Pakistan Journal of Health Sciences

Antimicrobial Stewardship in Pakistan: Lost in Policy, Weak in Practice

Ayesha Humayun — Tue, 31 Mar 2026 00:00:00 +0000

Antimicrobial resistance (AMR) is one of the most critical emerging public health threats in this century, jeopardizing decades of success in the treatment of infectious diseases in medical sciences. The discovery and effectiveness of these miracle drugs have now changed into a nightmare due to inefficient regulatory oversight, overprescription, and misuse as a widespread practice. Highly infectious disease-burden countries are poorly performing in stewardship practices, including Pakistan.

Antimicrobial stewardship is considered a fundamental strategy to optimize and rationalize the use of antibiotics. An analysis of antibiotic consumption over the last two decades has risen dramatically, showing a 65% increase between 2000 and 2015, with the fastest growth in LMICs. Pakistan is one of these countries with limited regulatory frameworks and diagnostic capacity [1]. High patient volume, poor microbiological support, patients & families’ pressure, healthcare providers’ attitude, over-the-counter availability of antibiotics, and delayed diagnostic results are major contributing factors towards high consumption of antibiotics in Pakistan.

Pakistan endorsed the Global Action Plan on AMR by the WHO and developed the National Action Plan (NAP) on AMR in 2017. The NAP emphasizes surveillance, infection prevention and control, rational use of antimicrobials, and multisectoral collaboration using the “One Health” approach through integrating human, animal, and environmental sectors [2]. National institutions such as the National Institutes of Health Pakistan have strengthened surveillance systems and are coordinating national efforts to monitor antimicrobial resistance trends. Now, Pakistan has initiated development of a second national action plan to strengthen provincial implementation mechanisms [3].

The National Institute of Health (NIH) is actively working on policy development and AMR reporting; the national strategies are poorly translated into existing stewardship efforts across Pakistani institutions. Evidence suggests that AMS (antimicrobial stewardship) programs are implemented in only a minority of hospitals, as reported in a study that only 7.6% of paediatricians worked in institutions with functional AMS and merely 15% had received formal training in antibiotic use, AMR, or stewardship principles [4].

Hospital policies and prescribing SOPs and practices further illustrate the level and scale of the challenge. There is substantial antibiotic utilization in hospitals of Pakistan, so a need for structured stewardship interventions to rationalize prescribing patterns [5]. The empirical therapy predominates, while microbiological culture and sensitivity testing remain underutilized.

The change in the use of antibiotics in Pakistan has been in terms of the increase in the number of doses per day used over the past decades, with an approximate of 800 million to over 1.3 billion doses being used daily. Implementation of stewardship is not a universal requirement of accreditation of hospitals, and thus institutional priorities are inconsistent [6].

The Pakistani hospitals do not have specific spreaders of infectious diseases, well-trained clinical pharmacists, and electronic prescription systems, which are normally needed in facilitating successful stewardship programmes. Another critical aspect of evidence-based prescribing that impedes it in lower levels of the healthcare system is diagnostic limitations.

However, it is possible to note that academic and tertiary healthcare organizations are forming multidisciplinary stewardship teams that include infectious disease specialists, microbiologists, pharmacists, and infection prevention experts. Such teams have been aiming at interventions like formulary restrictions, antimicrobial review rounds, and the spread of hospital antibiograms. It is indicated that the interventions can enhance the prescribing behaviours and decrease the use of antimicrobials when implemented properly [7].

Education and capacity building are also some of the essential pillars of antimicrobial stewardship. Research in Pakistan has demonstrated that specific training can increase knowledge levels on AMR and stewardship to a great extent [8]. The implementation of stewardship ideas in undergraduate and postgraduate medical, pharmacy, and nursing programs should be adopted as a long-term sustainable approach to enhance the stewardship capacity. CPD programs and institutional training initiatives can further support clinicians in implementing evidence-based prescribing practices.

Beyond hospitals, a broader systems approach is needed for combating AMR. Community prescribing practices, the private healthcare system, and pharmaceutical supply chains all influence antibiotic consumption patterns in Pakistan. Over-the-counter access to antibiotics continues to contribute to self-medication and inappropriate use among the general population. Regulatory oversight of antibiotic dispensing, expanding public awareness campaigns, and improving infection prevention and control practices across healthcare settings need to be strengthened, as these are the essential components of a comprehensive national strategy.

Pakistan is at a critical juncture in its response to AMR, so strengthening stewardship efforts is essential to preserve the effectiveness of existing antimicrobials and to prevent the escalating threat of antimicrobial resistance.

Impact of Intermittent Fasting on Human Endocrine and Metabolic Physiology: A Systematic Review

Tue, 31 Mar 2026 00:00:00 +0000

Intermittent fasting (IF) is increasingly recognized as a dietary approach that may improve endocrine and cardiometabolic health by aligning eating patterns with circadian rhythms. Objectives: To systematically evaluate recent human studies (2018–2024) investigating the effects of intermittent fasting on endocrine and metabolic physiology, with emphasis on insulin sensitivity, hormonal balance, and cardiometabolic outcomes. Methods: PubMed, Scopus, and the Cochrane Library were searched according to PRISMA 2020 guidelines. Randomized controlled, crossover, cohort, and observational studies reporting endocrine (insulin, leptin, ghrelin, cortisol) and metabolic (glucose, lipids, body composition) outcomes associated with intermittent fasting were included. Study quality was assessed using the Joanna Briggs Institute tools. Results: Eighteen studies (~1,250 participants) were included. Early time-restricted eating and alternate-day fasting were consistently associated with improved insulin sensitivity, glycemic control, lipid profiles, and blood pressure. Several trials reported endocrine benefits independent of major weight loss. Most randomized studies showed low risk of bias. Conclusions: Low-risk randomized evidence supports early time-restricted eating and alternate-day fasting as effective strategies for improving insulin sensitivity and glycemic control. Other hormonal outcomes remain associative and require further trials. Intermittent fasting is a promising, culturally adaptable approach for metabolic risk reduction.

