The Professional Medical Journal

A diagnostic dilemma: Severe hypokalemia presenting with GBS-like clinical feature.

2025-09-09T07:10:29-07:00

Acute flaccid paralysis is a potentially life- threatening presentation necessitating prompt and precise diagnosis. Guillain-Barre’ Syndrome (GBS) is often the first consideration due to its prevalence and severity. However, non-neurological conditions, particularly metabolic disturbances such as hypokalemia, can clinically and electrophysiologically mimic GBS. Hypokalemic paralysis, albeit rare, represents a reversible etiology of acute limb weakness. It may present with symptoms indistinguishable from GBS, including areflexia and ascending limb paralysis, resulting in a diagnostic dilemma. A misdiagnosis can delay appropriate treatment and subject the patient to unnecessary interventions. This case report elucidates a patient who exhibited classic features of GBS but was ultimately diagnosed with severe hypokalaemia. It underscores the imperative of good clinical assessments including correctly identifying serum electrolytes abnormalities in all patients presenting with acute neuromuscular weakness.

Gender based differences in in-hospital complications in patients with acute coronary syndrome.

2025-10-30T07:42:14-07:00

Objective: Ischemic heart disease has become the major cause of disease burden worldwide, as measured by disability-adjusted life years. The impact of gender on mortality in acute coronary syndrome patients is unclear. Study Design: Cross-sectional study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: 01-01-2022 to 30-06-2022. Methods: objective of the present study was to determine the frequency of in-hospital complications in patients being admitted with acute coronary syndrome and also to compare the prevalence of in-hospital complications between male and female patients presenting with acute coronary syndrome. Results: Among 965 ACS patients (mean age 58.4 ± 11.5 years, range 26–92), most were over 55 years (56.7%), and males constituted 66.6%. STEMI was the most prevalent ACS type (58.1%), followed by NSTEMI (35.9%) and unstable angina (6.0%). STEMI was more common in males (60.7%) compared to females (53.1%), while NSTEMI was more prevalent in females (41.9% vs. 32.8%). Conclusion: This study highlights significant patterns in the presentation, complications, and gender differences among patients with acute coronary syndrome (ACS). These findings underscore the importance of gender-specific approaches in ACS management.

Frequency, types and causes of anaemia in ischemic stroke patients admitted to medical wards of Khyber Teaching Hospital.

2025-03-10T04:16:08-07:00

Objective: To determine the frequency, types and causes of anaemia in ischemic stroke patients admitted to medical wards of Khyber Teaching Hospital Peshawar. Study Design: Cross-sectional study. Setting: Department of Medicine, Khyber Teaching Hospital, Peshawar. Period: 5th December 2023 till 4th June 2024. Methods: Convenient sample technique was used. A total 368 patients presenting with stroke were enrolled. The patients were evaluated for the type and cause of anemia. Hb <12.0gm/dl was considered the cut off for anemia. Data was analysed using SPSS version 24. Results: Mean age of the patients was 53.34 ± 13.29 years. Male to female ratio was nearly 1: 1. Hypertension was the most common comorbidity observed in 86 patients (23.4%). Normochromic normocytic anemia was the common type observed in 150 patients (40.7%). Conclusion: Normochromic normocytic anemia is the most common type of anemia in patients with ischemic stroke. Elderly female patients with underlying chronic disease like disease and prolonged illness are more likely having anemia.

Serum ferritin-based assessment of iron deficiency in individuals with β-thalassemia trait.

2025-08-07T03:57:21-07:00

Objective: The study aims to evaluate the potential coexistence of iron deficiency and BTT. Additionally, this study assesses the effect of iron deficiency on haematological indices of individuals with BTT. Study Design: Cross-sectional study. Setting: Noor Thalassemia Foundation, Lahore. Period: May 2024 and May 2025. Methods: Model and involved the random selection of 74 participants, including parents of known beta thalassemia major cases and patients with beta thalassemia trait (HbA2 >3.5%), who visited the OPD department of a private thalassemia center in Lahore. 5ml venous blood was drawn and subjected to complete blood count CBC, Haemoglobin electrophoresis, and serum ferritin measurement. Results: Out of 74 participants, 65 were females and 9 were males. Iron deficiency, characterized by a serum ferritin concentration below 15 ng/mL, was found in 23 individuals, while 42 individuals had a serum ferritin concentration above 15 ng/mL. Mean levels of HbA₂were 5.6±0.4%, mean haemoglobin concentration was 10.24±1.36g/dL, mean MCV was 64.73±7.32fL, and mean MCH was 19.94±4.04%. The mean value of serum ferritin levels in our study population was 34.74±32.27 ng/mL. Conclusion: A total of 23 individuals (31%) were found to be iron deficient. Iron deficiency reduced the red blood cell count, haemoglobin concentration, and MCV while it increased the RDW in BTT individuals (p<0.05), indicating that iron deficiency significantly affects the haematological indices in carriers of BTT.

Prenatal exposure and risk of medication in autism spectrum disorder.

2025-07-15T06:12:09-07:00

Objective: The research aims to investigate correlations between prenatal medication exposure and ASD risk. Study Design: Cross-Sectional Observational Study. Setting: Department of Speech Language Pathology, The University of Lahore. Period: 22^nd April 2024 22^nd October 2024. Methods: Involving 45 mothers of autistic children. The research spanned 12 months, employing a purposive sampling technique and a self-designed questionnaire. Data analysis utilized SPSS software, focusing on demographic characteristics and questionnaire responses. Results: Findings reveal a variety of factors potentially associated with ASD, including abrupt medication changes (26.7%), pre-clampsia (35.6%), maternal age (60% within 25-30 age group), neurological conditions (37.8%), cousin marriages (37.8%), and complications during delivery (22.2%). The study emphasizes the complexity of ASD and highlights potential risk factors. Conclusion: The research concludes that while no specific prenatal factor is implicated in ASD etiology, certain associations suggest that exposure to pregnancy complications may increase the risk. The study underscores the need for a nuanced understanding of ASD and early intervention strategies.

Establishment of reference range of HER2 by chemiluminescence method in healthy females.

