Pakistan Journal of Health Sciences

Smog Exposure and Its Consequences for Human Health in Lahore

Riffat Mehboob — Sun, 30 Nov 2025 00:00:00 +0000

Lahore is a metropolitan city and the capital of Punjab province, which is acclaimed due to historical sites, cultural diversity, and economic involvement. It is under this vibrant city atmosphere that there is a serious environmental and health concern of smog. Smog can be defined as a continuous presence of smoke, dust, and chemical contaminations suspended in humid air, which are very dangerous to human health. Research has reported its influence on respiratory and cardiovascular outcomes in residents, and thus an urgent need to intervene. [1-3]

The smog is a complex of various pollutants, among which are: particulate matter (PM2.5 and PM10), nitrogen oxides (NOx), sulfur dioxide (SO2), ozone (O3), and volatile organic compounds. These are due to motor vehicle emissions, industrial operation, construction, brick kiln, crop burning and burning of solid waste. Lahore has a high traffic density with intersections like Kalma Chowk, Liberty Roundabout, and Thokar Niaz Baig showing the level of vehicular pollution, and the industrial estates significantly add to the ambient pollutant concentrations. The issue is aggravated by winter months when the meteorological conditions promote the accumulation of smog. [4]

The long-term effects of being exposed to smog are health-threatening. Fine particulate matter is very deep-seated and aggravates asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. There is also epidemiological evidence that smog contributes to cardiovascular risks (such as ischemic heart disease and stroke) with systemic inflammation and oxidative stress. The children, the elderly and socioeconomically disadvantaged populations are more affected at the expense of the rest of the population and this is part of greater environmental health disparities. The hospital surveys in Lahore verify that residents regularly cough, wheeze, have eye irritation, and shortness of breath at the time of high pollution, and the effects of this on daily living and well-being can be measured. [5,6]

The smog crisis in Lahore needs a well-coordinated, evidence-based approach. Although the health risks are well documented, the lack of appropriate interventions is due to the ineffective regulation enforcement, industrial lobby, and poor awareness among the population. The main actions that should be taken are the strong air quality monitoring, the tightening of the industrial emission regulations, the propagation of cleaner transportation use, the development of the urban green areas, and the educational campaigns among people to make them more aware and precondition the protective behavior. [2,5]

Smog is a critical health crisis affecting respiratory and cardiovascular well-being. Policymakers, industry, and citizens must take urgent measures to reduce emissions, improve air quality, and protect vulnerable populations. While actions like stricter emission controls, cleaner transportation, and public awareness are essential, extensive urban plantation and afforestation should be central to the strategy. Planting trees along roads, industrial zones, and residential areas can trap pollutants, absorb harmful gases, and enhance air circulation. Prioritizing green belts and urban forests alongside other interventions will help Lahore effectively combat smog, improve ecological resilience, and safeguard the health of its citizens.

Comparison of Intralesional Triamcinolone and Intralesional Verapamil in The Treatment of Keloids

Asma Batool, Aliya Akhtar, Sidra Tahir, Zahra Akhtar, Amra Batool, Shoaib Iqbal — Sun, 30 Nov 2025 00:00:00 +0000

An imbalance between synthesis and degradation of collagen and the extracellular matrix leads to keloid formation. Inadequately treated keloids lead to significant physical and emotional distress. Objectives: To compare the mean reduction of the Vancouver Scar score in patients with keloids after 3 months of treatment with intralesional triamcinolone versus intralesional verapamil. Methods: This parallel‐group, single‐blind randomized controlled trial was performed at the dermatology department, Nishtar Hospital, Multan, from April 2025 to September 2025. Sixty patients aged 10–50 years with keloids (1–5 cm, duration <5 years, baseline Vancouver score ≥5) were enrolled. Exclusion criteria were pregnant and lactating women, positive family history of keloids, conditions of acromegaly, and congestive heart illnesses. Group A (n=30) received intralesional verapamil monthly, and Group B (n=30) received intralesional triamcinolone acetonide (40 mg) monthly until keloid flattening or for three months. Vancouver scores were assessed at 16 weeks (four weeks post-treatment), and data were analyzed using SPSS version 23.0. Mean ± SD was recorded for quantitative and frequencies and percentages for categorical data. An independent sample t-test was used for numerical comparison at 5% significance level. Results: The mean age was 28.6±7.9 years with 58.3% males. The baseline Vancouver score was 8.7 ± 1.7, improving to 4.9 ± 1.5 after treatment. The triamcinolone group had a lower score (4.0 ± 0.7) and greater reduction (4.6±1.2) than the verapamil group (5.9 ± 1.5; reduction 2.9 ± 0.8; p<0.001). Conclusions: Overall, intralesional triamcinolone acetonide is clearly more effective than verapamil in reducing keloid severity.