Empathy in Medical Ethics: A Systematic Review of Its Role in Healthcare Integrity

Tue, 31 Mar 2026 00:00:00 +0000

Empathy is the capacity to relate to and reflect on the emotions of others. Empathy improves outcomes in healthcare environments if one delivers compassionate, patient-centered treatment. Objectives: This systematic review examines empathy’s role in medical ethics, its impact on patient outcomes, and barriers to its practice. Methods: This systematic review used PRISMA rules and used major databases, including PubMed, Scopus, Web of Science, and the Boolean search string. The studies included were published in the English language between 2002 and 2023. Among the search terms used were "empathy," "medical ethics," "healthcare settings," and "patient-centered care". Fourteen studies in all fit the inclusion criteria. Comprising medical schools, hospitals, clinics, and community health centers, among other healthcare environments, the studies were published during the selected time bracket. Results: According to the review, Empathy correlates with Ethical practice: Supports beneficence, autonomy, and reduces litigation. Patient outcomes are related to Higher satisfaction and treatment adherence when treated by an empathetic doctor. Barriers are Burnout and empathy decline during training. Interventions like Role-playing and neuroscience-based curricula improved empathy. Conclusions: Medical ethics cannot be valued without empathy. Encouragement of empathy in healthcare environments will help to raise patient outcomes, satisfaction, and the general standard of quality of treatment. Empathy is a measurable, teachable skill critical to ethical practice. Address burnout and integrate training to sustain healthcare integrity.

The Clinical Spectrum of Autoimmune-Mediated Neurological Diseases in Patients Presenting to a Tertiary Care Hospital in Rawalpindi

Tue, 31 Mar 2026 00:00:00 +0000

Autoimmune-mediated neurological diseases (AMNDs) affect the central and peripheral nervous systems through inflammation and demyelination, leading to diverse neurological dysfunctions. Their heterogeneous clinical presentations complicate diagnosis, and epidemiological data in adult Pakistani populations remain scarce. Objectives: To determine the frequencies of different AMNDs among adult patients presenting to a tertiary care hospital in Rawalpindi. Methods: This cross-sectional study was conducted at the Department of Neurology, Pak Emirates Military Hospital, Rawalpindi, from 1^st April to 20^th September 2025, including 177 adult patients consecutively presenting with neurological symptoms suggestive of autoimmune etiology. The diagnosis was made on the basis of clinical manifestations supported by MRI, cerebrospinal fluid analysis, and autoantibodies. The analysis was performed using SPSS version 27.0. Results: The mean age of the patients was 47.9 ± 11.4 years. The majority of patients were female 108 (61%). Multiple Sclerosis was the most frequent diagnosis (27.1%), followed by autoimmune encephalitis (20.3%), Guillain-Barré syndrome (16.4%), myasthenia gravis (13.6%), and neuromyelitis optica spectrum disorder (10.7%). Anti-ganglioside antibodies showed the highest seropositivity (12.4%), while MRI and CSF abnormalities were observed in 33.9% and 38% of patients, respectively. Significant associations were found between disease type and age (p=0.018), gender (p=0.006), residence (p=0.041), family history (p=0.032), and symptom duration (p=0.014). Conclusions: Multiple Sclerosis, autoimmune encephalitis, and Guillain-Barré syndrome are the most prevalent AMNDs in this population, with distinct demographic patterns and variable diagnostic findings. Early recognition and integrated diagnostic approaches are essential to improve patient outcomes.

Short-Term Outcomes of Transcatheter VSD Closure Using the MFO Device at a Tertiary Cardiac Centre in Lahore

Tue, 31 Mar 2026 00:00:00 +0000

Transcatheter closure is the commonly used approach to treat congenital ventricular septal defect (VSD), though local outcome data on the use of KONAR-Multi Functional Occluder (MFO) in Pakistan are scarce. Objectives: The purpose of this study was to evaluate the short-term outcomes following transcatheter VSD closure with the MFO device and to compare the results in retrograde versus the antegrade methods. Methods: Prospective observational research was carried out in the Department of Pediatric Cardiology, Punjab Institute of Cardiology, Lahore. They included patients aged between three years and thirty-one years of age who had previously experienced transcatheter VSD closure using the MFO device between January 2021 and June 2024. There were 30 patients who were enrolled, of whom 20 patients were under retrograde, and 10 patients were under antegrade. The predictors of residual shunt were determined by logistic regression. Results: Four patients (13.3) had a residual shunt at discharge, and it reduced to one (3.3) at one-month follow-up. There were three patients with aortic regurgitation in the early post-procedure period (10%). The significance of the ventricular septal defect diameter exceeding six millimeters was only significantly related to residual shunt (odds ratio 4.28, p = 0.041). There were no significant conduction changes or device embolization during hospitalization or 1-month follow-up. Conclusions: Short-term success with low complication rates was observed in both methods of Transcatheter closure of VSD with the MFO device. The results demonstrate the safety of this method within a local Pakistani tertiary care environment.

Diagnostic Accuracy of Xpert Mycobacterium Tuberculosis/Rifampicin in Detecting Pulmonary Tuberculosis from Bronchoalveolar Lavage Fluid in Sputum-Negative Patients

Tue, 31 Mar 2026 00:00:00 +0000

Pulmonary Tuberculosis (TB) is also a substantial health issue in high-burden countries like Pakistan. Diagnostic methods such as sputum smear microscopy and culture have limitations in smear-negative cases, necessitating the use of alternative methods. The Xpert MTB/RIF assay is a fast molecular diagnostic option, but its accuracy on bronchoalveolar lavage fluid (BALF) in sputum-negative patients is not well established. Objectives: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Xpert MTB/RIF assay on BALF, using culture as the gold standard. Methods: This prospective diagnostic validation study was conducted at Lady Reading Hospital, Peshawar, from May 2025 to September 2025, including 679 adult patients with smear-negative pulmonary TB suspicion undergoing bronchoscopy. BALF samples were tested using smear microscopy, culture (gold standard), and the Xpert MTB/RIF assay. Data were analyzed using SPSS version 25.0. Results: Most of the patients were male 389 (57.3%). The mean age was 41.3 ± 14.2 years. Among 171 culture-positive cases, 145 were also positive by Xpert. Among 508 culture-negative cases, 490 tested negatives with Xpert. Xpert test showed 84.8% sensitivity, 96.5% specificity, 88.9% PPV, 94.9% NPV, and 93.3% diagnostic accuracy. Stratified analysis showed comparable diagnostic metrics across gender and age groups. The AUC of the ROC curve is 0.91, which indicates that Xpert performed excellently in diagnosing TB. Conclusions: Xpert MTB/RIF on BALF provides high diagnostic accuracy for detecting pulmonary TB in sputum-negative patients, with excellent sensitivity, specificity, and predictive values.

