The Professional Medical Journal

Outcomes of partial thickness skin graft donor site scar in patients treated with standard therapy versus. massage therapy.

2025-07-24T04:16:34-07:00

Objective: To compare the donor site scar outcomes of partial thickness skin graft in patients treated with standard therapy versus massage therapy. Study Design: Randomized Controlled study. Setting: Burns and plastic surgery center, Peshawar. Period: 15^th January 2025 15 July 2025. Methods: A randomized controlled study was conducted on 60 patients in Burns and plastic surgery center, Peshawar over a period of 6 months. They were divided two groups with 30 patients in each; Group A patients were treated with petroleum jelly only and Group B patients received massage therapy that is friction therapy for 30 minutes. Scar outcome was assessed using Vancouver Scar Scale (VSS) at 12 weeks post operative time. Results: Both groups showed improvement in scar parameter. Group B showed significantly better VSS scores (1.9 ± 1.06) than Group A (4.3 ± 1.12), p < 0.001. Pliability of scar improved more in Group B followed by height of scar. Vascularity is improved moderately and Pigmentation differences were minimal between groups. Conclusion: Massage therapy improves partial thickness skin graft donor site scar outcomes in terms of scar pliability and height and it can be helpful adjunct in postoperative period. Patient education about treatment, their compliance largely affects the treatment outcome.

Impact of biliopancreatic length following revision of sleeve gastrectomy to one anastomosis gastric bypass.

2025-08-09T03:56:57-07:00

Objective: To evaluate the early Impact of Biliopancreatic Length on the outcome in revisional bariatric surgeries. Study Design: Retrospective Review. Setting: Lady Reading Hospital, Peshawar. Period: 1^st March 2017 to 28^th February 2022. Methods: Prospectively maintained data of 43 patients with the BMI of less than 50, who underwent laparoscopic OAGB Patients were placed in three groups including Group A 180cm, B 220cm and C 250 cm respectively corresponding to the biliopancreatic limb length. The patients were set for follow-up at 7th, 14th, 28th postoperative days for the first one month and then subsequently at 3 months and 6 months. All data was evaluated on SPSSR version 22.0 and is depicted in tabulated form. Continuous data was compared using Student t tests and Mann Whitney U test. In low figures from a 2X2 table Fischer’s exact test was performed and the significance of a test was considered as a p value of lower than 0.05. Multivariate analysis was performed to exclude confounding elements such as gender and pre-operative data. Results: A total of 43 patients were included in the study. Patients who completed 6-months of follow-up were analyzed. Preoperative weight after LSG & before REVISION OAGB were 113 ± 28.5 kg (180cm), 106.9+22.7 (220cm), 117.1+17.3 (250cm) and BMI were 45.8 +4.1 (180), 41.9 +5.3 (220cm), 44.3 +4.7 (250cm). A total of 43(%) patients attended the 6 months follow-up after revision OAGB (clinical and hematological) (group A = 18; group B = 12, group C = 13). A total of 43 (%) TWL achieved in 180 cm, 220 cm, and 250 cm groups were 27.4(+19.1), 17.8(+14), and 28.9(+9.5) respectively (p=0.81). There was no protein deficiency reported at 6 months of follow-up. Regarding albumin levels in group A at 1st,03^rd & 06^thmonth was 3.4 ±0.3, 3.3 ±0.4, & 3.6 ±0.3 respectively while Albumin in Group B at 1^st, 3^rd, & 6^th month was reported as 3.2 ±0.4, 3.2 ±0.3, & 2.8 ±0.4 respectively and Albumin levels in Group C at 1^st, 3^rd, & 6^th Month was 3.6 ±0.3, 3.1 ±0.4, 2.7 ±0.5 respectively(p=0.07). A significant difference was noted in the long lengths of Biliopancreatic group C with a mean figure of 22.1g/ml. (p=0.01). Conclusion: Results in terms of weight loss and its relationship to length of biliopancreatic limb while performing one anastomosis Gastric Bypass (OAGB) has no significant benefit. A modest Biliopancreatic limb length attains similar results after revision from Sleeve gastrectomy to OAGB. Adding length to the bypassed bowel confers nutritional complications especially Serum Ferritin.

Initial experience of robot-assisted cholecystectomy at Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat.

2025-04-04T04:40:56-07:00

Objective: To evaluate the safety, learning curve and outcomes of RAC using the Versus Surgical System® in a public sector hospital. Methods: Retrospective Observational study. Setting: Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat, Pakistan. Period: 1^st December 2022 to 30^th June 2023. Methods: Analyzed patients who underwent RAC Key parameters assessed include docking and console times, conversion rates, intraoperative complications, and postoperative outcomes. This study also analyzed the RAC learning curve. Results: A total of 50 patients (74% female) underwent RAC. The median docking time was 20 minutes (range: 10–40), improving significantly after the first five cases (p < 0.00001). The mean console time decreased from 156.0 min in the initial 25 cases to 105.6 min in subsequent 25 cases (p < 0.00001), demonstrating a clear learning curve. Only single conversion to open procedure (2%) occurred due to hemorrhage. No bile duct injuries or postoperative complications were observed, Similarly, no readmission at 90-day follow-up was recorded. Conclusion: RAC using the Versius Surgical System® is a safe technique. Regarding the learning curve, despite initial technical challenges, experience leads to reduced operative times. Further studies are required to compare outcomes and cost-effectiveness in resource-limited hospitals.

Frequency of biliary complications after laparoscopic cholecystectomy.