Anatomical Variation in Sigmoid Sinus and Its Impact on Mastoid Exploration in Atticoantral Chronic Suppurative Otitis Media Surgery: A Prospective Study at Khyber Teaching Hospital, Peshawar

Sun, 30 Nov 2025 00:00:00 +0000

Atticoantral Chronic Suppurative Otitis Media (CSOM) with cholesteatoma frequently causes intraoperative complications. Anatomical variations of the sigmoid sinus (SS) can increase surgical risk. This study correlates CT-identified SS variations with operative challenges and outcomes, addressing the limited literature on their specific impact. Objectives: To evaluate the anatomical variations of the sigmoid sinus on preoperative CT scans and determine their impact on intraoperative challenges and postoperative outcomes during mastoid exploration for atticoantral chronic suppurative otitis media. Methods: This analytical cross-sectional study of 300 patients undergoing radical mastoidectomy at a tertiary care hospital from January to December 2024. Temporal bone CT scans assessed variation in SS position and bony plate integrity. Intraoperative and postoperative complications were recorded. Categorical data were analyzed using chi chi-square test (p<0.05). Results: CT evaluation demonstrated intact bony plates in 77.3% of cases, with 12.3% showing erosion and 11.3% exhibiting exposure; sinus position was posterior in 63%, anterior in 25%, and normotopic in 12%. Intraoperative observations matched CT findings. Anterior displacement was significantly associated with increased surgeon fatigue (p = 0.014), Dural injury (p < 0.001), significant hemorrhage (p=0.032), facial nerve palsy (p=0.006), and incomplete disease clearance (p < 0.001). Eroded or exposed plates also correlated with higher complication rates (p<0.01). No postoperative meningitis occurred. Conclusions: Preoperative CT accurately predicts sigmoid sinus variations in atticoantral CSOM, aiding surgical planning and reducing intraoperative complications.

Diagnostic Accuracy of Ottawa Ankle Rules in Acute Ankle Injuries in Patients Above Five Years of Age

Sun, 30 Nov 2025 00:00:00 +0000

Ankle injuries are a common reason for emergency visits, but only 15% have fractures. The Ottawa Ankle Rules were introduced to reduce unnecessary imaging. Objective: To assess the diagnostic accuracy of Ottawa ankle rules in predicting ankle fractures and identify the main clinical predictors. Methods: This analytical cross-sectional study was conducted in the emergency department of Ghurki Trust and Teaching Hospital, Lahore, from July 2024 and March 2025 on consecutive patients with acute ankle trauma. OAR was used to evaluate patients, followed by radiography. Calculations were done on sensitivity, specificity, PPV, and NPV. Data were analyzed using frequencies and percentages for categorical variables and means with standard deviation for continuous variables. Results: In this cohort of 71 patients (66.2% male; mean age 36.6 ± 15.3 years), falls and road traffic accidents were the primary injury mechanisms. X-rays revealed fractures in 69.0% of the cases. The Ottawa Ankle Rules (OAR) achieved a sensitivity and negative predictive value of 100%, although the specificity was low at 13.6%, leading to 19 false-positive results. Notably, medial malleolus pain (p<0.001) and inability to bear weight (p=0.003) were the strongest predictors of fracture. Conclusion: Our study demonstrated 100% sensitivity and negative predictive value for detecting fractures and no false negatives, but specificity was low at 13.6%, resulting in 19 false positives. Fractures were present in 69.0% of cases and were found mostly to be bimalleolar (25.4%) and tri-malleolar (18.3%). Medial malleolus pain and inability to bear weight had the strongest capability to predict fractures clinically.

Association of Serum Uric Acid with Cardiovascular Diseases in Pakistani Adults: A Cross-Sectional Analysis

Sun, 30 Nov 2025 00:00:00 +0000

Numerous researchers have identified a strong link between increased levels of serum uric acid and cardiovascular disease. Objectives: To find out the association of serum uric acid with cardiovascular disease, independent of major confounding variables including age, sex, hypertension, diabetes, dietary habits, and lifestyle factors. Methods: A descriptive cross-sectional study was carried out at Fazaia Ruth Pfau Medical College. Data collection involved demographic, anthropometric, blood pressure, biochemical measurements, and electrocardiography. SPSS-22 was used for data analysis. Statistical methods included t-tests. one-way ANOVA, Mann-Whitney U test, and Pearson correlation were applied. To find the strength of association, a multivariate regression model was applied, and the odds ratio was calculated. Results: The frequency of hyperuricemia was 27.5%. Previous medical history of hypertension found a strong, significant association among the groups. The Frequency of cardiovascular diseases, including acute coronary disease, myocardial infarction, and cardiac failure, was 47%, 29.1% and 6% in the normouricemia group and 54.9%, 25.5% and 6.9% in the hyperuricemia group, respectively. Multivariate regression analysis revealed that the severity of cardiovascular diseases increased linearly with increasing serum uric acid concentration. Interestingly, the serum uric acid concentration was high in the cases of myocardial infarction in comparison to other cardiovascular diseases. The cardiovascular disease odds ratio was 1.84 to 2.45 times as the serum uric acid concentration rose above 9mg/dL. Conclusions: The Current study identified a significant association of hyperuricemia with cardiovascular diseases. The severity of cardiovascular diseases was observed to rise with increasing serum uric acid levels, and this link remained significant.

