The Professional Medical Journal

Comparison of early versus late enteral feeding after elective ileostomy closure.

2025-10-06T04:19:58-07:00

Objective: To compare early and late entera1 feeding after Elective Ileostomy Closure in terms of mean hospital stay and frequency of wound infection. Study Design: Randomized Controlled Trail. Setting: Department of Surgery, Allied Hospital I Faisalabad. Period: April to September 2024. Methods: Ninety patients undergoing elective ileostomy closure were randomly divided into two equal groups. Group E received oral intake after 24 hours, while Group L began feeding after the return of bowel sounds. Outcomes measured were wound infection within seven days postoperatively and length of hospital stay. Results: Mean hospital stay was significantly shorter in Group E (10.00 ± 3.61 days) compared to Group L (12.93 ± 2.32 days; p < 0.001). Wound infection occurred in 13.3% of patients in Group E and 35.6% in Group L (p = 0.014). Stratified analysis showed consistent benefits of early feeding across age, gender, and BMI categories. Conclusion: Early enteral feeding after ileostomy closure significantly reduces wound infections and hospital stay. It is a safe and effective practice, especially beneficial in low-resource surgical settings.

Comparison of difficult vs simple laparoscopic cholecystectomy in a tertiary care hospital.

2026-02-17T03:43:20-08:00

Objective: To determine the percentage of patients with difficult laparoscopic cholecystectomy for gall bladder calculi done and to compare the various factors and outcomes of simple and difficult laparoscopic cholecystectomy for gall bladder calculi done in our tertiary care hospital. Study Design: Cross sectional study. Setting: Department of General Surgery, Liaquat University Hospital, Hyderabad. Period: March to Aug 2025. Methods: A total of 73 patients aged 20–70 years, scheduled for LC, were enrolled using non-probability consecutive sampling. Difficulty was assessed intraoperatively based on anatomical and technical factors. Patient demographics, comorbidities, operative time, and hospital stay were recorded and analyzed using SPSS v26. Results: Simple LC was performed in 74.0% of the 73 patients, while the remaining 26.0% underwent difficult LC. The patients had a mean age of 44.15 ± 15.23 years and a mean BMI of 25.98 ± 4.41 kg/m². No significant relationships were found between LC difficulty and factors such as age, sex, BMI, diabetes, hypertension, or dyslipidemia. However, prolonged hospitalization (>8 days) was significantly associated with difficult LC (p = 0.003). Conclusion: Difficult LC was observed in over one-fourth of patients and was significantly associated with prolonged hospitalization. Preoperative identification of high-risk cases can improve surgical preparedness and reduce complications.

Outcome of total thyroidectomy: A prospective study.

2026-05-06T03:25:48-07:00

Objective: To evaluate the incidence, outcome and complication of total thyroidectomy. Study Design: Prospective study. Setting: Surgical Department, Services Hospital Lahore. Period: from 1^st January 2020 to 1^st January 2023. Methods: Eighty hundred and twenty six consecutive patients underwent total thyroidectomy were included. Results: There were 124 male and 702 female. Their ages were between 18 to 82 years with mean age 48 years. Out of 826 patients, 430 have MNG (52%), 281 have cancer thyroid (34%), 58 have toxic nodular goiter (7%), 33 have Grave’s disease (4%), 16 have Hashimoto’s thyroiditis (2%) and 8 have Follicular adenoma (1%). Post operative hematoma was found in 17 patients (2%), Transient hoarseness in 25 patients (3%), unilateral permanent RLN paralysis in 4 patients (0.5%). No patient has permanent bilateral RLN paralysis. Transient hypocalcemia was found in 41 patients (5%) and permanent hypocalcemia in 3 patients (0.4%). Conclusion: Total thyroidectomy is safe procedure in experienced hands. Most of complications are managed conservatively.

Frequency of venous thromboembolism risk factors assessed by the caprini score in patients undergoing elective lumbar spine surgery.

2026-04-20T05:52:58-07:00

Objective: To quantify the frequency of venous thromboembolism risk factors stratified by the Caprini Risk Assessment Model in adults undergoing elective lumbar spine surgery. Study Design: Analytical Cross-sectional. Period: January 2025 to January 2026. Setting: Nishtar Hospital II, Multan. Methods: Three hundred ten consecutive patients scheduled for L1–S1 procedures were enrolled after excluding trauma, active malignancy, infection and preoperative thromboembolism. Demographic, clinical, and operative data was taken using standardized proforma. The 2013 Caprini instrument assigned weighted points for risk stratification into low, moderate, high, and very high categories. Statistical analysis employed descriptive frequencies and chi-square test by using SPSS version 21.0. Results: The mean age of participants was 52.4±11.7 years, with male predominance (54.8%). Multilevel fusion procedures constituted 54.2% of the surgical cohort, with open posterior approaches utilized in 68.4%. Predominant risk factors included planned postoperative immobilization exceeding twenty-four hours (92.3%), hypertension (41.3%), and obesity (38.7%). Zero patients qualified as low risk. High-risk stratification encompassed 58.7%, while very high-risk comprised 32.3%. The aggregate mean Caprini score reached 4.1±1.3. Advanced age, elevated body mass index, multilevel instrumentation, and operative duration surpassing three hours demonstrated statistically significant correlations with heightened risk categories. Conclusion: Elective lumbar instrumentation universally generates substantial thrombotic vulnerability. Mandatory preoperative Caprini screening coupled with risk-adapted prophylaxis protocols and targeted metabolic optimization remains imperative for mitigating postoperative complications and enhancing surgical recovery pathways.

Detection of causative organisms on bacterial culture in pleural tissue versus pus in patients with thoracic empyema.

2026-05-12T07:54:45-07:00

Objective: To determine the diagnostic yield of bacterial culture in pleural tissues and pus in patients with pleural empyema and assess the applicability of pleural biopsy in diagnosis. Study Design: Prospective Comparative Observational study, non-probability consecutive sampling. Setting: Department of Pulmonology Out Patients (OPD) and Indoor Wards, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute Lahore, Pakistan. Period: Spanned 18-months, 21 October 2020 to 20 April 2022. Methods: The study included 75 consenting patients (18-70 years) with thoracic empyema, excluding those on antibiotics, with prior pus sample collection >1 week ago, or with pulmonary/extra-pulmonary tuberculosis. Pleural tissue and pus samples were collected for bacterial culture. Diagnostic yields were compared, and data stratified by age, gender, BMI, and symptoms duration, with statistical significance set at P value ≤ 0.05. Results: The study included 75 patients with pleural empyema, with a mean age of 38.1 years and BMI of 25.4 kg/m². Males accounted for 65.3% of the cohort. Pleural tissue samples showed a higher diagnostic yield (84%) compared to pus samples (58.7%). BMI was significantly associated with pleural tissue yield (p=0.040). Klebsiella species, Staphylococcus aureus, Streptococcus species, and E. coli were the most common pathogens isolated from pleural tissues, while Staphylococcus aureus was most common in pus samples. Conclusion: Pleural biopsy with bacterial culture offers a higher diagnostic yield than pus culture alone in patients with thoracic empyema, enhancing diagnostic accuracy and informing treatment strategies effectively.

Effect of Low molecular weight heparin on pregnancy outcomes in oligohydramnios and Intrauterine growth restriction.