2025-05-30T04:50:24-07:00

Objective: To determine the frequency of biliary complications, specifically bile leak and post-cholecystectomy syndrome, following laparoscopic cholecystectomy, and to assess their associations with demographic variables. Study Design: Prospective Observational Study. Setting: Department of General Surgery, Hayatabad Medical Complex, Peshawar. Period: March 2021 to February 2022. Methods: A total of 171 patients aged 20–60 years undergoing elective laparoscopic cholecystectomy were enrolled through convenience sampling. Patients were followed for six months to assess for bile leak and post-cholecystectomy syndrome. Data were analyzed using SPSS version 24, and associations with demographic variables were assessed using the Chi-square test. Results: Bile leak occurred in 19 patients (11.1%) and post-cholecystectomy Out of 171 patients, bile leakage occurred in 19 cases (11.1%) and post-cholecystectomy syndrome in 32 cases (18.7%). Bile leakage was observed in 11 males (14.1%) and 8 females (8.6%), while post-cholecystectomy syndrome was noted in 14 males (17.9%) and 19 females (19.4%). Across BMI categories, bile leak was reported in 6 patients (15.4%) with BMI 20–23, 11 (9.9%) with BMI 24–27, and 2 (9.5%) with BMI 28–30. Post-cholecystectomy syndrome was most common in the 28–30 BMI group (6 patients, 28.6%). None of the associations with age, gender, or BMI were statistically significant (p > 0.05). Conclusion: Biliary complications following laparoscopic cholecystectomy were relatively infrequent and showed no significant association with demographic variables.

Patient-Centered outcomes and complication profiles of anterior versus posterior fixation in subaxial cervical facet dislocation: A comparative study.

2025-06-18T07:34:10-07:00

Objective: To compare anterior cervical discectomy and fusion (ACDF) and lateral mass screw (LMS) fixation for subaxial cervical facet dislocation such as complications, patient satisfaction, and recovery time. Study Design: Prospective Comparative study. Setting: Ghurki Trust Teaching Hospital. Period: March 2023 to December 2024. Methods: We prospectively analyzed 60 patients diagnosed with traumatic subaxial cervical facet dislocation and treated surgically. Based on the surgical approach, patients were divided into two groups: 32 underwent anterior cervical discectomy and fusion (ACDF) and 28 underwent lateral mass screw (LMS) fixation. Outcomes assessed included surgical complications, operative duration, hospital stay, time to return to work, postoperative pain (VAS), and patient satisfaction (Likert scale). Results: ACDF patients had significantly shorter operative times than LMS (88.20 ± 10.29 minutes vs. 102.14 ± 13.33 minutes, p < 0.01), a faster return to work (6.1 ± 1.4 weeks vs. 8.2 ± 1.9 weeks, p < 0.01).. Dysphagia was observed in 16% of patients in the ACDF group (5 out of 32), while hardware-related complications occurred in 7.1% of LMS cases (2 out of 28). Conclusion: ACDF shows superior outcomes in operative efficiency, early functional recovery, and patient-reported satisfaction, though with a higher risk of transient dysphagia. LMS remains a viable alternative when posterior stabilization is prioritized. These findings support a patient-centered approach in surgical decision-making.

Radiological outcome of Distal Radius fracture treated conservatively (MUA Plaster of Paris) Vs ORIF (Open Reduction and Internal Fixation): A comparative analysis.

2025-07-15T06:16:04-07:00

Objective: To compare the radiological outcomes of distal radius fractures treated conservatively (MUA + POP) versus operatively (ORIF) in adult patients, focusing on key radiographic parameters and early functional range of motion. Study Design: Prospective Comparative study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: December 15, 2024, and April 15. Methods: A total of 70 patients with Fernandez Type I distal radius fractures were enrolled and randomized into two equal groups: Group A (MUA + POP) and Group B (ORIF). Radiological parameters (radial height, radial inclination, volar tilt, and ulnar variance) and range of motion were assessed at 12 weeks post-treatment. Statistical analysis was performed using t-tests and chi-square tests, with a significance threshold of p < 0.05. Results: Group B (ORIF) demonstrated significantly better radiological alignment in terms of radial inclination (p = 0.015), radial height (p = 0.024), and ulnar variance (p = 0.019). Volar tilt showed improvement but was not statistically significant (p = 0.145). Despite superior alignment, ORIF was associated with a higher rate of articular step-off >2 mm (48.6% vs. 14.3%, p = 0.001). Range of motion outcomes (dorsiflexion, palmar flexion, and pronation) were statistically similar in both groups. Conclusion: Although ORIF offers superior radiographic restoration of anatomical parameters in distal radius fractures, functional outcomes in the short term, particularly range of motion, were comparable to conservative management. The increased incidence of articular incongruity in the ORIF group raises concerns about potential long-term implications. Thus, the choice of treatment should be individualized, balancing radiological goals with risks, patient profile, and resource availability.

Proximal Optimization Technique (POT) Puff sign as an indicator for left main stem stent optimization in acute coronary disease.

2025-05-14T05:28:54-07:00

Objective: To assess the impact of Optimal POT and its clinical importance in left main stem stenting as well as to explore its potential advantages in guiding clinical decisions to enhance procedural success and patient outcomes. Study Design: Retrospective Analysis. Setting: Peshawar Institute of Cardiology, Peshawar. Period: January 2023 to January 2024. Methods: Data was extracted from the Hospital Information Management System (HMIS) and Electronic Medical Records (EMR) of patients aged 18 and above who presented with either acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD) and had Distal Left Main Stem Severe Disease not a Surgical Candidate. The procedure was done in a stepwise manner, beginning with loading patients with aspirin, clopidogrel or ticagrelor, and heparin and PCI steps. Results: The study included 119 patients who underwent stenting with the POT Puff technique. The presence of the POT puff sign during balloon inflation was found to be a significant indicator for optimizing stent deployment, with no contrast leakage observed in adequately sized balloons. The results highlight the potential of the POT puff sign in guiding effective stent optimization, improving procedural outcomes. Conclusion: Our findings suggest that the POT Puff sign, as visualized through advanced imaging modalities, provides an essential step in confirming effective proximal optimization, ultimately leading to better short and long-term clinical outcomes.

