Pakistan Journal of Health Sciences

Angiotensin-Converting Enzyme Inhibitors Increase Substance P, Which Is Involved in Coughing, Inflammation, and Lung Cancer

Miguel Munoz, Riffat Mehboob — Sat, 28 Feb 2026 00:00:00 +0000

Angiotensin-converting enzyme inhibitors (ACEIs) are effective and safe drugs that have been used for many years to control high blood pressure. However, a systematic review and meta-analysis have reported the association between long-term (more than five years) use of ACEIs and the risk of lung cancer (LC). Of the 2,400 records reviewed, 13,061,226 patients met the inclusion criteria [1]. In line with this, it is known that the substance P (SP) peptide, after binding to the neurokinin-1 receptor (NK-1R), is involved in coughing [2], neurogenic inflammation (inflammation SP mediated) [3], and LC [4] and, therefore, could be considered mechanistically responsible for the risk of LC mediated by prolonged ACEIs use for the following reasons: ACE hydrolyze SP [5], while ACEIs can prevent the degradation of SP by blocking ACE [5], ACEIs increases SP levels and induces cough, in fact, ACEIs to cause coughing in 5-10% of patients [2]. SP also induces neurogenic inflammation [3] and LC [4]. ACE or kininase II is a peptidyl dipeptidase that splits C-terminal dipeptides of a large range of substrates, including angiotensin I, bradykinin, neurotensin, and SP [5]. It is a fact that ACE transforms the dormant decapeptide angiotensin I to the octapeptide angiotensin II. However, an important, lesser-known fact is that ECA also hydrolyzes SP, increasing its levels. In contrast, SP hydrolysis was completely blocked by the ACEI, captopril, in a concentration-dependent manner [5]. Thus, ACEI therapy increases SP levels and induces cough [2]. SP plasma levels are higher in subjects with cough [3] (including patients with ACEI treatment) and in patients with cancer compared to healthy subjects [3]. Previous studies indicate that long-term use of ACEIs may increase SP levels in lung tissue and mediate chronic neurogenic inflammation via SP [3, 6]. In addition, it is well known that chronic inflammation is the hallmark of cancer promotion. In fact, chronic inflammatory diseases are known to cause cancer (chronic pancreatitis can promote pancreatic cancer, chronic hepatitis can promote hepatocellular carcinoma, and inflammatory bowel disease can promote colon cancer) [6]. Similarly, persistent neurogenic inflammation mediated by SP can promote LC [3, 6]. Moreover, LC cells overexpress SP and NK-1R, and SP is a mitogen in LC cells [4]. In contrast, the drug aprepitant, a specific NK-1R antagonist, has an antitussive effect in patients with LC and refractory cough [7], as well as anti-inflammatory effects [3], and inhibits LC cell proliferation and induces apoptosis in LC cells [4]. In conclusion, ACEIs block ACE and increase SP levels, which, after binding to NK-1R, can cause coughing and neurogenic inflammation. Persistently elevated SP levels would cause chronic neurogenic inflammation, which, in the long term, could lead to the promotion of LC. Conversely, the use of the specific NK-1R antagonist drug, aprepitant, counteracts coughing, inflammation, and LC.

Effect of Percutaneous-Nephrolithotomy on Renal Function Tests and Hemoglobin Levels in the Early Postoperative Period at 24 Hours and 21st Day

Sat, 28 Feb 2026 00:00:00 +0000

The impact of percutaneous nephrolithotomy (PCNL) on renal function tests (RFTs) and hemoglobin (Hb) levels remains debated. Early postoperative changes may indicate transient renal dysfunction and hematological shifts. Objectives: To evaluate measurable changes in serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and hemoglobin (Hb) following PCNL at 24 hours and 21 days post-procedure. Methods: A detailed case series was conducted at the Department of Urology, Ayub Teaching Hospital, Abbottabad, for exactly three months (2^nd August to November 2025). During consecutive sampling, 68 patients aged 18–65 years, ASA Class I–II, subjected to PCNL were included. Renal functions were assessed using eGFR (MDRD formula), while Hb was measured at baseline, 24 hours, and 21 days postoperatively. Repeated-measures ANOVA was performed to analyze within-subject comparisons, while chi-square tests were used for categorical variables. Results: Both eGFR and Hb showed significant declines at 24 hours post-PCNL (64.8 ± 12.9 ml/min/1.73m² and 12.4 ± 2.2 g/dL, respectively; p<0.001 vs. baseline). By day 21, partial recovery (eGFR 69.7 ± 13.1; Hb 13.4 ± 1.9) was noted, showing significantly lower values compared to preoperative levels (p<0.001). Higher eGFR and Hb values were observed in younger patients (18–35 years) across all time points (p<0.05). Conclusions: PCNL produces an initial decline in renal function and hemoglobin levels, with partial recovery by three weeks. Postoperative fluctuations are significantly influenced by age, emphasizing the need for close monitoring in younger patients.

Outcomes of One Point versus Two Point Fixation in Zygomatic Bone Fracture

Sat, 28 Feb 2026 00:00:00 +0000

Fractures of the zygomatic bones are quite common injuries. There are several different surgical methods for fixing zygomatic bone fractures, and there is no universally accepted one. Objective: To compare the outcomes of one-point and two-point fixation in zygomatic bone fractures. methods: This prospective comparative study was carried out on 60 patients admitted to the Department of Oral and Maxillofacial Surgery at Sharif Medical and Dental Hospital, Lahore, from September 2023 to August 2024. The patients were divided into two groups (A/B). Thirty consecutive patients in group A received one-point fixation, and thirty consecutive patients in group B received two-point fixation for their zygomatic fracture repair. The outcomes of procedures were evaluated by assessment of the bone diastasis at the inferior orbital margin and frontozygomatic suture on postoperative CT scan, and evaluation of malar height clinically. Results: There was a non-significant association between bone reduction in the Frontozygomatic suture and method of fixation (p=0.237). The association between bone reduction in the infraorbital margin and method of fixation was significant (p=0.005). For malar height, a statistically non-significant difference in the post-operative malar height among the groups that had undergone one and two-point fixation (p=0.067). Conclusion: The majority of individuals who had two-point fixation exhibited appropriate reduction at the infra-orbital margin and frontozygomatic suture. Those who had one-point fixation treatment exhibited higher post-operative malar height.