Causes Of Acute Abdomen Diagnosed Through Gray-Scale Ultrasonography in Adults at A Tertiary Care Hospital, Lahore

Sun, 30 Nov 2025 00:00:00 +0000

Acute abdomen is a severe and sudden onset of pain over a short span of time, requiring urgent diagnosis and treatment. The prevalence of acute abdomen is found to be 5 percent in emergency department cases and a lower percentage in the OPD cases. Objectives: To diagnose the causes of acute abdomen via gray-scale ultrasonography in adults at a tertiary care hospital. Methods: The Study design was a descriptive cross-sectional. Data was collected through proforma and reports, and collected from the Diagnostic Center CMH Lahore. Data analysis was done through IBM SPSS software version 26.0, and the association between causes and the gender of the patient was calculated via chi chi-square test. Results: Out of 186 patients, 45.7% were male and 54.3% female, with a mean age of 47.44 years. Common symptoms/signs included nausea/vomiting (72.6%), fever (50%), abdominal tenderness (52.7%), and abdominal distension (33.9%). Moderate pain was the most prevalent severity of pain in 41.9% patients. RHC was the most prevalent region of pain (71%). Ultrasound diagnoses included cholelithiasis (20.4%), hydronephrosis (13.4%), acute cholecystitis (12.4%), renal colic (11.8%), and acute pancreatitis (8.1%), respectively. Other diagnoses were liver abscess (2.7%), splenic lesions (1.6%), and an unremarkable study (18.82%). Conclusions: The Current study concludes that there is a significant association between acute cholecystitis and the gender of the patient. It also highlights the significance of ultrasound in diagnosing the causes of acute abdomen, with cholelithiasis, hydronephrosis, renal colic, and acute cholecystitis as the most frequent causes of acute abdomen.

Evaluating Perception of Undergraduate Medical Students About Integrated Modular System

Sun, 30 Nov 2025 00:00:00 +0000

The Integrated Modular System (IMS) is a structured program that begins with basic medical concepts and integrates all medical science components both horizontally and vertically. Objectives: To assess total perception scores, sub-variable scores, and the associations between research and demographic variables. Methods: An analytical cross-sectional study was conducted at Gomal Medical College using a quantitative approach with undergraduate students. Stratified random sampling was applied. The sampling frame comprised official enrollment lists from GMC's registrar. Strata were defined by academic year (Year 1–Final Year) to ensure proportional representation. Within each stratum, students were randomly selected using Google Sheets' RAND function to generate random numbers assigned to roll numbers. The top 40 unique random numbers per year were selected. A self-administered questionnaire, scored on a five-point Likert scale, assessed student perceptions across four sub-variables and three demographic variables. Scores were categorized as poor, fair, or good using Bloom’s criteria. SPSS version 27.0 was used to compute frequencies, percentages, and perform chi-square and Fisher’s exact tests. Results: Out of 200 participants, 72.5% had fair perception, 16.5% good, and 11.5% poor. No significant association was found between gender or residence and total perception score. However, a significant association existed between students’ year of study and their perception score. Conclusions: Students generally had an average yet cautiously positive perception of IMS, especially regarding learning behaviour and future outcomes. Concerns remain about achieving IMS goals and resource availability. DME should enhance evaluation guidelines and time allocation, while administration must improve self-directed learning resources

Relationship of Lower Urinary Tract Symptoms with Post Void Residual Urine and Prostatic Volume

Sun, 30 Nov 2025 00:00:00 +0000

Benign prostatic hyperplasia (BPH) is a frequent occurrence in older male. Objectives: To assess the correlation between International Prostate Symptoms Score (IPSS), prostate volume, and post-void residual volume (PVR). Methods: This was an analytical cross-sectional study conducted in the Urology Department of Sheikh Zayed Hospital, Rahim Yar Khan. Eighty-four men aged 40-70 years with BPH and LUTS for ≥ two months were recruited consecutively. Participants completed the IPSS, and PVR was assessed by abdominal sonography and prostate volume through transrectal ultrasound. A urinary tract infection was labelled by the growth of ≥ 10⁵ CFU/ml of pathogenic microorganisms. Pearson correlation between IPSS and prostate volume and post-void urinary volume was calculated at 5% significance level. Results: Mean age was 57.9 ± 6.9 years, and 63.1% were ≤60 years of age. Mean prostate volume was 68.9 ± 17.0 cm³, and PVR was 191.5 ± 53.3 ml. Mean IPSS was 16.3 ± 6.4, with 67.9% having moderate LUTS. UTI prevalence was 54.8%. IPSS correlated positively and strongly with prostate volume (r = 0.911) and PVR (r = 0.920; p<0.001). UTI was more common in patients >60 years (80.6% vs. 39.6%) and in those with moderate (56.1%) and severe (100%) versus mild (13.3%) LUTS. Conclusions: IPSS showed a positive correlation with prostate volume and PVR, highlighting the utility of combined symptom scoring and ultrasound in managing benign prostatic enlargement.

Local Recurrence Rate after Clear Margins in Wide Local Excision in Soft Tissue Sarcoma 2 Years after Index Surgery

Sun, 30 Nov 2025 00:00:00 +0000

Soft tissue sarcomas include a diverse collection of uncommon, malignant neoplasms originating in mesenchymal tissues. Recent cancer studies indicate that they comprise around 1% of all malignancies globally. Objectives: To evaluate the incidence of local recurrence among patients who achieved clear surgical margins following wide local excision for soft tissue sarcoma. Methods: This cross-sectional retrospective study was conducted at the Orthopedic Department of Shifa International Hospital, Islamabad. Sixty patients participated in this investigation. In this investigation, patients who underwent wide local excision and attained clear surgical margins were enrolled after being diagnosed with histologically confirmed soft tissue sarcoma. Results: The study included 60 sarcoma patients (63.3% males, mean age 46.15 ± 22.74 years). Two-year recurrence occurred in 8 (13.3%) cases, mostly synovial sarcoma. Recurrence showed no significant association with histologic subtype, therapy type, surgical margin, or tumor grade (p>0.05). Conclusions: This study corroborates existing literature on the recurrence patterns of STS, emphasizing the significance of histological subtypes, comorbidities, and surgical margins in influencing patient outcomes. Continued research into the molecular underpinnings of STS and the development of targeted therapies are crucial for improving prognosis and reducing recurrence rates.

