The Professional Medical Journal

Effectiveness of Intracanal Cryotherapy on Postoperative Pain in Teeth with Symptomatic Apical Periodontitis.

2026-03-30T07:30:24-07:00

Objective: To assess the impact of intracanal cryotherapy in patients with pulp necrosis and symptomatic apical periodontitis at 12, 24, and 72 hours after single-visit root canal therapy using cold saline (2.5°c) as a final irrigant. study design: Randomized Clinical Trial. setting: Operative Dentistry & Endodontics, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. Period: May to October 2025. methods: Group a (intracanal cryotherapy: 20 ml of 2.5°c normal saline) and group b (control: 20 ml of room-temperature saline) were randomly assigned 1:1 to 196 systemically healthy adults (aged 18–60 years) with pulp necrosis and symptomatic apical periodontitis. every tooth received a single-visit root canal treatment. visual analog scale (vas) was used to measure postoperative pain at 12, 24, and 72 hours. the chi-square test (p < 0.05), general linear model, and mann-whitney u test were used to evaluate between-group differences. results: All 196 participants completed the study. the groups were comparable at baseline for age and sex (p > 0.05). no significant between-group differences in pain scores were observed at 12 hours (5.07 ± 0.646 vs. 5.01 ± 0.634; p = 0.668) or 24 hours (3.97 ± 1.000 vs. 3.99 ± 1.108; p = 0.749). at 72 hours, the cryotherapy group demonstrated significantly lower mean pain scores than the control group (1.31 ± 1.304 vs. 2.08 ± 1.843; p = 0.008), with a significantly greater proportion achieving no or mild pain (vas 0–3: 89.8% vs. 70.4%; χ² = 10.371, p = 0.001). male participants and anterior teeth in the cryotherapy group demonstrated greater analgesic benefit at 72 hours. no adverse events were recorded in either group. conclusion: Intracanal cryotherapy using 20 ml of 2.5°c saline significantly reduced postoperative pain intensity and improved clinical success rates at 72 hours compared with room-temperature saline in patients with symptomatic apical periodontitis.

Use of red cell indices in identifying beta thalassemia trait in undergraduate medical students-a pilot study.

2026-02-21T03:37:21-08:00

Objective: To determine the prevalence of beta thalassemia trait (BTT) among undergraduate medical students using red cell indices in a pilot study. Study Design: Cross-sectional descriptive study. Setting: Rashid Latif Khan University (RLKU) Medical College. Period: Over one year, February 2024 to February 2025. Methods: A total of 100 undergraduate medical students were included. Complete blood count (CBC) was performed for all participants. Anaemia was defined according to World Health Organization criteria (hemoglobin <13 g/dL in males and <12 g/dL in females). Anaemic students were further evaluated using red cell indices (MCV, MCH, RDW, RBC count). Mentzer Index (MCV/RBC) was calculated, and values <13 with elevated RBC count were considered suggestive of BTT. Suspected cases underwent hemoglobin electrophoresis using capillary electrophoresis for confirmation. Results: The mean age was 20 ± 2 years, with 40% males and 60% females. Anaemia was present in 23% students. Four students (17.4% of anaemic group) had a Mentzer Index <13 with raised RBC count. Hemoglobin electrophoresis confirmed BTT in 2 cases, giving a prevalence of 2%. The positive predictive value of Mentzer Index was 50%. The estimated prevalence was 2% (95% CI: 0.24%–7.0%). Conclusion: In this pilot study, red cell indices appear to be a cost-effective screening tool for identifying suspected BTT cases. Larger studies are required to validate these findings.

A clinicopathological study on IDH (Isocitrate Dehyrogenase Glioblastoma) wild type gliomas.