Anatomical Study: Anatomical Variations of Dorsalis Pedis Artery and Its Correlation with Clinical Assessment

Sat, 28 Feb 2026 00:00:00 +0000

The dorsalis pedis artery, the distal continuation of the anterior tibial artery, is a key landmark for pulse assessment, vascular access, and reconstructive procedures of the foot. Its anatomical variability, however, may complicate clinical examination and contribute to diagnostic uncertainty. Objectives: To describe the anatomical configurations and morphometric features of the DPA and to determine how these variations influence clinical pulse palpability. Methods: A descriptive cross-sectional study was conducted at Khyber Medical College, Peshawar, from March 2024 to August 2025, in collaboration with the Radiology Department at Khyber Teaching Hospital. A total of 103 lower limbs were examined through standardized palpation followed by colour Doppler ultrasonography using a 7.5–10 MHz linear transducer. The artery’s origin, course, termination, diameter, and length were documented and classified. Associations between anatomical type and pulse palpability were assessed using Chi-square tests and Cramer’s V. Results: The DPA was present in all limbs. Type I was the most common pattern (80.6%). Variant origins (Types II, IV, V) accounted for roughly one-fifth of cases. A palpable pulse was detected in 88.3% of limbs, with significantly higher palpability in Type I compared with variant types (p<0.001). Pulse palpability did not differ by sex or limb side. Conclusions: Although the DPA generally follows a predictable anatomical course, variations are not uncommon and may reduce clinical pulse detectability. Recognition of these variants is important for accurate vascular assessment, imaging interpretation, and surgical planning.

Platelet Rich Plasma Dressing Versus Normal Saline Dressing in the Management of Chronic Diabetic Wounds

Sat, 28 Feb 2026 00:00:00 +0000

Platelet-rich plasma (PRP) has emerged as a promising modality in wound healing due to its concentration of platelets and growth factors that stimulate tissue repair, angiogenesis, and epithelialization. Objectives: To compare the efficacy of PRP dressings with normal saline dressings in the management of chronic diabetic ulcers. Methods: This randomized controlled trial was conducted at the Department of Surgery, Gulab Devi Hospital, Lahore, from January 2025 to June 2025. After ethical approval, 156 patients with chronic diabetic wounds were recruited using consecutive sampling and randomly allocated into PRP and NS dressing groups (1:1). Interventions were administered over six weeks. Baseline and weekly wound area and healing status were assessed. Data were analyzed using SPSS version 26. A confidence level of 95% was used for all statistical analyses. Results were considered statistically significant at a p-value ≤0.05. Results: A total of 156 patients were enrolled, with a mean age of 39.05 ± 9.75 years and mean BMI of 25.85 ± 2.30 kg/m². Males comprised 63.5% of the participants, and 53.2% were aged 41–60 years. Complete healing was achieved in 92.3% of PRP patients compared to 61.5% in the NS group (p<0.001). PRP significantly reduced healing time (3.62 ± 1.25 vs. 4.85 ± 1.27 weeks; p<0.001) and post-treatment infections (7.7% vs. 23.1%; p=0.008), with no amputations in the PRP group. Conclusions: PRP dressing offers a more effective and safer alternative to conventional care in managing chronic diabetic wounds, promoting timely healing and supporting its inclusion in clinical wound care strategies.

Role of Intravenous Dexmedetomidine for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation in Controlled Hypertensive Patients: A Prospective Cohort Study

Sat, 28 Feb 2026 00:00:00 +0000

Due to sympathetic stimulation, laryngoscopy and endotracheal intubation are known to cause brief but noticeable elevations in blood pressure and heart rate, which can be dangerous for hypertensive individuals. It has been demonstrated that the specific α2-adrenergic agonist dexmedetomidine reduces these reactions. Objectives: To evaluate whether intravenous dexmedetomidine could effectively reduce hemodynamic reactions to laryngoscopy and intubation in patients with controlled hypertension. Methods: This prospective cohort study was carried out at Sindh Institute of Urology and Transplantation (SIUT) and used a non-probability consecutive sampling technique for six months from January 1, 2025, to June 30, 2025. Eligible were ASA II patients with high blood pressure who had been planned for elective surgery while under the influence of general anesthesia. Individuals were randomly assigned to receive either a placebo (20 mL normal saline) or dexmedetomidine (0.5 µg/kg diluted to 20 mL in saline) ten minutes before induction. Repeated-measures ANOVA and the Student's t-test were used to examine the data; p ≤0.05 was deemed significant. Results: The groups' baseline characteristics were similar. When compared to control, dexmedetomidine significantly reduced the increase in HR and SBP following laryngoscopy and intubation (p < 0.001 at all post-intubation intervals). Bradycardia (5.7%) and hypotension (2.9%) were rare but clinically treatable adverse effects. Conclusions: In hypertensive patients, intravenous dexmedetomidine (0.5 μg/kg) administered as a single pre-induction dosage is safe and efficient in reducing the hemodynamics of laryngoscopy and intubation while also enhancing cardiovascular stability throughout induction.

Effectiveness of Holter Monitoring in the Detection of Atrial Fibrillation after Ischemic Stroke

Sat, 28 Feb 2026 00:00:00 +0000

Atrial fibrillation (AF) is an important but often hidden cause of recurrent ischemic stroke, requiring early detection for timely anticoagulation. This study assessed the effectiveness of 72-hour Holter monitoring in identifying previously undiagnosed AF in acute ischemic stroke patients, particularly in resource-limited settings. Objectives: To determine the effectiveness of 72-hour Holter monitoring in identifying previously undiagnosed AF in acute ischemic stroke patients. Methods: This analytical cross-sectional study was conducted at the Department of Neurology, Pak Emirates Military Hospital, Rawalpindi, from May to September 2025, enrolling 256 patients with neuroimaging-confirmed ischemic stroke. Holter monitoring was initiated within 2 hours of admission and continued for 72-hours, accompanied by 8-hourly pulse checks and symptom logs to identify AF episodes lasting ≥30 seconds. Chi-square or Fisher’s exact tests were used, keeping p≤0.05 statistically significant. Results: The mean age was 65.4±11.2 years; 59.4% were male. AF was detected in 17 patients (6.6%), with 72-hour Holter yielding significantly higher detection than baseline ECG (17(6.6%) vs.5(2.0%), p=0.002, with diagnostic accuracy of 95.3%. Cumulative detection increased over time: 29.4% within 24 hours, 70.6% by 48 hours, and 100% by 72 hours. AF was significantly associated with age ≥65 years (p=0.008), hypertension (p=0.047), and diabetes (p=0.029). Conclusions: 72-hour Holter monitoring is a useful non-invasive method of correctly detecting occult AF in patients after acute ischemic stroke, with superior diagnostic yield over baseline ECG. These results favor routine use of 72-hour Holter monitoring as part of post-stroke protocols.

