Pakistan Journal of Health Sciences

Twincretins and the Gut Microbiome: The Missing Link

Sami Ullah Mumtaz — Fri, 31 Jul 2026 00:00:00 +0000

The novel treatment for type-II diabetes mellitus (T2DM), obesity, and associated metabolic dysfunctions is based on the insulinotropic actions of the two gut incretin hormones, glucagon-like peptide-1 (GLP-1) and the gastric inhibitory polypeptide (GIP), together known as twincretins. GLP-1 is primarily secreted by the small intestine and colon. While GIP is secreted from the duodenum and proximal jejunum. Both are secreted in response to a meal [1].

The human microbiome is composed of healthy bacteria, viruses, and microbes that boost metabolism and immunity and protect against pathogenic organisms. These also break down dietary fibers into metabolites that directly stimulate the endogenous release of incretins, which further regulate appetite and blood sugar [2].

Few studies demonstrate that twincretins promote a healthier microbial ecosystem. This results in an abundance of healthy gut bacteria like Bifidobacterium, Akkermansia muciniphila, and Bacteroides. This regulates appetite and blood sugar [3]. However, it is unclear how the gut microbiome may regulate insulin resistance, glucose control, and metabolic health. This is such an interesting and very beneficial link in many ways. Twincretins strengthen the gut lining, decreasing its permeability, which results in less penetration of harmful bacterial endotoxins into the body and hence lowers inflammation [4]. Twincretins also enhance gut microbiota and affect the adipokine pathway, altering fat metabolism [5]. Twincretins also alter bile acid metabolism, which helps reduce liver lipid deposition, thus helpful in managing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) [6].

This bidirectional relationship between the gut microbiome and twincretins is far more beneficial in patients with obesity, diabetes, and metabolic dysfunctions. While twincretins suppress inflammation and alter bacterial diversity, gut microbes are responsible for drug metabolism and the release of endocrine hormones [1-3].

Recent limited studies correlate poor metabolism with a decrease in bacteria. The most missing healthy bacteria include Akkermansia muciniphila, Faecalibacterium prausnitzii, Bacteroides, and Bifidobacterium [1-5].

The dynamic triangular relationship among twincretins, microbial composition, and metabolism is the basis for future therapies on obesity, associated metabolic dysfunction, and diabetes. In the future, routine microbiome profiling could predict a patient's response to incretin drugs, allowing clinicians to tailor treatments using targeted prebiotics or probiotics. Your baseline microbial composition dictates how effectively your body responds to twincretins. The people with healthy bacteria will have improved insulin sensitivity as well as GLP-1 secretion. Individuals with fewer healthy bacteria may show "GLP-1 resistance". This severely affects weight-loss and glucose-lowering potential [1, 2].

The future of weight loss therapies lies in the emerging field of pharmacomicrobiomics. A personalized treatment approach will work for every patient rather than one approach for all patients, like microbiome profile, which should be checked in every patient to predict the exact response to twincretins. Secondly, twincretins should be combined with precise prebiotics or probiotics to potentiate the gut's healthy microbiome in advance. This will surely increase twincretin's effect and hence personalized metabolic dysfunction, diabetes, and weight management [1-5].

Pulley-Augmented EIP to EPL Transfer: A Novel Solution to Prevent Ulnar Subluxation at MCPJ

Fri, 31 Jul 2026 00:00:00 +0000

In zone 3 injuries, the Extensor indicis Pollicis to Extensor Pollicis Longus tendon transfer comes with the problem of ulnar subluxation at the metacarpophalangeal joint (MCPJ), which results in ineffective extension of the thumb, which, in the long term, results in boutonniere deformity. Objectives: To observe the effects of stabilizing this transferred tendon at the MCPJ by adding a tendinous pulley and achieving significant improvement in extension of the thumb. Methods: A Total of 12 patients were in this study with delayed presentation (i.e., 6 to 12 weeks after trauma) of zone 3 EPL injuries, over a period of 2 years. Among these patients, 8 were males, and 4 were females. Surgery was performed under local anesthesia in 10 patients and general anesthesia in 2 patients. The EIP tendon was transferred to the transected EPL with a tendinous pulley reconstructed at the MCPJ. Postoperatively, a splint was applied for 4 weeks. Physiotherapy started on the first post-op day. Mean follow-up time was 5 months. Results: As per the Geldmacher score, an excellent score was achieved in 7 (58.3%) patients, a good score in 3 (25%), and a satisfactory score in 1 (8.3%) patient, a poor score in 1 (8.3%) patient. No extension lag was observed in the index finger in any case. Conclusions: This traditional transfer done in zone 3 gives excellent results when done with the addition of a pulley at MCPJ, improving the vector of excursion of the transferred tendon by stabilization at MCPJ and inhibiting its ulnar subluxation.

Comparison of Prolene Sutures Versus Skin Staples for Mesh Fixation in Lichtenstein Inguinal Hernioplasty: A Randomized Controlled Trial

Fri, 31 Jul 2026 00:00:00 +0000

Chronic postoperative groin pain following Lichtenstein inguinal hernia repair is commonly attributed to nerve irritation during mesh fixation. Alternative fixation methods, such as skin staples, have been proposed to reduce postoperative pain. Objectives: To compare postoperative pain outcomes following mesh fixation with Prolene sutures versus skin staples in Lichtenstein inguinal hernioplasty. Methods: This randomized controlled trial was conducted at Mayo Hospital, Lahore. 132 adult male patients undergoing elective unilateral Lichtenstein inguinal hernioplasty were randomized to mesh fixation using either Prolene sutures or stainless-steel skin staples. Postoperative pain was assessed using the Visual Analogue Scale (VAS) on postoperative days 1, 14, 30, and 90. Statistical analysis included the Mann–Whitney U test, chi-square test, and logistic regression. Results: Baseline characteristics were comparable between groups. Median VAS on day 1 was higher in the Prolene group compared to the staple group, but pain scores declined significantly in both groups over time. By day 90, 37.9% of patients were pain-free, with no significant difference in pain-free rates between fixation methods (p=0.858). No independent predictors of persistent pain were identified. Conclusions: Mesh fixation with Prolene sutures and skin staples results in comparable postoperative pain outcomes. Fixation choice may therefore be guided by surgeon preference and operative considerations.