Frequency of Microorganisms Detected in Patients with Empyema Thoracis at Department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan

2025-08-13T04:15:00-07:00

Objective: To determine the frequency and types of microorganisms isolated from pleural fluid samples of patients with empyema thoracis, in order to aid empirical antibiotic selection and improve microbiological diagnosis in the local clinical setting. Study Design: Cross-sectional study. Setting: Department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Period: March 2024 to February 2025. Methods: A total of 102 patients aged 13–70 years with clinically and radiologically confirmed empyema thoracis were enrolled through non-probability consecutive sampling. Pleural fluid was aseptically aspirated and subjected to microbiological culture and sensitivity testing. Data were recorded on a structured proforma and analyzed using SPSS version 26.0, with statistical significance set at p < 0.05. Results: Out of 102 patients, the mean age was 44.7 ± 13.4 years, with a mean symptom duration of 20.9 ± 7.4 days. Males comprised 68.6% and rural residents 58.8%. Right-sided effusion was most common (60.8%). Comorbidities included hypertension (25.5%) and diabetes (21.6%). Culture revealed monomicrobial growth in 54.9%, polymicrobial in 17.6%, and sterile fluid in 27.5%. Staphylococcus aureus was the most frequently isolated organism with significant male predominance (p = 0.041). Gram-positive organisms accounted for 39.2%, Gram-negative for 33.3%. Conclusion: Empyema thoracis in our region showed predominance of Gram-positive organisms, especially Staphylococcus aureus, with a significant male association, emphasizing the need for tailored empirical antimicrobial strategies.

Clinical profile of nonproteinuric kidney disease in Type 2 diabetic patients.

2025-08-05T05:14:43-07:00

Objective: To compare the demographic, clinical, and biochemical characteristics of nonproteinuric versus proteinuric diabetic kidney disease (DKD) among patients with type 2 diabetes mellitus (T2DM). Study Design: Cross-sectional Observational study. Setting: Department of Nephrology, Nishtar Hospital, Multan. Period: November 2024 to April 2025. Methods: Adult patients diagnosed with T2DM attending the Nephrology Department of Nishtar Hospital, Multan, were enrolled through non-probability consecutive sampling based on predefined inclusion criteria. Participants were classified into nonproteinuric and proteinuric DKD groups according to standard albuminuria cut-offs and estimated glomerular filtration rate (eGFR) values. Baseline demographic details, clinical data, and biochemical profiles were systematically documented and compared between both groups using appropriate statistical tests. A p-value < 0.05 was considered statistically significant. Results: Among 300 patients, nonproteinuric diabetic kidney disease (DKD) was observed in 32.3%. Compared to the proteinuric group, nonproteinuric DKD had mean age (55.33 ± 7.99 vs 58.67 ± 7.43 years, p < 0.001), shorter diabetes duration (10.75 ± 3.65 vs 12.80 ± 4.25 years), higher hemoglobin (11.27 ± 1.05 vs 10.35 ± 1.61 g/dL), higher serum albumin (3.87 ± 0.62 vs 3.42 ± 0.31 g/dL), lower serum creatinine (1.15 ± 0.26 vs 1.42 ± 0.39 mg/dL, p < 0.001), lower HbA1c (7.02 ± 1.15% vs 7.71 ± 1.31%), and higher eGFR (54.90 ± 13.17 vs 41.94 ± 8.21 ml/min/1.73m²). Hypertension, dyslipidemia, and RAAS inhibitor use were more frequent in the proteinuric group (all p < 0.05). Conclusion: Nonproteinuric diabetic kidney disease is common in type 2 diabetes and exhibits distinct demographic and biochemical features compared to proteinuric DKD, underscoring the need for targeted recognition and management.

Evaluating the impact of Dapagliflozin on outcomes in systolic heart failure.

2025-08-25T04:41:23-07:00

Objective: To determine the efficacy of dapagliflozin in reducing cardiovascular events and improving clinical outcomes in patients with systolic heart failure. Study Design: Randomized Controlled Trial. Settings: Department of Internal Medicine and Cardiology, PAF Hospital, Islamabad. Study Period: November 2022 to April 2024. Method: A total of 1470 systolic heart failure (HF) patients aged ≥ 18 years with symptoms of New York Heart Association class (NYHA) II, III or IV, ejection fraction ≤ 40% and raised levels of plasma pro-B-type natriuretic peptide (pro-BNP) were enrolled in the study and randomized in 2 equal groups of 735 patients each. In Group-A, patients received dapagliflozin 10 mg once daily while the patients in Group-B received a matching placebo, over a period of one year. The primary outcome was set as worsening of HF (unplanned consultation/hospitalization due to HF). The secondary outcome was a change in the Kansas City Cardiomyopathy Questionnaire (KCCQ). Results: The mean age of participants in this study was 64.81±7.98 years. The results showed that worsening of heart failure (19.05% Vs 26% respectively, p-value=0.001), unplanned hospital visits due to HF (10.34% Vs 14.1% respectively, p-value=0.031), hospitalization due to HF (8.84% Vs 12.65% respectively, p-Value=0.032) was significantly lower and statistically significant change in KCCQ score (5.2±17.6 Vs 3.1±18.4 respectively, p-value=0.026) was observed in Group-A compared to Group-B. Conclusion: In systolic heart failure patients with reduced ejection fraction, dapagliflozin lowered the risk of worsening of heart failure and improved the symptoms of heart failure.