Normal Pediatric Kidney Dimensions on Multidetector CT: Defining Standards for Pakistani Children

Tue, 31 Mar 2026 00:00:00 +0000

Kidney size in children is a key marker for detecting congenital abnormalities and conditions that may develop later. In South Asia, CT-based normative data are limited. Objectives: To establish CT-derived reference ranges for renal size in Pakistani children and examine their relationship with somatic measurements. Methods: This retrospective study examined 15 years of data (2010–2024) from Aga Khan University Hospital, Karachi, focusing on CT scans conducted with GE 128-slice or Toshiba 640-slice scanners. The study included children aged one week to 16–17 years, categorized by age, and utilized both descriptive and inferential statistics. Results: Kidney size in children is a key marker for detecting congenital abnormalities and conditions that may develop later in life. The right kidney volume rises from about 19 cm³ in infants to 146 cm³ in late adolescence, while the left kidney grows from approximately 21 cm³ to 146 cm³. There is a strong correlation between renal size and factors like age, height, weight, and body surface area (p<0.001). No significant differences were observed between sexes, and multiple regression analysis confirmed these associations with significant models for both kidneys. Conclusions: This study provides the first CT-based reference ranges for renal dimensions in Pakistani children. Renal volume rises consistently with age and strongly correlates with somatic factors, offering valuable benchmarks for clinical assessment.

Efficacy of Oral Progesterone Treatment in Women with Unexplained Recurrent First Miscarriages

Misbah Ul Ain Aziz, Sadia Zainab — Tue, 31 Mar 2026 00:00:00 +0000

Recurrent miscarriage in the first trimester is a difficult and emotionally draining problem, affecting nearly 1–2% of women. In many cases, no clear cause can be found. Progesterone is known to help support early pregnancy by stabilizing the endometrium and reducing uterine contractions. Objective: To assess how effective oral progesterone is in women who have had repeated unexplained first-trimester miscarriages. Methods: This was a prospective, non-randomized single-arm interventional study conducted in the Department of Obstetrics and Gynecology, Combined Military Hospital, Bahawalpur, between August 02, 2024, and February 01, 2025. A total of 152 women aged 20–40 years, each with a history of ≥2 unexplained consecutive first-trimester miscarriages and a confirmed intrauterine viable pregnancy of <12 weeks, were included. All participants received oral dydrogesterone (10 mg twice daily) until completion of 12 weeks’ gestation, with follow-up assessments every two weeks. Data were analyzed using SPSS version 26.0. Efficacy was defined as pregnancy continuation beyond 12 completed weeks of gestation following therapy; live birth (where available) was recorded as an additional outcome. Associations were examined using chi-square tests and multivariable binary logistic regression, with p<0.05 considered statistically significant. Conclusions: In this single-arm cohort, oral dydrogesterone was associated with continuation of pregnancy beyond 12 weeks or live birth in 78.9% of women with unexplained recurrent first-trimester miscarriages. As no untreated comparator group was included, this study cannot determine whether dydrogesterone improves live birth outcomes compared with no progesterone therapy; randomized controlled studies are needed to confirm comparative effectiveness.

Comparative Effect of Green and Blue Filters on Near Point of Accommodation among Emmetropes and Myopes

Tue, 31 Mar 2026 00:00:00 +0000

Coloured filters are optical devices that selectively transmit certain wavelengths of light while absorbing others. Green and blue filters can reduce glare and improve contrast. Objectives: To determine the effect of green and blue filters on relieving excessive near point of accommodation among emmetropes and myopes. Methods: This analytical cross-sectional study was conducted at the Rashid Latif Khan University, Lahore, Pakistan, from May 2023 to January 2024. 110 participants of both genders, aged 15-30 years, were included. The participants were divided into emmetropes and myopes, with 55 participants in each group. The near point of accommodation (NPA) was assessed objectively using the RAF rule. Both groups were examined initially without any filter and then using green and blue filters. Data were analysed using SPSS-24. A repeated-measures ANOVA test was applied to compare the effect of green and blue filters in emmetropes and myopes. Results: Mean NPA ± SD without filter, with green filter, and with blue filter in emmetropes was 14.89 ± 1.64, 12.07 ± 1.15, and 12.25 ± 1.03, respectively, with (p<0.001) while, mean NPA ± SD without filter, with a green filter, and with a blue filter in myopes was 13.92 ± 1.68, 11.92 ± 0.58, and 12.53 ± 0.55, respectively, with (p<0.001) suggesting that both green and blue filters contribute to a reduction in excessive accommodation among emmetropes and myopes. Conclusions: The use of green and blue filters could decrease excessive NPA both in emmetropes and myopes (mild to moderate myopes).

Left Ventricular Ejection Fraction among Patients with Acute Myocardial Infarction

Tue, 31 Mar 2026 00:00:00 +0000

After an acute myocardial infarction (AMI), the LVEF may be used for prognosis and therapy purposes. Despite the importance of left ventricular ejection fraction (LVEF) testing as a performance indicator for AMI patients, nothing is known about the current rates of in-hospital assessment or how it relates to therapeutic utilization. Objective: To ascertain the prevalence of LVEF patterns in individuals with AMI. Methods: It was a cross-sectional descriptive study conducted at the Department of Cardiology, King Edward Medical University/ Affiliated Hospital, Lahore, from March 2025 to September 2025 under IRB number 783/RC/KEMU. A total of 110 patients were enrolled through nonprobability purposive sampling. Data analysis was done on SPSS version 26.0. Quantitative variables were presented as mean ± S.D. Qualitative variables, i.e., gender, types of myocardial infarction (STEMI/ NSTEMI), and patterns of left ventricular function (Abnormal/ moderately to severely impaired) were presented as frequency and percentage. Results: The average age of the cases in this study was 52.74 ± 8.08 years. There were 72 (65.5%) males and 38 (34.5%) females enrolled in this study. The mean BMI, LVEF, and duration of MI were 27.62 ± 4.27 (kg/m²), 35.30 ± 7.88 (%), and 176.18 ± 5.65 (minutes). There were 35 (31.8%) patients diagnosed with STEMI and 75 (68.2%) diagnosed with NSTEMI. There were 40 (36.4%) patients found with abnormal LVEF patterns and 70 (63.6%) with moderately to severely impaired LVEF. Conclusion: The results of this study showed that the majority of patients with acute MI had moderately to severely impaired LVEF.