2026-03-28T05:04:37-07:00

Objective: To compare the frequency of obstetric outcomes between low molecular weight heparin and conservative treatment for oligohydramnios and intrauterine growth restriction. Study Design: Comparative Observational Study. Setting: Obstetrics and Outpatient Departments, Hilal-e-Ahmar Hospital, Faisalabad, Pakistan. Period: Six months 15/3/2022 to 15/9/2022. Methods: Five hundred pregnant women with pregnancies complicated by unexplained oligohydramnios were enrolled. Patients were randomly divided into two groups using block randomization with computer-generated numbers. Patients in Group A were administered a daily dose of 40 mg enoxaparin subcutaneously for up to two weekly till 36 weeks in addition to normal treatment (oral aspirin 75 mg once daily), while group B received only standard aspirin-based treatment. Results: In our study, the mode of delivery was compared in both groups, showing that cesarean section in Group A was 83.2%(n=208) and in Group B was 74.8%(n=187), whereas normal vaginal delivery in Group A was 16.8%(n=42) and in Group B 25.2%(n=63),p valuewas0.021. Preterm delivery in group A was 17.2%(n=43) and 28.8%(n=72) in group Group-B p = 0.002). The frequency of live births in group A was 93.2% (n=233), whereas it was 81.2%(n=203) in group Group-B p = 0.0005). Conclusion: We conclude that LMWH is significantly more effective than conservative treatment for oligohydramnios and IUGR.

Comparative study of Arabin Cerclage Pessary and McDonald stitch regarding fetal outcome in Preterm Labour

2026-06-19T05:02:39-07:00

Objective: To assess fetal outcomes in the form of mean birth weight and admission of infants to neonatal intensive care unit against women with threatened preterm labour treated with Arabin cervical pessary and McDonald cervical stitch. Study Design: Randomized Controlled study. Setting: Department of Gynecology, Aziz Fatimah Hospital, Faisalabad. Period: Dec 2025 to May 2026. Methods: One hundred and eighty two (182) pregnant women aged between 18 and 35 years and with singleton pregnancy with cervical length less than 25mm on transvaginal ultrasound, were the participants. Patients with a cervical dilatation of 4 cm and above, cervicofetal or fetal conditions, proven premature labour, torn membranes, liquor drainage, or infection were ruled out. The sample was divide into two groups (1:1 ratio). Group A consisted of 91 patients who were treated with the use of Arabin cervical pessary and Group B consisted of 91 patients treated with the use of McDonald cervical stitch. The patients were also followed up to delivery. The birth weight and admission of the child to the NICU (12 hours of birth) were captured. The SPSS version 25 was used to analyze the data. Results: Group A had a mean age of 27.42 + 4.36 years, whereas Group B had a mean age of 27.91 + 4.21years high and significant difference was found in the mean birth weight between the two groups, 2.74 ± 0.89kg in Group A and 2.31 ± 0.81kg in Group B with p=0.001. Group A had much lower rates of admission to NICU compared to Group B, 28 (30.8%) and 48 (52.7), respectively, with a p=0.003. Conclusion: Arabin cervical pessary has significant difference regarding mean birth weight or NICU admission relative to McDonald stitch in pregnant women with threatened preterm labour

Oral health of pregnant women; Dentition and periodontal status at antenatal care clinic in Moshi Municipal, Tanzania.

2026-06-18T05:47:55-07:00

Objective: To evaluate dentition and periodontal status in pregnant women. Study Design: Cross-sectional study. Setting: Moshi Municipal, Tanzania. Period: July 2024 to October 2025. Methods: A multistage sampling was carried out among pregnant women attending antenatal clinics at public health facilities. Data collected was based on World Health Organization recommended methods. SPSS package version 26 was used for processing and analysis of the data. Kappa test evaluated reproducibility. Mann Whitney U-tests and Kruskal Wallis H-tests used to determine the differences in specific socio-demographic characteristics of pregnant women by median DMFT scores and its components. Chi-square and Fisher’s Exact tests were used to evaluate the relationship between socio-demographic characteristics of pregnant women and gingival bleeding as well as periodontal pockets. Odds ratio and 95% confidence intervals were used to assess odds of developing periodontal diseases. A p-value <0.05 was considered significant. Results: Mean DMFT score of the sample was 1.78 with a decay component of 50.4%. Overall caries prevalence was 58.7%. Prevalence of unhealthy periodontal conditions was 28.6%. Periodontal pockets occurrence was 7.7% and loss of attachment according to the highest score was 1.6%. Conclusion: Caries prevalence than periodontal diseases were present in this community.

Comparison of efficacy of one-step versus two-step oral glucose tolerance test in pregnant women and its impact on obstetrical outcomes.

2026-07-09T06:27:32-07:00

Objective: To compare the effectiveness of the one-step and two-step OGTT in diagnosing GDM among high-risk pregnant women and to evaluate the impact of each screening strategy on obstetrical outcomes. Study Design: Prospective Comparative Cohort study. Setting: Department of Obstetrics and Gynecology, Dr. Faisal Masood Teaching Hospital, Sargodha, Pakistan. Period: May 2025 to October 2025. Methods: One hundred and ten high-risk pregnant women at 24–28 weeks of gestation were enrolled using non-probability consecutive sampling and allocated equally to Group A (one-step 75 g 2-hour OGTT) and Group B (two-step 50 g GCT followed by 100 g OGTT if indicated) after approval from institutional ethical review committee (number smc/prin/5754 dated 17-4-2025). Primary outcome was GDM diagnosis rate; secondary outcomes included gestational age at delivery, birth weight, neonatal glucose, and maternal and neonatal complications. Results: The mean age of participants was 27.23±4.33 years, with a mean gestational age of 26.91±3.86 weeks. GDM was diagnosed in 30 (54.5%) women in Group A compared with 18 (32.7%) in Group B (p=0.021). Women screened by the one-step approach had significantly higher gestational age at delivery (38.00±1.42 vs. 37.40±1.56 weeks; p=0.038) and higher neonatal blood glucose levels (71.02±14.84 vs. 53.18±20.67 mg/dL; p<0.001). Rates of preterm birth, operative delivery, shoulder dystocia, and polyhydramnios were significantly lower in Group A (p<0.05). No significant differences were observed between the groups regarding large-for-gestational-age infants, perineal injury, postpartum hemorrhage, respiratory distress, neonatal intensive care unit admission, or neonatal hypoglycemia. Conclusion: The one-step OGTT demonstrates higher diagnostic yield in diagnosing GDM and is associated with improved key obstetrical outcomes including lower rates of preterm birth, operative delivery, shoulder dystocia, and polyhydramnios. These findings support the use of the one-step OGTT as an effective screening strategy for high-risk pregnancies.

Assessing the efficacy and outcomes of oxytetracycline pleurodesis in the management of malignant pleural effusion.

2026-03-31T06:01:05-07:00

Objective: To determine the outcome of OTC pleurodesis in patients with MPE in terms of efficacy, safety, and complications. Study Design: Quasi-experimental study. Setting: Department of Pulmonology, Jinnah Hospital, Allama Iqbal Medical College Lahore. Period: September, 1^st 2025 to February, 28^th 2026. Methods: A total of 127 patients diagnosed with MPE full filling the inclusion criteria were selected through non-probability consecutive sampling. Written informed consent was taken from all the patients. Pleurodesis was performed using a dose of 35 mg/kg OTC. All the patients were followed up to 30 days after the procedure. Statistical analysis was performed using SPSS version 20.0. Descriptive statistics were calculated for baseline characteristics, including mean (M) ± standard deviation (SD) for continuous variables while percentages and frequencies for categorical variables. The Independent t-test was used to compare continuous variables. For categorical variables, the Chi-square test was applied to assess the association with pleurodesis success. A p-value of ≤ 0.05 was considered statistically significant. Results: The cohort consisted of 67 males (52.76%) and 60 females (47.24%), with mean age of 58.4 ± 6.3 years. The duration of malignancy was 1.8 ± 0.4 years. The overall post pleurodesis success rate was 66.15%. Post-procedural complications included chest pain in 24.40% and fever in 17.32% of patients. Statistical analysis showed no significant associations between pleurodesis success and patient demographics or disease characteristics. Conclusion: These findings support OTC pleurodesis as a viable and effective option for MPE management, especially in resource-limited settings.