2025-07-19T06:35:43-07:00

Objective: To establish reference range for serum HER2 levels in normal Asian females and provide a comprehensive overview of its current understanding to step towards improving the accuracy and utility of serum HER2 as biomarker. Study Design: Cross Sectional study. Setting: Farooq Hospital Westwood, College of Allied Health Sciences, Akhtar Saeed Medical & Dental College Lahore. Period: October 2024 to December 2024. Methods: The female participants visited aged 30-70 years, free of symptoms and signs suggestive of any breast abnormality were included. The 120 female participants were enrolled for establishing reference value of serum HER2 levels. The venous blood sample was drawn for HER2 levels. The auto analyzer was used for HER2 estimation. The data was analyzed through the IBM SPSS V.27.0. Results: A total 120 females were enrolled. The mean + SD was 45.0 + 9.879. The weighted average test was used to determine 25^th and 95^th percentile value in order to establish lower reference limit and upper reference limit of HER2 assay. The established reference range was 9.41 to 14.03 ng/ml. The results revealed that 25% data was below 9.41ng/ml and 95 % of females HER2 levels were under 14.03ng/ml. Conclusion: The present study established a preliminary reference range for serum HER2 in healthy females, contributing to improved breast cancer diagnostics and monitoring in our region.

Diagnostic accuracy of diffusion weighted magnetic resonance imaging in differentiating benign and malignant meningioma taking histopathology as gold standard.

2025-09-23T06:38:07-07:00

Objective: To evaluate the ability of diffusion-weighted MR Imaging to distinguish malignant meningiomas from benign, taking histopathology as the gold standard. Study Design: Cross-Sectional Validation Study. Setting: Department of Radiology, Aziz Fatimah Hospital and Allied Hospital, Faisalabad. Period: October 2024 to April 2025. Methods: A total of 225 patients aged between 20 to 60 years with suspected meningiomas were enrolled. DWI-MRI was performed using a 1.5 Tesla scanner (b-values 0, 500, and 1000 s/mm²). Findings were interpreted by a consultant radiologist and compared with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated using SPSS version 20.0; a p-value < 0.05 was considered significant. Results: DWI-MRI showed a high diagnostic accuracy (86.67%) in distinguishing malignant from benign meningiomas, with sensitivity 88.52%, specificity 84.47%, PPV 87.10% and NPV 86.14% (p = 0.0001). Conclusion: DWI-MRI is a reliable, non-invasive imaging modality with high diagnostic accuracy for differentiating benign and malignant meningiomas and can significantly aid in preoperative assessment and treatment planning.

A comparative study of intrathecal 1mg nalbuphine as adjunct to 15mg of bupivacaine 0.75% versus 15mg of bupivacaine 0.75% alone in spinal anesthesia for infraumbilical surgeries.

2025-09-23T06:58:18-07:00

Objective: To compare mean duration of analgesia when 1mg Nalbuphine is added to 15mg of Bupivacaine 0.75% versus 15mg of Bupivacaine 0.75% alone in spinal anesthesia for infraumbilical surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Allied Hospital, Faisalabad. Periods: April 2024 to October 2024. Methods: Total 60 subjects undergoing elective infraumbilical surgery under spinal anesthesia were assigned to two groups; Group A received inj. 0.75% Bupivacaine 15mg along with inj. Nalbuphine 1mg (0.1ml) in subarachnoid space via 25 gauge Quinke type spinal needle and Group B received 0.75% bupivacaine 15mg alone in subarachnoid space using 25guage spinal needle. Analgesia duration (hours) was calculated from sensory block onset to first request of analgesia using VAS score. Analysis of data was done using SPSS.23, for statistical significance p-value ≤0.05 was taken. Results: Sensory and motor block onset in Group A vs B noted was 3.25 ± 0.41 minutes & 6.36 ± 0.66 minutes vs 4.31 ± 0.39 minutes & 7.90 ± 0.63 minutes (p<0.001). Duration of postoperative analgesia was longer in Group A 5.77 ± 0.57 hours vs 5.03 ± 0.29 hours in Group B (p < 0.001). Conclusion: These findings suggest that intrathecal Nalbuphine added to Bupivacaine can considerably prolonged the duration of analgesia versus when Bupivacaine used alone in spinal anesthesia for infraumbilical surgeries irrespective of age, gender, or comorbidity status.

Evaluation of the effectiveness of multimodal analgesia with low-dose opioids in reducing the need for stronger opioids (Nalbuphine) in post-operative pain management for CABG patients: A quasi-experimental study.

2025-08-05T04:43:50-07:00

Objective: To evaluate effectiveness of multimodal analgesia (MMA) with low-dose opioids in reducing postoperative pain and the need for stronger opioids (nalbuphine) in patients undergoing coronary artery bypass grafting (CABG). Study Design: Quasi-experimental study. Setting: Department of Anesthesia Peshawar Institute of Cardiology, A Tertiary Care Hospital. Period: November 2024 to March 2025. Methods: Was conducted with 30 CABG patients receiving a standardized MMA regimen (acetaminophen, gabapentin, ketorolac, and low-dose morphine) for 72 hours postoperatively. Effectiveness was defined as maintaining Visual Analog Scale (VAS) scores ≤6/10 without nalbuphine escalation. Data on pain scores, opioid consumption, mobilization time, hospital stay, and complications were analyzed using SPSS v23. Results: MMA was effective in 83.3% of patients (n=25), while 16.7% (n=5) required nalbuphine. Median VAS pain scores decreased from 4 (IQR 3-5) at 6 hours to 0 (IQR 0-0) at 72 hours. Sedation was significantly associated with effectiveness (56% vs. 0%, p=0.022). No significant associations were found with demographic or surgical variables (all p>0.05). Postoperative complications included nausea (36.7%), vomiting (23.3%), and respiratory depression (16.7%). Conclusion: MMA with low-dose opioids effectively controlled post-CABG pain in most patients, reducing the need for stronger opioids. Sedation may serve as a clinical indicator of effective analgesia.

Comparison of pain scores between first and second session ESWL treatment for kidney stone patients.