Comparison of Pain Intensity After Laparoscopic Cholecystectomy Between Patients with and Without Periportal Lidocaine Infiltration

Tue, 31 Mar 2026 00:00:00 +0000

Early postoperative pain after laparoscopic cholecystectomy (LC) is largely related to port-site trauma. Peri-portal lidocaine infiltration is a simple technique used to reduce this discomfort, but evidence from local clinical settings remains limited. Objectives: To compare postoperative pain intensity between patients receiving peri-portal lidocaine infiltration and those undergoing LC without local anesthesia at a tertiary hospital in Karachi, Pakistan. Methods: This prospective cohort included 148 adults undergoing elective LC who were allocated to receive either periportal infiltration of 10 mL 2 % lidocaine (n=74) or no local anaesthetic (n=74). Pain at rest was assessed on a 10-cm visual analogue scale immediately post extubating and at 3, 6, 12, and 24 h. Secondary outcomes were time to ambulation, time to oral intake, and length of hospital stay. SPSS version 23.0 was used to analyze the data. Results: Pain scores were significantly lower in the lidocaine group at the immediate (3.42 ± 0.64 vs 4.38 ± 0.85, p=0.001), 3-hour (2.83 ± 0.63 vs 3.76 ± 0.63, p=0.001), and 6-hour assessments (1.95 ± 0.67 vs 2.53 ± 0.92, p=0.001). Patients receiving lidocaine mobilized earlier (4.43 ± 1.57 h vs 6.32 ± 2.37 h, p=0.001), resumed oral intake sooner (6.18 ± 1.52 h vs 7.70 ± 1.84 h, p=0.001), and had a slightly shorter postoperative stay (9.31 ± 1.57 h vs 9.99 ± 0.07 h, p=0.001). Conclusion: Peri-portal lidocaine infiltration effectively reduces early postoperative pain after LC.

Association of TLR7 Variants with Secondary Bacterial Pneumonia in COVID-19 Patients

Beenish Khalid, Saeeda Baig, Faiza Agha, Hina Faisal, Aliya Jafri, Afreen Bhatty — Tue, 31 Mar 2026 00:00:00 +0000

Variations in the TLR7 gene have been linked to impaired immune signaling, which may increase a person's risk of developing secondary infections and developing severe COVID-19. Objectives: To investigate the relationship between variations in the TLR7 gene and the prevalence of co-infections and secondary bacterial pneumonia among hospitalized COVID-19. Methods: A case-control study was a hospital-based study done among 200 RT-PCR-confirmed COVID-19 patients. The secondary bacterial pneumonia (SBP) was determined as another type of clinical deterioration that appeared over 48 hours of admission and was proven by radiological infiltrates and the increase of inflammatory factors; the microbiological confirmation was viewed as supportive but not obligatory. Hardy-Weinberg equilibrium of the female control group was checked, and the genotype was determined with the help of Taqman SNP assays. Results: The average age of the participants was 45.6 ± 12.3 years, and 60 percent of them were men. Among the SBP cases, 85% had microbiological confirmation, while 15% fulfilled predefined clinical, radiological, and inflammatory marker–based criteria for SBP despite negative cultures. Hence, pathogens in SBP cases were Klebsiella pneumoniae 25%, as well as Staphylococcus aureus 35%. Conclusions: TLR7 gene polymorphisms were substantially linked to a roughly three-fold higher risk of secondary bacterial pneumonia in this cohort of hospitalized COVID-19 adults, ages 18 to 65. These results imply that bacterial superinfection may be predisposed by compromised TLR7-mediated antiviral innate responses.

Psychological Impact of Infertility on Couples: A Cross-Sectional Study of Coping Strategies

Munazza Yousaf, Unzila Umer, Naila Raziq, Laila Shinwari — Tue, 31 Mar 2026 00:00:00 +0000

Infertility is not only a biomedical concern but also a source of considerable psychological stress for both partners, affecting emotional health and relationship functioning. The distinct emotional and coping processes of infertile couples necessitate understanding emotional distress for the planning of structured psychosocial support. Objective: To evaluate the psychological effect of infertility and find the coping mechanisms employed by infertile couples attending Maqsood Medical Complex and General Hospital, Peshawar. Methods: This cross-sectional descriptive study was carried out from April 1st, 2025, to September 30, 2025, on 130 infertile couples. Data were gathered on sociodemographic characteristics, the Hospital Anxiety and Depression Scale (HADS), and the Brief COPE inventory. The means ± SD were calculated for continuous variables, the frequencies were calculated for categorical variables, while the associations of coping strategies with psychological distress were handled using chi-square and Pearson correlation tests. Results: Of the 130 couples studied, 61.5% reported clinically significant anxiety and 49.2% reported depressive symptoms. Female partners consistently had higher mean scores for anxiety and depression than their male counterparts. Problem-focused coping (planning, active coping, and positive reframing) was related to lower levels of distress, while avoidant and emotion-focused coping were associated with higher anxiety and depression. Conclusions: Infertility carries a significant emotional burden, especially for women, and emotional coping strategies have a strong bearing on the psychological impact. It is critical that couple-focused psychosocial support and stress-management counseling be integrated into the psychosocial aspects of infertility care.