Accuracy of Focused Assessment with Sonography in Trauma (FAST) In Detecting Visceral Injury Following Blunt Trauma with Computed Tomography (Ct) as A Gold Standard

Saad Saleem Qureshi, Dawar Burhan, Nashmia Zubair, Saira Samnani, Minaa Shahid — Sat, 28 Feb 2026 00:00:00 +0000

Blunt abdominal trauma is one of the major causes of morbidity and mortality around the world. The prompt identification of visceral damage is crucial for effective management, and FAST is a proven, widely adopted first-line imaging tool. Objectives: To investigate the diagnostic value of FAST for ascertaining the presence of visceral injuries after blunt abdominal injury, keeping the CT scan as the reference measure. Methods: A cross-sectional study was implemented at the Department of Radiology, Aga Khan University Hospital, Karachi, from June 2025 to September 2025. A population of 103 patients meeting eligibility criteria with blunt abdominal trauma was selected by non-probability consecutive sampling. FAST was performed on all patients, with the findings subsequently correlated with subsequent CT scans. A 2x2 contingency table in which the CT scan served as the gold standard was used to estimate sensitivity, specificity, positive and negative predictive values of FAST, and its diagnostic accuracy. SPSS version 26.0 was used to analyze data using the Shapiro-Wilk test. Results: FAST had a sensitivity of 88.24% and a specificity of 81.16%. Total diagnostic accuracy was 83.50%. The PPV was 69.77% and the NPV 93.33%. FAST was noted to be highly efficient for detecting intra-abdominal injuries; however, some false positives were also reported. Conclusions: FAST is a non-invasive, diagnostic measure as a preliminary assessment of blunt abdominal trauma with a good sensitivity and NPV, and hence turns out to be a useful screening test, particularly in resource-limited and emergency settings.

Assessment of Maternal Risk Factors in Preterm Labor in A Tertiary Care Hospital of Pakistan

Sat, 28 Feb 2026 00:00:00 +0000

Preterm labor remains a major contributor to perinatal morbidity and mortality, particularly in low- and middle-income countries. Identification of maternal risk factors is essential for prevention, timely intervention, and improved pregnancy outcomes. Objectives: To determine the frequency of maternal risk factors associated with preterm labor in a tertiary care setting. Methods: A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, University of Lahore Teaching Hospital, from May 3, 2025, to August 2, 2025. A total of 155 multigravida women aged 20–40 years with gestational age <37 weeks, diagnosed with preterm labor, were included through non-probability consecutive sampling. Data were collected using a structured proforma and analyzed in SPSS version 25.0. Descriptive statistics were calculated, and stratification was done with the chi-square test, considering p≤0.05 as significant. Results: The mean maternal age was 31.03 ± 5.89 years, and mean gestational age at delivery was 33.88 ± 1.43 weeks. The most frequent maternal risk factors were vaginal discharge (46.5%), urinary tract infection (45.2%), anemia in pregnancy (39.4%), previous cesarean section (23.9%), and gestational hypertension (18.1%). A history of previous preterm birth was present in 12.9% of women, leaking per vagina in 11.6%, and placental abruption in 2.6%. Conclusions: Infections, particularly vaginal discharge and urinary tract infection, were the leading maternal risk factors associated with preterm labor in this population. Routine screening and prompt management of maternal infections, alongside targeted antenatal interventions, may help reduce the burden of preterm births.

Patterns and Outcomes of Adult Cardiac Surgery in a Tertiary Hospital in Pakistan: A Seven-Year Single-Surgeon Retrospective Study

Muhammad Sher i Murtaza, Muhammad Hamid Chaudhary, Khurram Hafeez — Sat, 28 Feb 2026 00:00:00 +0000

Cardiovascular disease is a major health burden in Pakistan, where access to cardiac surgery is limited. Understanding disease patterns and cardiac surgical procedures in high-burden societies can guide resource allocation to improve patient outcomes. Objectives: To evaluate retrospectively the pattern of adult cardiac surgical procedures and their outcomes performed by a single surgeon at a tertiary hospital in Pakistan. Methods: This retrospective observational study included 1,404 consecutive adult patients operated on by a single surgeon at CPEIC, Multan. Data were collected from all consecutive adult patients (≥15 years), of either sex, who underwent surgery by a single cardiac surgeon between May 2018 and July 2025. The data were obtained from a prospectively maintained surgeon's database. Fisher’s exact test was used for small group comparisons. Results: A total of 1,404 patients underwent cardiac surgery. Coronary artery bypass grafting comprised 70.0% (on‑pump 55.9%, off‑pump 11.3%), valvular surgery 21.6%, congenital repairs 2.3%, aortic root 1.0%, and post-MI VSR repair 1.5%. In isolated CABG, the internal mammary artery was used in 92.4%, with a mean of 2.96 ± 0.93 grafts. Complications occurred in 20.4%. Early mortality was 3.1%, with the lowest rates in CABG (1.9%) and the highest in VSR repair (23.8%). Ventilation time and hospital stay were significantly longer in aortic root and redo procedures (p<0.05). Conclusions: Over seven years, CABG and valvular procedures predominated, with overall mortality and complication rates comparable to regional benchmarks. On-pump CABG provided more complete revascularization, while complex surgeries carried a higher risk.

Natural Conception Rate in Sub-Fertile Couples Following Laparoscopy and Dye Test

Fatima Akram, Aisha Taj, Rabia Rind, Nudrat Nazir, Saima Rajab — Sat, 28 Feb 2026 00:00:00 +0000

Infertility represents a major reproductive health issue, affecting between 8-12% couples worldwide. Objectives: To determine the natural conception rate in sub-fertile couples following laparoscopy and dye test (LDT). Methods: This single-center, prospective, observational, cohort study was performed at the Department of Obstetrics and Gynecology, Liaquat National Hospital, Karachi, Pakistan, during May 2024 to August 2025. A total of 131 couples with sub-fertility were consecutively enrolled if the female partner was scheduled for LDT. Baseline demographic and clinical data were recorded from both partners. All procedures were performed by experienced gynecologic surgeons. Participants were followed for six months to assess natural conception, confirmed clinically and by ultrasound. Statistical analyses included chi-square, t-test, or independent sample t-test, with p<0.05 considered significant. Results: Out of the 131 women, the mean age was 30.1 ± 6.0 years. The mean duration of subfertility was 25.6 ± 9.2 months. On laparoscopy, 69.5% had normal tubes, while unilateral and bilateral tubal abnormalities were seen in 16.0% and 8.4%. Natural conception within six months occurred in 76 (58.0%) women, with a mean interval to conception of 4.8 ± 1.1 months. Women who conceived were significantly younger (p=0.035), had lower BMI (p=0.003), and were more often nulligravid (p=0.001). Hypothyroidism was more prevalent among those who did not conceive (p=0.004). Conclusions: The study provides evidence supporting LDT as a valuable diagnostic and therapeutic modality in the management of sub-fertile couples. Younger age, lower BMI, and absence of hypothyroidism were associated with successful natural conception following LDT.