Patient Reported Symptoms and Quality of Life during Radiotherapy: Cross-Sectional Analytical Study in a Tertiary Care Setting

Asima Luqman, Maria Hassan, Wajahat Hussain — Fri, 31 Jul 2026 00:00:00 +0000

Radiotherapy is integral to cancer care, yet its impact on patient-reported symptoms and health-related quality of life (HRQoL) remains understudied. Objectives: To assess the severity of patient-reported symptoms and HRQoL during active radiotherapy and examine associations between specific symptoms and QoL domains among adult cancer patients. Methods: This cross-sectional analytical study was conducted from July 2024 to June 2025 at Bahawal Victoria Hospital, Bahawalpur. A total of 85 adult patients undergoing external beam radiotherapy (without concurrent chemotherapy) completed validated PRO instruments, the EORTC QLQ-C30 and site-specific modules (e.g., QLQ-H&N35, QLQ-CR29), and the PRO-CTCAE at mid-treatment. Data were analyzed using SPSS Version 23.0; Spearman correlation and multiple linear regression identified symptom QoL relationships. Results: Mean global QoL score was 58.4 ± 18.3. Fatigue (64.7 ± 24.1), pain (57.3 ± 26.8), and insomnia (52.9 ± 28.4) were the most severe symptoms. PRO-CTCAE revealed 71.8% reported moderate to severe fatigue. Fatigue (r = –0.52), pain (r = –0.48), and appetite loss (r = –0.41) strongly correlated with lower QoL (all p<0.001). Regression confirmed fatigue (β = –0.31), pain (β = –0.24), and palliative intent (β = –8.9) as independent predictors of reduced global QoL (adjusted R² = 0.486). Conclusions: Fatigue, pain, and treatment intent significantly impair QoL during radiotherapy. Routine PRO integration and context-adapted supportive care are urgently needed to preserve patient well-being in resource-limited oncology services.

Comparative Analysis of Outcomes: Intra-Oral and Transbuccal Approach Using Trocar for Fixation of Mandibular Fractures

Fri, 31 Jul 2026 00:00:00 +0000

Mandibular fractures are frequent maxillofacial injuries. Open reduction and internal fixation may be intraoral or transbuccal, with each having varying access, visualization, and aesthetic effects. Objectives: To compare intraoral and transbuccal methods of fixation of mandibular fractures. Methods: It was a prospective interventional study among 70 patients with unilateral displaced fracture of the mandible, who were divided into intraoral (n=35) and transbuccal (n=35) groups. All cases were subjected to standard intraoral access. The fixation was done intraorally & using a transbuccal trocar. They were assessed in relation to surgical time, ease of accessibility (VAS 13), post-operative occlusion, and radiographic fracture reduction (adequate 3 mm gap or below). The continuous variables were evaluated using the Mann-Whitney U test, and the chi-square test was applied to the categorical variables with a level of significance at p<0.050. Results: Fracture reduction (82.9 vs. 80.0; p=0.759) and post-operative occlusion (both 88.6; p<0.001) did not reveal any significant difference. The transbuccal group had better access to surgery. The intraoral method was shorter in terms of the time of operations (median 45 vs. 70 minutes; p<0.001). Conclusions: The transbuccal method enhances the accessibility of the surgery, and the intraoral method is faster. The choice of approach must take into account the position of fractures and the experience of the surgeon.

Role of Vitamin D in Prevention of Preeclampsia Recurrence in Pregnant Women with Previous History of Preeclampsia: A Randomized Controlled Trial

Tehseen Aslam, Saima Abdul Jabbar, Mehnaz Khakwani, Fatima Arshad, Amna Razzaq — Fri, 31 Jul 2026 00:00:00 +0000

Vitamin D deficiency may contribute to abnormal placentation and endothelial dysfunction leading to preeclampsia (PE). Objectives: To compare the recurrence of preeclampsia in pregnant females having a previous history of PE receiving vitamin D supplementation versus placebo. Methods: This double-blind randomized controlled trial was done at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, over six months from August 2025 to February 2026. A total of 146 pregnant ladies, 20-45 years old, with singleton pregnancy, gestational age ≥20 weeks, and previous preeclampsia were enrolled. Women with chronic hypertension, cardiac diseases, renal disease, and thyrotoxicosis were excluded. Participants were randomized to receive either oral vitamin D 4000 IU daily or a placebo. Follow-up continued until 36 weeks. Preeclampsia recurrence was defined as hypertension ≥140/90 mmHg with proteinuria ≥+1 on spot urine test. Data were analyzed through SPSS version 27.0, descriptive statistics were run, group comparisons were done through chi-square and independent sample t-test as required, and a p-value<0.050 was considered significant. Results: Mean age was 27.9 ± 4.6 years, and mean gestational age was 30.5 ± 2.8 weeks. Age and gestational age differed between the groups. Overall recurrence of preeclampsia was 21.9%. Recurrence was markedly less in the vitamin D compared to placebo (13.7% vs. 30.1%, relative risks 0.46, p=0.016) groups. Significant reductions were observed among women aged <30 years, gestational age 24-30 weeks, and non-obese participants. Conclusions: Vitamin D therapy decreased recurrence of preeclampsia in high-risk pregnant females, supporting its potential role as an effective preventive strategy in antenatal care.

Relationship of Serum Ferritin Levels with Haemoglobin Percentage and Its Impact on Fetomaternal Outcome of the Pregnancy

Fri, 31 Jul 2026 00:00:00 +0000

Iron stores in the body exist primarily in the form of ferritin. Low serum ferritin levels, even in females with ideal haemoglobin levels, can lead to poor fetal-maternal outcome. Objective: To determine the frequency of low serum ferritin in non-anaemic pregnant females and its Fetomaternal outcomes. Methods: This Comparative analytical study was carried out in the Department of Gynaecology and Obstetrics, Fauji Foundation Hospital, Rawalpindi. Patients were enrolled from the Fauji Foundation Hospital, Rawalpindi. Detailed history was taken, and pregnant females with normal haemoglobin were selected; their serum ferritin was followed. Patients with low serum ferritin levels were observed for maternal and fetal outcomes. Data were entered and analysed by SPSS version 25.0. RESULTS: The mean age of cases was 29.95 ± 3.57 years, with minimum and maximum ages of 25 and 35 years. Low serum ferritin levels were found in 248 (46.44%) cases, while in 286 (53.56%) cases serum ferritin levels were normal. 16 (21.72%) neonates were born preterm, 285 (53.37%) females had C-section, 41 (7.68%) had PPH, 96 (17.98%) neonates had low birth weight, and 94 (17.60%) neonates needed an ICU admission. Significant association of this outcome with low serum levels was found, p-value<0.001. Conclusions: The females with Hb levels ≥ 11g/dl should be screened for their serum ferritin levels, as females with low serum ferritin levels were associated with poor maternal outcome, like C-section, NICU admission, PPH, and poor fetal outcome, like preterm birth and low birth weight.

