95, p=0.003) were significant predictors. Conclusions: The high prevalence of early cardiovascular risk factors in Pakistani children highlights the urgent need for structured pediatric screening protocols.

Estimation of Stature from Index Finger and Ring Finger Length of Male Adults of Central Punjab

Khalid Mahmood — 2025-08-31

Forensic anthropology often relies on skeletal measurements for identifying unknown deceased individuals, with stature estimation being pivotal in cases involving dismembered remains. Objectives: To examine the correlation between stature and the lengths of the index and ring fingers in Central Punjabi adult male and to develop population-specific regression equations for height estimation. Methods: A descriptive cross-sectional study was conducted on 246 male adults aged 21-40 from Central Punjab at PGMI/Ameer-ud-Din Medical College Lahore. Height and finger lengths were measured using standardized methods, with a Vernier caliper for finger lengths. Data were analyzed using SPSS version 25.0. Pearson’s correlation and regression analyses determined relationships and predictive models. Results: Statistically significant moderate positive correlations were observed between stature and both index and ring finger lengths. The right index finger length showed the highest correlation (r=0.512, p<0.001). Regression equations were derived, with Right Index Finger Length providing the best height prediction (R² = 0.259). Conclusions: Index and ring finger lengths can reliably estimate stature in Central Punjabi male, with right-hand measurements proving more predictive. Population-specific regression models enhance accuracy and provide important forensic tools for victim identification from mutilated remains. These findings bolster forensic research by enabling better biological profiling in this demographic.

Knowledge and Opinions of Dental Practitioners for the Use of Artificial Intelligence (AI) in Dentistry

Sana Adeeba Islam — 2025-08-31

Recent technological developments have paved the way for the application of Artificial Intelligence (AI) in dental care, offering improvements in diagnosis, treatment planning, and overall service delivery. Objective: To assess the level of awareness and perceptions of dental practitioners in Pakistan regarding the utilization of AI in clinical dentistry. Methods: A cross-sectional survey was executed between January and June 2024, encompassing 126 dental professionals. A structured questionnaire was shared via email and social media, gathering data on demographics, familiarity, and perspectives on AI in dentistry. Perceptions were measured using a 5-point Likert scale. Statistical analysis was performed using SPSS version 21.0, employing both descriptive and inferential methods. A p-value of <0.05 was considered statistically significant. Results: The average participant age was 41.14±13.76 years, with a predominance of female respondents (66.7%). A considerable portion (74.6%) reported familiarity with AI, while 77.8% were informed about its uses in dentistry. Although practical engagement was limited, 48% acknowledged AI's potential to enhance the field, while the same proportion expressed concerns over AI possibly replacing dental professionals. Enthusiasm toward AI was notable, with 55% showing interest. Many participants recognized AI's benefits in diagnostics and prognosis. Conclusions: Despite strong awareness and interest, the practical implementation of AI in dental practice remains low. Educational updates and supportive policies are essential to promote the integration of AI tools in clinical workflows.

Prevalence and Impact of Vertigo and Dizziness in Adults: A Hospital-Based Evaluation

Amir Hamza — 2025-08-31

Vertigo and dizziness are common complaints in adults, often affecting daily functioning and potentially linked to conditions such as hypertension, anxiety, and migraine, highlighting the need for more local data. Objectives: To determine the prevalence of vertigo and dizziness among adults in the local population, assess their impact on daily functioning using the Dizziness Handicap Inventory, and identify associated clinical and demographic risk factors, including hypertension, anxiety, and migraine. Methods: This cross-sectional study was conducted from January 2025 to June 2025 at Bolan Medical College, Quetta and Jhalawan Medical College, Khuzdar, enrolled 371 adults (≥18 years, residing in Quetta or Khuzdar for at least one continuous year, experiencing vertigo/dizziness, and providing consent) via simple random sampling. Data from interviews, records, and DHI assessed demographics, comorbidities, and symptom characteristics. Exclusions included psychiatric/CNS disorders. Analysis (SPSS v25) used descriptive statistics, parameter estimation, chi-square, and logistic regression (p<0.05 significant). Results: The mean age of patients was 42.3 ± 12.7 years. Male were 170 (45.8%) and female 201 (54.2%). Hypertension was found in 123 (33.2%), diabetes mellitus in 77 (20.8%), migraine in 62 (16.7%), and anxiety/depression in 93 (25.1%). The overall mean Dizziness Handicap Inventory score was 48.6 ± 18.4; male had 44.7 ± 17.2 and female 51.8 ± 18.9. Based on the Dizziness Handicap Inventory score, 104 (28.0%) had mild, 193 (52.0%) moderate, and 74 (19.9%) severe symptoms. Conclusions: Dizziness and vertigo are common in adults, often linked to hypertension, anxiety, and migraines. Early diagnosis, screening, and multidisciplinary management help reduce the burden and improve outcomes.