To evaluate severity among IBD (Inflammatory Bowel Disease) patients presenting at a Tertiary Care Hospital of Karachi, Pakistan.

2025-05-26T04:30:57-07:00

Objective: To determine the disease severity and associated factors among patients having inflammatory bowel disease (IBD). Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: February 2024 to July 2024. Methods: A total of 146 patients aged 18-65 years with a confirmed IBD diagnosis for ≥6 months were analyzed. Data on demographics, disease characteristics, and IBD type were recorded. Crohn’s disease (CD) severity was assessed using the Harvey-Bradshaw Index. Ulcerative colitis (UC) severity was evaluated with the Mayo Score. Statistical analysis was done using SPSS v26.0, applying chi-square or Fisher’s exact test with significance set at p<0.05. Results: Among 146 study subjects, 66 (45.2%) were males, and 80 (54.8%) females, with a mean age of 39.64±14.79 years. The study revealed that 20 (13.7%) patients had CD, out of which 12 (60.0%) had moderate disease severity. Among IBD patients, 126 (86.3%) were having UC, out of which, 74 (58.7%) had moderate disease severity. Level of education (p=0.009), occupation (p=0.011), length of the disease (p=0.003), and marital status (p=0.012) had significant association with CD severity. Gender (p=0.757), age groups (p=0.340), and socio-economic status (p=0.189) were not having significant association with CD severity. Conclusion: Moderate disease severity is the most prevalent category among IBD patients attending a tertiary care center in Karachi, Pakistan. Disease severity in CD was significantly associated with education, occupation, disease duration, and marital status, while UC severity correlated with age, education, occupation, and socioeconomic status.

Clinical profile and outcome of myocarditis in children.

2025-06-02T04:16:09-07:00

Objective: To determine the clinical profile and outcome of myocarditis in children. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 73 children between 1 months up to 15 years of age, and admitted with myocarditis were analyzed. Demographic details, presenting complaints, and features were noted. Outcomes were noted in the form of survived and discharged successfully, or mortality. Data analysis was conducted by using IBM-SPSS Statistics, Version 26.0. Results: In a total of 73 children, 44 (60.3%) were females. The mean age was 2.0±0.9 years. At the time of presentation, fever (100%), loose motion (28.8%), and difficulty in breathing (21.9%) were the most frequent. Tachycardia, and respiratory distress noted among 71 (97.3%), and 71 (97.3%) children, respectively. During the treatment, ventilatory support, and inotropic support were given to 41 (56.2%), and 72 (98.6%) children, respectively. Mortality was documented among 27 (37.0%) children, whereas 46 (63.0%) children improved and discharged successfully. At the time of presentation, vomiting (0.047), hepatomegaly/splenomegaly (p<0.001), delayed capillary refill time (p<0.001), gallop (p<0.001), hypotension (p<0.001), and signs of shock (p<0.001). Place of admission as PICU (p<0.001), and need for ventilatory support (p<0.001) were also significantly associated with mortality. Conclusion: The high mortality rate in children with myocarditis underscores the need for early recognition of critical symptoms, standardized treatment protocols, and improved diagnostic and therapeutic infrastructure.

Comparative effectiveness of rosuvastatin and atorvastatin in preventing Contrast-Induced Nephropathy (CIN) in patients with Chronic Kidney Disease (CKD).

2025-04-22T04:48:16-07:00

Objective: To compare the efficacy of rosuvastatin and atorvastatin in preventing contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Study Design: Randomized Controlled Trial. Setting: Department of Nephrology, Shaikh Zayed Hospital, Lahore. Duration: 26/10/2024 to 26/03/2025. Methods: A total of 150 patients with CKD Stage G3, G4, and G5 were randomly assigned to two equal groups (75 patients each) using an online randomizer. Group A received atorvastatin (80 mg at baseline and daily), and Group B received rosuvastatin (40 mg at baseline and daily). Both medications were administered for three days before PCI and continued for two days after PCI. Results: The study included 60 participants with an average age of 57.15 ± 5.56 years and a mean BMI of 27.69 ± 1.62 kg/m². Baseline creatinine levels were 2.53 ± 1.23 mg/dL, increasing to 2.94 ± 2.03 mg/dL post-procedure. CIN occurred in 13 (21.7%) of participants. Among CIN cases, 8 (61.5%) were in the atorvastatin group, while 5 (38.5%) were in the rosuvastatin group (p = 0.347). CIN was more frequent in CKD Stage 5 patients (84.6%), showing a significant association with CKD stage (p < 0.001). However, diabetes (p = 0.387), hypertension (p = 0.276), BMI (p = 0.139), and smoking (p = 0.321) did not show significant associations with CIN. Conclusion: CIN occurred in 21.7% of the study population, with CKD Stage 5 as the strongest predictor (p < 0.001). No statistically significant difference was observed between atorvastatin and rosuvastatin in preventing CIN (p = 0.347).

Role of imaging in the diagnosis and treatment of brain vascular malformations.