Etiology, Treatment, and Early Postoperative Outcomes of Neonatal Hydrocephalus

Fri, 31 Jul 2026 00:00:00 +0000

Neonatal hydrocephalus is a neurological condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) in the ventricular system of the brain, leading to increased intracranial pressure. Objective: To determine the etiology and early postoperative outcomes in neonatal hydrocephalus. Methods: This prospective observational study was conducted at the Pediatric Neurosurgery Department of the Children's Hospital and the Institute of Child Health, Multan, Pakistan, from September 2023 to March 2025. A total of 120 newborns aged 0-28 days, who were diagnosed with hydrocephalus on clinical and radiological grounds and subsequently underwent surgical intervention, were analyzed. Postoperative complications and their association with demographic and clinical characteristics were assessed up to 30 days. Data were analyzed using IBM-SPSS Statistics, version 26.0. P<0.05 was taken as significant. Results: Among 120 neonates, the mean age at presentation was 14.28 ± 7.53 days, gestational age 36.61 ± 1.93 weeks, and birth weight 2508.89 ± 375.78 grams. Preterm birth and low birth weight were seen in 64.2% and 52.5% neonates, respectively. Common etiologies included congenital (30.0%) and intraventricular hemorrhage (28.3%). Early postoperative complications occurred in 15.8%, with significantly longer hospital stays (9.21 ± 3.44 vs. 6.54 ± 1.78 days, p<0.001). Prematurity (p=0.022), low birth weight (p=0.044), maternal infection (p=0.009), congenital anomalies (p=0.033), intraventricular hemorrhage (p=0.045), and post-infectious hydrocephalus (p=0.033) were significantly associated with complications. Conclusions: In neonates with hydrocephalus undergoing surgical management, intraventricular hemorrhage, post-infectious etiologies, prematurity, low birth weight, and abnormal antenatal history were significantly associated with early postoperative complications.

Comparison of Induction of Labour with Sublingual Versus Vaginal Misoprostol 25 UG in a Primigravida with Post-Date Pregnancy

Fri, 31 Jul 2026 00:00:00 +0000

In obstetrics, the induction of labour has been widely used in clinical practice for a decade. Misoprostol is effective for the induction of labour. It can be administered either sublingually or via the vaginal route. Objective: To compare the induction of labour with sublingual versus vaginal Misoprostol 25 ug in primigravida with postdate pregnancy. Methods: Our Study Prospective Comparative Study with consecutive sampling, conducted at the department of Gynecology, and Obstetrics at Saidu Group of Teaching Hospitals Swat, from March 2025 to September 2025 (6 months duration). Results: 160 participants were analyzed, with 80 in Group A (sublingual) and 80 in Group B per-vaginal route). Vaginal delivery within 24 hours occurred in 84.4% of the sublingual group and 80.8% of the vaginal group (p=0.612), while the mean induction-to-delivery time was significantly shorter in the sublingual group (9.1 ± 2.9 hrs vs. 10.4 ± 3.2 hrs; p=0.04). Maternal side effects and neonatal outcomes, including Apgar scores and birth weights, were comparable between the two groups. Conclusions: Both sublingual and vaginal misoprostol (25 µg) were effective for labour induction in post-date primigravida. The sublingual route demonstrated a significantly shorter induction-to-delivery interval with comparable safety outcomes, offering a practical alternative for routine clinical use.

Patient Preferences and Concerns Regarding Stoma Formation Versus Sphincter-Sparing Surgery in Rectal Cancer

Farrukh Ozair Shah, Hussain Jan Abbasi, Tilal Ahmad Raza, Hajra Imtiaz — Fri, 31 Jul 2026 00:00:00 +0000

The outcome of the decision between stoma construction and sphincter-sparing procedures is critical to the quality of life of the patients after a rectal cancer operation. In a socio-culturally diverse society like Pakistan, clinical outcomes are significant to the surgeon to reach a decision, but the views of the patients are significant as well. Objectives: To assess the preferences and concerns of rectal cancer patients regarding permanent stoma formation versus sphincter-preserving surgery in Khyber Pakhtunkhwa (KPK), Pakistan. Methods: This analytical cross-sectional study was carried out in the Department of General Surgery, Hayatabad Medical Complex, Peshawar, between January 2022 and December 2024. A total of 250 patients with rectal cancer were enrolled. The final analysis included 220 patients after excluding those who had undergone previous surgery (n=12), cognitive impairment (n=8), recurrent rectal cancer (n=6), and those who refused participation (n=4). Results: Among 220 respondents, 63.6% preferred sphincter-sparing surgery and 36.4% preferred abdominoperineal resection (APR). Female gender (p<0.069), rural residence (p=0.024), and a high concern level (p<0.001) were significant predictors of preference for APR, while knowledge of stoma was associated with lower odds of APR preference (p<0.012). Higher education (p=0.165) and age (p=0.271) were not statistically significant. Conclusions: Psychosocial, informational, and demographic factors all affect patient preferences for rectal cancer surgery. Patients with greater preoperative concerns, female gender, and those who lived in rural areas were all linked to a stoma favor. However, prior experience with stoma care was protective of this choice.

Effect of Hemodialysis on Serum Phosphate Levels in Patients with End-Stage Renal Disease: A Quasi-Experimental Study at Sir Ganga Ram Hospital, Lahore

Iqra Farooq, Shahid Anwar — Fri, 31 Jul 2026 00:00:00 +0000

Hyperphosphatemia is a common complication in patients with end-stage renal disease (ESRD). Hemodialysis remains the primary mode of phosphate elimination; however, the impact of demographic and clinical factors on individual patients' clearance is still being studied. Objective: To determine the mean change in serum phosphate levels before and after a single session of hemodialysis in patients with ESRD. Methods: This quasi-experimental study included 115 adult patients undergoing maintenance hemodialysis three times a week at the Department of Nephrology, Sir Ganga Ram Hospital, Lahore, between February and July 2025, and were recruited. Serum phosphate concentration was measured at the beginning and end of the dialysis session. The statistical analysis was performed using SPSS version 26.0, with significance set at p<0.050. Results: Among the 115 patients (mean age, 46.5 years), a statistically significant decrease in mean serum phosphate levels from 5.44 ± 1.71 mmol/L to 2.53 ± 0.98 mmol/L was observed as a result of hemodialysis. Multivariate regression supported the view that the model explained 77.3% of the variance in phosphate reduction (R² = 0.773, p<0.001), with pre-dialysis levels being the only significant independent predictor (β = -0.892, p<0.001). There was no statistically significant influence of age, gender, or BMI on the magnitude of reduction (p>0.050). Conclusions: A single maintenance hemodialysis session significantly reduced serum phosphate levels in patients with ESRD. Although reductions were observed across all demographic variables, the magnitude of reduction did not differ significantly between these groups.