Prescribing Patterns and Utilization Trends of Anti-Asthmatic Drugs in Children: An Observational Study in a Pediatric Population

Ubedullah Bahalkani — 2025-08-31

Pediatric asthma occurs as a common chronic respiratory illness. Objectives: To evaluate the prescribing patterns and utilization trends of anti-asthmatic medications in pediatric patients, assessing adherence, appropriateness, and factors influencing drug selection. Methods: This observational study investigated pediatric asthma patients over six months, collecting data from 160 children aged 4–10 years. The data was obtained from pediatric asthma patients about their demographic information, alongside their asthma severity status and medication choices, and delivery methods. Data were analyzed by SPSS version 21.0. Chi-square test evaluated all associations between variables. Results: The study included 160 patients, with 31.3% of them within the age range of 8–9 years, and males represented 56.3% of the group. Urban residents (62.5%) were more affected. The bronchodilator medicine Salbutamol received the highest prescription rate (56.3%), and Budesonide held the position as the most commonly chosen corticosteroid (31.3%). The usage rate of Montelukast reached 45.0% while Theophylline's prescription was limited to just 11.3% of patients. The primary choice of medication delivery involved nebulization for 53.1% of patients, whereas 31.3% received inhalers and 15.6% had oral administration. The standard treatment for mild asthma patients involved Montelukast at a rate of 37.5% and Budesonide treated 34.4% of moderate cases, while severe asthma patients received Salbutamol + Ipratropium in 28.1% of cases. Conclusions: Prescribing patterns in pediatric asthma were closely linked to disease severity, with increased use of nebulizers and combination therapies in severe cases. Tailored, severity-based management can enhance treatment outcomes and promote rational drug use in children.

Association of Serum Creatinine and Cortical Thickness with Renal Echogenicity on Ultrasound in Chronic Kidney Disease

Maria Iram — 2025-08-31

The Incidence of chronic kidney disease (CKD) is increasing day by day all over the globe. In assessing the progression of CKD, both the function and structure of the kidney need to be evaluated. Objectives: To determine the association between serum creatinine and cortical thickness with renal echogenicity on ultrasound in patients with CKD. Methods: This cross-sectional analytical research was carried out at the Department of Radiology and Biochemistry, Shahida Islam Medical and Dental College, Lodhran, for six months (June 2024 to November 2024). All patients who were referred for ultrasonography of the kidneys, with serum creatinine and serum urea checked on the same day on which U/S was carried out, were included. Patients who were k/c of acute renal injury, on hemodialysis, peritoneal dialysis, renal transplant, chronic liver disease, fatty liver, or those having a solitary kidney were all excluded. SPSS version 23.0 was used for data analysis. A one-way ANOVA test was applied to test for association, keeping p<0.05 statistically significant. Results: Mean age of participants was 52.26 ± 12.50 years (95% CI: 39.76–64.76). The study found that higher serum creatinine and urea levels were significantly associated with increased cortical echogenicity and reduced cortical thickness on ultrasound. The mean serum creatinine was 2.11 ± 1.2 mg/dL, and cortical thickness progressively declined from 1.11 cm to 0.71 ± 0.10 cm across echogenicity grades. Conclusions: The study found a significant association between elevated serum creatinine and cortical thickness levels with renal echogenicity on ultrasound in CKD patients.