Gender Based Differences in Pain, Anxiety, and Disability in Response to Epidural Steroid Injection for Low Back Pain

Sat, 28 Feb 2026 00:00:00 +0000

Emerging research suggests that pain perception, tolerance, and response to treatment may differ between males and females due to a complex interplay of biological, psychological and sociocultural factors. Objective: To determine gender differences in pain intensity, anxiety, depression, and disability outcomes following epidural steroid injection in patients with chronic low back pain. Methods: This comparative cross-sectional study was conducted from July 2024 to January 2025 after taking approval from the IRB of Evercare Hospital Lahore. Total 9 male and 9 female patients with low back pain were enrolled from the Anesthesia and Pain Medicine Department. Fluoroscopy-guided epidural injection was performed in all patients. Patients were followed at 3 and 6 weeks to assess pain, anxiety, depression, and disability. Data were analyzed using SPSS v26. Results: At both 3 and 6 weeks, females reported significantly lower mean Visual analogue scores (2.44 ± 0.53 and 2.11 ± 1.06, p=0.007) compared to males (5.11 ± 2.52 and 5.11 ± 2.26; p=0.002). Oswestry Disability scores were considerably lower in females at 3 weeks and 6 weeks; p=0.04. However, no significant gender differences were observed in HADS anxiety and depression scores at any follow-up point (p>0.05). Conclusions: The current study suggests that female patients demonstrated greater reductions in pain and disability scores than male patients following fluoroscopy-guided epidural steroid injection, whereas changes in anxiety and depression scores were comparable between genders. These findings indicate that gender may influence physical, but not psychological, recovery outcomes after the procedure.

Comparison of Dexmedetomidine and Labetalol for Attenuating Stress Response in Hypertensive Patients

Sat, 28 Feb 2026 00:00:00 +0000

Laryngoscopy and tracheal intubation during general anesthesia provoke a sympathetic stress reaction that has significant hemodynamic changes. This can be risky, particularly in patients with controlled hypertension with compromised cardiovascular reserve. Objective: To compare the effect of dexmedetomidine and labetalol for attenuating stress response in hypertensive patients. Methods: A quasi-experimental study that involved 200 controlled hypertensive patients admitted to the elective surgery and placed under general anesthetic procedures. Patients received Intravenous dexmedetomidine (0.1 mcg/kg) or labetalol (0.1 mg/kg). It was observed that the mean heart rate and mean arterial blood pressure were measured at baseline and two minutes after endotracheal intubation. The statistics were performed using the independent sample t-test, which was used to compare the results observed between the two treatment groups. Results: The heart rate 2 minutes following intubation was much lower in Group D (78 ± 8.27 beats/minute) than in Group L (81 ± 5.30 beats/minute, p=0.0026). Further, the mean arterial blood pressure was declining remarkably in the dexmedetomidine group (98 ± 7.26 mmHg), compared to the labetalol group (101 ± 8.2 mmHg; p=0.0067). Conclusions: The present group of controlled hypertensive patients indicated that dexmedetomidine pre-induction, in comparison to labetalol, led to a significantly more significant reduction of hypertensive and tachycardic reaction to laryngoscopy and endotracheal intubation.

Positive Predictive Value of Dried Blood Sampling of TSH in Diagnosing Congenital Hypothyroidism in Neonates Born at a Tertiary Care Hospital

Sat, 28 Feb 2026 00:00:00 +0000

Congenital hypothyroidism (CH) is one of the most common preventable causes of intellectual disability in children. Early detection through newborn screening is essential for timely intervention. However, the predictive accuracy of DBS-TSH varies across populations, and limited local data are available from Pakistan. Objectives: To determine the positive predictive value (PPV) of dried blood samples of thyroid-stimulating hormone (DBS-TSH) in diagnosing congenital hypothyroidism (CH) in neonates. Methods: This retrospective cohort study using screening registry data was conducted at the newborn screening program, Aga Khan University Hospital, Karachi, from March 2023 to March 2024. Records of neonates screened from April 2019 to December 2022 were reviewed. Neonates with DBS-TSH >10 mIU/L were labeled screen-positive and underwent confirmatory testing with serum TSH and free T4 within two weeks. Neonates with Serum TSH (>20 mIU/L) were considered true positive for congenital hypothyroidism. Results: Of 30,402 neonates screened, 538 (1.76%) were screen positive. Mean DBS-TSH was 16.1 ± 12.6 mIU/L. Among them, 478 (88.8%) had 10–20 mIU/L (Group 1), and 60 (11.2%) had >20 mIU/L (Group 2). Confirmatory testing was available for 385 infants, of whom 33 were true cases of CH, yielding a PPV of 8.57% (95% CI: 5.9%–11.7%). Higher PPV was observed when sampling occurred at >48 hours. A DBS-TSH cutoff ≥35 mIU/L showed PPV of 95% (95% CI: 76.18 – 99.88), which may justify early treatment consideration. Conclusions: DBS-TSH screening at a cutoff of >10 mIU/L yields modest PPV for CH. Higher DBS-TSH values and appropriate sampling time significantly enhance predictive accuracy.

Association of Dry Socket (Alveolar osteitis) with Gender and Site of Extraction (Maxillary and Mandibular)

Sat, 28 Feb 2026 00:00:00 +0000

American dentist James Young Crawford coined the phrase "dry socket" (Alveolar Osteitis) in 1896 to refer to an acute infection of alveolar bone surrounding the location of a tooth extraction. Severe pain, the lack of a blood clot inside the socket, and food particles inside the socket are clinical indicators of dry socket. Most frequently seen after the extraction of mandibular third molars, the incidence of dry socket ranges greatly, from 1% to over 25%. Objectives: To assess the frequency of dry socket and its association with gender and site of teeth extraction at a tertiary care hospital. Methods: The descriptive cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery of Jinnah Postgraduate Medical Center, Karachi. Demographic data, such as age and gender, and clinical data, such as the extraction site, smoking status, extraction type and extent, and the frequency of dry socket within five days after extraction. Results: Dry socket was found in 22.5% higher in male, 26.5% compared to female 17.3%. The incidence of dry socket was significantly greater in mandibular extractions 31.1% than in maxillary extractions 8.7% with a p-value of less than 0.01. Smokers exhibited a notably higher rate of dry socket 41.7% compared to non-smokers, 9.7%. Furthermore, 41% of surgical extractions resulted in dry socket, compared to 13.6% of non-surgical extractions. Conclusions: The reported frequency of dry socket was slightly higher in male as compared to female, and it was more commonly observed in patients who underwent mandibular tooth extractions.