Efficacy of immunomodulator drug thalidomide in multi-transfused thalassemia patients: A single center experience from South Punjab, Pakistan.

2026-03-30T07:25:32-07:00

Objective: To determine the efficacy of thalidomide in multi transfused Thalassemic Children. Study Design: Quasi-experimental study. Setting: Thalassemia Center, The Children’s Hospital and Institute of Child Health, Multan, Pakistan. Period: August 2023 to December 2024. Methods: A total of 121 transfusion dependent thalassemia (TDT) children of either gender, aged between 2 to 15 years, were analyzed. Non-probability, consecutive sampling technique was adopted. Children were given thalidomide at a dose of 1.5mg/kg/day. CBC evaluation and clinical examination were done at 3-months interval for a duration of 6 months. At each visit, side effects, subjective complaints and rise /fall of Hemoglobin was noted. Statistical analysis was conducted using IBM-SPSS version 26.0. Results: In a total of 121 children, the median age was 8.00 years (IQR, 5.00-11.00), while 77 (63.6%) children were males. At baseline, the median hemoglobin level was 8.00 g/dL (IQR, 6.75-8.75), increasing to 8.90 g/dL (IQR, 7.65-9.80) at 3 months, and 9.90 g/dL (IQR, 8.70-11.00) at 6 months (p<0.001). By the end of 6-months period, excellent, partial, and no response were noted among 59 (48.8%), 41 (33.9%), and 21 (17.4%) children, respectively. The most common treatment related side effects were constipation (n=9, 7.4%), neutropenia (n=6, 5.0%), and skin rash (n=5, 4.1%).No reported cases of severe adverse effects leading to discontinuation. Conclusion: In children with TDT, thalidomide significantly increased hemoglobin levels and reduced transfusion needs over six months.

Biochemical response to aortic cross-clamp duration: CK-MB and Troponin-I dynamics during myocardial ischemia in CABG patients.

2026-03-25T07:00:28-07:00

Objective: To evaluate perioperative changes in creatine kinase–myocardial band (CK-MB) and cardiac troponin-I levels in patients undergoing coronary artery bypass grafting (CABG) in relation to aortic cross-clamp duration. Study Design: Cohart Study. Setting: Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan. Period: Six Months from November 2022 to April 2023. Methods: A total of 190 patients undergoing elective on-pump CABG were included using a non-probability consecutive sampling. Patients were categorized into two groups based on aortic cross-clamp duration: Group A (<75 minutes) and Group B (≥75 minutes). Blood samples were collected at baseline, after cross-clamp removal and during the early postoperative period. Serum CK-MB and troponin-I levels were measured. Data was analyzed by SPSS version 25. Quantitative variables were expressed as mean ± standard deviation and an independent sample t-test was used to compare biomarker levels between the groups. A p-value ≤0.05 was considered statistically significant. Results: Baseline CK-MB and troponin-I levels were similar between two groups. Both biomarkers showed a significant increase after cross-clamp removal, reflecting myocardial stress associated with surgical ischemia. CK-MB levels increased significantly after cross-clamp exposure=0.004) and remained elevated in the early postoperative period (p=0.030). Similarly, troponin-I levels showed a significant rise following cross-clamp removal (p=0.035) and remained elevated postoperatively (p=0.050). Conclusion: Perioperative monitoring of CK-MB and troponin-I provides useful insight into myocardial injury during CABG and may help improve assessment of myocardial protection during cardiac surgery.

In-hospital outcomes in patients of STEMI (STsegment elevation MI) undergoing PPCI (Primary Percutaneous Coronary Intervention) with Intra Coronary Tirofiban vs Intravenous Tirofiban.

2026-05-12T07:55:47-07:00

Objective: To compare the frequency of in hospital outcomes in patients of acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with intracoronary Tirofiban vs intravenous Tirofiban. Study Design: Non-randomized Controlled Trial. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: Six months Nov 2025 to April 2026. Methods: Included 210 patients aged 20–65 years with STEMI undergoing primary PCI. Patients were equally divided into intracoronary (Group A) and intravenous (Group B) tirofiban groups. Outcomes assessed included Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, TMP grade 2–3 flow, and MACE during hospital stay. Results: Intracoronary tirofiban resulted in significantly higher TIMI grade 3 flow (96.2% vs 80.0%, p<0.001) and TMP grade 2–3 flow (89.5% vs 67.6%, p<0.001) compared to intravenous administration. The incidence of MACE was significantly lower in the intracoronary group (11.4% vs 27.6%, p=0.003). Conclusion: Intracoronary administration of tirofiban was superior to intravenous administration route showing more improved coronary and myocardial perfusion and reduced in-hospital MACE in STEMI patients undergoing primary PCI.

Prevalence and risk factors associated with frailty in end stage renal disease patients on maintenance haemodialysis.

2026-04-20T05:54:37-07:00

Objective: To determine the frequency of frailty and identify its associated risk factors among end-stage renal disease (ESRD) patients undergoing maintenance haemodialysis. Study Design: Cross-sectional study. Setting: Hemodialysis Unit, The Kidney Centre. Postgraduate Training Institute, Karachi, Pakistan. Period: March 2025 to December 2025. Methods: A total of 200 participants of any genders, aged 18-70 years, with ESRD and undergoing maintenance hemodialysis were analyzed. Frailty was measured using the Frail Scale. Demographic, clinical, and laboratory data were collected. Data analysis was carried out using IBM-SPSS Statistics version 26, employing descriptive statistics. Chi-square tests, and independent t-tests were performed to compare frail and non-frail participants while logistic regression was used to determine predictors of frailty. Statistical significance was defined as p<0.05. Results: In a total of 200 patients, 101 (50.5%) were males. The mean age, and weight were 52.8±13.2 years, and 66.3±12.6 kg, respectively. Regarding frailty status, 64 (32%) were robust, 82 (41%) pre-frail, and 54 (27%) frail. Age (aOR=1.1, 95% CI: 1.1–1.2, p=0.019), unemployment (aOR =6.9, 95% CI: 1.1–42.2, p=0.036), diabetes mellitus (aOR=7.3, 95% CI: 1.8–30.7, p=0.006), and history of hospitalization (aOR=5.1, 95% CI:1.04–24.6, p=0.044) were found to be independent predictors of frailty. Conclusion: Frailty and pre-frailty affected a substantial proportion of patients on maintenance hemodialysis in ESRD patients. Relatively older age, unemployment, diabetes mellitus, and prior hospitalization identified patients at particularly high risk of frailty.

Correlation of platelet indices with microvascular complications in patients with type 2 diabetes mellitus: an analytical cross-sectional study.

2026-04-04T05:56:54-07:00

Objective: To compare platelet indices between T2DM patients with and without microvascular complications and to evaluate their correlation with diabetic retinopathy, nephropathy, and neuropathy. Study Design: Cross-sectional Observational study. Setting: Department of General Medicine, Federal Government Polyclinic Hospital, Islamabad. Period: April to December 2025. Methods: An analytical cross-sectional study of 220 T2DM patients (110 with microvascular complications, 110 without) was conducted at a tertiary care hospital in Islamabad, Pakistan. Platelet indices were measured on an automated hematological analyzer. Independent samples t-test and Spearman's rank correlation were used for analysis. Results: MPV (13.41 ± 2.10 vs. 12.00 ± 1.89 fL), PDW (16.81 ± 2.73 vs. 15.24 ± 2.67%), and P-LCR (28.66 ± 7.00 vs. 24.00 ± 6.71%) were significantly higher in the complication group (all p < 0.001). Spearman's correlation confirmed significant positive associations for MPV (ρ = +0.343), PDW (ρ = +0.283), and P-LCR (ρ = +0.309; all p < 0.001). Platelet count showed no significant differences or correlations. Conclusion: MPV, PDW, and P-LCR are significantly elevated and positively correlated with microvascular complications in T2DM. These routinely available, low-cost indices may serve as practical adjuncts for microvascular risk stratification, particularly in resource-constrained settings.