Safety and Efficacy of Intravenous Brivaracetam versus Levetiracetam in the Management of Status Epilepticus in Children

Ikram Ur Rahman, Muhammad Zubair Ahmad, Ali Tariq — Tue, 31 Mar 2026 00:00:00 +0000

Status epilepticus (SE) is one of the most common pediatric neurological emergencies and a major cause of all pediatric epilepsy-related hospital admissions. Objectives: To compare the safety and efficacy of intravenous (IV) brivaracetam versus levetiracetam in the management of SE in children. Methods: This randomized controlled trial was performed at the Department of Pediatric Neurology, Institute of Child Health, Multan, Pakistan, from January to September 2025. A total of 152 children (76 in each group), aged 1 month to 16 years with SE, were randomly assigned to receive IV brivaracetam (2 mg/kg) or levetiracetam (40 mg/kg). Seizure cessation within 30 minutes of infusion, time to cessation, recurrence, hospitalization duration, and adverse events were documented. Data were analyzed using SPSS v26.0, with p<0.05 considered significant. Results: In a total of 152 children, the median age was 6.2 years (IQR 3.4–10.7), and 84 (55.3%) children were males. Seizure cessation within 30 minutes was noted in 65 (85.5%) children receiving brivaracetam and 55 (72.4%) receiving levetiracetam (p=0.047). The median time to cessation was 4.5 (IQR 3.0–7.0) minutes in bivarectam, vs. 6.0 (IQR 4.0–9.5) minutes with levetiracetam (p=0.009). The median hospital stay was 4.0 (IQR 3.0–6.0) days vs 5.5 (IQR 4.5–7.0) days (p=0.034) in brivarecetam and levetiracetam groups, respectively. Adverse events occurred in 10 (13.2%) children in the Bivaracetam group vs. 14 (18.4%) with levetiracetam (p=0.374), while no mortality was documented. Conclusions: IV brivaracetam achieves faster and more effective seizure cessation compared with levetiracetam in children with SE, with lower rates of adverse effects.

Prevalence of Childhood Unintentional Injuries Presenting to the Emergency Department of a Tertiary Care Hospital

Tue, 31 Mar 2026 00:00:00 +0000

Childhood unintentional injuries are one of the leading public health concerns worldwide. These injuries need immediate medical attention to prevent any adverse outcomes. Objectives: To determine the prevalence, types, severity, and outcome of unintentional injuries in children presenting to the Emergency Department at Shalamar Hospital, Lahore. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Shalamar Hospital, Lahore. Non-probability consecutive sampling was used to include a total of 242 children with unintentional injuries up to 12 years of age. Validated questionnaires filled out by attending doctors, covering demographic details, injury type, injury setting and circumstances, primary caregiver, and clinical outcomes were used to collect the data. SPSS version 25.0 was employed to analyze the data. Results: Out of 242 children, males accounted for 55% of the cases. The mean age of children was 6.5 ± 3.2 years. 35% of the injuries were transport-related injuries, followed by falls, which accounted for 30% of injuries. Minor injuries (40%) were most frequent, followed by moderate (35%) and severe injuries (25%). The average time between injury and hospital presentation was 3.2 ± 1.5 hours. 45% of the children presented within 1^st hour of the injury, and 25% presented after 3 hours. There was no significant difference in injury severity by gender. Conclusions: Transport-related injuries and falls are the leading causes of unintentional injuries, which are more common in boys, occurring more frequently among young children.

Determinants of Repeated Hospital Admission in Dialysis-Dependent Chronic Kidney Disease Patients

Saqib Khan, Muhammad Feroze Khan, Amer Azhar, Sehrish Saeed — Tue, 31 Mar 2026 00:00:00 +0000

Studies evaluating the factors leading to repeated hospital admissions in dialysis-dependent CKD patients are scarce in the context of local settings. Results of the study would benefit clinicians and patients in reducing hospitalization burden and health care costs by prompt management of potential factors leading to hospitalization. Objective: To determine the frequency of factors leading to repeated hospitalization in dialysis-dependent chronic kidney disease patients. Methods: The descriptive study was conducted at the Department of Nephrology, Khyber Teaching Hospital, Peshawar, during the period 11^th May 2025 to 10^th September 2025. A total of 176 male and female patients diagnosed with chronic kidney disease and receiving maintenance hemodialysis were enrolled. The patients were evaluated for factors leading to repeated hospitalization, including the presence of heart failure, anemia, mode of vascular access, and low serum albumin. Results: The mean age of patients was 58.68±6.73 years. 89 patients (50.6%) were female. Repeated hospitalization was recorded in 87 patients (49.0%). Factors of repeated hospitalization revealed heart failure in 82 patients (46.6%), anemia in 30 (17.0%), low albumin in 118 (67.0%), and AV fistula in 82 patients (46.6%) as a mode of vascular access. Female patients had more frequent repeated hospitalization (n = 45, 50.6%), p value 0.762. Conclusions: Heart failure, AV fistula usage, and low albumin were the most common variables associated with frequent hospitalization. A connection between hospitalization, duration, and cause of CKD was observed, but did not reach statistical significance.

Outcomes Following the Cutting Seton Procedure for High Anal Fistula

Tue, 31 Mar 2026 00:00:00 +0000

Fistula in ano is a prevalent perianal condition caused by infection of the anal glands between the sphincter muscles, leading to substantial morbidity. It is reportedly more prevalent in males globally. Surgical management of high anal fistula remains challenging, and the cutting seton technique continues to be used as a treatment option. Objective: To evaluate the outcomes following the cutting seton procedure for high anal fistula. Methods: This cohort study was carried out at the Department of General Surgery, Hayatabad Medical Complex, Peshawar, and involved 171 patients who were diagnosed with high anal fistula, and the cutting seton procedure was performed on them. The demographic data, clinical characteristics, and surgical outcomes were documented. The pain was rated with the help of the Visual Analogue Scale (VAS), and recurrence and incontinence were recorded in the course of follow-up. The chi-square test was used, keeping p-value > 0.05 as statistically significant. Results: The mean age of patients was 42.3 ± 11.4 years, with 60.8% being male. Postoperative pain was reported in 55.0% of patients. Recurrence occurred in 12.9%, and incontinence was observed in 18.1%, primarily to flatus. Stratification showed no significant associations between outcomes and demographic or clinical variables (p>0.05 for all). Conclusions: Seton is a safe and efficient intervention in high anal fistula, and results are satisfactory regardless of the demographics of patients and are largely dependent on the surgical approach and fistula features.