2025-06-12T05:11:15-07:00

Objective: To evaluate the effectiveness of advanced MRI sequences and DSA in the detection, classification, and treatment planning of brain vascular malformations, and to compare their diagnostic value with ultrasonography. Study Design: Observational study. Setting: Bajwa Trauma Centre & Teaching Hospital, Sargodha. Period: 1^stNovember 2024 to 1^st May 2025. Methods: Involving 59 patients clinically suspected of harboring brain vascular malformations. All patients underwent MRI using a comprehensive protocol including T1, T2, SWI, DWI, contrast-enhanced 3D sequences, and ANGIO TWIST. Ultrasonography was used as a preliminary modality, while DSA was performed in selected cases for confirmatory vascular mapping. Data were analyzed for lesion detection rate, subtype classification, and contribution to treatment planning. Results: MRI demonstrated high sensitivity (91.5%) in detecting vascular lesions, with susceptibility-weighted imaging (SWI) accurately identifying hemosiderin in 94.4% of cavernomas and 4D flow/ANGIO TWIST detecting arteriovenous shunting in 88% of AVMs. DSA, while more invasive, remained critical for confirming angioarchitecture and dynamic flow patterns. Ultrasonography offered supportive but limited diagnostic specificity. AVMs were the most common lesion type (42.4%), followed by cavernous malformations (30.5%) and DVAs (16.9%). Additional findings such as intracranial hemorrhage (33.9%) and perilesional edema (23.7%) were also characterized. Conclusion: Advanced imaging modalities, especially MRI with SWI and dynamic sequences, play a pivotal role in the early and accurate diagnosis of brain vascular malformations. DSA remains indispensable for treatment confirmation. The integration of radiomics and machine learning, as supported by current literature, offers promising directions for individualized risk stratification and therapeutic planning.

Evaluation of discomfort in the ICU of a low and middle income country.

2025-06-20T02:27:56-07:00

Objective: To evaluate the frequency and severity of discomfort among intensive care unit (ICU) patients. Study Design: Prospective Observational study. Setting: The ICU of the Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 151 adult patients aged ≥18, admitted to the ICU for ≥48 hours, and discharged with a Glasgow Coma Scale (GCS) score of 15 were included. Data were collected within 24 hours of ICU discharge using a validated questionnaire assessing discomfort across eight domains including noise, light, bed comfort, sleep, thirst, hunger, cold, and heat, rated on a 0–10 scale. Demographic and clinical information were documented. Statistical analysis was performed using IBM-SPSS Statistics, version 25.0. Results: Of 151 patients, 102 (67.1%) were male, and the mean age was 39.0±14.6 years. Severe bed discomfort was reported 22 (14.6%) patients. Severe sleep disruption was reported in 20 (13.2%) patients. Severe thirst, and hunger were reported in 5 (3.3%) patients each. Patients requiring mechanical ventilation experienced higher levels of severe discomfort, with 30 (19.9%) reporting severe bed discomfort, and 27 (17.9%) severe sleep disruption. In patients on renal replacement therapy, 29 (19.2%) experienced severe bed discomfort, and 21 (13.9%) severe sleep disruption. Conclusion: Discomfort in the ICU is multifaceted and may be influenced by clinical interventions and duration of stay. Targeted interventions to improve bedding, reduce sleep disruption, and manage invasive procedures are essential for enhancing patient comfort, particularly in low-resource ICU settings.

Women with postpartum hemorrhage at a tertiary care hospital: Frequency, risk factors, and clinical outcomes.

2025-04-06T14:59:14-07:00

Objective: To record the outcomes of postpartum hemorrhage for mothers, as well as to investigate the prevalence, factors that are susceptible to causing PPH, and clinical outcomes of PPH. Study Design: Retrospective study. Setting: Department of OBG, MTI Hayatabad Medical Complex, Peshawar. Period: January 2023 to December 2023. Methods: The study encompassed all the women who experienced postpartum hemorrhage ensuing birth in the labor unit, however patients with an erstwhile history of bleeding disorders and those taking “Warfarin” were excluded from the study. Relevant data of patients who suffered from PPH during the study period was obtained from the medical records of the unit, reviewed, and analyzed to obtain the required frequencies and sort the risk factors. Results: The frequency of postpartum hemorrhage among the 6235 patients was 3.61% (n=225). Out of 225 PPH cases, the primary PPH occurred in 215 (95.11%) cases while 10 (4.89%) patients suffered from secondary PPH. The mean age of the women was 28.26 years (SD ±5.84). The principal causes of PPH were uterine atony, RPOCs, and Trauma / perineal and vaginal tears accounting for 173 (76.89%), 27 (12.00%), and 21 (9.33%) cases respectively. Conclusion: Uterine atony was found to be the leading cause of PPH, followed by RPOCs and perineal and vaginal tears. Un-booked patients were found to be more vulnerable to PPH. To prevent PPH, it is important to assess risk factors, and actively manage the 3^rd stage of labor.

Frequency and impact of contributing factors for episiotomy use in multiparous women in Liaqat Memorial Hospital Kohat.

2025-06-13T03:21:03-07:00

Objective: To determine the frequency of episiotomy use in multiparous women and assess its association with demographic, obstetric, and clinical factors. Study Design: Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Liaqat Memorial Hospital, Kohat. Period: 18^th May 2024 to 18^th November 2024. Methods: A total of 146 multiparous women aged 18–40 years were enrolled using non-probability consecutive sampling. Data on age, BMI, gestational age, socioeconomic status, education, occupation, comorbidities (diabetes, hypertension), and predisposing factors (fetal position, obesity, previous episiotomy/C-section) were collected. Episiotomy rates and associations were analyzed using IBM SPSS version 25, with Chi-square/Fisher’s exact tests (p ≤ 0.05 considered significant). Results: Episiotomy was performed in 80 women (54.8%). Significant associations were found with BMI (p=0.002), gestational age >38 weeks (p=0.005), hypertension (p=0.008), and employment (p=0.016). No significant links were observed with age, diabetes, education, or socioeconomic status (p > 0.05). Predisposing factors included previous episiotomy (35.6%), obesity (20.5%), and occipito-posterior fetal position (17.8%). Conclusion: Episiotomy was frequently performed in multiparous women, with higher likelihood in overweight/obese, hypertensive, employed, and late-term pregnancies. Evidence-based guidelines are needed to optimize selective use.