Impact of Surgical Duration on Morbidity after Monopolar Transurethral Resection of the Prostate: A Prospective Analysis

Babar Zaman, Faisal Haneef, Shuah Ullah, Asad Shehzad, Adib Ul Hassan Rizvi — Fri, 31 Jul 2026 00:00:00 +0000

Benign prostatic hyperplasia (BPH) is associated with high morbidity and poses serious health problems in elderly males. The most effective surgical treatment for BPH that effectively relieves lower urinary tract symptoms is transurethral resection of the prostate (TURP). Still, TURP is not without complications, which can impact patient issues. Objective: To contribute to the existing knowledge on TURP complications with respect to resection time duration. Methods: From January 2021 to June 2022, this prospective cross-sectional study included 639 individuals with benign prostatic hyperplasia (BPH) and a prostate volume of 30 – 80 milliliters who underwent monopolar transurethral resection of the prostate (M-TURP) at Sindh Institute of Urology and Transplantation between the periods of 50 and 80. Complications were noted throughout a one- month follow-up period, and cases were grouped according to the length of surgery. The purpose of the study was to assess the results and benefits of M- TURP in BPH cases. Results: In 639 cases undergoing monopolar TURP, postoperative complications were observed in 11.6 % of cases, with a significant association between complications and surgical duration (p=0.006). Sepsis was more common in longer procedures (p=0.025), followed by Incontinence (6%), hematuria (4.6%), and urinary tract infections (1.5%). Conclusions: M-TURP is a dependable and effective treatment for enlarged prostate, with careful case selection and optimized surgical duration being pivotal to minimizing complications.

Pattern and Distribution of Symphysis and Parasymphysis Fracture among Patients of Road Traffic Accident at Tertiary Care Hospital Karachi

Fri, 31 Jul 2026 00:00:00 +0000

Maxillofacial trauma resulting from road traffic accidents (RTAs) constitutes a significant public health burden, particularly in developing countries. Objectives: To establish the trend and location of symphysis and parasymphysis mandibular injuries and their relationship with the road traffic accident mechanism. Methods: This cross-sectional research was done at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, during a period of six months after receiving ethical approval. Non-probability consecutive sampling was used to include 122 patients aged 18-60 years who sustained a mandibular fracture as a result of RTA either at the symphysis or parasymphysis. The structured Performa was utilized in data collection, and SPSS version 23.0 in data analysis. Descriptive statistics were used, and a chi-square test was used to identify the association, and a p-value less than 0.05 was taken to be significant. Results: The average age of patients was 34.6 +9.8 years with the male preponderance (79.5%). The majority were related to motorcycles (69.7% and 78.7% of the cases, respectively), and most of the victims did not take any preventive measures (69.7%). The most commonly associated was the parasymphysis region (53.3%), which was then followed by symphysis (32.0%), and most fractures were unilateral (68.0%) and displaced (55.7%). A statistically significant relationship between mechanism of injury and fracture site (p=0.032) and fracture pattern (p=0.041) existed. Conclusion: Symphysis and parasymphysis mandibular fractures are mostly caused by motorcycle road traffic accidents, especially in young males.

Impact of Speech Sound Disorders on the Academic Performance of Children

Hira Munawar, Tahira Yousaf, Muhammad Farhan, Ghulam Saqulain — Fri, 31 Jul 2026 00:00:00 +0000

Speech sound disorders (SSD) have a high prevalence and impact an individual’s capability to make and produce speech sounds, essential for humans to communicate. Children's participation in the educational environment may be restricted in children with SSD. Objectives: To determine the impact of Speech Sound Disorders on the Academic Performance of children. Methods: This Cross-Sectional study was conducted at Riphah International University, Islamabad, from 1st June 2024 to 30th November 2024. The study recruited a sample of n=67 children of both genders, aged 5 to 11 years, diagnosed with SSD by qualified Speech-Language pathologists (SLPs), who used standardized and clinical evaluation processes to make the diagnosis. Children of The Spirit School, The Thinking School, and ASAS International School were recruited. Their academic performance was assessed utilizing the APRS, and previous academic grades of students were also noted. The Academic Performance Rating Scale was used for data collection. SPSS version 23.0 was used for data collection. Results: Students with mild SSD demonstrated performance in higher grade ranges (51-70%), indicating negligible academic influence. Conversely, individuals with moderate SSD predominantly scored in the mid-range (41-50%), but students with severe SSD were primarily situated in the lowest grade range (30-40%). Conclusions: The conclusion shows a direct and significant correlation between children's academic achievement and the severity of speech sound disorder. Academic achievement tends to decrease with increasing SSD severity, as seen by instructors' observations in the classroom and lower annual grades.

Comparison of the Effect of Insulin with Metformin on Neonatal Outcome in Booked Patients with Gestational Diabetes Mellitus

Fri, 31 Jul 2026 00:00:00 +0000

Insulin has long been used as a treatment for gestational diabetes that is not well managed with diet. Metformin has been shown in several trials conducted in recent years to produce perinatal and obstetric results that are comparable to those of insulin. Studies have reported conflicting results regarding both modalities, and not all clinical recommendations support its usage. Objective: To compare neonatal outcomes in patients with metformin-treated gestational diabetes mellitus versus those with insulin-treated gestational diabetes mellitus. Methods: An observational study took place at the Obstetrics and Gynaecology Unit-III of Lady Willingdon Hospital, Lahore, during the time period starting from January 1, 2023, until December 1, 2023. One hundred and eighty-eight patients (94 in each group) were included in the study. In Group A, metformin tablets were given, and patients in Group B were given insulin. Outcome variables were measured as per the operational definition, respectively. Results: Patients receiving insulin therapy developed macrosomia more frequently (10.6% in the Metformin group vs. 23.4% in the Insulin group, p=0.029), along with hypoglycaemia (19.2% for Metformin vs. 33% for Insulin, p=0.031) and respiratory distress (9.6% Metformin vs. 20.2% Insulin, p=0.041) statistically often. Research showed no meaningful differences in findings between study groups regarding jaundice occurrence, together with intrauterine growth restriction (IUGR) and amniotic fluid measurements. Conclusions: In comparison to insulin, metformin is equally effective in preventing neonatal complications such as macrosomia, hypoglycaemia, and respiratory distress in women with gestational diabetes.