Prevalence of Gestational Diabetes Mellitus among Pregnant Females

Tue, 31 Mar 2026 00:00:00 +0000

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication marked by glucose intolerance, which poses significant risks to both maternal and fetal health, including preeclampsia, cesarean delivery, macrosomia, and an increased susceptibility to type 2 diabetes later in life. Objectives: To determine the frequency and prevalence of GDM in pregnant women. Methods: A descriptive cross-sectional study was conducted with 160 pregnant women aged 18-45 years at the University of Lahore Teaching Hospital. Data were collected using a structured questionnaire and clinical measurements, including a 50-gram oral glucose challenge test (GCT), followed by a 100-gram oral glucose tolerance test (OGTT) for those with positive GCT results. Results: The mean age of participants was 27.08 ± 4.35 years, with a majority being well-educated (57.9% graduates, 35.2% with master’s degrees, and 1.3% with an MBBS). Most women were housewives (50.3%), followed by office workers (27%) and teachers (20.1%). The mean BMI was 31.70 ± 6.18, indicating a high prevalence of overweight/obesity. Despite recognizing the seriousness of GDM and the importance of a healthy lifestyle, 27% of participants did not exercise regularly, and 23.8% met the criteria for GDM. Conclusions: The study revealed a high prevalence of GDM, primarily driven by overweight/obesity and physical inactivity.

Comparison of Treatment Outcomes Between Intravenous Immunoglobulin and Steroid Therapy in Pediatric ITP (Idiopathic Thrombocytopenic Purpura)

Tue, 31 Mar 2026 00:00:00 +0000

Idiopathic Thrombocytopenic Purpura (ITP) is a common and significant bleeding disorder in children with variable underlying etiologies. Objectives: To compare the short-term effectiveness and safety of IVIg versus corticosteroids in children with newly diagnosed ITP. Methods: An observational, cross-sectional comparison was conducted at a tertiary pediatric care center over a period of one year. Using consecutive sampling, 210 children were assigned to initial therapy with IVIg (n=105) or corticosteroids (n=105). Primary endpoints were time to platelet recovery and complete response by day 7; secondary endpoints included hospital stay, relapse ≤3 months, and adverse events. Group comparisons used Mann–Whitney U or chi-square/Fisher’s exact tests; multivariable logistic regression adjusted for age, gender, and baseline platelet count. Results: IVIg led to faster recovery (median 2 vs 4 days) and shorter hospital stay (3 vs 5 days), both p<0.001; higher complete response by day 7 (90.5% vs 71.4%, p<0.001); lower relapse (9.5% vs 21.0%, p=0.012) and fewer adverse events (11.4% vs 33.3%, p<0.001). IVIg independently predicted day-7 complete response (OR 4.5, 95% CI 1.9–10.8). Conclusions: In this non-randomized cohort, IVIg showed superior short-term effectiveness and safety versus corticosteroids.

Effect of a Six-Month Certificate Course in Health Professions Education on the Adversity Quotient of Medical Teachers

Bilquis Shabbir — Tue, 31 Mar 2026 00:00:00 +0000

Medical teachers frequently face high-stakes, stressful situations that challenge their emotional and professional effectiveness. Adversity Quotient (AQ) reflects an individual’s ability to withstand stress, and faculty development programs like CHPE may enhance both teaching competence and psychological resilience. Objective: To evaluate the effects of a six-month course in CHPE on the AQ of the medical teachers. Methods: The study was a pre-test post-test quasi-experimental quantitative study on 55 medical teachers who participated in the CHPE program at Fatima Jinnah Medical University, Lahore. The data were gathered on the Adversity Response Profile (ARP) questionnaire. The measurement of AQ scores was undertaken before the course and after the course. IBM SPSS Statistics version 28.0 was used to analyze the data. Results: The AQ of the participants improved significantly after the CHPE intervention (Median [IQR]: 106 [96 -118] vs. 142 [134-156]; Z = -5.943, p<0.001). Before the course, 69.1% had Low AQ and 30.9% had Moderately Low AQ. Once it was completed, 49.1% got Moderate AQ, 16.4% got Moderately High AQ, and 5.5% got High AQ. The subgroup analyses showed an increase in median AQ scores where gender and years of experience did not significantly affect the results (p>0.05). Conclusions: The six-month CHPE program had a statistically significant impact on the Adversity Quotient of the medical teachers and implied that a well-designed faculty development intervention could make academic healthcare professionals resilient and adaptive.

Success of Endoscopic Dacryocystorhinostomy Using Flap Technique

Tue, 31 Mar 2026 00:00:00 +0000

Acquired nasolacrimal duct obstruction is a frequent cause of epiphora and recurrent dacryocystitis, leading to substantial impairment in quality of life. Endoscopic dacryocystorhinostomy using mucosal flap techniques has been advocated to enhance ostium patency and reduce failure rates. Objectives: To evaluate the success rate, complications, and factors associated with outcomes of flap-based endoscopic dacryocystorhinostomy in patients with acquired nasolacrimal duct obstruction. Methods: This prospective single-arm interventional study was conducted in the Department of Otorhinolaryngology, Shaikh Zayed Hospital, Lahore, from January to June 2025. Seventy-two adults with syringing-confirmed acquired nasolacrimal duct obstruction were enrolled through non-probability consecutive sampling. All underwent standardized endoscopic dacryocystorhinostomy using a mucosal flap technique under general anaesthesia. Results: Seventy-two patients were enrolled, with a mean age of 42.03 ± 11.36 years and a mean disease duration of 7.97 ± 2.61 months. Most patients were female (63.9%). At 3 months, functional success was 66/72 (91.7%), anatomical success 68/72 (94.4%), and overall success 66/72 (91.7%; 95% CI 83.0–96.1), with no significant associations with baseline variables (all p>0.05). Complications declined over time; 3-month rates were infection 2.8%, granulation 5.6%, synechiae 2.8%, and restenosis 5.6%. At 1 week, infection 6.9% and granulation 11.1%. Conclusions: Endoscopic dacryocystorhinostomy using a mucosal flap technique provides a high success rate with low complication frequency in acquired nasolacrimal duct obstruction and appears largely independent of baseline clinical variables.