Comparison of Efficacy of Ferric Carboxymaltose versus Iron Sucrose Complex for the Treatment of Iron Deficiency Anemia in Pregnancy

Sat, 28 Feb 2026 00:00:00 +0000

During pregnancy, iron deficiency anemia (IDA) is a common complication that exposes both the mother and fetus to a lot of risks. Objectives: To compare intravenous ferric carboxymaltose (FCM) versus iron sucrose in the treatment of moderate to severe anemia in pregnant women. Methods: This quasi-experimental study was conducted in a tertiary care hospital in Lahore, which registered 62 pregnant women having 16-34 weeks of gestation and hemoglobin levels of 7-9 g/dl. The participants were randomly divided into two groups, with intravenous FCM in one of them and the other without. The level of base hemoglobin and post-treatment were taken three weeks after the completion. There was also the evaluation of effectiveness and adverse impacts. Results: The average basal hemoglobin was 7.88 ± 0.42 g/dl. The levels after treatment were significantly higher in the FCM group (10.93 ± 0.63 g/dl) compared to the IS group (9.98 ± 0.51 g/dl), with an increase in statistically significant HB (p<0.001). The efficacy was reported in 87.1% of patients treated with FCM versus 38.7% in the SI group. The adverse effects were remarkably lower in the FCM group (19.4%) compared to IS (61.3%) (p=0.001). Although multiparous women had significantly lower basal HB, both parity groups showed similar responses to treatment. Conclusions: Ferric carboxymaltose demonstrated superior efficacy and tolerability compared to iron sucrose in the first leg during pregnancy. Its ability to achieve rapid HB correction with fewer side effects supports its consideration as preferred intravenous iron therapy.

Frequency and Factors of High-Degree Atrioventricular Block in Patients with Acute Anterior Wall Myocardial Infarction

Sat, 28 Feb 2026 00:00:00 +0000

High-degree atrioventricular block (HAVB) is a serious complication of acute anterior wall myocardial infarction (AWMI), contributing significantly to early morbidity and mortality. Early identification of high-risk patients is essential for timely intervention. Objectives: To determine the frequency, clinical predictors, and in-hospital outcomes of HAVB among patients presenting with acute AWMI. Methods: This cross-sectional study included 78 acute AWMI patients presenting at Rahman Medical Institute from June 2024 to July 2025. Demographic data, clinical characteristics, and ECG findings were recorded. Patients were monitored continuously for the development of HAVB. Outcomes included cardiogenic shock, ICU admission, pacing requirements, and in-hospital mortality. Associations were analyzed using chi-square and logistic regression, with p<0.05 considered significant. Results: The mean age of patients was 56.8 ± 8.2 years, predominantly male 51(65.4%). The majority of patients were in the age group 51–60 years, 31 (39.7%). HAVB occurred in 7 (9%) patients. Older age (>60 years) and diabetes mellitus were significantly associated with HAVB (p=0.03) and (p=0.04), respectively. HAVB was strongly associated with cardiogenic shock (p=0.01), ICU admission (p=0.002), and need for temporary pacing (p<0.001). In-hospital mortality was significantly higher in the HAVB group (p=0.04). On multivariate analysis, HAVB independently predicted mortality (aOR 4.9, p=0.03). Conclusions: HAVB is an important predictor of adverse outcomes in AWMI, particularly among older and diabetic patients. Early monitoring and timely pacing interventions are crucial to improving survival.

Genotype-Phenotype Correlation in Idiopathic Cerebral Palsy

Sat, 28 Feb 2026 00:00:00 +0000

Genetic etiology is an important cause of idiopathic cerebral palsy, especially in consanguineous populations. Objectives: To determine the genotype-phenotype correlation in idiopathic cerebral palsy at a tertiary care hospital in Lahore, Pakistan. Methods: This retrospective descriptive cross-sectional study was conducted in the Department of Developmental and Behavioral Pediatrics, University of Child Health Sciences, Lahore. The data on cerebral palsy children with Whole Exome Sequencing was collected from January 2022 to January 2025. The study duration for all patients with reports available from March to August 2025 was included using nonprobability consecutive sampling. Results: Eighty-two patients were included after receiving their whole exome sequencing reports, and 35 genes were identified in 58 patients, showing a diagnostic yield of WES as 70.2%. There were 52 (63.4%) males. The average age was 8.3 ± 4.1 years (SD). The phenotype of positive patients showed spastic cerebral palsy to be the most common (79%), with a predominant quadriplegic subtype (55%). Seventeen genes (SYNE 1, PYCR2, PTS, SEPSECS, MOCS1, SERAC1, DEGS1, ECHS1, HPDL, ALS2, BLM, ITPA, PARD3, RIF1, CHD2, RAB3GAP1, ADAD2, WDR62) were associated with quadriplegic type, five (TBC1D14, CENPJ, ADAMDEC1, AMPD2 and TKTL1) with spastic diplegic, five (BICRA, ADGRG, CENPF, MAGEL2, TXNDC11) with hemiplegic, five (MIX23, EXOSC8, METTL5, GNG7, EZH1) with dyskinetic and two (SLC25A12, LPIN1) with mixed type. Conclusions: Epilepsy was present in 69%, feeding issues in 84%, drooling in 74%, recurrent chest infections in 60%, sleep issues in 60%, and constipation in 79%. GMFCS level V and MACS level V were the most common. Genotype–phenotype correlations in idiopathic cerebral palsy will help in comorbidity management and prognosis.