Frequency of left mainstem disease in patients with unstable angina undergoing coronary angiography.

2026-04-11T06:40:06-07:00

Objective: To determine the frequency of left main stem disease (LMS) in patients presenting with unstable angina (UA) undergoing coronary angiography (CA). Study Design: Cross-sectional Study. Setting: Department of Cardiology, Rehmatul-lil-Alameen Postgraduate Institute of Cardiology, PESSI, Lahore. Period: 1^st August 2025 to 31^st January 2026. Methods: A total of 199 patients were enrolled in the study based on non-Probability consecutive sampling. The study population comprised all adult patients (aged ≥18 years; both genders) admitted to the cardiology department with a clinical diagnosis of unstable angina who subsequently underwent coronary angiography. The data was stratified (With LMS & without LMS disease) according to age, gender, BMI, duration of disease, family history, comorbidities (diabetes, hypertension & hyperlipidemia) and smoking status. Post-stratification chi-square test was applied to identify association between stratified groups. Statistical analysis was performed using SPSS Version 27. A p-value of ≤0.05 was considered statistically significant. Results: The mean age of the study population was 58.4 ± 10.2 years (range; 36-69 years). One hundred & thirty (65.3%) male; 69 (34.7%) females. The most common cardiovascular risk factor was hypertension, present in 110(55.3%) patients, followed by diabetes mellitus; 91(45.7%) patients, current smoking; 65(32.7%) patients, positive family history; 60(30.1%), dyslipidemia; 43(21.6%) & Obesity (BMI>30); 39(19.6%) patients. Patients with LMS disease were significantly older with 86.9% having age >50 years (p <0.001). Additionally, the prevalence of diabetes 69.6% vs 42.6 %; p =0.027), positive family history (65.2% vs 19.8 %; p <0.001), hyperlipidemia (43.8% vs 18.7%; p=0.015), duration of disease >10 years (78.3% vs. 21.6%; p<0.001) and concomitant multi-vessel disease (78.3% vs. 21.6%; p <0.001) was significantly higher among patients with LMS disease. Conclusion: This study demonstrates that left main stem (LMS) disease is present in a clinically significant proportion of patients presenting with unstable angina (UA) who undergo coronary angiography. The frequency observed in this study (11.5%) underscores the importance of maintaining a high index of suspicion for LMS involvement in this high-risk patient population.

Frequency of early stent thrombosis in patients presenting with STEMI Undergoing Primary Percutaneous Coronary Intervention (PPCI) at a Tertiary Care Hospital.

2026-06-03T03:55:16-07:00

Objective: To determine the frequency of early stent thrombosis in patients presenting with STEMI undergoing PPCI. Study Design: Case Series. Setting: Department of Cardiology at Sheikh Zayed Hospital, Rahim Yar Khan. Period: October 2025 to March 2026. Methods: The patients were selected using non-probability consecutive sampling and a total of 234 patients with an age range of 18-60 years and STEMI who underwent PPCI were included in the study. Demographic, clinical, biochemical, angiographic, and procedural characteristics were recorded. Patients were followed for 30 days after PPCI for the development of early stent thrombosis. SPSS version 23 was used for data analysis. Results: The mean age of the patients was 54.9 ± 9.2 years, and 78.6% were male patients. Common comorbidities were dyslipidemia (70.1%), hypertension (47.9%), and diabetes mellitus (44.9%). There were 13 (5.6%) patients with early stent thrombosis. The commonest presenting symptom was chest pain. The involvement of the culprit vessel was statistically significant (p=0.028) in association with early stent thrombosis, and there were no other significant associations with the demographic and clinical variables. Conclusion: Early stent thrombosis is still a clinically relevant complication following PPCI in STEMI patients. Strategies to minimize thrombotic complications and enhance patient outcomes may include careful procedural planning, aggressive management of risk factors, and monitoring to ensure proper post-procedural care.

Diagnostic accuracy of doppler ultrasonography to detect carotid artery disease in hypertensive patients, while taking CT Angiography as the gold standard.

2026-04-16T03:36:30-07:00

Objective: To evaluate the diagnostic accuracy of Doppler ultrasonography in detecting carotid artery disease in hypertensive patients, using CT angiography as the reference standard. Study Deisng: Cross-sectional study. Setting: Radiology, Ghurki Trust Teaching Hospital, Lahore. Period: November 2025 to March 2026. Methods: Which consisted of 148 hypertensive patients. Each patient was exposed to Colour Doppler ultrasonography and then to CTA within 24 hours. The results obtained were classified into true positive, true negative, false positive, and false negative. Calculation of sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy was made based on CTA as the gold standard. Results: The presence of carotid stenosis was confirmed by CTA in 60.8% of patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of diagnosis by DUS were 93.3%, 75.9%, 85.7%, 88.0%, and 86.5%, respectively. DUS accurately detected 93.3% of patients with stenosis and excluded 75.9% of patients without stenosis. Similar results were obtained in the subgroups stratified by age, gender, BMI, and concomitant diseases. The prevalence of detection increased with the progression of stenosis severity. Conclusion: Doppler ultrasonography demonstrates high sensitivity and commendable diagnostic accuracy in identifying carotid artery disease among hypertensive patients. But its moderate specificity shows that CT angiography is still important for confirmation and planning before an intervention. For the best care of patients, a combined diagnostic approach is recommended.

Frequency of different uropathogens in diabetic patients of Southern Khyber Pakhtunkhwa, Pakistan.

2026-02-12T03:41:19-08:00

Objective: To determine the frequency of commonly found uropathogens causing urinary tract infection in diabetic patients. Study Design: Cross-sectional, Descriptive study. Setting: Department of Medicine and Endocrinology MTI DHQ Hospital Bannu. Period: 1^st December 2021 to 1^st March 2025 with the duration of study over 4 years. Methods: In this study, midstream urine of about 125 diabetic patients (25-35 ml) was obtained from each patient in a sterile, leak proof container and labelled for microbiological analysis. Two types of urine cultures were observed, positive urine cultures showing uropathogen growth and negative urine culture. Only positive cultures were further analyzed for uropathogen identification. Results: In this study, 62 urine samples showed uropathogen growth while 63 urine samples did not show any growth. About 80 % patients were female. E. coli was the most commonly observed uropathogen (54.8%), followed by Enterococcus spp. (12.9%), Klebsiella pneumoniae (8.1%), Candida albicans (8.1%), and Pseudomonas aeruginosa (6.5%). Conclusion: This study showed that most uropathogens causing urinary tract infection in diabetic patients belong to the Gram‑negative group, predominantly E. coli (54.8%), while other organisms such as Enterococcus spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans, and Staphylococcus aureus were less frequent.

Impact of Percutaneous Nephrolithotomy (PCNL) on renal cortical function evaluated by 99mTc-DMSA scintigraphy: A single-centre study.