Knowledge, Attitude, and Practice of Healthcare Professionals of Pakistan Regarding Consumption of Carbonated Drinks

Fri, 31 Jul 2026 00:00:00 +0000

Carbonated drinks contain acidic ingredients and high amounts of sugar. Such constituents lead to adverse oral and systemic manifestations, such as caries, dental erosion & hypersensitivity, diarrhea, GERD, respiratory, and bone disorders. Objectives: To determine the awareness, attitude, and practice of healthcare workers regarding carbonated drinks and to gauge their attitude and consumption habits regarding these drinks. Methods: A cross-sectional study was carried out across Pakistan, over eight months from January 2022 to August 2022. There was adequate representation from all provinces, and 1930 MBBS, BDS, and Allied Health Science workers filled out a pre-tested questionnaire. These professionals had different designations in government and private setups. A non-probability convenience sampling was done. Frequency and percentages depicted the data. One-way ANOVA was performed to compare composite knowledge and attitude scores, while Chi-square tests with Cramer’s V were used for practice variables. Results: 97.5% of the healthcare workers knew about carbonated drinks, but only 85.1% were aware of their composition, whereas 93.1% knew about their side effects. 34.4% consumed carbonated drinks with meals. 87.2% believed that carbonated drinks have harmed teeth, and 60.2% experienced changes in the oral environment. Conclusions: Despite an abundance of knowledge regarding the composition and harmful effects of carbonated beverages, their consumption was high among the targeted population.

The Stone Kidney Size (SKS) Score Breakthrough: A Simple Yet Powerful Tool to Predict Success and Safety Outcomes in Pediatric Mini Percutaneous Nephrolithotomy (PCNL)

Fri, 31 Jul 2026 00:00:00 +0000

Mini percutaneous nephrolithotomy (PCNL) is now considered one of the important treatment modalities for large renal stones or stones that are refractory to other treatments. Objective: To evaluate the predictive accuracy of the Stone Kidney Size (SKS) score for the prediction of the success rate of mini PCNL in the pediatric population. Methods: A prospective cross-sectional validation study was conducted at Tabba Kidney Hospital for a period of 7 months (from June 2025 to December 2025). A total of 124 children aged 1–14 years with unilateral renal stones were included. SKS score was calculated preoperatively using Ultrasound KUB based on the number of stones and Stone Kidney Index (SKI). Statistical analysis included chi-square test, logistic regression, and ROC curve analysis. Results: The mean age of the participants was 6.05 ± 3.32 years, and 67.7% male predominance was observed. Overall, the stone clearance rate was 81.4%. A total of 19% patients experienced postoperative complications, with a higher proportion in patients with a SKS score of ≥ 6 (P=0.034). The SKS score was found to be an independent predictor of incomplete stone clearance (p<0.001) with good predictive accuracy on ROC analysis. Conclusions: The SKS score is a simple, non-invasive, and reproducible tool that could be evaluated preoperatively with the use of Ultrasound KUB. It has good predictive ability for stone clearance and postoperative complications.

Frequency and Precipitating Factors of Hyperglycemic and Hypoglycemic Emergencies in Diabetic Patients Presenting at Tertiary Care Hospital, Islamabad

Fri, 31 Jul 2026 00:00:00 +0000

Diabetes mellitus (DM) is a highly widespread chronic metabolic condition and one of the major challenges to the health care system because of its acute and chronic complications. Objective: To determine the frequency and precipitating factors of hyperglycemic and hypoglycemic emergencies among diabetic patients presenting to a tertiary care hospital in Islamabad. Methods: A cross-sectional study at the Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, between 5^th April 2025 and 5^th October, 2025. The enrolled sample size was 150 diabetic patients with altered consciousness (GCS ≤13) between the ages of 30 and 80 years using non-probability consecutive sampling. A structured pre-tested proforma was used to gather socio-demographic and clinical information such as type and duration of diabetes, modality of treatment, comorbidity, and past glycemic emergency. The Chi-square test, t-test, and the Mann–Whitney U test was applied, and a p-value of less than 0.005 was considered statistically significant. Results: Hyperglycemic emergencies were found to be 64.0%, and hypoglycemic emergencies were found to be 36.0%. The predictors of hyperglycemia that had significant values were missed insulin/medication (AOR = 4.21, p<0.001), infection (AOR = 3.67, p=0.001), and poor dietary adherence (AOR = 1.92, p=0.045). Hypoglycemia was independently predicted by excess levels of insulin/OHA (AOR = 5.62, p<0.001). Conclusion: Hyper and hypoglycemic crises are frequently observed in diabetic patients, and they are mostly caused by modifiable factors, including missed medications, infections, noncompliance with diets, overdosing, and missed meals. By focusing on these particular factors, it is possible to minimize morbidity and enhance the outcome.

Microbial Profiles and Antibiotic Resistance Patterns in Neonatal Sepsis: A Frequency Analysis

Fri, 31 Jul 2026 00:00:00 +0000

Neonatal sepsis remains an important cause of neonatal morbidity, mortality, and prolonged hospitalization, and the spectrum of causative organisms and their antibiotic susceptibility varies across settings. Updated local microbiological data are therefore essential for appropriate empirical therapy and antimicrobial stewardship. Objective: To determine the frequency of different microorganisms and their antibiotic susceptibility pattern in neonatal sepsis. Methods: This descriptive cross-sectional study was conducted in the Pediatric Ward of Bahawal Victoria Hospital, Bahawalpur, from 09-02-2024 to 08-08-2024. A total of 119 term neonates with clinical features of sepsis were included. Blood cultures were processed by standard microbiological methods, and antibiotic susceptibility was assessed against commonly used antibiotics. Data were analyzed using SPSS version 25.0. Post-stratification Chi-square test was applied, and p≤0.05 was considered statistically significant. Results: Escherichia coli was the most frequent isolate, identified in 41 (34.45%) cases, followed by Staphylococcus aureus in 24 (20.17%) and Klebsiella species in 19 (15.97%). Overall, gram-negative organisms predominated. Amikacin showed the highest sensitivity, 111 (93.28%), followed by gentamicin, 107 (89.92%), whereas relatively lower sensitivity was observed for ceftazidime, 85 (71.43%), cefotaxime, 86 (72.27%), and tobramycin, 91 (76.47%). Stratification by age and gender showed no statistically significant differences in microorganism distribution or antibiotic susceptibility (all p>0.05). Conclusions: Escherichia coli was the leading pathogen in neonatal sepsis in this cohort. The comparatively higher sensitivity to amikacin and gentamicin, together with lower sensitivity to some cephalosporins and tobramycin, supports the need for hospital-specific empirical antibiotic policies, regular antibiogram updates, and antimicrobial stewardship.