2025-05-26T04:14:32-07:00

Objective: To determine and compare pain scores between the first and second session ESWL treatment for kidney stone patients. Study Design: Descriptive, Case Series. Setting: Armed Forces Institute of Urology, Rawalpindi. Period: 1^st January 2021 to 30^th June 2021. Methods: A total of 133 patients with renal pelvis stone of 8-20 mm, 15 to 65 years old of the two sexual orientations were incorporated. Patients with stone in calycealdiverticulae with limited infundibulum, Renal ectopia or contortion, pregnancy, pyonephrosis and PUJO, claustrophobic and cardiovascular speed producer were prohibited. In the wake of taking informed assent, extracorporeal shock wave lithotripsy (ESWL) was finished in every patient. After this, anti-infection (infusion ceftriaxone 1gm IV x detail) and pain relieving (infusion dyclo IM x detail) was given to all patients before every meeting. Then extracorporeal shock wave lithotripsy (ESWL) was finished in every patient by single specialist (something like 3 years of post-cooperation experience). In all patients, two meetings were finished and torment score after first and second meeting (in no less than 10 days) was noted. Results: Age range in this study was from 15 to 65 years with mean time of 41.17 ± 8.83 years. Larger part of the patients 76 (57.14%) were between 15 to 40 years old. Out of 133 patients, 84 (63.16%) were male and 49 (36.84%) were females with male to female proportion 1.6:1. In our review, mean agony score after first meeting of ESWL was 5.29 ± 0.79 and after second meeting of ESWL was 3.75 ± 0.89 with p-worth of 0.0001. Conclusion: This study concluded that VAS scores is significantly lower in the second session of ESWL.

Effect of spinal anesthesia versus general anesthesia on blood glucose concentration in patients undergoing elective cesarean sections.

2025-05-22T07:05:33-07:00

Objective: To compare mean blood sugar levels in patients undergoing elective cesarean sections through spinal versus general anaesthesia. Study Design: Prospective Cohort Study. Setting: Department of Anaesthesiology, Allama Iqbal Teaching Hospital DG Khan. Period: 1^st March 2024 to 31^st August 2024. Methods: Non-diabetic pregnant women aged 20 – 45 years with ASA-I status undergoing elective cesarean section were enrolled. Women with diabetes, eclampsia / preeclampsia, cardiomyopathy or allergy to anesthetic agents were excluded. Participants were categorized as exposed if opted for spinal anesthesia and unexposed if opted for general anesthesia. Blood glucose levels were measured preoperatively and 30 minutes of surgery using a standardized glucometer. Descriptive statistics are run using SPSS version 23. Numerical and categorical comparisons across the groups are made through t-test and chi-square test respectively at 5% significance level. Results: A total of 248 patients (124 per group) were included. Baseline characteristics including BMI, fasting duration, surgery duration and fluid type were comparable. Mean preoperative blood glucose was higher in spinal than general anesthesia group (83.9 ± 8.3 vs. 81.2 ± 8.6 mg/dl; p = 0.011). Post-operative glucose levels were significantly higher in spinal (126.4 ± 15 vs. 56.7 ± 9.8 mg/dl; p-value < 0.001). This difference remains significant across stratified groups. Conclusion: Spinal anesthesia was associated with significantly higher postoperative blood glucose levels compared to general anesthesia in non-diabetic women undergoing cesarean section. Monitoring perioperative glucose in spinal anesthesia may warrant further attention.

Incidence and risk factors of acute kidney injury in term neonates.

2025-07-14T04:35:57-07:00

Objective: To determine the incidence and risk factors of acute kidney injury in term neonates. Study Design: Prospective Observational study. Setting: Neonatal Intensive Care Unit (NICU) of National Institute of Child Health, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 190 neonates suspected to have AKI and admitted to the NICU were enrolled. The development of AKI during the study or discharge from the NICU was noted. Risk factors of AKI were also evaluated. Multivariate binary logistic regression analysis was performed for the determination of risk factors associated with the development of AKI in neonates taking p<0.05 as statistically significant. Results: Among 190 term neonates, 104 (54.7%) were male, and the mean age at admission was 2.92±1.89 days. There were 72 (37.9%) neonates who developed AKI, with stage 1 in 58.3%, stage 2 in 26.4%, and stage 3 in 15.3%. Mortality was higher in the AKI group (11.1% vs. 3.4%, p=0.035). Multivariate logistic regression identified maternal diabetes (adjusted odds ratio [aOR]: 3.22), pregnancy-induced hypertension (aOR: 2.85), IUGR (aOR: 3.75), and longer NICU stay (aOR per day: 1.16) as independent risk factors for AKI. Mortality was significantly high in AKI neonates (11.1% vs. 3.4%, p=0.035). Conclusion: This study demonstrated a high incidence of AKI among term neonates, with maternal diabetes, pregnancy-induced hypertension, maternal infection, IUGR at birth, and prolonged NICU stay identified as significant and independent risk factors.

Effect of human milk fortification at different volume of feeds in pre-term newborns (< 32 weeks of gestation).

2025-07-19T04:05:37-07:00

Objective: To assess how feeding volume of `human milk fortification (HMF) influences growth and bone mineral status in preterm infants. Study Design: Parallel-arm, Randomized Controlled Trial. Setting: Department of Neonatology, RTEH Indus Hospital, Muzaffargarh, Pakistan. Period: September 2024 to June 2025. Methods: A total of 132 preterm newborns born before 32 weeks of gestation, with Apgar scores below 7 at five minutes, admitted to the NICU within 24 hours and exclusively fed maternal human milk were enrolled. Infants were randomized into early (70–100 ml/kg/day), middle (101–130 ml/kg/day), or late (130–160 ml/kg/day) HMF initiation groups. Growth parameters, bone mineral status (BMS), and complications were recorded at 36 weeks post-menstrual age (PMA). Data were analyzed using ANOVA and chi-square tests, with statistical significance set at p<0.05. Results: Among a total of 132 preterm infants, 66 (50.0%) were male, and the mean gestational age was 30.1±1.1 weeks. At 36 weeks PMA, the early HMF group showed significantly greater weight gain (1021.8±156.3 g) and linear growth (3.7±0.8 cm), with higher head circumference increase (3.3±0.7 cm), compared to the late HMF group (p<0.001). Early HMF was associated with lower alkaline phosphatase (309.2±61.6 IU/L) and higher calcium and phosphorus levels. Conclusion: The early initiation of HMF at lower enteral feeding volumes in preterm infants is associated with improved growth and BMS at 36 weeks PMA.