Patient Satisfaction Levels and Determinants among Inpatients in Tertiary Hospitals in Hayatabad, Peshawar

Tue, 31 Mar 2026 00:00:00 +0000

Quality of healthcare is assessed by patient satisfaction, which is a very important factor. There has been very little research on the reasons for inpatient satisfaction referring to tertiary healthcare centers in Peshawar, Pakistan. Objectives: To find out the factors and levels of inpatient satisfaction in tertiary healthcare setups in Hayatabad, Peshawar. Methods: A cross-sectional comparative study was done in Hayatabad, Peshawar, from March to August 2025. Three public hospitals and three private hospitals were selected for this purpose. A convenience sample of 664 adults was collected through the proportionate method of sampling. Data analysis was performed with SPSS version 25.0. Results: Overall, patient satisfaction was low – only approximately 13.9% of patients reported being satisfied. Patients who received services in private hospitals had a higher satisfaction level (16.9%) compared to patients who were treated in public hospitals (12.0%) (p=0.05). Patient satisfaction also had a positive relationship with socioeconomic status, with a higher number of middle-class patients being satisfied (30.4%) (p=0.001). Patients’ ratings for cleanliness in private hospitals were higher (p=0.045). Education, occupation, and place of residence were significant indicators of patients’ ratings of quality, efficiency, and cost (p<0.05). Conclusions: Patient satisfaction levels among tertiary hospitals in Hayatabad, Peshawar is low; therefore, these centers need to improve affordability, cleanliness, and the efficiency of service delivery for patient satisfaction and patient-centered services.

Faculty Perceptions of Feedback in Objective Structured Clinical Examinations (OSCEs)

Tue, 31 Mar 2026 00:00:00 +0000

Objective Structured Clinical Examinations (OSCEs) are widely used to assess clinical competence in health professions education. Although OSCEs are considered reliable and objective, their educational impact largely depends on the quality of feedback provided. Objective: To evaluate the faculty perceptions regarding OSCE feedback practices in local institutional settings. Methods: This descriptive cross-sectional study was conducted at Bashir Institute of Health Sciences, Islamabad, from January 2025 to June 2025. A total of 110 faculty members involved in OSCE conduction and evaluation were recruited using non-probability consecutive sampling. Data were collected using a structured, self-administered questionnaire developed using expert opinion and feedback from the literature, addressing demographic characteristics, perceptions of OSCE feedback, preferred feedback practices, and perceived barriers. Data were analyzed using SPSS version 26.0 with descriptive statistics and the Pearson Chi-square test. Results: The mean age of participants was 43.37 ± 8.17 years, with females comprising 52.7% of the sample. Most faculty agreed that feedback is essential for student learning (60.0%) and improves clinical competence (84.5%). Immediate feedback was preferred by 52.7% of participants, while written (33.6%) and one-to-one (31.8%) methods were most favored. Lack of formal training (57.3%), large student numbers (43.6%), and stressful OSCE environments (42.7%) were identified as key barriers. No significant associations were observed between overall perception of feedback and faculty characteristics. Conclusions: Faculty members value feedback in OSCEs but face practical challenges that limit its effective delivery. Focused faculty development and institutional support are needed to enhance feedback quality.

Evaluation of the Efficacy of Rifaximin versus Mebeverine in the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome

Shahan Ahmad, Mamoona Zaman, Nauman Idrees, Rabia Gul, Yasir Aziz, Faryal Ahmad — Tue, 31 Mar 2026 00:00:00 +0000

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a widespread functional gastrointestinal disease characterized by frequent abdominal pain and frequent looseness. Antispasmodics such as Mebeverine have proven effectiveness, whereas microbiota-targeted antibiotics such as Rifaximin could be more advantageous because of the effect on gut dysbiosis. Objectives: To compare the effectiveness of Rifaximin and Mebeverine to treat IBS-D through the treatment of diarrhea-predominant irritable bowel syndrome. Methods: This prospective comparative study was conducted at Khyber Teaching Hospital for six months from 1st January 2024 to 30th June 2024. Rifaximin or Mebeverine had been administered to the patients (n = 50 in each group). The collected data were the demographics, IBS Symptom Severity Score (IBS-SSS) at baseline, three months, and six months, and stool consistency, abdominal pain, bloating, and patient-reported satisfaction. The statistical analysis was performed with independent t-tests and chi-square tests; the p-value ≤ 0.05 was taken as significant. Results: Significantly greater improvements were observed in IBS-SSS in the Rifaximin group during three months (p=0.0002) and six months (p<0.0001) than in the Mebeverine group. Even though the Rifaximin group had better outcomes on categorical outcomes, such as stool normalization and first-line resolution of symptoms, most of them were not statistically significant. Conclusions: Rifaximin produced much improved symptomatic improvement as compared to Mebeverine in patients with IBS-D. The findings substantiate its use as a better treatment option clinically.

Comparison of Intravenous Bolus with Infusion Regimen of Oxytocin in Patients Undergoing Elective Cesarean Delivery

Tue, 31 Mar 2026 00:00:00 +0000

Postpartum hemorrhage is one of the leading causes of maternal mortality, and its rate of occurrence increases with the increase in the rates of cesarean section. The main prophylaxis is oxytocin, although the best way to administer it (intravenous bolus or continuous infusion) is the most effective and safe. Objectives: To compare the effectiveness and safety of intravenous bolus with the infusion regimen of oxytocin in patients undergoing elective cesarean delivery. Methods: The quasi-experimental study compared intravenous oxytocin bolus versus continuous infusion for the prevention of postpartum hemorrhage in women undergoing elective cesarean section. Ninety term pregnant women (ASA I–II) were allocated to receive either a 3 IU IV bolus followed by infusion or a 10 IU continuous infusion. The primary outcome was postpartum hemorrhage, while secondary outcomes included uterine tone, additional uterotonic requirement, hemodynamic stability, and maternal side effects. Data were analyzed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: The incidence of postpartum hemorrhage was similar in the bolus (4.4%) and infusion (2.2%) groups (p=0.78), with no significant difference in uterine atony or mean blood loss, indicating comparable uterotonic efficacy. However, hypotension and tachycardia were significantly more frequent in the bolus group (p=0.02 and p=0.03, respectively). Conclusions: Intravenous oxytocin bolus and infusion are equally effective in preventing postpartum hemorrhage and maintaining uterine tone during elective cesarean section; however, continuous infusion offers superior maternal hemodynamic stability with significantly lower rates of hypotension and tachycardia, making it the safer regimen.