Bacteriology of Lower Respiratory Tract Samples with Antibiotic Susceptibility Patterns at a Tertiary Care Hospital in Karachi

Anoosha Jameel, Sana Jamil, Yousra Pervaiz, Muneeba Musharraf, Muhammad Ali — Fri, 31 Jul 2026 00:00:00 +0000

Lower respiratory tract infections are widespread in Pakistan. Determining sensitivity is crucial to combat increasing antimicrobial resistance. Objectives: To ascertain the prevalence of bacterial pathogens isolated in lower respiratory tract samples and the antimicrobial susceptibility patterns of these pathogens in one of the tertiary care hospitals in Karachi. Methods: This study was a prospective observational study that took place for six months. Three hundred and thirty-five positive respiratory samples of patients with clinical LRTIs were collected. Identification of the bacteria was conducted by the standard microbiological procedures, and the determination of antimicrobial resistance was conducted by the Kirby-Bauer disk diffusion test according to the guidelines of CLSI 2025. SPSS version 26.0 was used to analyze data. The chi-square test was applied, and a p-value <0.050 was deemed significant. Results: The study examined 335 culture-positive patient isolates, revealing Gram-negative rods (GNR) as the predominant pathogens (n=275), mainly Klebsiella spp., Acinetobacter spp., and Pseudomonas aeruginosa. Gram-positive cocci (GPC) (n=38) included Staphylococcus aureus and Streptococcus pneumoniae, while Nocardia was identified among gram-positive rods (n=22). Organism type significantly influenced resistance patterns (p<0.001), but specimen type did not (p=0.401). Conclusions: The most common LRTI pathogens were Klebsiella spp., Acinetobacter spp., and Pseudomonas aeruginosa that exhibited a wide spectrum of multidrug resistance. Stringent antibiotic stewardship plays a crucial role in preventing further increases in resistance.

Risk Factors for the Onset of Aspiration Pneumonia in Stroke Patients

Fri, 31 Jul 2026 00:00:00 +0000

The third causes disability and is the second most common cause of death in the world. It is an interruption in the flow of blood to the brain and denies the brain tissues oxygen and other vital nutrients, thus causing ischemic damage. Objective: To determine the risk factors associated with the onset of aspiration pneumonia in stroke patients. Methods: A cross-sectional study was carried out from December 2, 2023, to May 1, 2024, at the Department of Medicine, Khyber Teaching Hospital. Participants included 149 patients aged ≥18 years who had been diagnosed with aspiration pneumonia complicating a stroke. The following risk variables for aspiration pneumonia were investigated: diabetes, smoking, age over 65, stroke type, Glasgow Coma Scale (GCS) <8, and nasogastric (NG) feeding. Data analysis was done with SPSS version 25.0. Results: The patients' average age was 61.77 ± 9.58 years. The most frequent risk factor seen in 101 individuals (71.8%) was the kind of ischemic stroke, which was followed by the lack of NG feeding in 95 patients (63.8%). The least prevalent factor was diabetes mellitus (n=66, 44.3%). Conclusions: Aspiration pneumonia is a dreadful complication in stroke patients. It is more frequent in patients with advanced age, with a GCS less than 8, and without NG feeding.

Frequency and Association of Distal Interphalangeal Joint Enthesitis with Nail Psoriasis in Patients with Psoriasis and Psoriatic Arthritis Presenting at a Tertiary Care Hospital in Karachi

. Ekta, Humaira Talat, Pushp Mala, Faryal Naimat, Areeba Rais — Fri, 31 Jul 2026 00:00:00 +0000

Psoriasis is an autoimmune inflammatory disease that has a chronic disease or chronic illness nature, and that is commonly presented in the form of psoriatic arthritis. Objectives: To estimate the frequency and association of dip joint enthesitis with nail psoriasis in patients with psoriasis and psoriatic arthritis presenting at a tertiary care hospital in Karachi. Methods: This cross-sectional analytical study was conducted in the Department of Dermatology and Rheumatology, Civil Hospital Karachi, six months following the ethical consent. The enrolment was done through non-probability consecutive sampling among 96 patients aged 18-65 years old with or without psoriatic arthritis, having psoriasis. This data was analyzed in SPSS version 27.0, and the correlation between nail psoriasis and DIP joint enthesitis was discovered with the assistance of chi-square or Fisher's exact test, and a p-value under 0.005 was considered to be statistically significant. Results: Nail psoriasis was found in 64.6% of the patients, and ultrasound-verified DIP joint enthesitis was observed in 37.5% of the 96 patients in this cohort. A statistically significant association was found between nail psoriasis and DIP enthesitis confirmed with ultrasound (p=0.003). Moreover, the multivariate logistic regression analysis showed that nail psoriasis was independently related to DIP joint enthesitis following the adjustment of age, sex, psoriasis duration, and occurrence of psoriatic arthritis (adjusted OR 3.52; 95% CI 1.289.67; p=0.014). Conclusion: Nail psoriasis has a strong correlation with distal interphalangeal joint enthesitis in patients with psoriasis and psoriatic arthritis.