Frequency and outcomes of cumulative excess oxygen exposure in ventilated pediatric ICU patients.

2025-10-09T05:50:55-07:00

Objective: To determine the frequency of cumulative excess oxygen exposure (CEOE) and its association with mortality in ventilated children. Study Design: Retrospective Cohort study. Setting: Pediatric ICU of Sindh Institute of Child Health and Neonatology, Karachi. Period: January 2023 to June 2023. Methods: The study sample size of 200 was determined using the OpenEpi sample size calculator employing a non-probability consecutive sampling method, and included children (1 month–15 years) admitted who required invasive ventilation ≥24 hours. CEOE was defined as mean hourly FiO₂ >0.21 with SpO₂ ≥95% in the first 24 hours of ventilation. Patients were stratified into quartiles: hypoxemia (SpO₂ <94%), no CEOE, and CEOE quartiles (Q1: >21–30%, Q2: 30–45%, Q3: 45–60%, Q4: ≥60%). Variables included hourly FiO₂ >21% with SpO₂ >95%, clinical parameters, admitting diagnosis, length of stay, comorbidities, and outcome (survival or exitus). Statistical analysis was performed using Chi-Square and Mann-Whitney U tests, with p <0.05 considered significant. Results: Among 115 patients, mean CEOE was 37.3 ± 11.9%, with overall mortality of 26.1%. Non-survivors had higher mean CEOE than survivors (41.2 ± 10.9% vs. 36.2 ± 12.0%; p<0.009). Mortality, multi-organ dysfunction, and PICU stay increased stepwise across CEOE quartiles. Logistic regression showed higher odds of mortality in Q2 and Q3 versus Q1, though not statistically significant after adjusting for age and gender. Conclusion: In ventilated children, excessive oxygen exposure was common and associated with increased mortality, organ dysfunction, and longer PICU stay. These findings highlight the need for vigilant oxygen titration and careful avoidance of hyperoxia to improve outcomes in pediatric critical care

Association of heart rate and oculocardiac reflex (OCR) during strabismus surgery in children.

2025-11-01T07:04:03-07:00

Objective: To determine the relationship between the baseline heart rate and the occurrence of the oculocardiac reflex in pediatric strabismus surgery using horizontal extraocular muscles. Study Design: Observational study that was designed as a retrospective study. Setting: Mughal Eye Hospital, Lahore, Pakistan. Period: January-July 2024. Methods: Fifty children aged 3-12 years old who had elective surgery on strabismus (either esotropia or exotropia) were included. The baseline heart rate was used to classify patients as low (70-90bpm) and high (91-120bpm). All the surgeries were done under a standardised general anesthesia with intraoperative follow-up. The OCR was characterized as a 20 percent or more decrease in heart rate at baseline with extraocular muscle traction. Data were also analyzed with SPSS version 26, and associations were determined with the Chi-square test, and p was taken as significant (p < 0.05). Results: The mean age of participants was 7.6 ± 2.4 years, and the overall incidence of OCR was 58%. OCR occurred in 78.6% of patients with a low baseline heart rate and 31.8% of those with a high baseline heart rate, showing a statistically significant association (p = 0.001). OCR was more frequent during medial rectus surgery (35.7%) than lateral rectus (22.7%), though this difference was not statistically significant (p = 0.320). All OCR episodes were transient and managed successfully with cessation of traction and deepening of anesthesia. Conclusion: Children with lower baseline heart rates are significantly more prone to developing the oculocardiac reflex during strabismus surgery. Preoperative assessment of heart rate can thus serve as a simple yet valuable predictor for identifying high-risk patients and enhancing intraoperative preparedness.

Frequency of retinopathy of prematurity in preterm low birth weight vs preterm very low birth weight admitted to Abbasi Shaheed Hospital, Karachi, Pakistan.

2025-07-19T04:09:26-07:00

Objective: To determine the prevalence of retinopathy of prematurity (ROP) in preterm low birth weight (LBW) versus very low birth weight (VLBW) among admitted infants. Study Design: Prospective Observational study. Setting: The Pediatric Department, Abbasi Shaheed Hospital, Karachi, Pakistan. Period: January 2025 to June 2025. Methods: A total of 100 preterm newborns (50 LBW, and 50 VLBW) of any gender, admitted to the NICU within 48 hours, and without congenital ocular abnormalities were included. All infants were examined and managed for ROP using standard protocols. Data were analyzed using SPSS version 26.0. Stratification of effect modifiers was done to observe their effect on ROP. Inferential statistics were applied taking p<0.05 as significant. Results: In 100 preterm newborns, 51 (51.0%) were females, and the mean age was 11.4±5.5. ROP was found in 61 (61.0%) infants. Those with ROP had significantly lower birth weight (1390.2±286.8 g vs 1604.6±361.3 g, p=0.001) and gestational age (29.7±2.0 vs 31.1±1.1 weeks, p<0.001), with VLBW seen in 67.2% versus 23.1% without ROP (p<0.001). Cesarean section delivery (80.3% vs 43.6%, p<0.001), lower Apgar scores, surfactant (34.4% vs 7.7%, p=0.002), steroid use (9.8% vs 0%, p=0.047), longer oxygen therapy and NICU stay, and all deaths (14.8%) were significantly associated with ROP. Conclusion: There is a substantial burden of ROP among preterm VLBW infants, with key risk factors including lower gestational age, lower birth weight, and prolonged oxygen therapy.

Predictive Value of Ultrasonography and Alkaline Phosphate (ALP) in Common Bile Duct (CBD) Stones.