Morphological Variations of the Cusp of Carabelli in Permanent Maxillary First Molars and Their Correlation with Caries Risk in the Peshawar Population

Sat, 28 Feb 2026 00:00:00 +0000

The Cusp of Carabelli is a common non-metric morphological trait of permanent maxillary first molars. Although its anthropological significance is well recognized, its clinical relevance in relation to dental caries remains controversial, with limited regional data from Khyber Pakhtunkhwa. Objectives: To determine the prevalence and morphological patterns of the Cusp of Carabelli and evaluate their association with caries risk in a young population of Peshawar. Methods: A descriptive cross-sectional study was conducted at the Dental Outpatient Department of Khyber College of Dentistry, Peshawar. A total of 103 participants aged ≥12 years were examined using non-probability consecutive sampling. The Cusp of Carabelli was assessed on teeth 16 and 26 using the ASUDAS/Dahlberg classification (Types 0–6). Caries experience was recorded using the DMFT index. Oral hygiene behaviors were obtained through a structured questionnaire. Data were analyzed using descriptive statistics, chi-square, independent t-test, and Pearson correlation. Results: The Cusp of Carabelli was present in 62.1% of participants, with a mean severity score of 1.47 ± 1.41. The mean DMFT score was 4.48 ± 2.42, and 53.4% were classified as high caries risk. No significant associations were observed between Carabelli morphology, side expression, or severity score and caries experience (p>0.05). Oral hygiene behaviors also showed no significant association with caries risk. Conclusions: The Cusp of Carabelli is common in the studied population; however, its presence and morphology do not significantly influence caries risk and should be regarded primarily as a normal anatomical variation.

Evaluating The Role of Point-of-Care Lactate Measurement in Predicting Severity and Outcomes of Diabetic Ketoacidosis in Emergency Settings

Sat, 28 Feb 2026 00:00:00 +0000

Diabetic ketoacidosis is one of the severe diabetic emergencies with hyperglycaemia, acidosis, and ketonemia, and an increased level of lactate is an indicative feature of metabolic stress and unfavourable prognosis, necessitating urgent assessment and immediate care. Objectives: To assess the frequency of elevated point-of-care lactate in patients presenting with diabetic ketoacidosis (DKA) and to evaluate its association with DKA severity and in-hospital mortality. Methods: Data were prospectively collected from patients after obtaining verbal consent. Both quantitative and qualitative data were collected and analysed using SPSS version 23.0. Chi-square tests were applied, with a p-value of ≤0.05 considered significant. The study employed a descriptive cross-sectional design, conducted over six months (January 7, 2023, to June 7, 2023) at the Department of Medicine, Civil Hospital, Karachi. Results: A total of 131 patients were included, with a mean age and duration of T2DM of 47.14 ± 16.49 years and 1.72 ± 1.24 years, respectively. Among the participants, 71 (54.2%) were male, and 60 (45.8%) were female. Out of 131 patients, 64 (48.9%) had elevated point-of-care lactate, while 67 (51.1%) did not. In-hospital mortality occurred in 14 (60.9%) patients with elevated point-of-care lactate. The majority of patients presented with moderate DKA. Conclusions: The findings conclude that initial lactate levels in DKA patients are significantly associated with the need for critical care, suggesting that lactate can be used as a reliable marker for monitoring and managing DKA patients.

Frequency of Post-Thyroidectomy Hypoparathyroidism in Surgical Patients

Sat, 28 Feb 2026 00:00:00 +0000

The risk of post-operative hypoparathyroidism is increased after thyroidectomy. It can be transient or permanent, potentially leading to severe neuromuscular and respiratory complications. Objectives: To identify postoperative hypoparathyroidism based on serum post-thyroidectomy hypoparathyroidism (PTH) levels after total thyroidectomy. Methods: This was a cross-sectional study, conducted after total thyroidectomy on 88 participants at the Department of Surgery, Niazi Welfare Foundation Teaching Hospital, Sargodha, from 1^st October, 2024 to 30^th November, 2025. Patients with an age range of 22 to 62 years undergoing total thyroidectomy were included in this study, while others with hyperparathyroidism, a history of neck radiotherapy, preoperative hypocalcemia, or preoperative suspicion of malignancy were excluded. A predesigned form was used to collect data regarding demographics, personal habits, comorbidities, reasons for performing total thyroidectomy, and postoperative hypoparathyroidism. Serum PTH level of <10 pg/ml was marked as diagnostic criteria for postoperative hypoparathyroidism. SPSS version 26.0 was used to analyze data. Results: In this Study, out of 88 participants, there were 25 male patients and 63 females. The patients' ages ranged from 22 to 62 years, with a mean age of 40.56 ± 8.23 years. 30 participants belong to the age group of 22-42 years, whereas 58 participants were in the age range of 43 to 62 years. Post-operative hypoparathyroidism was revealed in 19 (21.59%) participants. Conclusions: Postoperative hypoparathyroidism was observed in the majority of patients after total thyroidectomy.

Frequency of ACS among Patients Presenting with Atypical Presentation in the National Institute of Cardiovascular Diseases Emergency Room

Sat, 28 Feb 2026 00:00:00 +0000

Acute coronary syndrome (ACS) classically presents with chest pain; however, many patients present atypically, which can delay diagnosis and treatment. Objectives: To determine the frequency of ACS among patients presenting with atypical symptoms to the emergency room of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Methods: This prospective cross-sectional study was conducted in the NICVD emergency room from 28 May to 27 September 2025. Adults aged 18–80 years presenting with atypical symptoms (dyspnea, fatigue, epigastric pain, dizziness, or syncope ± chest pain) were consecutively enrolled (n=165). ACS was defined by ischemic ECG changes and/or elevated troponin I/T and confirmed by a consultant cardiologist. Associations were assessed using Chi-square or Fisher’s exact tests; p<0.05 was considered statistically significant. Results: Mean age was 61.8 ± 12.6 years; 54.5% were male. ACS was diagnosed in 49 patients (29.7%). Dyspnea was the most common symptom (40.0%) and was significantly associated with ACS (51.0% vs 35.3%; p = 0.031). ACS was more frequent in patients aged ≥60 years (36.5% vs 18.9%; p=0.012). Hypertension (p=0.021), diabetes (p=0.038), and obesity (p=0.047) were significantly associated with ACS. Conclusions: Approximately one in three patients presenting atypically in the NICVD emergency room had ACS. Older age, dyspnea, hypertension, diabetes, and obesity were significantly associated with ACS, supporting early ECG and troponin testing in atypical presentations.