Frequency of Hyponatremic Dehydration in Children (6-59 Months) Presenting with Acute Gastroenteritis in a Tertiary Care Facility

Fri, 31 Jul 2026 00:00:00 +0000

Acute gastroenteritis (AGE) is one of the primary morbid and mortal causes among children under five years old, especially in low- and middle-income countries (LMICs). Objective: To determine the frequency of hyponatremic dehydration in children aged 6 to 59 months with acute gastroenteritis. Methods: The cross-sectional design was employed in the Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad. Non-probability consecutive sampling of children aged 6-59 months of both genders with acute gastroenteritis over six months, from 1^st August 2025 to 31^st January, 2026, was used to enroll the children. The exclusion criteria were chronic diarrhea, previous administration of intravenous fluids, septic shock, severe malnutrition, chronic illness (CKD, CHD, RTA, CAH), or use of diuretic/steroids. SPSS version 25.0 was used to analyze data. The relationship between hyponatremia and clinical/sociodemographic variables was evaluated using a chi-square test, with p ≤ 0.005 considered significant. Results: Among the 113 children who participated in the study, hyponatremic dehydration was identified in 14.2% (95% CI: 8.1%-21.8%). The prevalence of hyponatremia was more common in children with severe dehydration, underweight nutritional condition, frequent stool frequency, incomplete rotavirus vaccination, and low socioeconomic status (p<0.005). Conclusions: Hyponatremic dehydration is a significant, yet not very widespread, complication in children with acute gastroenteritis. Morbidity needs to be reduced through preventive steps, such as rotavirus vaccination and education of caregivers.

Linking Clinical Presentation with Coronary Anatomy: A Study of Angina Severity and Its Relationship with Angiographic Findings in Coronary Artery Disease

Haseeb Ullah, Muhammad Asif Iqbal, Shahzeb Khan, Nida Khan, Sana Ullah — Fri, 31 Jul 2026 00:00:00 +0000

No intensive studies have been conducted locally or even in broader regions of the country, which results in a crucial knowledge gap in the establishment of the relationship between the severity of angina and the angiographic findings in patients with coronary artery disease (CAD). Objectives: To determine the correlation of angina severity with angiographic findings in patients diagnosed with coronary artery disease. Methods: This cross-sectional study was carried out at the Department of Cardiology, Lady Reading Hospital, Peshawar. Male and female patients of age 30 to 70 years diagnosed with coronary artery disease were evaluated for angina severity in comparison to angiographic findings. Results: Among 304 patients, angina severity demonstrated a strong positive correlation with angiographic findings (ρ = 0.875, p<0.001). Diabetic patients with severe angina had a higher proportion of high angiographic burden (36.8%) compared to non-diabetics (10.2%), while patients with family history of CAD showed a strong correlation (ρ = 0.886) and relatively weak correlation with Type C complex lesions (ρ = 0.706). Conclusions: A strong positive correlation was observed between angina severity and angiographic CAD burden, though this relationship was modified by diabetes, family history, and lesion complexity.

Efficacy Of Spinal Anesthesia Versus General Anesthesia for Single-Level Microdiscectomy at POF Hospital, Wah Cantt

Haris Ali, Mehboob Alam, Sohail Ahmad — Fri, 31 Jul 2026 00:00:00 +0000

Existing studies show varying results regarding the outcomes of single-level lumbar microdiscectomy under spinal anesthesia and general anesthesia, leaving uncertainty about their relative benefits. Objective: To compare the outcomes of spinal anesthesia versus general anesthesia in single-level microdiscectomy. Methods: This quasi-experimental study was conducted at the Department of Neurosurgery, POF Hospital, Wah Cantt. A total of 60 male and female patients with lumbar disc herniation with single-level microdiscectomy under spinal and general anesthesia were compared for outcomes in terms of surgery time, post-anesthesia care unit time, intraoperative blood loss, dural tear, post-operative pain, and hospital stay. Results: The mean age of the participants was 49.65 ± 7.43 years, and participants aged more than 45 years were 37 (61.7%), while the majority of the patients were female, n=32 (53.3%). The mean operative time with spinal anesthesia was 71.0 ± 4.30 minutes versus 88.00 ± 4.21 minutes with GA (p<0.001). Mean PACU time spent by patients with spinal and general anesthesia was 1.50±0.63 days and 2.03 ± 0.85 days, respectively (p=0.008). Mean hospital stay of patients with spinal was 2.57 ± 0.63 days versus 3.67 ± 0.80 days with general anesthesia (p<0.001). Dural tears were observed in patients (3.3%) with spinal versus 02 patients (6.6%) with general anesthesia (p=0.643). Conclusions: Spinal anesthesia was associated with better perioperative outcomes than general anesthesia in patients who underwent lumbar microdiscectomy when assessed in terms of operative time, PACU time, and hospital stay.

Diagnostic Accuracy of Elevated Neutrophil: Lymphocyte Ratio (NLR) and Platelet: Lymphocyte Ratio (PLR) for the Prediction of 28-Day Mortality in Patients Presenting with Acute Exacerbation of COPD at Tertiary Care Hospital, Karachi

Fri, 31 Jul 2026 00:00:00 +0000

Chronic obstructive pulmonary disease (COPD) patients experiencing sudden flare-ups and immediate risk of death, and basic inflammatory indicators may assist in early risk assessment. Objectives: To assess the diagnostic performance of elevated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting 28-day mortality among patients presenting with acute exacerbations of chronic obstructive pulmonary disease. Methods: The study was a prospective observational cohort study conducted at the Ojha Institute of Chest Diseases, Karachi (June 2025 to November 2025), following ethical approval. 88 AECOPD patients aged 20-70 years were recruited through consecutive sampling. Complete blood counts were used to calculate baseline NLR and PLR, which had predetermined cutoffs (>6.74 and >203.6). Mortality within 28 days was tracked among patients. Data analysis was done using SPSS version 25.0. Sensitivity, specificity, and ROC curves, along with multivariate logistic regression with confounder adjustments, were used to assess prognostic performance. Results: Among 88 AECOPD patients, the mean age was 61.16 ± 9.89 years, and 26 (29.5%) died within 28 days. Elevated NLR (84.1%) and PLR (78.4%) were common. The sensitivity of NLR was higher (80.77%), whereas its specificity (14.52%) and prognostic value (AUC 0.58) were lower, and the performance of PLR was poorer (AUC 0.52). Subgroup analysis indicated a better performance among older patients. In general, both biomarkers showed less than optimal prognostic value for 28-day mortality, with NLR being slightly better than PLR. Conclusions: While increased NLR and PLR were typical findings in acute COPD exacerbations, they showed poor diagnostic utility for forecasting 28-day mortality.