Psychological Well-being and Its Predictors among Doctors in Tertiary Care Hospitals of Rawalpindi and Islamabad, Pakistan

Tue, 31 Mar 2026 00:00:00 +0000

Psychological well-being (PWB) is a very important aspect of doctors' lives since their work is associated with a lot of stress. In Pakistan, the area has not been frequently studied to understand how PWB, as a multidimensional concept, appears among the doctors. Objectives: To assess the psychological well-being and factors affecting it among medical professionals working in tertiary care hospitals of Rawalpindi and Islamabad, Pakistan. Methods: A cross-sectional study was carried out among 385 doctors recruited through convenience sampling from April to June 2025 online-based structured questionnaire comprising sociodemographic information and the Ryff Psychological Well-Being Scale. Participant characteristics and well-being scores were summarized using descriptive statistics. Predictors of psychological well-being were identified using multiple linear regression analysis (p<0.05). Results: Among 385 doctors, 52.7% were male, and 47.3% were female. Descriptive analysis showed higher psychological well-being scores for Personal Growth (14.1 ± 2.6), Autonomy (13.7 ± 2.8), and Self-Acceptance (12.9 ± 2.7), with a total well-being score of 65.8 ± 11.5. The regression analysis revealed that marital status (β = 0.19, 95% CI [0.96, 4.26], p=0.002) and duty hours per day (β = –0.25, 95% CI [–4.66, –1.28], p=0.001) emerged as significant PWB predictors. Gender, age, years of service, and department were found to be non-significant predictors. Conclusions: Moderate psychological well-being was reported by doctors working in tertiary care hospitals, which was impacted by marital status and duty hours. It is advised to improve doctors' well-being and their professional performance through the use of workload management, institutional support, and mental health programs.

Diagnostic Accuracy of Color Doppler Ultrasonography for Differentiating Benign and Malignant Thyroid Nodules: Sensitivity, Specificity, and ROC-Based Evaluation Using FNAC as Reference Standard

Tue, 31 Mar 2026 00:00:00 +0000

Thyroid nodules are frequently encountered in clinical practice, and accurate discrimination between benign and malignant lesions remains essential to avoid unnecessary invasive procedures. Objectives: To evaluate the diagnostic accuracy of Doppler ultrasonography using fine needle aspiration cytology (FNAC) as the reference standard. Methods: This cross-sectional diagnostic accuracy study was conducted in the Department of Radiology, Medical Teaching Institution Bacha Khan Medical College and Mardan Medical Complex, Pakistan, from 18 August to 18 December 2025. A total of 83 patients underwent gray-scale and Doppler ultrasonography followed by FNAC. Doppler findings were categorized using predefined thresholds and compared with cytology. Results: The mean age was 45.1 ± 17.2 years. Malignancy was detected in 22.9% of nodules on FNAC. Doppler ultrasonography demonstrated sensitivity 100% (95% CI: 82.4–100), specificity 85.9% (95% CI: 74.6–93.3), and overall accuracy 89.2%. The ROC curve showed an AUC of 0.93 (95% CI: 0.876–0.984). Conclusions: Doppler ultrasonography is a reliable adjunct to gray-scale ultrasound for triaging thyroid nodules and guiding FNAC selection. However, cytology remains essential for confirming malignancy.

The Role of Neutrophil to Lymphocyte Ratio in Predicting the Response to Neoadjuvant Targeted Therapies in HER2-Positive Breast Cancer

Tue, 31 Mar 2026 00:00:00 +0000

The neutrophil-lymphocyte ratio (NLR) is a basic systemic inflammatory biomarker, previously associated with treatment response in different forms of cancer. Its predictive importance on response to neoadjuvant HER2-targeted therapies in HER2-positive breast cancer has not been well-established, especially in Pakistani patients. Objectives: To identify the relationship between pretreatment NLR and response to neoadjuvant HER2-targeted therapy in women with HER2-positive breast cancer. Methods: This was a descriptive study carried out in Khyber Teaching Hospital. Non-probability consecutive sampling was used to enroll 120 patients. Standard neoadjuvant HER2-targeted therapy was given to patients, and after 12 weeks, treatment response was evaluated based on Miller-Payne criteria. SPSS version 25.0 was used to analyze data. Chi-square/Fisher exact tests were used to establish associations between NLR and treatment response, and multivariate logistic regression was used to determine independent predictors of complete response. Results: Out of the 120 patients, 70 (58.3%) patients had low NLR, and 50 (41.7%) patients had high NLR. Full response was obtained in 16 (22.9%) low (NLR) and 4 (8%) high (NLR) (p=0.004) patients, respectively. High NLR was an independent predictor of reduced odds of complete response using logistic regression (p=0.035). Conclusions: A low pretreatment NLR is linked to better response rates to neoadjuvant HER2-targeted therapy, which indicates its potential use as a cost-efficient biomarker in informing decisions on the use of treatment strategies in the management of patients with HER2-positive breast cancer.

Vitamin D Deficiency and Its Association with Cirrhosis among Patients with Chronic Hepatitis C Infection

Tue, 31 Mar 2026 00:00:00 +0000

Vitamin D deficiency represents a common metabolic disturbance in chronic liver disorders, with a particularly high prevalence among individuals affected by chronic hepatitis C virus (HCV) infection. Evidence reported that progressive hepatic dysfunction can be linked to the waning levels of vitamin D; the information on South Asian populations is scarce. Objectives: To evaluate the association between deficient serum vitamin D levels and the presence of liver cirrhosis among individuals with HCV infection. Methods: The case-control study involved 162 chronic hepatitis C patients in the Department of Medicine, Kishwar Fazal Teaching Hospital, Lahore. Demographic, clinical, and laboratory parameters were taken. The level of vitamin D in serum was determined and categorized based on the severity. The statistical analysis was conducted using SPSS version 25.0 through suitable tests. Results: The study population had a vitamin D deficiency of 92.0%. Cases of severe vitamin D deficiency were found 30.2 higher in cirrhotic patients than in non-cirrhotic patients (30.2% vs. 14.0%). Severe vitamin D deficiency, female gender, and longer HCV infection were significantly related to cirrhosis. Extremely vitamin-D-deficient patients showed a high concentration of alanine aminotransferase and aspartate aminotransferase, elevated serum bilirubin, and decreased serum albumin, which is indicative of severe hepatic dysfunction. Conclusions: In chronic hepatitis C patients, vitamin D deficiency, especially the severe form, is highly correlated with cirrhosis and poor biochemical markers in the patients. These results justify the inclusion of regular screening of vitamin D status in the overall evaluation of patients with chronic HCV infection.