2026-02-16T04:31:29-08:00

Objective: To determine the mean change in split renal cortical function before and three months after Percutaneous Nephrolithotomy (PCNL), using 99mTc-DMSA scintigraphy in patients undergoing the procedure at a single tertiary care centre. Study Design: Quasi-experimental study. Setting: Sindh Institute of Urology and Transplantation (SIUT). Period: February 19 to August 18, 2022. Methods: Enrolling 127 patients through non-probability consecutive sampling. All included patients underwent unilateral single-tract PCNL. Written informed consent was obtained from all participants. Each patient underwent a preoperative DMSA scan. To assess changes in split renal function on the operated side, both preoperative and postoperative DMSA scans were analysed. Results: The mean age of the participants was 44.90 ± 10.63 years. Of the total, 45 patients (35.43%) were female and 82 (64.57%) were male. Regarding the laterality of surgery, 47 patients (37.01%) underwent PCNL on the left kidney, while 80 patients (62.99%) had the procedure on the right. Comparison of split renal function before and after PCNL revealed a significant improvement: the mean preoperative value was 38.59 ± 7.10%, whereas the postoperative mean was 41.84 ± 6.73% (p < 0.001). Conclusion: Technetium-99m DMSA scintigraphy provides a reliable, non-invasive method to assess individual renal cortical function. This study demonstrates that PCNL does not significantly impair the treated kidney. In fact, a statistically significant improvement in split renal function was observed following stone removal.

Correlation of C Reactive protein with acute kidney injury after coronary artery bypass grafting.

2026-02-12T03:37:30-08:00

Objective: To determine the correlation of preoperative CRP level with cardiac surgery associated AKI, morbidity and mortality after CABG Surgery. Study Design: Prospective Comparative study. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: January 2023 to December 2023. Methods: After approval from the Ethical Review Committee, informed consent from patients was taken and they were included in this study. Patients were interviewed, explained and counseled about the procedure of the study. Routine Investigations including CRP levels were performed. Patients were divided into 2 groups as Group A (with Raised CRP (More than 5.0mg/L) and Group B (with Normal CRP (Less than 5.0mg/L) and CABG was performed. Post-operative outcomes in term of serum creatinine levels, length of ICU and hospital stay and mortality in early post-operative period was recorded and compared between the two groups. Results: Mean age was determined as 56.01 ± 7.07 years in Group A and 54.66 ± 7.3 (p<0.001) in Group B. Mean CRP of the population at the time of admission was determined as 6.8 ± 0.97 mg/L in Group A and 2.70 ± 0.97 (p<0.001) in Group B. Mean of baseline serum creatinine was determined as 1.107 ± 0.04 in Group A as compared to 1.199 ± 0.03 in Group B (p<0.001). Mean of peak serum creatinine were observed which were same as the values on the first day i.e., 1.39 ± 0.028 in Group A and 1.31 ± 0.030 in Group B. A significant correlation (p<0.001) was found in higher CRP levels and higher incidence of AKI in Group A and AKI was lower in case of group B. Chi-square test was used to determine that the incidence of AKI was greater in males in both groups as compared to females. Moreover, patients were distributed based on the follow-up treatments and outcomes, they received, and it was observed that majority of patients suffered AKI followed by medication, dialysis and death respectively in case of both Groups A and B. Conclusion: Conclusively, it can be stated that CRP levels at presentation are a direct predictor of acute kidney injury in the Pakistani local population especially in case of patients undergoing CABG. This is supported by evidence of increased serum creatinine levels with time, low urine output etc. in the patients with elevated CRP levels.

Frequency of reasons of plate removal following maxillofacial trauma in patients presenting to Ayub Teaching Hospital Abbotabad.

2026-07-01T06:20:37-07:00

Objective: To find out the incidence and causes of plate removal in cases of maxillofacial trauma at a tertiary healthcare facility. Study Design: Cross-sectional study. Setting: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad. Period: October 2025-March 2026. Methods: A total of 133 patients having undergone ORIF surgery for maxillofacial fractures and who later needed plates to be removed were selected by non-probability consecutive sampling. Information related to demographic characteristics, location of fractures, and causes of plate removal was collected on a predesigned questionnaire. SPSS version 26 was used for data analysis. Results: A total of 133 subjects were contained in the study; of these subjects, 97 (i.e., 72.9%) were males and 36 (i.e., 27.1%) were females. The maxilla was the most common fracture location (53.4%). 46 (i.e., 34.6%) patients had surgical site infections as the rationale for removing the plate implant. Plate exposure (27 patients; 20.3%), pain or discomfort due to the implant (19; 14.3%), mechanical failure of the implant (15; 11.3%), and the desire for reconstructive surgery (7; 5.3%) were additional reasons for removal of the implants. No statistical association was found between the indication for plate removal and the patient's gender (p=0.110), age category (p=0.505), or the fracture's location (p=0.523). Conclusion: Surgical site infection remains the predominant reason for plate removal after treatment of facial trauma. Improved postoperative care can potentially reduce the incidence of complications associated with the use of plate implants for treatment of facial trauma.

Distally based medial hemisoleus muscle flap for reconstruction of distal and middle third leg defects.

2026-05-08T04:07:40-07:00

Objective: To prospectively assess the clinical efficacy, flap survival, functional, and donor-site morbidity of the distally based medial hemisoleus muscle flap in reconstruction of soft tissue defects located in the distal and middle thirds of the lower leg. Study Design: Prospective Cohort study. Setting: Department of Plastic and Reconstructive Surgery, Bakhtawar Amin Medical and Dental College, Multan. Period: January 2024 to December 2025. Methods: The reconstruction was done in forty-two adult patients with traumatic, post-oncological, or post-infectious defects (4-10 cm) in the distal or middle leg. Vascular mapping before surgery, standardized surgical practice and standardized postoperative practices were adopted. Outcomes were determined as primary flap survival, complication rates, Lower Extremity Functional Scale (LEFS) scores, ankle range of motion (ROM), donor-site morbidity and patient-reported aesthetic satisfaction. Descriptive statistics, chi-square/Fisher exact tests, paired t-tests, and multivariate logistic regression (alpha=0.05) were performed using statistical analysis. Results: The survival rate of complete flaps was 40/42 (95.2). Significant complications were experienced in 4 patients (9.5%), of which 2 experienced a partial distal necrosis, 1 experienced a superficial infection and 1 experienced a wound dehiscence. Free tissue transfer did not need any flap loss. Mean LEFS improved from 38.2±6.1 preoperatively to 72.4±5.8 at 12 months (p<0.001). Multivariate analysis showed that the size of defects greater than 8 cm and active smoking were independent predictors of minor complications (p=0.012 and p=0.028, respectively). Conclusion: The medial hemisoleus flap, which is distally based and of a medial location, is a reliable and single-stage, functional preserving reconstructive option in distal and middle third leg defects. It provides high rates of survival, low rates of donor-site morbidity, and good functional recovery as a useful alternative to free flaps and traditional local flaps in suitably selected patients.

Frequency of chronic osteomyelitis in open tibia fracture treated by external fixator at tertiary care hospital.