Diagnostic Accuracy of the Oxygen Desaturation Index for Screening Severe Obstructive Sleep Apnea

Fri, 31 Jul 2026 00:00:00 +0000

Obstructive sleep apnea (OSA) is a common disorder with significant cardiovascular and metabolic effects. Although polysomnography-derived Aponea-Hypopnea Index (AHI) is the diagnostic gold standard, limited access has increased interest in simpler alternatives like Oxygen Desaturation Index (ODI). Objective: To determine the diagnostic accuracy of the ODI in identifying severe OSA compared with the AHI. Methods: This cross-sectional study was conducted at the Pulmonology department, Pak Emirates Military Hospital, from 01-03-2025 to 30-11-2025, including 126 patients with a STOP-BANG score>5. Overnight monitoring was performed for 4–8 hours using polysomnography with integrated pulse oximetry. ODI was calculated as a ≥3% drop in oxygen saturation lasting at least 10 seconds. All participants underwent polysomnography for AHI assessment. SPSS version 27.0 was used for analysis. Pearson correlation, linear weighted kappa measure, and ROC curve analysis were performed. Results: The patients’ mean age was 54.6 ± 11.9 years, and BMI was 34.1 ± 5.5 kg/m², predominantly male. Many patients had severe OSA. AHI and ODI showed a strong positive correlation with significant predictive value, and substantial agreement was observed between their severity classifications (κ=0.676, p<0.001). ROC analysis showed good diagnostic performance of ODI for identifying severe OSA (AUC=0.961, 95% CI: 0.932–0.990, p<0.001), with a sensitivity (94.3%) and specificity (79.5%) at an ODI cutoff ≥35. Conclusion: ODI shows a strong association with AHI and good accuracy for detecting severe OSA. It may be used as a non-invasive screening tool in resource-limited settings, but it cannot replace polysomnography.

Intermittent Bolus via Surgeon-Placed Adductor Canal Catheter for Postoperative Analgesia in Total Knee Arthroplasty: An Observational Longitudinal Study

Fri, 31 Jul 2026 00:00:00 +0000

Effective postoperative pain control after total knee arthroplasty (TKA) is essential for early mobilization and better outcomes. The adductor canal block (ACB) provides effective, motor-sparing analgesia. Objectives: To evaluate the efficacy of surgeon-placed ACB in reducing postoperative pain and analgesic requirements in patients undergoing TKA. Methods: This observational longitudinal study was conducted in the hospital's Orthopedic Department from 14^th February 2026 to 13^th May 2026. A total of 38 patients were enrolled through consecutive sampling and underwent standard TKA under spinal anesthesia, with ACB placement by an experienced surgeon. Pain was assessed using the visual analogue scale preoperatively and at 24 and 48 hours postoperatively. Data on time to first analgesia and analgesia consumption during 0-48 hours were collected. Statistical analysis included the Friedman test with Bonferroni-corrected post-hoc comparisons for longitudinal data, and the Wilcoxon Signed-Rank test for postoperative analgesia consumption. Results: Overall mean age was 63.7 ± 7.4 years, and 31 (81.6%) were females. Median pain VAS score decreased from baseline 7.0 (1.0) to 4.0 (2.0) at 24 hours, and 1.0 (2.0) at 48 hours. Similarly, 29 (76.3%) patients required no rescue medication in the first 24 hours, and 32 (84.2%) during the 24–48 hours period. Median analgesia consumption dropped from 0.0 (25.0) mg to 0.0 (0.0) mg across these intervals (p=0.007). Conclusions: The surgeon-placed ACB was associated with low postoperative pain scores and minimal need for rescue analgesia among patients undergoing TKA in this setting.

Biochemical Markers and Physiological Dysregulation Associated with Sleep Deprivation: A Systematic Review

Sara Yar Khan, Bela Inayat, Khushboo Ihsan, Asma Aziz, Najma Fida, Gul Muhammad — Fri, 31 Jul 2026 00:00:00 +0000

Sleep deprivation has become increasingly common in modern society and is associated with various adverse health outcomes. Evidence suggests that inadequate sleep may disrupt biochemical regulation and contribute to systemic physiological disturbances. Objectives: To synthesize current evidence on biochemical markers and physiological dysregulation associated with sleep deprivation in adult populations. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A literature search was conducted in PubMed, Scopus, and the Cochrane Library for studies published between January 2017 and March 2024. Original human studies reporting biochemical or physiological outcomes related to sleep deprivation or sleep restriction were included. Titles and abstracts were screened, followed by full-text evaluation. Data on study characteristics, sleep assessment methods, and outcomes were extracted. Study quality was assessed using the National Institutes of Health Quality Assessment Tool. Due to heterogeneity across studies, findings were synthesized narratively. Results: Fourteen studies met the inclusion criteria. The evidence consistently showed that sleep deprivation is associated with neuroendocrine stress activation, metabolic disturbances, inflammatory responses, and oxidative stress. Increased cortisol levels, impaired glucose metabolism, elevated inflammatory markers such as C-reactive protein and interleukin-6, and increased oxidative stress markers were commonly reported. Physiological consequences included cardiovascular strain, autonomic imbalance, cognitive impairment, mood disturbances, and reduced immune function. Conclusions: Sleep deprivation is associated with significant biochemical alterations and multi-system physiological dysregulation. Adequate sleep duration and quality appear to be important modifiable determinants of cardiometabolic and neuroimmune health.

Placental Implantation Sites, Uterine Anatomy, and Uterine Physiology in Relation to Postpartum Hemorrhage: A Systematic Review

Fri, 31 Jul 2026 00:00:00 +0000

Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Increasing evidence suggests that the placental implantation site and uterine structural characteristics influence the effectiveness of hemostasis after placental separation, particularly in placenta previa and placenta accreta spectrum (PAS). Objectives: To systematically review human studies examining the relationship between placental implantation site, uterine anatomy, uterine physiology, and the risk of postpartum hemorrhage. Methods: This systematic review followed PRISMA 2020 guidelines. PubMed, Web of Science, and Scopus were searched for studies published between January 2018 and December 2025. Eligible studies included observational human studies and imaging-based diagnostic studies evaluating placental implantation or uterine structural or physiological factors in relation to PPH. Animal studies, case reports, and review articles were excluded. Data were extracted using a standardized form, and methodological quality was assessed using the Newcastle–Ottawa Scale. Due to heterogeneity in study design and outcome definitions, a narrative synthesis was performed. Results: Eighteen studies met the inclusion criteria. Abnormal placental implantation, particularly lower uterine segment placentation, placenta previa, pernicious placenta previa, and PAS, was consistently associated with increased PPH risk. Structural factors, including reduced myometrial thickness and disruption of the uteroplacental interface, were frequently reported contributors to excessive bleeding. Conclusions: Abnormal placental implantation and associated uterine structural changes are important contributors to postpartum hemorrhage. Antenatal imaging may assist in identifying high-risk pregnancies and guiding delivery planning.