Comparison of Letrozole and Clomiphene in Infertile Male Patients with Oligoasthenozoospermia

Sun, 30 Nov 2025 00:00:00 +0000

Infertility often causes significant emotional distress, and in about 50% of cases, male factors such as oligoasthenozoospermia play a key role in the challenges you're facing. Objectives: To compare two medications, clomiphene citrate and letrozole, to see which one works better for improving sperm count and motility in men with oligoasthenozoospermia. Methods: This non-randomized controlled study was conducted at DHQ Teaching Hospital in D.I. Khan with 140 men diagnosed with oligoasthenozoospermia. Participants were divided into two groups of 70, receiving either letrozole or clomiphene citrate. Sperm concentration and motility were measured at three months, with improvements compared between the two groups. Statistical analysis was performed using SPSS version 21, with p-values <0.05 considered significant. Results: Both letrozole and clomiphene significantly improved sperm concentration and motility, with letrozole showing greater improvement in both parameters compared to clomiphene citrate. An increase of 48.23% in sperm concentration was observed in the letrozole group, while the clomiphene citrate group showed a 26.26% increase at 12 weeks post-treatment. Sperm motility improved by 42.08% with letrozole and by 18.55% with clomiphene citrate at the 12-week mark. Conclusions: Both letrozole and clomiphene citrate have been shown to improve sperm parameters in men diagnosed with oligoasthenozoospermia. The letrozole group showed a more significant effect than the clomiphene group.

Comparison of Incision Given with Electrocautery Versus Stainless Steel Scalpel for Neck Dissection in Oral Cancer Patients

Sun, 30 Nov 2025 00:00:00 +0000

Both scalpels and electrocautery are frequently used for incisions during surgery, and each has an impact on postoperative scarring, bleeding, and operating efficiency. Objective examination of neck scars is clinically significant since visible scars may affect quality of life. Objectives: To evaluate the differences between scalpel and electrocautery incisions in neck dissection about of scar quality, surgical time, and blood loss as determined by the Manchester Scar Scale (MSS). Methods: In a prospective comparative cross-sectional study, a total of 76 patients who were having neck dissections at Sharif Medical and Dental College were included and divided into two equal groups (n=38 for scalpels and another 38 for electrocautery). The Mann-Whitney U test was used to examine intraoperative blood loss and surgical duration. Thirty days after surgery, the MSS was used to evaluate the scar's colour, gloss, contour, and distortion. The results were compared using the Chi-square test. Results: Both surgical time (33 vs. 42 minutes, p<0.001) and blood loss (123 mL vs. 240 mL, p<0.001) were dramatically decreased by electrocautery. There were no significant differences in scar colour (p=0.341), contour (p=0.359), or distortion (p=0.364) between the groups; however, glossy scars were more common with electrocautery (34.2% vs. 15.8%, p=0.022). Conclusions: Except for a higher frequency of shiny scars, electrocautery gives comparable scar results to knife incisions, but with a shorter operating time and less blood loss. When choosing a technique, aesthetic considerations are still crucial.

Comparison of Fetomaternal Outcome between Early Planned Labor Induction and Expectant Management in Late Preterm Pre-Labor Rupture of Membrane (PPROM)

Sadaf Irshad, Musarrat Ahad, Mehreen Faizan — Sun, 30 Nov 2025 00:00:00 +0000

Late preterm pre-labor rupture of membranes (PPROM) remains a clinical dilemma, with conflicting evidence regarding early induction versus expectant management. Objectives: To compare maternal and neonatal outcomes between early planned labor induction and expectant management in women with late preterm PPROM. Methods: This prospective comparative observational cohort study was conducted at the Department of Obstetrics and Gynecology, Kharadar General Hospital. A total of 134 women with late preterm PPROM (34+0 to 36+6 weeks) were enrolled and managed with either early planned induction (Group A, n=67) or expectant management (Group B, n=67). Outcomes were analyzed using Chi-square and Mann–Whitney U tests, and multivariate logistic regression was applied to adjust for maternal risk factors, including BMI, diabetes, and hypertension. Results: Maternal infection [40.3% vs. 23.9%, p=0.042], cesarean delivery [55.2% vs. 37.3%, p=0.038], neonatal infection [53.7% vs. 35.8%, p=0.037], and neonatal intervention [41.8% vs. 23.9%, p=0.027] were significantly higher in the induction group. Multivariate analysis showed hypertension as a strong predictor of maternal infection (aOR 11.45, 95% CI: 1.5–85.6, p=0.018) and neonatal intervention (aOR 3.22, 95% CI: 2.1–17.1, p=0.017), while obesity and diabetes significantly predicted cesarean delivery and neonatal infection. Conclusions: Early induction in late preterm PPROM was associated with increased maternal and neonatal complications, particularly among women with comorbidities. Expectant management with close surveillance may be safer in stable patients, especially in populations with high rates of hypertension, diabetes, and obesity.