2025-07-24T04:27:43-07:00

Objective: To assess the predictive performance of trans‑abdominal US (TAUS) and serum ALP for detecting CBD stones in adults by taking MRCP as the reference standard. Study Design: Prospective Cross-validation study. Setting: Department of Gastroenterology, Kulsoom Bai Valika Hospital, Karachi, Pakistan. Period: Oct 2024 to Apr 2025. Methods: Adults (≥ 18 years) with clinical suspicion of common bile duct stones underwent TAUS (2–5 MHz convex probe) and serum ALP measurement within 6 hours of admission. All participants then received MRCP within 48 hours, interpreted by a radiologist blinded to TAUS and ALP results. In a subset proceeding to surgery (n=80), intraoperative findings and cholangiography confirmed stone presence and clearance. We calculated sensitivity, specificity, positive and negative predictive values, overall accuracy and area under the receiver‑operating‑characteristic curve (AUC) for TAUS, ALP ≥ 400 IU/L and their combination. Results: Of 210 enrolled patients (mean age 45.7 ± 12.5 years; 61.9 % female), MRCP confirmed choledocholithiasis in 122 (58.1 %). TAUS detected stones with 78.7 % sensitivity, 72.1 % specificity, 80.0 % PPV and 71.1 % NPV. ALP ≥ 400 IU/L yielded 65.6 % sensitivity, 42.0 % specificity, 61.1 % PPV and 46.8 % NPV. Among 80 surgically explored patients, 68 (85 %) had stones confirmed and 42 of 45 (93.3 %) underwent successful intraoperative cholangiographic clearance. Conclusion: High‑resolution TAUS outperform ALP ≥ 400 IU/L for non‑invasive choledocholithiasis detection and should remain the frontline diagnostic modality. MRCP or endoscopic ultrasound should be reserved for equivocal cases or intermediate‑risk patients.

Comparison of the frequency of post-operative wound infection and mean length of ICU stay after tight versus standard glycemic control among diabetic patients undergoing CABG.

2025-07-21T07:29:26-07:00

Objective: To compare post-operative wound infection rates and average ICU stay length in diabetic patients undergoing coronary artery bypass surgery at Azra Naheed Medical College, Lahore, based on strict glycemic control versus standard glycemic control. Study Design: Randomized Controlled Trial. Setting: Azra Naheed Medical College, Lahore. Period: January 2023 to June 2023. Methods: Total 260 eligible diabetic patients scheduled for surgery provided informed consent following ethical committee approval. A lottery-based randomization process allocated patients to Group A (tight glycemic control, blood sugar levels 120-160 mg/dL) or Group B (standard glycemic control, blood sugar levels 161-200 mg/dL). Treatment was as per standard protocols, and blood sugar levels were monitored accordingly. Proforma entries documented ICU stay and wound infections during hospitalization, ensuring data confidentiality. Results: The study involved 260 cases, with 130 in each group. In Group-B, the mean age was 51.56+6.07 years, and in Group-A, it was 52.09+5.86 years. Males constituted 53.85% (n=70) in Group-B and 53.08% (n=69) in Group-A, while females were 46.15% (n=60) in Group-A and 46.92% (n=61). Wound infection development differed, with 29.23% (n=38) in Group-A and 59.23% (n=77) in Group-B. The remaining 70.77% (n=92) in Group-A remained infection-free. Regarding mean hospital stays, Group-A stayed for 3.92+0.95 days, while Group-B spent 5.73+0.76 days (p = 0.0001). Conclusion: Strict glycemic control significantly reduces postoperative infections and ICU stay duration in diabetic patients undergoing coronary artery bypass surgery compared to standard glycemic control.

Pattern of fodder chopper machine injury in Gujranwala, Punjab, Pakistan.

2025-07-14T04:14:58-07:00

Objective: To find out the pattern of injury caused by toka / Fodder Chopper machine in Gujranwala Punjab. Study Design: Observational Retrospective Study. Setting: Department of Surgery, Gujranwala Teaching Hospital, Gujranwala. Period: March 2021 to August 2021. Methods: All the patients having fodder chopper machine injury were the part of study and their pattern of injury was studied. Age of patient, sex, side of injury and extent with severity were recorded. Results: Out of 100 patients, 82 (82.00%) were male and 18(18.00%) were female. Mean age was 17 years. Digits, palm and wrist, distal forearm, proximal forearm and arm had 53(53.00%), 20 (20.00%), 11 (11.00%), 9(9.00%) and 7 (7.00%) injuries, respectively. Right upper limb is more common presentation 81.00% than left upper limb 19.00%. Conclusion: Fodder Chopper machine injuries are one of most common cause of disability and are very common in our region especially in our rural area and mostly effected are children of younger age group under 14 years. This is due to inexperience and no training and design of Toka/ Fodder Chopper Machine.

Assessing the impact of urethroplasty on erectile function in patients with pelvic fracture urethral injuries: A comparative analysis of pre- and post-operative outcomes.

2025-08-19T00:18:37-07:00

Objective: To evaluate the mean change in erectile function before and after urethroplasty in patients with Pelvic Fracture Urethral Injuries (PFUIs) and to identify predictors of post-operative erectile dysfunction. Study Design: Retrospective Cohort study. Setting: Department of Urology at A Tertiary Care Hospital Bilawal Medical College for Boys, Liaquat University of Medical & Health Sciences, Jamshoro. Period: January 2015 to December 2020. Methods: A total of 100 male patients (≥18 years) who underwent urethroplasty for PFUIs were included. Erectile function was assessed using the International Index of Erectile Function (IIEF-5) at baseline (pre-operative) and at 3, 6, and 12 months post-operatively. Data on demographics, injury severity, type of urethroplasty, and pre-operative erectile dysfunction were collected. Paired t-tests compared pre- and post-operative erectile scores. Multivariate regression identified predictors of changes in erectile function. Statistical analysis was performed using SPSS, with p < 0.05 considered significant. Results: The mean pre-operative erectile function score was 22.4 ± 4.2. Post-operatively, scores decreased to 19.8 ± 4.8 at 3 months, 20.5 ± 4.6 at 6 months, and 21.0 ± 4.5 at 12 months. Mean changes were statistically significant at all follow-ups (p < 0.05), indicating a temporary decline with gradual recovery. Severe PFUIs (p = 0.004) and pre-operative erectile dysfunction (p = 0.001) were significant predictors of greater declines. Complications included stricture recurrence (15%), post-operative infection (10%), dilation (12%), and repeat urethroplasty (8%). Conclusion: Urethroplasty for PFUIs results in a temporary decline in erectile function with partial recovery over one year. Patients with severe injuries or pre-existing erectile dysfunction are at greater risk for persistent post-operative dysfunction. Pre-operative counseling and tailored post-operative care are essential to address sexual health concerns and optimize long-term outcomes.