Safety and Efficacy of Spinal Anaesthesia for Ureteroscopy and in Situ Lithotripsy in Proximal Solitary Pelvic Stones

Shumaila Ashfaq — 2025-08-31

Ureteroscopy and in situ lithotripsy provide an alternative treatment for patients with proximal solitary pelvic stones, but their safety and efficacy using spinal anesthesia are poorly studied. Objectives: To evaluate the safety, efficacy and patient satisfaction with spinal anesthesia during these procedures. Methods: A single-arm, prospective observational study was conducted at Islam Medical College, Sialkot, from May to October 2024, involving a total of 81 patients aged 20 to 60 years, ASA class I to III, who underwent elective ureteroscopy or lithotripsy. 15 mg of 0.75% bupivacaine was used to perform spinal anesthesia at the L3-L4 interspace. The main endpoints were success, complications, recovery times, and patient satisfaction. Other secondary outcomes were intraoperative hypotension, bradycardia, pain as measured by visual analogue scale (VAS) and post-dural puncture headache (PDPH). SPSS version 26.0 was used for statistical analysis. Results: A total of 97.5% patients completed the procedure under spinal anesthesia. The mean procedure time was 37.4 ± 6.2 min. In 53.1% of patients, the maximum sensory blockade level was T6. Hypotension (14.8%), bradycardia (6.2%), and PDPH (2.5%) were the complications. Next, postoperative pain significantly decreased over the 24 hours. In 55.6% of patients, excellent satisfaction was observed. Mean recovery time was 165.3 ± 22.4 minutes. Conclusions: Overall, spinal anesthesia for ureteroscopy and in situ lithotripsy in patients with proximal solitary pelvic stones is safe, effective, and has a high patient satisfaction rate.

Comparing the Efficacy of Microscopic Tympanoplasty (MT) and Endoscopic Tympanoplasty (ET) For Tympanic Membrane and Middle Ear Surgery

Sanaullah Bhatti — 2025-08-31

Endoscopic tympanoplasty and microscopic tympanoplasty is performed to restore hearing. But ET superior to MT as it less invasive. Objective: To evaluate the comparative efficacy of endoscopic tympanoplasty vs microscopic tympanoplasty for middle ear and tympanic membrane surgery. Methods: A prospective, quasi-experimental study was conducted in the ENT and Surgical Department of Bakhtawar Amin Memorial Trust Hospital, Multan from 15^th October 2024 to 15^th May 2025. A total of 100 adult patients undergoing type 1 endoscopic tympanoplasty or microscopic tympanoplasty were selected for the study by convenience sampling. Preoperative and postoperative air conduction, air bone gap and bone conduction were measured by pure tone. Picture archiving and communication system was used to perform preoperative speech audiometry to measure the perforation size. Results: The average surgery duration in endoscopic group was 79.23 ± 11.97 minutes and in microscopic group was 93.05 ± 19.81, which was significantly longer than the former (p<0.001). The length of hospital stay was also significantly short in endoscopic group (4.44 ± 1.11 min) due to less postoperative pain and minimally invasive procedure than microscopic group (8.09 ± 1.27 min) (p<0.001). On follow up, 5 (10%) patients in endoscopic group and 6 (12%) patients had a re-perforation (p=1.0). There was no significant difference between incidence of otorrhea (6% vs 12%, p=0.36) and pain (4% vs 2%, p>0.05). Conclusions: The audiological outcomes between type 1 endoscopic tympanoplasty and microscopic tympanoplasty were similar. However, surgical duration and length of hospital stay was better in endoscopic group.

Prevalence of Intradialytic Hypertension in Patients with End-Stage Renal Disease on Maintenance Hemodialysis

Maimoona Tariq — 2025-08-31

Intradialytic hypertension (IDH) is emerging as a relevant and recurrent problem in end-stage renal disease patients. This can result in escalated morbidity and even fatality in the event of this not being diagnosed promptly. Objectives: To determine the prevalence of intradialytic hypertension in end-stage renal disease (ESRD) patients on maintenance hemodialysis. Methods: This descriptive cross-sectional study included adult patients with end-stage renal disease (ESRD) on maintenance hemodialysis. Data on demographic and co-morbid conditions were noted. Six dialysis sessions were observed for each patient. Presence of >10 mmHg increases in systolic blood pressure between before and after the start of four out of six dialysis sessions was used to label IDH. Descriptive analysis was run, and the factors associated with IDH were compared through a chi-square test at 5% significance level. Results: The participants had a mean age of 48.03 ± 13.2 years, with females comprising 52.8% (n=76) of the total 144 patients. Hypertension emerged as the most frequent comorbidity, affecting 77.8% (n=112), while intradialytic hypertension (IDH) was identified in 19.4% (n=28) of cases. IDH showed a significant association with diabetes (30.9% vs. 12.4%, p=0.006) and was exclusively present in hypertensive patients (p=0.001). Conclusion: IDH is a relatively common occurrence and warrants careful monitoring, particularly among individuals with hypertension and diabetes mellitus.