Prevalence and Risk Factors of Vitamin D Deficiency in Children Aged 0–5 Years: A Cross-Sectional Study in Khairpur District, Sindh

Sun, 30 Nov 2025 00:00:00 +0000

Vitamin D insufficiency is a major public health concern among young children, leading to skeletal deformities and impaired immune function. Limited sunlight exposure, poor diet, and low socioeconomic status contribute significantly to its burden in developing regions. Objectives: To determine the prevalence, risk factors, clinical manifestations, and health outcomes of vitamin D deficiency in children aged 0–5 years in Sindh, and to develop evidence-based strategies for its prevention and management. Methods: This cross-sectional analytical study was conducted at Khairpur Medical College, Khairpur Mir’s, Sindh, over six months (September 2024–February 2025). A total of 500 children were assessed for serum vitamin D levels and categorized as deficient (<20 ng/mL), insufficient (20–30 ng/mL), or sufficient (>30 ng/mL). Data on sunlight exposure, dietary intake, and socioeconomic factors were collected. Clinical manifestations, including growth retardation, dental issues, muscle weakness, and respiratory problems, were documented. Statistical analysis employed chi-square and logistic regression tests. Results: Vitamin D deficiency was observed in 50% of participants, while 29% had insufficiency. Key predictors included inadequate sunlight exposure (<30 minutes/day), poor dietary intake (OR=5.6, p<0.001), and low socioeconomic status (OR=4.3, p=0.002). Rickets (32.7%), recurrent respiratory infections (30.9%), delayed tooth eruption (29.1%), and muscle weakness (27.3%) were common findings. Conclusions: Vitamin D deficiency is highly prevalent among children in Sindh, with significant clinical and health implications. Public health initiatives promoting vitamin D supplementation, nutrition education, and sunlight exposure are urgently needed.

Postpartum Contraception: A Neglected Field to Avoid Unplanned Pregnancy and Short Inter-Pregnancy Intervals

Sun, 30 Nov 2025 00:00:00 +0000

Postpartum contraception plays a crucial role in preventing unintended pregnancies and optimizing birth spacing. However, its utilization remains suboptimal in many low- and middle-income settings. Objectives: To determine the prevalence, method mix, and factors associated with postpartum contraceptive use among women attending KMU-IMS, Kohat. Methods: A cross-sectional study was conducted among 103 postpartum women attending the Department of Obstetrics and Gynecology, Khyber Medical University Institute of Medical Sciences and Liaqat Memorial Hospital, Kohat. Data were collected using a structured questionnaire and analyzed using SPSS version 25.0. Descriptive statistics summarized demographic and clinical characteristics, while Chi-square and Fisher’s exact tests examined bivariate associations. Variables with p<0.2 were included in multivariable logistic regression to identify independent predictors. Results: The prevalence of postpartum contraceptive use was 47.6%. The most commonly used methods were the lactational amenorrhea method (28.6%), condoms (22.4%), and oral contraceptive pills (14.3%). Most women (38.8%) initiated contraception within six weeks postpartum. No significant associations were found between contraceptive use and socio-demographic or obstetric variables. Women with vaginal deliveries reported higher use (57.9%) than those with caesarean (35.0%) or assisted deliveries (33.3%) (Fisher’s p=0.071). After adjusting for confounders, none of the factors remained statistically significant; caesarean delivery showed higher but non-significant odds (aOR = 2.69, 95% CI 1.03–7.00, p=0.043). Conclusion: Postpartum contraceptive use among women attending KMU-IMS, Kohat, was moderate, with a preference for temporary methods. Utilization appeared independent of most socio-demographic and obstetric factors, underscoring the need to strengthen postnatal counseling and address individual and cultural barriers to improve uptake.

Reduction in Early Neonatal Mortality by Implementing Kangaroo Mother Care in a Tertiary Care Hospital of Karachi, Sindh

Sun, 30 Nov 2025 00:00:00 +0000

Sub-optimal weight, as a result of prematurity or restricted growth affects 15% newborns globally, and eventually contributes in up to 70% of neonatal deaths. In November 2015, the World Health Organization (WHO) officially recommended Kangaroo Mother Care (KMC) for newborns with a birth weight of less than 2 kg. Objectives: To evaluate the impact of Kangaroo Mother Care (KMC) on early neonatal death rate among preterm and low-birth-weight infants. Methods: This descriptive cross-sectional analysis was carried out over the period of six months, from July 2021 to January 2022. All the patients visiting Tertiary Care Hospital of Karachi, Sindh, who met the inclusion criteria were enrolled in this study. Informed consent was taken after explaining the procedures, potential risks, and anticipated benefits of the study. The three key elements of Kangaroo Mother Care were explained which included direct skin contact, breastmilk feeding exclusively, and expedited hospital discharge, with a demonstration of the proper technique for keeping infants on the mother’s chest, and using a sheet for wrapping around the baby and the mother. For research purposes, all data were recorded in a proforma and used electronically. Results: Mean ± SD of age of mother was 26.99±4.3 years. In the distribution of the gender of the baby, 121 (57.6%) were male, while 89 (42.4%) were female. Kangaroo-mother care in reducing early neonatal fatalities was noted as effective in 60 (28.6%) participants. Conclusions: In conclusion, Kangaroo Mother Care was successful in lowering early neonatal fatalities.