Effectiveness of the ponseti technique in treating children with different types of clubfoot: A cross-sectional study at Lady Reading Hospital.

2025-09-18T03:45:20-07:00

Objective: To evaluate the effectiveness of the Ponseti technique in relation to different types of clubfoot on the basis of Pirani scoring among patients at lady reading hospital (LRH) Peshawar. Study Design: Retrospective Cross Sectional study. Setting: Department of Clubfoot, Lady Reading Hospital Medical Teaching Institute, Peshawar. Period: Study conducted till November 2024; retrospective Data was obtained from December 2020 to December 2022. Methods: This was a retrospective cross-sectional study conducted on children with clubfoot deformity visiting Clubfoot department of Lady Reading Hospital Peshawar. On the basis of selection criteria, data of total 408 patients (mean age = 6.29 ± 6.04 months), comprising 271 males and 137 females were included in the study. Data related to study population was collected. Pirani score was used as an assessment tool to investigate the effectiveness of Ponseti method in treating clubfoot deformity. Data was analyzed using SPSS version 26. Results: Total 614 clubfoot were treated in this study. In this sample, the ratio of males to females was approximately 2:1, indicating that males were affected about twice as common as female. By the end of treatment, 76.34% (n = 468) of cases achieved maximum correction with a Pirani score of ≤ 1, including 48.77% who reached a score of 0.00. A marked shift was also observed in both the median and mode of Pirani scores from pre- to post-treatment, reflecting a significant improvement in clinical outcomes. The results of this study showed the Ponseti method is significant effective in treating clubfoot (p-value =0.001 Wilcoxon Signed-Rank Test). Conclusion: This study concludes that the Ponseti method is highly effective in the treatment of various types of clubfoot, including idiopathic, syndromic, and neurogenic forms. The significant improvement observed in Pirani scores from pre- to post-treatment demonstrates the method's ability to achieve substantial correction of the deformity.

Comparison of functional outcomes of dynamic hip screw and proximal femoral nail in elderly patients presenting with intertrochanteric femur fracture.

2025-07-14T04:42:58-07:00

Objective: To evaluate and compare the functional outcomes and perioperative metrics of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) fixation in elderly individuals with intertrochanteric femoral fractures. Study Design: Prospective, Observational Comparative study. Setting: Department of Orthopaedic, Ziauddin Hospital, Karachi. Period: August 2022 and February 2023. Methods: One hundred patients aged 60 years or older with OTA/AO type 31-A1 and 31-A2 intertrochanteric fractures were enrolled and divided equally into DHS and PFN groups. Patients with pathological fractures, high-energy trauma, or severe cognitive impairment were excluded. Surgeries were performed within 72 hours using standardized operative protocols. The primary endpoint was functional recovery at 6 months, assessed using the Harris Hip Score (HHS). Secondary variables included intraoperative parameters, hospital stay duration, time to mobilization, fracture healing time, and postoperative complications. Results: The PFN group demonstrated a shorter operative time, reduced blood loss, and earlier mobilization (p<0.001). Mean HHS at 6 months was significantly higher in the PFN cohort (85.8 ± 6.6) compared to DHS (80.9 ± 6.9, p<0.001). Excellent outcomes were more frequent in PFN (32%) than DHS (12%). Screw cut-out was seen only in the DHS group (10%, p = 0.022). Conclusion: PFN fixation provides superior early functional results and fewer mechanical complications compared to DHS in elderly patients with intertrochanteric fractures.

The effect of proximal cortical screw length of volar locking plates on clinical outcomes in distal radius fractures.

2025-07-19T06:48:58-07:00

Objective: To evaluate the impact of proximal cortical screw length in volar locking plates (VLPs) on clinical outcomes in patients with distal radius fractures (DRFs). Study Design: Prospective observational study. Setting: Department of Orthopedic Surgery, Nishtar Hospital, Multan, Pakistan. Period: June 2024 to April 2025. Methods: We enrolled 104 patients aged ≥18 years with DRFs treated with VLPs, followed for at least 12 months. Exclusion criteria included prior limb injuries, open fractures, non-VLP interventions, and extensor soreness from distal screws. Clinical outcomes, including grip strength (Jamar dynamometer), range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, and extensor tendon complications, were assessed. Radiological evaluations measured dorsal cortical screw prominence (>1.2 mm) using postoperative X-rays. Surgical procedures used a Colar Henry incision and Acu-Loc VLP with unicortical distal and bicortical proximal screws. Data were analyzed using SPSS 26.0, with Mann-Whitney U and chi-square tests for non-normally distributed continuous and categorical variables, respectively. Results: Of 104 patients (63 males, 60.6%; mean age 49.13 years), 61 (58.7%) had right-sided fractures, primarily caused by road traffic accidents. Extensor sensitivity occurred in 36 (34.6%) cases. Proximal screw prominence >1.2 mm was significantly associated with extensor synovitis (p<0.05), but not with grip strength, ROM, or QDASH scores. Patient satisfaction was 50.96% (53/104). Conclusion: Proximal cortical screw prominence >1.2 mm in VLPs significantly increases extensor tendon irritation in DRFs, emphasizing the need for precise screw length to optimize clinical outcomes and patient satisfaction.

Autonomy in family planning decision-making and its predictors among married women: A cross-sectional study at maternal and child health Centre Nawabshah.