Emotional Intelligence and Academic Performance among MBBS students in Blended Learning Environment: A Correlational Study

Sadia Yaseen, Mamoona Shabbir, Nosheen Khurram, Muhammad Ali Raza — Sat, 28 Feb 2026 00:00:00 +0000

Emotional intelligence (EI) is a critical factor influencing academic performance (AP) and professional competence in medical education. Objectives: To assess the correlation between EI and AP among MBBS students across different professional years, age groups, gender, and achievement levels within a blended learning environment. Methods: A correlational study was conducted at Rashid Latif Medical College, Lahore, from January to June 2023 after ethical approval. Stratified random sampling selected 300 MBBS students eligible for their annual professional examination, with full exposure of students to a blended learning curriculum. EI was measured using the validated National Health Service emotional intelligence questionnaire, and AP was assessed using annual professional marks. Data analysis was performed in SPSS version 25.0. Non-normal variables were reported as median IQR, and normally distributed variables as mean ± SD. Spearman's rank correlation evaluated the relationship between EI and AP, and Kruskal-Wallis tests compared groups. Statistical significance was set as p<0.05 and 95% confidence interval. Results: Overall, EI showed a moderate positive correlation with AP (r=0.557, p<0.001). The strongest correlation was observed in final year students (r=0.747, p<0.001). Third Year students had the highest mean emotional intelligence (202 ± 12.8, p<0.001). Positive correlation was consistent across genders and age groups. High achievers demonstrated significantly higher emotional intelligence than low achievers. Conclusions: Blended learning can enhance emotional intelligence and academic performance, particularly in early clinical years. Integrating structured emotional intelligence development into blended curricula may improve engagement and professional preparedness, including unforeseen challenges such as future pandemics.

Comparison between Lactobacillus Reuteri Probiotic in Addition to Standard Care versus Standard Care Alone in the Treatment of Infantile Colic

Sat, 28 Feb 2026 00:00:00 +0000

Excessive crying is one of the most common problems in the first three months of life, accounting for nearly 20% of pediatric consultations. Objectives: To evaluate the effectiveness of Lactobacillus reuteri in infants with infantile colic compared with standard care alone. Methods: A prospective quasi-experimental study was used to enroll 172 infants (<13 weeks of age) with clinically diagnosed infantile colic who were enrolled. Group A received probiotic L. reuteri in addition to standard care, while Group B received standard care alone. Outcomes included mean daily crying time, crying episodes/week, and daily sleep duration, measured at baseline, days 7, 14, 21, and 28. Between-group comparisons were performed using the Mann–Whitney U test, and within-group changes were analyzed using the Friedman test. Results: Over 28 days, Group A showed greater improvement than Group B in reducing crying and increasing sleep. Daily crying decreased by −3.53 ± 1.05 hours in Group A vs. −1.79 ± 1.19 hours in Group B (p<0.001), weekly crying episodes by −3.60 ± 0.69 vs. −3.36 ± 0.97 (p=0.041), and daily sleep increased by 5.38 ± 2.08 hours vs. 2.80 ± 3.52 hours (p<0.001). Conclusions: L. reuteri supplementation in addition to standard care significantly reduced crying time and episodes, and improved sleep-in infants with colic compared to standard care alone.

Etiological Profile of Epilepsy in Patients at a Tertiary Care Hospital: An Observational Study

Sat, 28 Feb 2026 00:00:00 +0000

Epilepsy has diverse etiologies that vary by age, gender, and region. Identifying the cause is essential for management and prognosis. Objectives: To determine the etiological profile of epilepsy in patients at a tertiary care hospital and assess associations with age and gender. Methods: This observational study was conducted in the Department of Neuro-medicine, Liaquat University of Medical and Health Sciences, Jamshoro, from March 15 to September 14, 2022. A total of 156 patients aged ≥18 years with epilepsy for over five years were enrolled by consecutive sampling. Those with acute symptomatic seizures or incomplete records were excluded. Etiologies were classified using International League Against Epilepsy 2017 criteria based on electroencephalography and magnetic resonance imaging. Results: A total of 156 adult epilepsy patients were included (mean age 54.7 ± 15.6 years; 101 male, 55 female). Acute ischemic stroke was the most common etiology, 74 (47.4%), followed by idiopathic epilepsy, 29 (18.6%), brain tumors, 15 (9.6%), traumatic brain injury, 13 (8.3%), intracerebral hemorrhage, 10 (6.4%), CNS infections, 8 (5.1%), and encephalitis, 11 (7.1%). A higher proportion of female was observed within the brain tumor and idiopathic epilepsy subgroups, 10 (66.7%) and 19 (65.5%), respectively (p < 0.05); however, these findings reflect distribution within the tertiary cohort and should not be interpreted as population-level risk. Insignificant associations were found between etiology and age group or epilepsy duration. Conclusions: Acute ischemic stroke was the leading cause of epilepsy, with significant gender differences for brain tumors and idiopathic epilepsy.

Efficacy of Long-Term Low-Dose Macrolide Therapy in Preventing Early Recurrence of Nasal Polyps after Endoscopic Sinus Surgery

Muhammad Shouzib Sultan, Waqas Javaid — Sat, 28 Feb 2026 00:00:00 +0000

Long-term low-dose macrolide therapy has been shown to reduce eosinophilic inflammation and delay early recurrence of nasal polyps following endoscopic sinus surgery (ESS). Objective: To compare the efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps after endoscopic sinus surgery. Methods: This randomized controlled trial was conducted in the Department of ENT, Sir Ganga Ram Hospital, Lahore, from October to December 2025. Male and female patients aged 15–75 years diagnosed with nasal polyps and undergoing ESS were included. Patients already receiving antibiotics or macrolides, those with multiple facial fractures, or those with neurological or psychological disorders were excluded. Preoperatively, Sino-Nasal Outcome Test (SNOT), Lund-Kennedy endoscopic score, and Lund-Mackay CT score were recorded. Postoperatively, Group A received clarithromycin 250 mg once daily for three months in addition to standard therapy, while Group B received standard postoperative treatment alone. Outcomes were reassessed at 8 and 12 weeks, and recurrence of nasal polyps was evaluated after three months. Results: Mean SNOT scores showed significant improvement in the macrolide group compared to controls at both 8 and 12 weeks (p<0.05). Similarly, Lund-Mackay and Lund-Kennedy scores demonstrated significantly greater reductions in the macrolide group than in the non-macrolide group (p<0.05). Recurrence of nasal polyps was observed in 12% of patients receiving macrolide therapy compared to 32% in the control group. Conclusions: Three-month low-dose clarithromycin therapy (250 mg/day) is a safe and effective adjunct to ESS, significantly improving clinical, endoscopic, and radiological outcomes while reducing early recurrence of nasal polyps.