Comparative Analysis of Pain Relief and Adverse Effects of Ibuprofen versus Naproxen in Elderly Knee Osteoarthritis

Suhail Marfani — 2025-08-31

Osteoarthritis (OA) has no definitive cure, and to improve the quality of life, analgesic medications are used. Objectives: To evaluate ibuprofen and naproxen in elderly patients with knee osteoarthritis in terms of pain relief (primary outcome) and adverse effects (secondary outcome). Methods: This comparative analytical study was conducted at the Rheumatology Clinic of Shahida Islam Medical College and Hospital from June to November 2024. Following ethical approval, patients aged over 50 years with stage I–III knee OA willing to participate were included. Exclusion criteria were stage IV OA, systemic or rheumatologic co-morbidities (e.g., hypertension, diabetes), prior use of naproxen or ibuprofen within one month, and history of surgery within the past year. Results: A total of 310 participants were enrolled, equally divided between two groups: Naproxen Sodium (440/660 mg, n=155) and Ibuprofen (1200 mg, n=155). Both drugs significantly reduced pain from baseline to day 7 post-medication, including pain at rest, on weight-bearing, during passive movements, morning stiffness, and pain throughout the day and night (p<0.01, assessed via Visual Analogue Scale). Conclusions: Minimal side effects were observed in both groups. Naproxen and ibuprofen were both effective and well-tolerated options for pain relief in elderly patients with knee OA.

Global Cancer Burden and Its Projected Growth by 2050: Trends, Disparities, and Future Implications

Riffat Mehboob — 2025-08-31

Cancer is a leading cause of disease and death globally, with millions of new diagnoses occurring annually [1]. In 2022, about 2 million new cancer cases and approximately 9.7 million cancer-related fatalities were documented worldwide, with respiratory malignancies being the most prevalent, followed by breast, colorectal, prostate, and gastric cancers [2]. In economically disadvantaged regions, infections from pathogens including Helicobacter pylori, human papillomavirus (HPV), and hepatitis B significantly contribute to the increasing cancer rates, underscoring the urgent necessity for extensive prevention and immunization initiatives [3]. These global disparities in cancer incidence and survival are further exacerbated by socioeconomic factors, with access to early diagnosis, treatments, and healthcare systems being unequally distributed across regions [4]. Significant inequalities in cancer incidence and mortality exist globally, predominantly affected by the Human Development Index. In countries with very high levels of development, the age-standardized cancer incidence rate in 2022 was 285.7 cases per 100,000 persons, while in countries with lower development indices, it was only 110.6 cases per 100,000 [5, 6]. This disparity is also reflected in survival rates, as the mortality-to-incidence ratio (which compares the number of cancer deaths to the number of cancer cases) is almost twice as high in countries with lower levels of development compared to those with higher levels. For example, in 2022, the global mortality-to-incidence ratio was 46.6%, while in Sub-Saharan Africa, it exceeded 67%. Furthermore, men generally have higher rates of cancer incidence and death than women, and low- and middle-income nations, notably in Africa and Asia, confront challenges in managing increasing cancer cases, owing to insufficient resources for prevention, diagnosis, and treatment [7]. The worldwide cancer burden is projected to rise significantly by 2050. The number of new cancer cases is projected to increase by 76.6%, reaching 35.3 million, while deaths related to cancer are expected to rise by 89.7%, to 18.5 million. However, this increase will not be uniform across regions. In countries with lower development, cancer cases are expected to rise by 142.1%, compared to a 41.7% increase in highly developed countries. Similarly, cancer deaths in less developed countries are expected to rise by 146.1%, whereas in more developed countries, the increase will be just 56.8%. This widening disparity highlights the urgent need for enhanced healthcare infrastructure, including prevention, early diagnosis, and treatment programs in low-resource settings. The number of new cancer cases is projected to rise by 76.6%, reaching 35.3 million, while deaths due to cancer are likely to increase by 89.7%, to 18.5 million [6, 8].