2025-05-22T07:00:23-07:00

Objective: To investigate the factors influencing family planning use among married women by assessing their autonomy of decision-making regarding family planning, identifying household predictors of this autonomy, and determining the association between reproductive health services and decision-making power. Study Design: Analytical Cross-sectional study. Setting: It was conducted at married women visiting MCH and Family Planning Centre at Nawabshah Sindh. Period: January 2025 to March 2025. Methods: A total of 345 married women were selected who visited MCH and Family Planning Centre at Nawabshah Sindh. The selection of the sample was done by using a consecutive sampling technique. Researchers collected data using structured and pre-tested questionnaires through Google Forms. Binary logistic regression and multiple logistic regression analysis were used to identify the associated factors and the odds ratio with 95% CI was computed to assess the strength of the association. Results: Overall only (19.4%) of the married women were found to have decision-making power in family planning. Women of graduate level of education [AOR: 7.156, 95% CI: (1.11 – 48.37)], husband’s secondary education [AOR: 0.220, 95% CI: (0.05 – 0.76)], husbands who were shopkeepers [AOR: 4.891, 95% CI: (1.57 – 15.87)], monthly income >100,000 [AOR: 32.06, 95% CI: (1.94 – 1498)] were significantly associated with women decision-making power in family planning. Conclusion: In this study, women had low decision-making power in family planning use. Women and their husband’s formal education, and husband’s occupational status, and monthly income had effects on women’s decision-making power.

Comparing cone beam computed tomography with panoramic radiography for prediction of implant planning and size.

2025-05-02T06:20:02-07:00

Objective: To compare the accuracy and effectiveness of CBCT and panoramic radiography for determining implant size and placement in patients requiring dental implants. Study Design: Cross-sectional study. Setting: Department of Operative Dentistry, Bakhtawar Amin Dental Hospital, Multan. Period: Jan 2025 to Oct 2025. Methods: Data were collected using a consecutive non-probability sampling technique, with a sample size of 97 edentulous sites from adult patients (18-55 years) who were candidates for dental implants. Both CBCT and panoramic radiography were used to measure implant length and width. Results: The results showed that CBCT provided more accurate measurements for both implant length (mean = 10.3 mm, SD = 1.4) and width (mean = 4.6 mm, SD = 0.6) compared to panoramic radiography (length: mean = 10.1 mm, SD = 1.5; width: mean = 4.5 mm, SD = 0.7). The correlation coefficient for implant length between CBCT and panoramic radiography was 0.92 (p < 0.01), while for implant width, it was 0.84 (p < 0.01). CBCT also demonstrated a higher success rate in implant planning (91.8%) compared to panoramic radiography (78.4%). Conclusion: It is concluded that CBCT provides superior accuracy and precision in implant planning compared to panoramic radiography, particularly for implant length and width. CBCT should be considered the preferred imaging modality for complex implant planning, especially when high precision is required.

Risk factors, microbiology and clinical outcomes of puerperal sepsis.

2025-09-02T06:10:27-07:00

Objective: To determine the factors leading to the development puerperal sepsis. A secondary objective was to determine the pattern of bacterial spectrum in-hospital mortality to puerperal sepsis in our local population. Study Design: Descriptive Cross-sectional study. Setting: A Tertiary Care Hospital Department of Gynaecology and Obstetrics, Unit 3, Civil Hospital Karachi. Period: 4^th March 2022 to 22^nd September 2022. Methods: The study recruited post-delivery women with clinically diagnosis of puerperal sepsis. Socio-demographic, clinical and obstetric information, factors leading of termination of pregnancy and in-hospital mortality were collected. Results: 177 Puerperal sepsis patients presenting with fever, lower abdominal pain, and foul-smelling lochia were analysed. The average age of the patients was 30.2 (± 7.4) years, ranging between 20-45 years. Mean gestational age was 37.9 (± 3.4) weeks. Majority (85%) were delivered after 36 weeks. Risk factors for puerperal sepsis included caesarean section in 137 (77.4%), anaemia in 105(59.3%) and diabetes in 4 (7.9%). A total of 108 (61.1%) blood cultures were positive. The most common organism was staphylococci aureus (32.2%) followed by E. coli (14.7%), klebsiella pneumonia (7.9%) and streptococcus pyogenes (1.1%). Both pseudomonas and proteus were observed in 2.8% cases. It has observed that 16 (9%) died during hospital stay. Conclusion: Caesarean delivery, anaemia and diabetes were associated with high risk of puerperal sepsis. Most of the bacterial infection was found to be caused by Staphylococcus Aureus which accounted for 57 [32.2%].

Age estimation from iliac crest epiphyseal fusion by conventional radiographic techniques.

2025-11-01T06:51:35-07:00

Objective: To determine the correlation between radiological age estimation from iliac crest fusion and actual chronological age. Study Design: Cross sectional study. Setting: Forensic Medicine & Toxicology Department, King Edward Medical University, Lahore and Radiology Department, Mayo Hospital, Lahore. Period: 01-08-2023 to 31-01-2024. Methods: Data collection & analysis: Digital X-rays of the pelvis of 80 individuals showing iliac crest in antero-posterior view were taken. The radiographic age was estimated. Then actual age of patients was noted from national identity card, form B, birth certificate of the municipal committee or hospital, school certificate and driving license. Demographic data (name, gender, ethnicity, occupation) was also recorded. Data was entered and analyzed in SPSS. Results: There were 51(63.7%) males and 29(36.25%) females. The mean estimated age on X-ray was 20.10+2.19 years. The correlation coefficient (r) value of estimated age (years) on X-ray was 0.964 which indicates very strong positive correlation with actual age and was significant (p<0.0001). Males showed stronger positive correlation(r=0.976, p<0.0001) with estimated age (years) on x-ray as compared to females. Conclusion: It can be concluded from the study that mean age observed on X-ray was almost same as actual age, among all the individuals. There is strong correlation coefficient (r) of estimated age (years) on X-ray with actual age, and p value was significant.

Seeing beyond vision: A comparative study of intelligence, academics, and lifestyle in myopic and non-myopic medical students.