The Functional Outcomes of Flexible Intramedullary Nails in the Management of Femoral Diaphyseal Fracture in Children

Rehman Ali, Muhammad Ali, Waheed Altaf, Fahad Saleem, Shahid Ali, Irfan Ullah — Sun, 30 Nov 2025 00:00:00 +0000

About 20-25 children per 100,000 experience femoral shaft fractures annually. Intervention varied by age, type of fracture, and resources. Flexible intramedullary nailing (FIN) is a popular minimally invasive treatment of choice, allowing early mobility with the least complications. Objectives: To evaluate the clinical effectiveness of using FIN for pediatric diaphyseal femur bone fracture treatment. Methods: This cross-sectional study was conducted at Ghurki Trust Teaching Hospital, Lahore, from February 2021 to August 2021, including 145 pediatric patients aged 5-12 years with closed femoral diaphyseal fractures treated with flexible intramedullary nailing (FIN). Patients with multiple fractures or metabolic bone diseases were excluded. Clinical assessments were carried out at the 3rd, 6th, 9th, and 12th postoperative weeks. Functional outcomes were examined using Flynn’s criteria, and data were analyzed via SPSS version 22. Results: Out of the total 145 patients, 101 (69.4%) were male, while 44(30.6%) were female. The mean age of the children was 8.32 ± 2.23 years. The time between injury and surgery was 4.27 ± 3.80 days in this study According to Flynn's criteria, 133 (91.9%) of the patients had excellent outcomes (95% CI: 86.8% to 95.7%), while 12 (8.1%) had satisfactory outcomes at 12 weeks No statistically significant associations were found between functional outcomes and demographic variables such as gender (p=1.000), age group (p=0.360), weight group (p=0.323), or fracture duration (p=0.280). Conclusions: FIN is a safe and effective treatment for pediatric femoral shaft fractures, which can help patients gain early functional recovery and reduce the risk of complications. It should be applied where necessary in clinical practice.

Comparison of Brain Drain Perception Between Medical and Non-Medical Undergraduate Students in Lahore

Sun, 30 Nov 2025 00:00:00 +0000

Brain drain is a serious issue for developing countries like Pakistan. Economic, political, and social determinants influence undergraduate students’ intention to migrate. Objectives: To evaluate the perceptions and trends that would determine the intention of brain drain among medical and non-medical undergraduate students in Lahore. Methods: A stratified sampling strategy selected 300 participants from both medical and non-medical programmes. This cross-sectional study was carried out through a properly structured questionnaire from October 2024 to March 2025. Data were entered and analyzed using SPSS V-26; the Chi-square test and Cramer’s V were applied for group comparisons. Results: A total of 300 undergraduates participated (47% male, 53% female; mean age 20.0 ± 1.4 years), with most in first (48.0%) or second year (29.7%). In general, 83.3% expressed willingness to migrate for foreign employment, while 90.3% cited poor working conditions and 76.7% long working hours as push forces. Employment safety abroad was perceived as better by 91.7% of respondents. Two significant discipline-based associations were observed: political instability was more frequently reported by non-medical students than medical students (16.7% vs. 5.3%, p=0.003, Cramer’s V = 0.17), and lifestyle/safety concerns were also more common among non-medical students (31.3% vs. 20.7%, p=0.03, Cramer’s V = 0.13). Conclusions: Brain drain intentions among medical and non-medical undergraduates are substantial overall, driven by workplace environment, as well as socio-economic factors. These systemic problems have to be resolved to ensure that skilled youth are retained.

A Comparative Analysis of Hypocalcemia Incidence in Patients Undergoing Thyroidectomy: LigaSure Versus Conventional Ligation of Vessels by Knot Tying

Sun, 30 Nov 2025 00:00:00 +0000

Hypocalcemia is a frequent postoperative complication after total thyroidectomy. It usually arises from unintentional injury to the parathyroid glands or disruption of their blood supply during surgery. Advanced vessel sealing technologies like LigaSure aim to lower this risk by ensuring greater surgical precision and reducing thermal injury to adjacent structures, particularly the parathyroid glands. Objectives: To compare the incidence of postoperative hypocalcemia between LigaSure and conventional knot-tying techniques in total thyroidectomy patients. Methods: A randomized controlled trial was conducted at the Surgical Department of Gulab Devi Hospital, Lahore, from April 2024 to March 2025. Seventy-six patients who underwent total thyroidectomy for benign thyroid disease were randomly allocated to the LigaSure (n=38) and conventional knot-tying (n=38) groups. Serum calcium levels were measured preoperatively and at 24/48 hours postoperatively. For statistical analysis, SPSS v24 was used, and non-parametric tests like the Mann-Whitney U and chi-square tests were used. Results: Incidence of hypocalcemia was higher in the LigaSure group (10.5%) as compared to the conventional group (7.9%), but of no statistical significance (p=0.692). Conclusions: Both techniques demonstrated comparable safety profiles with no statistically significant differences in postoperative outcomes. LigaSure offers a comparable alternative to conventional methods of vessel sealing/ligation.

Frequency of Raised Bedside Index for Severity in Acute Pancreatitis (BISAP) and Ranson Score in Patients of Acute Pancreatitis

Sun, 30 Nov 2025 00:00:00 +0000

Acute pancreatitis is a growing abdominal disorder that presents a major surgical problem to general surgeons across the globe. Objectives: To identify the raised Bedside Index for Severity in Acute Pancreatitis (BISAP) and Ranson scores frequencies in patients with acute pancreatitis. Methods: The cross-sectional descriptive study was carried out on 120 patients in the Emergency Department of the Sheikh Zayed Hospital in Lahore. Patients who fit into the inclusion criteria were enrolled. Clinical histories, physical examinations, and laboratory investigations were conducted in detail. Each patient had their BISAP and Ranson scores calculated- BISAP on initial presentation and Ranson scores at admission and 48 hours. There were high levels of BISAP and Ranson scores that were stipulated based on the operational standards. The data analysis was done in SPSS version 23.0. Results: The average age of the participants was 44.92 ± 8.92 years; 46 (38.3%) were male and 74 (61.7%) female. It was seen that a high BISAP and Ranson scores occurred in 28 (23.3%) and 42 (35%) patients, respectively. The percentage of patients who had an increased BISAP was 23.3, and the percentage of patients who had an increased Ranson score was 35, which means that a higher percentage were classified as severe by the Ranson classification criteria. Conclusions: The BISAP score is a convenient, valid, and time-saving instrument to evaluate the severity of acute pancreatitis at an early stage and risk classification in clinical practice, although the Ranson might be more effective in this regard.