2026-03-06T04:41:53-08:00

Objective: To determine the frequency of chronic osteomyelitis and associated factors in open tibia fractures treated with an external fixator at a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Orthopedic, Dr. Ruth K. M. Pfau Civil Hospital / DUHS. Period: May 2025 to Oct 2025. Methods: A total of 121 patients, aged 18–60 years, with open tibial fractures treated using external fixators, were enrolled consecutively. The subjects' data on sociodemographic characteristics, fracture details, and treatment-related variables were recorded on a standardized proforma. Patients were followed, and chronic osteomyelitis was diagnosed based on predefined clinical, radiological, and microbiological criteria. Data entry and analysis were done using the SPSS version 27.0.1. Descriptive statistics were employed, while associations were determined using the chi-square test; with a p value of less than 0.05 was regarded as statistically significant. Results: Chronic osteomyelitis developed in 12.4% of patients. Smoking, higher Gustilo–Anderson fracture grades (IIIB/IIIC), proximal tibial fracture location, and primary wound closure were independently associated with infection. Smoking showed the strongest association, markedly increasing the risk of chronic osteomyelitis while gender was not a significant predictor after adjustment. Conclusion: Chronic osteomyelitis remains a significant complication following open tibial fractures managed with external fixation. Injury severity and modifiable factors such as smoking and wound-closure strategy play a crucial role in infection development. Implementing strategies for managing wounds and associated risk factors can potentially decrease infectious complications.

Comparison of Mean Duration of PDPH (Post-Dural Puncture Headache) and Mean Length of Hospital Stay by Theophylline and Sumatriptan in the Treatment of Post-Dural Puncture Headache.

2026-04-16T04:16:39-07:00

Objective: To compare mean duration of PDPH and mean length of hospital stay by Theophylline and sumatriptan in the treatment of Post-Dural puncture Headache. Study Design: Quasi Experimental study. Setting: Department of Anesthesia, Allied Hospital Faisalabad. Period: January 2025 to July 2025. Methods: After taking written informed consent, 60 patients diagnosed with PDPH were enrolled. Participants were assigned into two groups of 30 each. Group A received oral theophylline anhydrous 150 mg, while Group B received oral sumatriptan succinate 25 mg; every 12 hours continued until NRS <3 or maximum of 48 hours. PDPH onset and duration were recorded in hours, and hospital stay in days. Data were analyzed using SPSS 26.0. Results: No significant difference was observed in hospital stay (Group A: 3.38 ± 0.87 days vs. Group B: 3.22 ± 0.75 days; p=0.449) or PDPH duration (Group A: 15.57 ± 4.57 hours vs. Group B: 14.45 ± 3.36 hours; p=0.285). Stratified analysis revealed significantly longer PDPH duration in Group A among patients with BMI ≤24 kg/m² (17.45 ± 2.71 vs. 14.17 ± 3.01 hours; p=0.01), male patients (16.52 ± 4.34 vs. 13.75 ± 3.47 hours; p=0.03), and those receiving 22G needles (16.35 ± 3.35 vs. 13.40 ± 3.64 hours; p=0.039). Conclusion: Both oral theophylline and sumatriptan were effective in managing PDPH. However, sumatriptan demonstrated slightly better outcomes, particularly in male patients, those with lower BMI, and those receiving 22G needles. These findings suggest that sumatriptan may be preferred in specific subgroups to reduce PDPH duration.

Comparison of the efficacy of intravenous lignocaine and intravenous dexmedetomidine in attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation.

2026-03-17T04:10:30-07:00

Objective: To compare the efficacy of intravenous lignocaine and dexmedetomidine in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesia, Fauji Foundation Hospital, Rawalpindi. Period: Jul-2025 to Sep-2025. Methods: A total of 170 patients aged18 years or above, belonging to ASA I or II and planned for elective surgeries under general anesthesia were randomized into two groups of 85 patients each. In Group L, patients received IV lignocaine (1.5 mg/kg, 3 minutes before intubation) while patients in Group D received IV dexmedetomidine (1 µg/kg infused over 10 minutes before induction). Hemodynamic parameters (systolic and diastolic blood pressure, and HR) were recorded at baseline and at 1, 3, 5 and 10 minutes following intubation. Efficacy was defined as maintaining the hemodynamic parameters within 20% of baseline values while the primary outcome was set as the peak change in these hemodynamic parameters within the first 5 minutes. Results: Mean age of patients was 47.25±8.15 years. Male patients were 57.06% while female patients 42.94% of total study population. The results of primary outcomes showed that the peak change in systolic and diastolic blood pressure and heart rate were significantly lower in Group D compared to the Group L (p<0.0001 for all parameters). Efficacy was achieved in 82.4% of patients in Group D versus 65.9% in Group L (p=0.01). Conclusion: Dexmedetomidine is more effective than lignocaine in attenuating the hemodynamic stress response to laryngoscopy and intubation.

Comparative analysis of c-mac video laryngoscopy and macintosh laryngoscopy for optimal glottic visualization in adult patients undergoing orthopedic surgery.

2026-04-16T03:43:35-07:00

Objective: To determine the visualization of the glottis using C-MAC videolaryngoscopy and Macintosh laryngoscopy in adult patients undergoing elective orthopedic surgery. Study Design: Randomized Controlled Trial. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: 01-01-2026 to 31-03-2026. Methods: One hundred and forty-six patients (ASA I-II) aged 18-45 years and having no predictors of challenging airways were recruited and assigned randomly to two groups: Macintosh laryngoscopy (Group A, n=73) and C-MAC videolaryngoscopy (Group B, n=73). Intraoperative evaluation of glottic visualization was carried out with the Cormack-Lehane grading system. The SPSS version 23 was used to analyze data, and the p-value below 0.05 was discussed as statistically significant. Results: Macintosh group (45.2) versus videolaryngoscopy group (87.7): Good glottic visualization (CormackLehane Grade I2) was found in 45.2 percent of patients versus 87.7 percent of patients. The poor visualization (Grade III-IV) was found in 54.8% of the patients in the Macintosh group and 12.3% in the videolaryngoscopy group. 5.5 percent of the patients in the Macintosh group had immediate post-intubation complications and none in the videolaryngoscopy group. Conclusion: C-MAC videolaryngoscopy is associated with much better glottic visualization and a superior safety profile than Macintosh laryngoscopy. It can be regarded as a better option in the daily airway management, even in patients with no expected problematic airway.

Association of platelet count during the course of admission with mortality in critically Ill children.

2026-04-16T04:05:26-07:00

Objective: To determine the pattern of platelet count during the course of admission in critically ill children and its association with in-hospital mortality. Study Design: Prospective Cohort study. Setting: Department of Pediatric, Abbasi Shaheed Hospital, Karachi, Pakistan. Period: March 2025 to January 2026. Methods: A total of 201 children admitted to PICU for more than 24 hours were included using non-probability consecutive sampling. Demographics, clinical and diagnostic evaluations were performed along with platelets count, and their association with final outcome was determined. IBM-SPSS Statistics, version 26.0 was used for data analysis. P-value < 0.05 was taken as signficant. Results: Among 201 critically ill children, 116 (57.7%) were male, and the median age was 18.0 (6.0–48.0) months. In-hospital mortality occurred in 39 (19.4%), and 162 (80.6%) were discharged. Median PRISM-III score was higher among children with mortality (p<0.001). Low platelets increased from 57 (28.4%) on day-1 to 70 (34.8%) on day-3, with no overall time effect (p=0.704), but distributions differed by outcome on each day (p<0.001). Mortality was associated with inotropes, respiratory support, mechanical ventilation, blood transfusion, sepsis, catheter-related bloodstream infection, aspiration pneumonia, dysglycaemia, acute kidney injury, and longer PICU stay. Conclusion: Serial platelet monitoring during early PICU admission provides clinically useful prognostic information and aligns with infection, organ dysfunction, and escalation of organ support.

Frequency of hypoglycemia among neonates presenting with fits in pediatric ward Bahawal Victoria Hospital Bahawalpur.