2025-06-18T07:39:10-07:00

Objective: To compare intelligence (IQ), academic performance, and lifestyle factors between myopic and non-myopic undergraduate medical students, while also evaluating demographic, familial, and environmental risk factors associated with myopia. Study Design: Cross-sectional study. Setting: CMH Lahore Medical College Lahore. Period: February to April 2025. Methods: Involving 302 undergraduate students (180 myopic, 120 non-myopic) from medical, dental, nursing, and allied health programs in medical college, Lahore, Pakistan. Participants were selected via non-probability convenience sampling. Data were collected on eyesight status, academic grades (matriculation, intermediate, and GPA), IQ levels, lifestyle habits (screen time, outdoor activities, posture), and familial myopia history. Statistical analyses included chi-square tests and independent sample t-tests, with a significance threshold of p < 0.05. Results: No significant differences were found between myopic and non-myopic students in IQ levels (myopic: 94.3 ± 23.1 vs. non-myopic: 96.2 ± 24.0; p = 0.419) or academic performance (GPA: 3.30 ± 0.50 vs. 3.29 ± 0.51; p = 0.864). Lifestyle factors, including screen time, study hours, and outdoor activities, also showed no significant associations (p > 0.05). A weak positive correlation was observed between myopia and paternal eyesight weakness (p = 0.048), but maternal myopia and family history of hypertension were not significant. Poor posture during studying was more prevalent among myopic students, though statistically insignificant (p = 0.174). Conclusion: Myopia prevalence was high (60%) among students, but no significant links were found with IQ, academics, or most lifestyle factors. The study highlights the need for awareness about eye health and debunks stereotypes linking myopia with intelligence.

Cutting costs, not quality: A cost minimization analysis of diabetes care at Northwest General Hospital and Research Center.

2025-08-06T03:49:13-07:00

Objective: To conduct a pharmacoeconomic evaluation and cost-minimization analysis of commonly used anti-diabetic medications, specifically comparing the costs of branded and generic versions of Empagliflozin and Metformin prescribed at Northwest General Hospital, Peshawar. Study Design: Cross-sectional, Retrospective Cost Minimization Analysis (CMA). Setting: The Northwest School of Medicine, Peshawar. Period: 3^rd June 2024 to 3^rd Jan 2025. Methods: This CMA was conducted by analyzing 202 prescriptions from 105 patients receiving anti-diabetic therapy. Retail prices of both branded and generic drug formulations were collected from local pharmacies. To ensure therapeutic equivalence, a UV spectrophotometric assay was used to compare active pharmaceutical ingredient concentrations between branded and generic products. Results: Metformin 500 mg and Empagliflozin 10 mg were the most commonly prescribed drugs. Generic versions demonstrated comparable bioavailability to branded counterparts. However, substantial cost differences were observed, with generic formulations offering significant savings. The average cost burden per patient was notably lower with generics, suggesting they are a viable and cost-effective alternative. Conclusion: Generic anti-diabetic medications, when bioequivalent, provide a cost-effective alternative to branded drugs without compromising efficacy. Promoting the use of generics in clinical practice can help reduce the financial burden on patients and improve access to essential diabetes care in resource-limited settings.

Assessment of medical students’ attitude toward the doctor-patient relationship.

2025-05-22T07:03:41-07:00

Objective: To evaluate the attitudes of medical students in Khyber Pakhtunkhwa (KPK), Pakistan, toward the doctor-patient relationship. Study Design: Descriptive Cross Sectional study. Setting: Department of Community Medicine, Gomal Medical College Dera Ismail Khan. Period: 10^th February to 10^th May 2025. Methods: Using non probability convenient sampling approach. 400 MBBS students from 17 medical colleges in Khyber Pakhtunkhwa (KPK), Pakistan, made up the sample. Data were collected using a validated, structured questionnaire that included the 18-item Patient-Practitioner Orientation Scale (PPOS) measured the "sharing" and "caring" domains. In order to investigate demographic correlations, statistical analysis was conducted with SPSS 27 trial version software, utilizing descriptive statistics, independent t-tests, and ANOVA with Post Hoc test. Results: A moderate patient-centered orientation was indicated by the overall mean PPOS score of (3.62 ± 0.45). Higher empathy than collaborative decision-making was suggested by subscale analysis, which showed higher scores in the caring subscale (3.95 ± 0.57) than the sharing subscale (3.30 ± 0.61). Students in the public sector performed better in the sharing domain (p = 0.044), while female students performed significantly better in the caring domain (p = 0.020). Conclusion: This study revealed that medical students in Khyber Pakhtunkhwa (KPK), Pakistan generally have moderately patient-centered attitudes. They are more inclined to provide empathetic care than to share decision-making. These results demonstrate the necessity of enhancing instructional approaches that foster empathy and teamwork in medical education.

Complete remission rate in advanced-stage diffuse large B-Cell lymphoma following treatment with R-CHOP.

2025-12-15T23:40:27-08:00

Objective: To evaluate the complete remission (CR) rate in patients with advanced-stage DLBCL following treatment with R-CHOP. Study Design: Descriptive Cases-series study. Setting: The Institute of Nuclear Medicine and Oncology (INMOL) in Lahore. Period: 16^th May 2025 to 16^th October 2025. Methods: Conducted on 60 patients diagnosed with stage III or IV DLBCL and treated with six cycles of R-CHOP chemotherapy at a tertiary care oncology unit were included in this observational study. Demographic baseline data, clinical record, and laboratory data were taken, such as age, gender, performance status, and stage of disease. The clinical evaluation and imaging assessment were used to evaluate response to treatment based on standard response criteria after therapy. Results: The average age of the patients was 44.17±12.85 years, and the patients were mostly men (61.7%). Over fifty percent of the patients (55) had stage III disease and forty five percent had stage IV disease. After six cycles of R-CHOP, the complete remission rate was 68.3 and partial remission of 21.7 and disease progression of 10 percent were seen. The CR rate in this study is also in line with other reports found in the literature that range between 65 and 75% of advanced-stage DLBCL. Conclusion: R-CHOP chemotherapy is a viable first-line therapy in achieving a high percentage of complete remissions in the advanced stage of DLBCL. However, a subset of patients unable to gain complete remission, which underlines the necessity to detect high-risk cases early and possibly to include new targeted or improved treatment methods.