Physiological and Biochemical Impacts of Gestational Diabetes on Maternal and Fetal Health: A Systematic Review

Sat, 28 Feb 2026 00:00:00 +0000

Gestational diabetes mellitus is increasingly recognized as more than a transient elevation of blood glucose during pregnancy. Evidence suggests that GDM represents a broader metabolic disturbance involving chronic low-grade inflammation, dyslipidemia, oxidative stress, endothelial dysfunction, and adipokine imbalance. These alterations appear to influence not only maternal metabolic health but also fetal growth and early developmental outcomes. Objectives: To synthesize recent evidence (2017–2024) on physiological and biochemical changes associated with GDM and to examine their implications for maternal and fetal health. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and ScienceDirect in accordance with PRISMA 2020 guidelines. Original human studies comparing GDM and normoglycemic pregnancies were included if they assessed metabolic, inflammatory, oxidative, vascular, or endocrine biomarkers. Study quality was evaluated using the National Institutes of Health quality assessment tools for observational studies and the Cochrane Risk of Bias 2 tool for randomized trials. Due to heterogeneity in study design and outcome measures, findings were synthesized narratively. Results: Thirteen studies met the inclusion criteria. GDM was consistently associated with elevated inflammatory markers (hs-CRP, IL-6, IL-18), increased triglycerides, oxidative stress markers such as malondialdehyde, and reduced adiponectin and antioxidant enzymes. Maternal hypertriglyceridemia independently predicted fetal macrosomia, while elevated umbilical cord C-peptide reflected fetal hyperinsulinemia. Nutritional interventions, including DHA supplementation, showed favorable modulation of selected adipokines. Conclusions: The evidence supports GDM as a systemic metabolic disorder characterized by interconnected disturbances in glucose, lipid, inflammatory, and oxidative pathways, with important maternal and fetal implications.

Oxidative Stress and Lipid Peroxidation Markers in Obesity-Related Polycystic Ovary Syndrome and Menstrual Irregularities: A Systematic Review of Biochemical and Pharmacological Interventions

Sat, 28 Feb 2026 00:00:00 +0000

Obesity in women with Polycystic Ovary Syndrome (PCOS) is strongly associated with oxidative stress and lipid peroxidation. Elevated reactive oxygen species and depleted antioxidant defenses contribute to menstrual dysfunction, insulin resistance, and impaired follicular quality. Objective: This review summarizes clinical evidence (2018–2024) on oxidative-stress and lipid-peroxidation markers in obesity-related PCOS and evaluates the effects of pharmacological and nutraceutical interventions targeting redox balance. Methods: Electronic searches of PubMed, Scopus, and Cochrane databases were conducted following PRISMA 2020 guidelines. Eligible studies included randomized controlled trials, case–control, and cross-sectional designs reporting oxidative or antioxidant biomarkers in human PCOS populations. Non-human studies and review articles were excluded. Extracted data included study design, biomarkers, interventions, and clinical outcomes. Results: Fifteen studies met the inclusion criteria. Observational data consistently showed elevated malondialdehyde (MDA) and reduced total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione (GSH) in women with PCOS, with greater abnormalities in obese participants. Interventional trials demonstrated significant improvements in oxidative profiles following antioxidant supplementation, particularly probiotics, selenium, ellagic acid, oleoylethanolamide, and resveratrol, with partial recovery of menstrual, metabolic, and inflammatory parameters. Conclusions: Oxidative imbalance is a defining feature of obesity-related PCOS and appears to contribute to menstrual and metabolic dysfunction. Antioxidant-based interventions show promising benefits in restoring redox balance, especially among obese women. These findings support oxidative modulation as a relevant therapeutic target in PCOS management.

Peritoneal Reflections and Ligamentous Anatomy of the Abdomen: A Systematic Review with Surgical Correlation

Naz Akhtar, Iqra Javed, Bushra Ghulam, Naila Jabbar, Sumta Khan, Khurram Shabeer — Sat, 28 Feb 2026 00:00:00 +0000

Peritoneal reflections and fibrous abdominal ligaments serve as anatomical scaffolds that guide surgical dissection, facilitate organ mobility, and influence the spread of disease. Recent advances in imaging and minimally invasive surgery have revealed greater anatomical variability than previously recognized, highlighting the need for an updated synthesis. Objectives: To systematically review recent anatomical, imaging-based, and intraoperative studies describing peritoneal reflections and abdominal ligaments, and to evaluate their surgical relevance across major abdominal specialties. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched for human studies published between 2018 and 2024. Original cadaveric, radiologic, and surgical studies were eligible for inclusion. Data screening, extraction, and quality appraisal were independently performed by two reviewers using the Joanna Briggs Institute (JBI) tools. Results: A total of 15 studies met the inclusion criteria. Most studies reported structural variation in pelvic peritoneal pockets, hepatogastric folds, the falciform and round ligaments, and the anterior peritoneal reflection. Imaging-based investigations demonstrated patient-specific variation in peritoneal surface area. Intraoperative studies highlighted the impact of these variations on dissection planes, reconstruction feasibility, surgical exposure, and oncologic decision-making. Conclusions: Anatomical variability of peritoneal reflections and abdominal ligaments significantly influences hepatobiliary, pelvic, hernia, and colorectal surgery. Recognition of these variations improves surgical safety and supports individualized operative planning.

Iron Supplementation in the Prevention and Treatment of Iron Deficiency Anemia in Children Under Five: A Systematic Review

Sat, 28 Feb 2026 00:00:00 +0000

Iron deficiency anemia (IDA) is a public health issue in children under 5 years of age, mostly in low and middle-income countries. Iron supplements are given for preventing or treating iron deficiency. Objectives: To systematically evaluate the effectiveness, safety considerations, and implementation characteristics of iron supplementation strategies used for the prevention and treatment of iron deficiency anemia among children under five years of age. Methods: An electronic literature search was performed in PubMed, Scopus, and Cochrane Library for any studies written in English and published between 2019 and 2024. Primary human research of any type assessing iron supplementation in children aged 0-59 months was encompassed. This excluded systematic reviews, meta-analyses, case reports, and animal studies. The study selection was in accordance with PRISMA 2020. The synthesis of the data was conducted narratively, and the risk of bias was assessed using the RoB-2 and Joanna Briggs Institute tools. Results: A total of 15 studies reported significant improvements in hemoglobin levels and iron status after iron supplementation, using either oral ferrous preparations or iron-containing micronutrient powders. Prevention measures reduced the rate of anemia, and treatment supplementation successfully corrected known IDA. High anemia burden, inconsistent adherence to supplementation, and dietary iron deficit were observed in observational studies. Conclusions: Iron supplementation remains an effective approach for preventing and treating iron deficiency anemia in children. Optimizing program delivery, adherence, and safety monitoring is essential to maximize benefits, particularly in resource-limited settings.