Current Status of Knowledge, Skill, and Attitude of Recent Medical Graduates Regarding Medicolegal Work in Lahore City

Sun, 30 Nov 2025 00:00:00 +0000

Medicolegal responsibilities, including autopsy performance, injury documentation, and courtroom testimony, are essential components of clinical practice. In Pakistan, recent medical graduates often lack adequate preparation in these areas, raising concerns about their readiness for legal and ethical duties. Objectives: To assess the knowledge, skills, and attitudes of recent medical graduates in Lahore regarding medicolegal responsibilities, and to identify gaps to inform curriculum reform. Methods: This cross-sectional descriptive study was conducted from 1 January to 31 March 2025 in Lahore General Hospital, Lahore. A total of 394 medical graduates (within two years of graduation and having completed house jobs) were selected through stratified random sampling. A validated, self-administered questionnaire assessed knowledge, skills (self-reported), and attitudes (Likert-scale items). Data were analyzed using SPSS version 26.0 at a 95% confidence level. Results: Only 28% of participants demonstrated adequate knowledge (≥70% score), with better performance in informed consent (71.1%) and death certification (62.9%), and poor understanding of sexual-assault protocols (20.6%) and injury documentation (17.5%). Just 15.2% felt confident performing medicolegal tasks, and only 12.2% had observed an autopsy. While 78% agreed that medicolegal competence is essential, only 26% felt adequately trained during medical school. Notably, 71% expressed interest in further training. Graduates from public institutions had slightly better knowledge and exposure. Conclusions: Recent medical graduates in Lahore exhibit significant gaps in medicolegal knowledge and practical readiness. Structured medicolegal education and practical exposure must be integrated into undergraduate curricula to ensure competent and legally accountable practice.

Frequency of Different Fracture Patterns of Acrylic Partial Denture in the Patients Visiting Sardar Begum Dental College

Sun, 30 Nov 2025 00:00:00 +0000

Fracture of acrylic removable partial dentures (RPDs) is a major cause of prosthesis failure, often requiring repair or replacement. Objective: To determine the distribution of fracture patterns in acrylic RPDs and assess associations with demographic and clinical factors in patients at Sardar Begum Dental College. Methods: In this cross-sectional study (Sept 2023–Mar 2024), 96 patients with fractured acrylic partial dentures were enrolled consecutively. Fracture types (midline, clasp, connector, crack line, multiple) and variables including age, gender, reinforcement, parafunctional habits, and ridge resorption were recorded. Data were analyzed using chi-square tests and Cramer’s V, with p<0.05 considered significant. Results: Midline fractures were most frequent (57.3%), followed by clasp fractures (28.1%), multiple-site (12.5%), connector (1.0%), and crack line only (1.0%). Parafunctional habits were significantly associated with fracture pattern (p=0.042, Cramer’s V = 0.321). Reinforcement showed borderline significance (p=0.060). Other factors showed no significant relationship. Conclusions: Midline fractures predominate in acrylic RPDs. Parafunction is a significant modifiable risk factor, and reinforcement may offer a protective benefit. Screening for parafunctional habits and implementing prudent reinforcement strategies could reduce fracture incidence.

Antibacterial Efficacy of Cinnamon Essential Oil Compared to Standard Antibiotics on Diabetic Foot Ulcer Isolates at Tertiary Care Units Karachi, Pakistan

Sun, 30 Nov 2025 00:00:00 +0000

Lower limb complications associated with Type Ⅱ Diabetes have become a serious public health issue in today's world. Diabetic patients with ulcers commonly experience infection due to Gram-positive, Gram-negative bacteria, as well as some anaerobes. Objectives: To investigate the antibacterial activity of Cinnamon essential oil on microbial isolates from diabetic foot ulcer. Methods: An experimental investigation was carried out on diabetic patients suffering from foot ulcers. A total of 115 pus swab samples from diabetic foot ulcer patients were acquired, who were recruited and processed at Baqai Institute of Diabetology and Endocrinology. Antibiotic sensitivity testing was performed by the Kirby agar Disc diffusion method. Antibacterial activity of cinnamon essential oil was checked by the Kirby agar well diffusion method. Results: Out of 115 samples, 138 bacteria were isolated. 80% of samples were mono-microbial and 20% were poly-microbial. Pseudomonas Aeruginosa was the most frequently encountered bacterium, followed by E. Coli, S. Aureus, Klebsiella Pneumonae, Proteus Mirabilis, Enterococcus species, Coagulase-negative Staphylococcus Species, and Proteus Vulgaris. All the isolated bacteria showed different resistance patterns against commercially available antibiotics. Cinnamon essential oil showed antibacterial activity against all isolated bacteria. Conclusions: The study demonstrated a high bacterial isolation rate from diabetic foot ulcer. Antibiotic resistance varied among bacterial isolates, highlighting the challenge of treating bacterial infections. Cinnamon essential oil exhibited strong antibacterial activity against all isolated bacteria, suggesting its potency of being used as an alternative antimicrobial agent.