2026-05-19T05:14:51-07:00

Objective: To determine the frequency of hypoglycemia among neonates presenting with clinical seizures. Study Design: Cross Sectional study. Setting: Department of Pediatrics-II, Bahawal Victoria Hospital, Bahawalpur. Period: July 2025 to January 2026. Methods: Fifty-nine neonates exhibiting clinical fits were enrolled via consecutive sampling. Cases with known metabolic diseases, congenital malformations, or tetany were excluded. Point of care blood glucose was measured immediately upon seizure recognition. Hypoglycemia was operationally defined as <30 mg/dL in term or <20 mg/dL in preterm infants within 72 hours of life, and <40 mg/dL thereafter. Statistical analysis employed SPSS version 25.0. Results: The cohort comprised 57.6% males with mean birth weight 2.8±0.7 kg. Hypoglycemia was documented in 23 participants (39.0%). Preterm neonates demonstrated a higher prevalence (52.9%) compared to term infants (33.3%), though statistically non-significant (p=0.18). Hypoglycemic infants experienced significantly greater seizure frequency (3.6±1.4 vs 2.3±1.3 episodes; p=0.002) and predominantly exhibited subtle semiology (p=0.04). Prolonged hospitalization exceeding seven days correlated significantly with hypoglycemia (47.8% vs 19.4%; p=0.03). Mortality was confined to the hypoglycemic subgroup (13.0% vs 0.0%; p=0.06). Conclusion: Hypoglycemia affects approximately two-fifths of neonates presenting with seizures, significantly associating with elevated seizure frequency, subtle clinical manifestations, and extended hospital stays. Mandatory immediate glucose assessment is crucial for optimizing acute neurological management.

Determinants of vaccine hesitancy among parents: A cross-sectional analytical study.

2026-05-20T05:55:22-07:00

Objective: To determine frequency and socio-demographic determinants of vaccine hesitancy among parents visiting a tertiary care hospital in Bahawalpur. Study Design: Analytical Cross-sectional study. Setting: Department of Pediatric Outpatient, Bahawal Victoria Hospital, Bahawalpur. Period: March 2025 to December 2025. Methods: A total of 151 parents who have children between 6 months and 2 years were included. Non-probability consecutive sampling method was used to enroll participants. Data was collected by using structured questionnaire that included the Parental Attitudes about Childhood Vaccines scale. Binary logistic regression analysis was used to find out the factors for vaccine hesitancy after controlling for any potential confounding variables. SPSS version 23.0 was used for analysis. Results: The overall frequency of vaccine hesitancy was 18.5%. Parents with low trust in healthcare providers had 4.2 times higher odds of hesitancy. Reliance on social media (AOR=3.8), primary-level education (AOR=3.1), and history of adverse events following immunization (AOR=2.9) were independently associated with hesitant attitudes. Socioeconomic status and parental age showed no significant association. Conclusion: Vaccine hesitancy is driven primarily by psychological and informational factors rather than access barriers. Interventions must prioritize rebuilding provider parent trust, combating digital misinformation and enhancing health literacy among populations.

Polypharmacy in critically Ill children: A prospective cross-sectional study from a Tertiary PICU in Pakistan.

2026-04-16T07:54:32-07:00

Objective: To determine the frequency and patterns of polypharmacy from the PICU of a tertiary care children’s hospital in Karachi, Pakistan. Study Design: Prospective Cross-sectional Observational study. Setting: PICU at Korangi Children Hospital, Karachi, Pakistan. Period: Three months: March–May 2025. Methods: All admitted children aged 1 month to 15 years were included. Patients with PICU stay of less than 48 hours were excluded. Data on clinico-demographic characteristics and prescribed medications were collected. Polypharmacy was defined as ≥5 medications, while hyper-polypharmacy was defined as ≥10. Descriptive statistics were used to summarize demographics, prescribing patterns, and the frequency of polypharmacy. Results: Among 499 patients included in the analysis, polypharmacy was observed in 46.9% of patients, while 26.3% had hyper-polypharmacy. The median number of medications per patient per day was 7 (interquartile range 4-10). Anti-infective agents were the most prescribed class of drugs; ceftriaxone (41%) and meropenem (15%) were the most frequently used. Other commonly prescribed drug classes included sedatives, vasoactive agents, and corticosteroids. Most medications were administered intravenously. Conclusion: Polypharmacy is highly prevalent among critically ill pediatric patients in this setting. These findings highlight the need for rational prescribing practices, pharmacovigilance, and the integration of clinical pharmacists into PICU care to optimize medication safety.

Screening for migraine and non-migraine headaches and their impact on daily functioning among undergraduate medical students.

2026-07-09T07:19:45-07:00

Objective: To assess frequency of migraines and measure their functional impact among undergraduate medical students. Study Design: Cross-sectional study. Setting: Aziz Fatimah Medical and Dental College, Faisalabad. Period: June 2024 to November 2024. Methods: 191 medical students (109 female, 82 male) were recruited through convenience sampling. Participants completed the 3-item Identify-Migraine (ID-Migraine) screening questionnaire and the 6-item Headache Impact Test (HIT-6) questionnaire through a virtual Google Form. The data was analyzed using SPSS version 27. Results: 79 (41%) screened positive for migraine using the ID-Migraine questionnaire. Migraine prevalence was higher in females than males (p = 0.005). Females also reported greater migraine-related disability than males, with higher proportions experiencing moderate (11% vs. 8.9%) and severe disability (20.4% vs. 6.8%) (p = 0.012). Among migraine-positive students, 14% of females versus 3% of males experienced severe disability. Notably, 19.5% of students who screened negative still reported moderate-to-severe disability. Conclusion: This study provides valuable insight into the prevalence and functional impact of migraine among undergraduate medical students, highlighting a significantly higher burden experienced by female students. The findings underscore the importance of early screening among populations of interest to help mitigate the academic and functional consequences of migraine.

Burn Out syndrome among resident doctors: Association with work hours and perceived organizational support.

2026-06-17T07:58:40-07:00

Objective: To evaluate the independent and moderating effects of perceived organizational support on burnout syndrome trajectories among resident physicians navigating clinical training environments. Study Design: Analytical Cross-sectional. Period: July to December 2024. Setting: Shahida Islam Medical College, Lodhran. Methods: Stratified random sampling enrolled 112 active postgraduate medical residents across diverse clinical specialties. Participants completed structured instrument capturing demographic and occupational variables, Maslach Burnout Inventory-Human Services Survey metrics, and the Survey of Perceived Organizational Support. Hierarchical multiple linear regression and moderation analyses were executed via SPSS version 25.0 to isolate predictive relationships and institutional buffering effects, adjusting for demographic confounders. Results: The participants average weekly work hours 72.5, with 64.3% exceeding 60 hours weekly. Extended duty hours demonstrated a significant positive correlation with emotional exhaustion (r=0.42) and depersonalization (r=0.35). Conversely, robust institutional support exhibited strong inverse correlations with these adverse psychological outcomes. Hierarchical regression models confirmed that prolonged work schedules (β=0.34) and diminished organizational backing (β=-0.31) independently predicted elevated emotional exhaustion. Crucially, moderation analysis revealed that perceived support significantly buffered the detrimental psychological impact of excessive clinical hours, effectively altering adverse burnout trajectories. Conclusion: While excessive clinical hours substantially fuel resident burnout, strong perceived organizational support serves as a vital protective buffer. Healthcare administrations must prioritize cultivating empathetic, supportive institutional cultures alongside strict duty-hour monitoring to safeguard trainee mental health and prevent professional attrition in medical training.

Effectiveness of Problem-based learning versus conventional lectures on knowledge retention and engagement, among adult nursing students in Pakistan.