Comparison of pain scores in laboring patients receiving morphine and fentanyl.

2025-05-02T06:34:50-07:00

Objective: To compare the effectiveness and side effects of morphine and fentanyl for pain relief in laboring patients. Study Design: Quasi-experimental study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: 18-10-24 to 17-01-25. Method: A total of 34 laboring patients (17 per group) aged 18 to 45 years with singleton pregnancies in active labor were included. Pain relief was assessed using the Visual Analogue Scale (VAS) at 30, 60, and 120 minutes post-administration. Side effects and neonatal outcomes were also recorded. Data analysis included repeated measures ANOVA for pain scores and the chi-square test for categorical variables. Results: Pain relief, side effects, and maternal satisfaction levels were compared between the two groups. The findings provide insights into the potency, safety, and patient experience associated with each opioid. Conclusion: The study findings will help guide clinical decision-making for optimal labor analgesia, ensuring better maternal comfort and neonatal safety.

Frequency of Malaria in neonatal sepsis.

2025-06-12T05:05:38-07:00

Objective: To determine the frequency of malaria in neonatal sepsis. Study Design: Cross-sectional study. Setting: Department of Neonatology, RTEH Hospital, Muzaffargarh, Pakistan. Period: July 2024 to December 2024. Methods: A total of 218 neonates presenting with suspected sepsis were analyzed. Demographical and clinical information was noted. Blood samples were collected and sent to laboratory for relevant investigations. Malaria parasite assessment was done using Acu-check Malaria P.f. / Pan Ag Rapid Test Device. Thin smear evaluation was be performed to identify the malarial parasite species. Results: In a total of 218 neonates, 112 (51.4%) were males. The mean age was 13.8±9.0 days. Hepatosplenomegaly, pallor, and jaundice were noted in 90 (41.3%), 107 (49.1%), and 53 (24.3%) neonates, respectively. Late-onset sepsis was the commonest type, found in 138 (63.3%) neonates. Malaria was present in 9 (4.1%) neonates, while P. falciparum, and P. vivax were identified in 4 (1.8%), and 5 (2.3%) neonates. Malaria in neonates with sepsis was found to have significant association with hepatosplenomegaly (100% vs. 38.8%, p<0.001), jaundice (77.8% vs. 22.2%, p<0.001), and higher temperature (38.9±0.3 vs. 37.4±1.3 ⁰C, p<0.001), lower hemoglobin level (8.6±0.5 vs. 12.5±1.4 g/dl, p<0.001), and lower platelet levels (89.8±29.5 vs. 276.8±100.2 (10⁹/L, p<0.001). Conclusion: Malaris should be considered in those neonates presenting with sepsis-like symptoms in endemic regions. The low prevalence (4.1%) observed reflects ongoing efforts to control malaria because of this life-threatening disease.

Frequency and outcome of hypomagnesamia in children admitted in PICU of National Institute of Child Health, Karachi, Pakistan.

2025-06-12T05:03:09-07:00

Objective: To determine the frequency of hypomagnesamia (HM) in children admitted to pediatric intensive care unit (PICU), and its association with outcomes. Study Design: Cross-sectional study. Setting: The PICU of National Institute of Child Health (NICH), Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 194 children between 1 month and 12 years admitted to the PICU were analyzed. Serum magnesium levels < 1.5 mg/dL were labeled as HM. Outcomes were recorded in the form of children requiring mechanical ventilation, duration of PICU stay, and discharged or mortality. Data analysis was performed using IBM-SPSS Statistics, Version 26.0. Chi-square test, or independent sample test (as appropriate) were applied to see the impact of effect modifiers on HM. For all statistical tests, p<0.05 as significant. Results: In a total of 194 children, 160 (54.6%) were female, and the mean age was 5.83±3.45 years. HM was identified in 91 (46.9%) children. HM was having significant association with sepsis (44.0% vs. 17.5%, p=0.032), severe acute malnutrition (40.7% vs. 29.1%, p<0.001), and hypocalcemia (33.0% vs. 16.5%, p=0.008). The mean duration of mechanical ventilation (p=0.025), and PICU stay (p=0.019) were significantly higher in children with HM. HM was significantly associated with mortality (14.3% vs. 2.9%, p=0.004). Conclusion: HM is a frequent electrolyte disturbance in PICU, linked with sepsis, and malnutrition. HM is associated with greater need for mechanical ventilation, prolonged PICU stay, and increased mortality.

Clinical spectrum, laboratory profile and outcome of aplastic anemia in children presenting at tertiary care hospital.

2025-06-21T07:42:52-07:00

Objective: To evaluate the clinical presentation, laboratory profile, etiological factors, and short-term outcomes of children with aplastic anemia presenting to a tertiary care pediatric hospital in Karachi, Pakistan. Study Design: Analytical, Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health (NICH), Karachi, Pakistan. Period: November 2024 to April 2025. Methods: A total of 114 children aged 6 months to 15 years with clinical features of bone marrow failure and confirmed aplastic anemia based on peripheral cytopenias and hypocellular marrow biopsy were included. Classification into non-severe, severe, and very severe aplastic anemia was done using modified Camitta criteria. Chi-square/Fisher’s exact, and Mann-Whitney U tests were used, with p<0.005 considered significant. Results: Out of 114 children enrolled, 70 (61.4%) were male. The median age was 8.00 years (Interquartile range: 5.00-10.00 years). Fever (86.0%), fatigue (68.4%), and bleeding (64.0%) were the most common presenting features. Antibiotic exposure (25.4%) and hepatitis C infection (5.3%) were notable etiological associations. Eight children left against medical advice, and were excluded from the final analysis. Among 106 children, mortality was reported in 34 (32.1%) and was significantly associated with fatigue (p<0.001), bleeding (p=0.001), pallor (p<0.001), severe cytopenias (p<0.001), and very severe aplastic anemia (p<0.001). Bone marrow severity correlated strongly with outcome (p<0.001). Conclusion: Aplastic anemia in children carries high short-term mortality, particularly in those with very severe disease, severe hypocellularity, and drug-related etiologies. Early identification and access to definitive therapy are crucial.