Anatomical Variations of Renal Arteries and Their Clinical Implications in Urological and Transplant Surgeries: A Systematic Review

Sun, 30 Nov 2025 00:00:00 +0000

Anatomical variations of the renal arteries are frequent and can complicate urological and transplant procedures. However, contemporary evidence on their prevalence and clinical implications remains fragmented. Objectives: To systematically review studies published between 2019 and 2025 that report renal artery variants and evaluate their surgical impact in urology and transplantation. Methods: This review was conducted following PRISMA 2020 guidelines. A systematic search of PubMed, Scopus, and Cochrane identified original human studies reporting quantitative data on accessory arteries, early branching, or unusual origins. Fifteen eligible studies were included in the final synthesis. Risk of bias was assessed using the Joanna Briggs Institute checklist for imaging studies and the Newcastle–Ottawa Scale for surgical cohorts. Risk of bias across imaging and surgical studies was rated low to moderate based on JBI and NOS appraisal. Results: The prevalence of accessory renal arteries and early branching varied widely, ranging from 10% to over 30% across populations. A recent donor CTA study reported accessory arteries in 25.6% and early branching in 17%, while a contemporary Omani series found more than 30% of kidneys with multiple arteries. In transplant cohorts, grafts with multiple renal arteries achieved outcomes comparable to those with single arteries when appropriate reconstruction was performed. Microsurgical and vascular techniques have enabled the successful management of complex arterial anatomy without compromising graft function. Conclusions: Renal artery variations are common and clinically important. Preoperative CT angiography remains the gold standard for differentiating true multiple arteries from early branches, ensuring safe surgical planning.

Understanding the Goals of Service Learning and Community-Based Medical Education: A Systematic Review

Sun, 30 Nov 2025 00:00:00 +0000

Service learning (SL) and community-based medical education (CBME) are increasingly integrated into undergraduate medical training to prepare students for socially accountable practice. While many programs report benefits for students and communities, the specific goals emphasized across contexts remain inconsistently defined.

Objectives: To provide a comprehensive understanding of how SL and CBME contribute not only to student learning but also to community engagement and institutional development. Methods: Following the PRISMA 2020 guidelines, PubMed, Scopus, and the Cochrane Library were searched for English-language studies published between 2019 and 2024. Eligible studies included those involving undergraduate medical students participating in SL or CBME interventions. Data on study design, participants, interventions, and reported outcomes were extracted. Quality appraisal was conducted using the CASP, MMAT, and JBI tools. A thematic synthesis approach was used to categorize findings into educational, community, and institutional domains. Results: Sixteen studies were included, spanning Africa, Asia, North America, and the Middle East. Most studies reported educational outcomes such as improved clinical competence, empathy, reflective capacity, and professional identity formation. Community-level goals included increased access to care, health promotion, and stronger partnerships. Institutional goals, such as enhancing curricular relevance and social accountability, were less frequently documented. Few studies evaluated long-term sustainability or objectively measured community outcomes. Conclusions: SL and CBME consistently promote student growth while fostering community engagement. However, systematic evaluation of institutional impact and program sustainability remains limited. Future research should adopt longitudinal, multi-institutional approaches to capture durable outcomes and guide curricular reforms aligned with social accountability.

Association of Oxidative Stress Biomarkers with Polycystic Ovary Syndrome (PCOS) and Its Metabolic Outcomes, Including Insulin Resistance and Dyslipidemia: A Systematic Review

Sun, 30 Nov 2025 00:00:00 +0000

Polycystic ovary syndrome (PCOS) is a common endocrine metabolic disorder characterized by hyperandrogenism, ovulatory dysfunction, and insulin resistance. Increasing evidence suggests that oxidative stress (OS) contributes to its metabolic and reproductive complications. Objectives: To systematically review primary studies evaluating oxidative stress biomarkers in PCOS and their associations with metabolic outcomes. Methods: A comprehensive search was conducted in PubMed, Scopus, and Cochrane Library up to April 2024, following PRISMA 2020 guidelines. Eligible studies included case–control and cross-sectional designs reporting quantitative OS biomarker data in PCOS versus controls. Quality and risk of bias were assessed using the Newcastle Ottawa Scale (NOS). Results: Fifteen studies (2014–2024) involving over 1,000 participants were included. Malondialdehyde (MDA) was elevated in nearly all studies, indicating enhanced lipid peroxidation. Total antioxidant capacity (TAC/FRAP) and enzymatic antioxidants (SOD, CAT) were consistently reduced, while non-enzymatic antioxidants (GSH, vitamins A/C/E) were also lower. PON1 activity and sRAGE levels decreased, and 8-isoprostane in follicular fluid correlated with poorer oocyte quality. OS markers were positively associated with BMI, insulin resistance, and dyslipidemia. Five studies were rated low risk and ten moderate risk by NOS criteria. Conclusions: PCOS is characterized by increased oxidative stress and reduced antioxidant defense, closely linked to metabolic severity. Incorporating OS biomarkers into clinical evaluation and exploring phenotype-specific antioxidant interventions may improve metabolic and reproductive outcomes. Future longitudinal studies should standardize biomarker measurement to strengthen clinical applicability.