2026-04-20T05:36:07-07:00

Objective: To compare the difference in outcome, educational experience and knowledge retention of PBL and conventional (lecture based) teaching of adult nursing students of Pakistan. Study Design: Quasi-experimental Cross Over study. Period: January to March 2025. Setting: College of Nursing, Bahawal Victoria Hospital/QAMC, Bahawalpur. Methods: After taking ethical approval (Ref No: 2387/DME/QAMC Bahawalpur) total of 60 4^th year nursing students were included (30 PBL and 30 conventional). Knowledge and competency related to myocardial infarction (MI) were assessed using a pretest posttest design with cross over to compare the knowledge acquisition and retention. The class attractiveness and overall educational experience was measured using a structured 12-item questionnaire. Perceptions regarding PBL were measured using a Likert-scale instrument. Data were analyzed using independent sample t-tests with significance set at p ≤ 0.05. Results: PBL students demonstrated significantly higher knowledge in multiple MI-related domains including symptom recognition (p=0.01), ECG interpretation (p=0.02), laboratory interpretation (p=0.009), counseling confidence (p=0.005), and pathophysiology understanding (p=0.01). They also reported significantly higher motivation and perceived understanding with PBL compared to traditional methods (p<0.05). The PBL groups showed significantly higher knowledge retention in first post-test score (p=0.001). After crossover, final scores were even better and comparable though the group who took PBL later had a slightly higher scores. There was a significant time effect (f-value 112.5 and p-value <0.001). Reliability was acceptable to good and improved in post-test (Cronbach’s alpha 0.84). Conclusion: PBL (Problem based learning) is associated with improved knowledge retention, greater perceived benefit, engagement, active participation and motivation as compared to traditional teaching. Exposure to both modalities/ hybrid approach maximizes benefits, leading to deeper understanding and better learning outcomes.

Students' lived experiences in a lower-ranked Medical College, KPK: A qualitative study.

2026-05-06T05:29:36-07:00

Objective: To understand students' experiences in a lower-ranked medical college in Khyber Pakhtunkhwa, Pakistan, and to identify their emotional reactions, academic and social adaptations and coping mechanisms to deal with academic stress. Study Design: Phenomenological Qualitative study. Setting: Period: January to March 2025. Methods: we conducted in-depth semi-structured interviews with ten undergraduates of medical college. Manual thematic analysis was used for data analysis. The study was designed in line with the COREQ guidelines. Results: Initially, students felt disappointment and a sense of failure but eventually adapted academically and socially through resilient coping strategies. Some participants felt the quality of education did not match their expectations, but others noted that hard work was more important than university ranking. Longitudinally, there was a greater emphasis on postgraduate education for future careers. The role of peer, faculty and family support were crucial for student success. Conclusion: This research sheds light on the complex emotional and academic experiences of students in "lower-tier" medical colleges. Students in lower-ranked medical colleges can fulfil their potential with the right institutional support, mentorship and career guidance programs, independent of the rank of their college.

Comparison of outcome in Hybrid Laser Surgery (DLPL) and Partial Fistulectomy with Seton in Complex Fistula-in-Ano: A randomized controlled trial.

2026-06-27T07:11:00-07:00

Objective: To compare the clinical outcomes of DLPL with partial fistulectomy combined with seton placement in patients with complex fistula-in-ano. Study Design: Randomized Controlled Trial. Setting: Aziz Fatimah Hospital which is Affiliated with Aziz Fatimah Medical and Dental College, Faisalabad. Period: One Year from January 2025 to January 2026. Methods: We enrolled 52 patients with complex fistula-in-ano. Patients were randomly allocated to either DLPL (n=26) or partial fistulectomy with seton placement (n=26). Inclusion criteria comprised recurrent fistulas, multiple external openings, and high-lying fistulas confirmed by MRI. Primary outcomes included healing rate, recurrence rate, healing duration, and incontinence. Secondary outcomes included return to work time and treatment cost. Follow-up assessments were conducted at 1, 3, 6, and 12 months postoperatively. Results: Of 52 enrolled patients, 42 completed the study (21 per group). The DLPL group demonstrated superior outcomes with an 85.7% healing rate compared to 62% in the fistulectomy group. Mean healing time was significantly shorter in the DLPL group (4±1.5 weeks vs. 11±2.3 weeks). Recurrence occurred in 3 patients (14.3%) in the DLPL group versus 8 patients (38%) in the fistulectomy group. Notably, no incontinence was observed in the DLPL group, while 17 patients (81%) in the fistulectomy group developed incontinence. Return to work was significantly faster with DLPL (14±4 days vs. 45±5 days). Treatment costs were comparable between groups (0.15 vs. 0.14 million rupees). Conclusion: Hybrid laser surgery (DLPL) represents a superior treatment modality for complex fistula-in-ano, offering significantly better healing rates, faster recovery, lower recurrence, and complete preservation of continence compared to partial fistulectomy with seton placement. Despite comparable costs, DLPL should be considered the preferred approach for complex anal fistulas in appropriate clinical settings.

Iron Deficiency Anemia in pregnant women at GMMMC Teaching Hospital Sukkur.

2026-08-17T06:11:41-07:00

Objective: To determine iron deficiency anemia (IDA) among pregnant women at GMMMC Teaching Hospital, Sukkur, Pakistan. Study Design: Across-sectional study. Setting: Department of Obstetrics & Gynecology, GMMMC Teaching Hospital, Sukkur. Period: June, 2024 to May, 2025. Methods: Pregnant women aged 18-40 years attending outpatient antenatal clinics were enrolled by consecutive sampling. Hemoglobin (Hb), red cell indices (MCV, MCH), serum ferritin and serum iron were measured (automated hematology analyzer and standard biochemical assays). Anemia was defined using WHO hemoglobin thresholds for pregnancy; IDA was diagnosed as anemia with ferritin <15 ng/mL together with low serum iron (<50 µg/dL) and microcytosis. Sociodemographic and obstetric variables (trimester, parity, interpregnancy interval, dietary iron intake and socioeconomic status) and symptoms were recorded on a structured questionnaire. Data were analyzed on SPSS 26 using descriptive statistics; was done using chi-square tests (p<0.05). Results: Among 1,240 pregnant women, 726 (58.5%) were anemic and 514 (41.5%) met criteria for IDA (70.8% of anemic women). IDA was most frequent in the third trimester (249/514, 48.4%) and among multiparous women (≥G2: 386/514, 75.1%). Mean Hb in IDA cases was 8.9±1.2 g/dL, mean ferritin 10.8±3.4 ng/mL and mean serum iron 38.6±6.8 µg/dL. Common symptoms were fatigue (82.7%), pallor (78.2%) and dizziness (43.4%). Low dietary iron intake (p<0.001), short birth spacing <2 years (p=0.002), multiparity (p=0.01) and low socioeconomic status (p<0.001) were significantly associated with IDA. Parenteral iron was required in 48 (9.3%) women and 5 (1.0%) required blood transfusion. Conclusion: IDA remains highly prevalent among pregnant women in Sukkur, predominantly affecting women in late pregnancy and those with high parity and socioeconomic disadvantage. Strengthening routine screening, nutrition counseling, iron supplementation adherence and birth spacing is essential.

Hypertension treatment protocol for general physicians based on European society of cardiology and American heart association.

2026-01-08T05:50:19-08:00

The majority of our hypertension-related patients are treated by general physicians, not specialists. And trend of continuing medical education is lacking in Pakistan. In many countries, including India, Bangladesh, and Africa, general physicians are provided with a basic framework. This article is an attempt in this direction. A simple one-page, easy-to-read protocol based on recent and up-to-date guidelines from the European Society of Cardiology. It gives a basic framework for uniform treatment across the country and also gives them a basic diagnostic approach. How to assess on the first patient visit and what to do if the patient's follow-up is in doubt. It also gives them a basic guideline on when to refer the patient for specialist review.