Comparison of vitamin D plus phototherapy versus phototherapy alone in the treatment of neonatal jaundice.

2025-03-17T07:25:00-07:00

Objective: To compare the mean serum total bilirubin levels following the administration of vitamin D plus phototherapy versus phototherapy alone in neonates with jaundice. Study Design: Randomized Controlled Trial. Setting: Akhtar Saeed Trust Hospital, Lahore. Period: November 2023 to April 2024. Methods: A total of 60 neonates meeting the inclusion criteria were randomized into two groups. Group A received phototherapy and 1000 IU of vitamin D daily for five days, while Group B received phototherapy alone for up to seven days. Serum bilirubin levels were measured at admission and after treatment. Data were analyzed using SPSS version 20, with an independent sample t-test used to compare groups. Statistical significance was set at p < 0.05. Results: Baseline bilirubin levels were comparable between groups. Post-treatment, Group A had significantly lower mean bilirubin levels (7.15 ± 0.37 mg/dL) compared to Group B (8.23 ± 0.39 mg/dL, p < 0.001). This reduction was consistent across all demographic and clinical variables. Conclusion: The addition of vitamin D to phototherapy significantly enhanced bilirubin reduction in neonatal jaundice, supporting its use as an adjuvant therapy to improve treatment outcomes.

Comparison of large antecubital vein versus small vein on dorsum of hand for prevention of propofol injection pain.

2025-04-26T07:47:19-07:00

Objective: To determine whether using a large antecubital vein versus a small dorsum hand vein reduces the incidence and severity of pain during propofol injection in pediatric patients. Study Design: Non Randomized Controlled Trial. Setting: Institute of Child Health, Faisalabad. Period: 01 January 2025 to 30 April 2025. Methods: This study included 214 children aged 8–14 years undergoing elective surgery under general anesthesia. Participants were assigned to two groups: Group 1 received a propofol-lidocaine mixture via a large antecubital vein, and Group 2 via a small vein on the dorsum of the hand. Pain during injection was assessed using a Visual Analogue Scale (VAS) from 0 to 10, and categorized as none, mild, moderate, or severe. Baseline and post-injection heart rate, blood pressure, and oxygen saturation were recorded. Results: Group 1 (antecubital vein) reported significantly lower pain scores compared to Group 2. Forty-seven (43.9%) patients in Group 1 reported no pain, versus 13 (12.1%) in Group 2. Severe pain was reported in only 10.3% of Group 1 compared to 31.8% of Group 2. The average pain score was 2.63 ± 1.80 in Group 1 and 5.95 ± 2.79 in Group 2 (p < 0.001). Conclusion: Administering propofol-lidocaine admixture through a large antecubital vein significantly reduces injection pain compared to a small dorsum hand vein in children. This simple technique should be considered to enhance patient comfort during anesthesia induction.

Prevalence of sexually transmitted infections among married women in Pakistan.

2025-07-25T04:06:24-07:00

Objective: To determine the prevalence of STIs and associated sociodemographic factors among married women in Khyber Pakhtunkhwa, Pakistan. Study Design: Community-based Cross-sectional study. Setting: Khyberpakhtunkhawa. Period: March 2023 to March 2024. Methods: Was conducted among 650 married women aged 18-49 years using multistage cluster sampling. Participants completed structured questionnaires and provided specimens for laboratory testing of five curable STIs (trichomoniasis, chlamydia, gonorrhea, syphilis) and three viral STIs (HBV, HIV, HPV). Multivariate logistic regression identified factors associated with STI positivity. Results: Overall STI prevalence was 22.0% (95% CI:19.0-25.3), with trichomoniasis being most common (15.1%). Significant risk factors included: no formal education (aOR=4.25, 95% CI:1.89-9.56), rural residence (aOR=1.92, 95% CI:1.31-2.81), household income <25,000 PKR/month (aOR=2.89, 95% CI:1.31-6.38), and marriage before age 18 (aOR=2.15, 95% CI:1.42-3.26). Women aged 35-49 years had lower risk (aOR=0.61, 95% CI:0.38-0.98) compared to younger women. Conclusion: Married women in Pakistan bear a high burden of STIs, particularly those with limited education, low income, and early marriage. These findings highlight the need for integrated STI screening in routine women's health services and targeted interventions addressing socioeconomic disparities.

Correlation of Upper Cross Syndrome with prolonged sitting among it workers in Lahore.

2025-05-02T05:37:40-07:00

Objective: To find out the correlation between upper cross syndrome and prolong sitting among IT workers of Lahore. Study Design: Cross Sectional Study. Setting: The data will be collected from different IT Companies in Lahore such as Wateen Telecom Limited Arfa Karim Technology Incubator. Period: July 2024 to December 2024. Methods: In this study, 278 IT professionals both males and females were included through non probability convenient sampling technique. REEDCO Posture Assessment Scale was used to assess the posture of IT workers and data were collected. REEDCO scale was used to analyze the proper alignment of head, shoulder, neck and upper back. The collected data was subjected to statistical analysis version 2021 using appropriate method to explore relationships and differences between the variables of interest. Results: The occurrence of upper cross syndrome was significant with the p<0.000 value. Out of 278 participants, 50.7% had poor posture, 30.2% had fair posture and 19.1% had good posture. Current study shows that females were more prone to Upper Cross Syndrome as compared to man. Conclusion: This study reveals significant correlation between upper cross syndrome and prolong sitting among IT workers in Lahore. It is found that underweight and overweight individuals are more prone to develop upper cross syndrome than the individuals with normal BMI.

Unveiling the implementation puzzle: Dental curriculum integration in Pakistan - A faculty perspective.

2025-05-12T05:08:06-07:00

Objective: To explore the challenges faced by faculty during the implementation of integrated dental curriculum at their documented level of integration in dental institutes of Pakistan. Study Design: Qualitative Exploratory Study. Setting: The study was carried out across three dental institutions in Pakistan. Period: January 1, 2023, to June 30, 2023. Methods: A "Qualitative Exploratory Study," carried out in three dental schools in Pakistan who are running integration of the existing curriculum for more than three years. Sampling technique employed was purposive sampling technique using criterion sampling strategy. Twenty one faculty members (seven from each institute) who were from basic sciences, preclinical sciences, clinical sciences & medical educationist were selected for one to one/online semi-structured interviews. Data saturation served as the criterion for determining the interview limit. The interviews were audio recorded and later on transcribed followed by thematic content analysis manually. Results: The researcher preferred a hands-on method without intrusion of computer software. Manual analysis was used because the transcript database was tiny (under 500 pages of transcripts). The procedure generated 154 codes, which were then categorized into five themes, including the difficulties and solutions in adopting an integrated dental curriculum in Pakistan. Conclusion: The implementation of an integrated dental curriculum is a difficult endeavor that calls for collaboration from all stakeholders. Three institutions took on these issues with a commitment, under the direction of their medical education departments, and developed strategies for effective execution. This study supports institutions that are having trouble making the transition.

Short term outcomes of breast conserving surgery in breast cancer after neoadjuvant therapy.

2025-09-04T07:14:23-07:00

Objective: To determine the short term outcomes of BCS after neo-adjuvant therapy in patients with carcinoma of breast. Study Design: Descriptive Case Series. Setting: Surgical Wards, Mayo Hospital, Lahore. Period: February 2020 to August 2020. Methods: This study was performed in 41 patients having breast lump, fulfilling inclusion criteria presented in outdoor of surgical department of Mayo Hospital Lahore with ethical approval on 10-01-2020. Before neo-adjuvant chemotherapy, clips were positioned in the breast at the site of lump. Immediate mammogram was obtained after that, to confirm clips position. Patients underwent pre planned cycles of chemotherapy and then was restaged after chemotherapy. Response to chemotherapy evaluated clinically, radiologically and on resected specimen all the information was noted on predesigned proforma. Data Analyzed through SPSS version 26. Results: Mean age of the patients diagnosed with carcinoma of breast fall in the age group 31-35 (Mean age 35 ± SD 1.456). More than 80% of the tumors came out to be invasive ductal carcinomas of breast with majority (about 65%) in the upper outer quadrant of breast. About 42% and 44% of the patients showed complete and partial clinical response respectively. In this study 17% of the patients showed no pathological response after chemotherapy. About 54% and 29% of the patients showed partial pathological response and complete pathological response respectively. About 100% of the tumors excised were having margins free of tumor. Conclusion: Based on the results of our study it can be concluded that breast conserving surgery after neo-adjuvant chemotherapy is choice of treatment with good short term outcomes, eradicating the need for mastectomy depending on response to chemotherapy.

Role of magnetic resonance imaging in diagnosis of perianal fistula: bridging the radiological and surgical divide.

2025-10-10T06:57:51-07:00

Objective: To determine the accuracy of magnetic resonance imaging in diagnosis and classification of perianal fistulae taking surgical findings as gold standard. Study Design: Prospective Cross Sectional study. Setting: Department of Radiology, Liaquat University of Medical and Health Sciences, Jamshoro. Period: 01-12-2021 to 31-08-2023. Methods: The non-probability consecutive sampling technique was used in this study. After taking the informed consent the MR imaging was be done to diagnose and classify the perianal fistula which was correlated with surgical findings. All the data will be entered and analyzed on SPSS version 21. Results: In this study the mean age of the patients was 42.25±13.44 years, the male to female ratio of the patients was 1.5:1. The sensitivity, specificity and diagnostic accuracy of MRI was 92.94%, 91.76% and 92.35% respectively taking surgical findings as gold standard. Conclusion: MRI has high diagnostic accuracy in evaluation of perianal fistulae and it helps in bridging the radio surgical divide.

Morphometrics in action: Predictive modelling of height using toe and hand dimensions.

2025-07-14T04:12:29-07:00

Objectives: To explore the link between hand and foot dimensions with stature, emphasizing gender-specific variations to improve personal identification or clinical measures. Study Design: Observational Cross-sectional study. Setting: Rai Medical College Teaching Hospital, Sargodha. Period: March to May 2025. Methods: Which analysed MBBS students from Rai Medical College, Sargodha, comprising 200 males and 205 females after getting informed consent. Ethical approval was obtained from the institutional review committee prior to conducting the research. The data were statistically analysed using SPSS version 27. Multiple linear regression analyses were performed separately for male and female participants for possible predictive association. Results: Separate regression models were conducted for males and females to assess the relationship between toe lengths, hand heights, and overall height. In males, left pinky toe length (B = -0.088, p = 0.020) and left hand height (B = 0.081, p = 0.008) were significant predictors of height, while other variables were not significant. In females, none of the measured variables significantly predicted height (all p > 0.05). Conclusion: In males, left-hand height and pinky toe length showed a dependable indicator of stature estimation models based on foot and hand measurements, which suggests the sex obligations of specific approaches in forensic biometric assessments.