2026-07-27T06:59:14-07:00

Objective: To describe the clinicopathological profile of IDH-wildtype gliomas and evaluate their association with age and sex. Study Design: Descriptive Cross-sectional study. Setting: Department of Histopathology, Shaukat Khanum Memorial Hospital and Research Centre, Lahore. Period: December 16, 2023 till June 16, 2024. Methods: A total of 73 IDH-wildtype glioma patients were included. The IDH1 (R132H) immunohistochemistry was performed to identify cases, and was confirmed by molecular testing when clinically indicated. Data from clinical, radiologic, histopathological, molecular, and treatment records were obtained from the hospital records. The diagnosis of the tumors was made by histological diagnosis and based on the 2007 WHO Classification of Central Nervous System Tumors. Data was analysed with SPSS version 26. The clinicopathological features were compared among the age groups and sex by Chi-square test or Fisher's exact test, p-value of <0.05 was regarded as significant. Results: The mean age was 39.45 ± 12.45 years, and 67.1% of patients were male. The most common location of the tumor was the right frontal lobe (37.0%). The most common histological subtype identified was glioma not otherwise specified (52.1%) and 58.9% of the tumors were WHO Grade III or IV. The most common radiological impression was high-grade glioma (47.9%) while surgery combined with chemoradiotherapy was the most common treatment (60.3%). There was a significant association between WHO grade (p<0.001) and radiological impression (p=0.002) and age, in that older patients had higher proportion of Grade IV tumors and high-grade radiological features. No differences were found between age and tumor location, histological subtype, tumor size or treatment modality. Likewise, there were no significant differences between gender with respect to clinicopathological parameters. Conclusion: IDH-wildtype gliomas were primarily in middle-aged men, and often were high-grade tumors of the frontal lobe. Tumour aggressiveness was significantly correlated with increasing age, but not significant for sex. The results help to define the clinicopathological spectrum of IDH-wildtype gliomas and can help to refine the process of diagnostic stratification as well as future prognosis research.

Outcome of Endoscopic Third Ventriculostomy (ETV) and Ventriculo-Peritoneal (VP) Shunt in Normal Pressure Hydrocephalus.

2026-04-21T07:52:27-07:00

Objective: Compare twelve-month functional recovery, complication profiles and long-term revision rates between endoscopic third ventriculostomy and ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus. Study Design: Retrospective Cohort study. Period: January to December 2025. Setting: Department of Neurosurgery, Nishtar Hospital Multan. Methods: Sixty-two adults aged fifty or older with radiologically confirmed ventriculomegaly and positive high-volume tap tests underwent either endoscopic third ventriculostomy or programmable ventriculoperitoneal shunting. Baseline characteristics were rigorously matched. Primary endpoints assessed functional restoration via standardized mobility and cognitive instruments. Secondary metrics evaluated procedure-related adverse events, secondary surgical interventions, hospitalization duration, and validated quality-of-life indices. Multivariate logistic regression and Kaplan-Meier survival analysis controlled for demographic and clinical confounders. Results: Meaningful functional improvement occurred in 77.4% of the endoscopic cohort versus 83.9% in the shunt group, confirming statistical non-inferiority. Gait parameters improved comparably across both interventions. No perioperative mortality was recorded in either cohort. The endoscopic approach demonstrated substantially lower complication frequencies (12.9% versus 48.4%), fewer reoperations (6.5% versus 29.0%), and reduced median hospital stays. Multivariate modeling identified positive tap test responsiveness and preserved cortical architecture as independent predictors of recovery, whereas procedural selection failed to independently influence outcomes. Conclusion: Endoscopic third ventriculostomy provides equivalent functional restoration to mechanical shunting while significantly minimizing hardware-related complications and revision burdens. Preoperative physiological profiling, rather than surgical tradition, must dictate therapeutic strategies in carefully selected candidates.

Pattern of spinal cord Injury in young adults: Etiology, level of injury and associated complications.

2026-08-03T07:49:16-07:00

Objective: To determine pattern of spinal cord injury in young adults aged 18–35 years, identify etiologies, most common neurological levels and types of early medical complications. Study Design: Cross Sectional Analytical study. Period: January 2024 to June 2025. Setting: Allama Iqbal Teaching Hospital, DG Khan Medical College, Dera Ghazi Khan. Methods: Three hundred sixty two young adults with imaging-confirmed traumatic spinal cord injury were enrolled consecutively. Demographics, mechanism of injury, ASIA impairment grade, anatomical level, time to presentation, and complications within three months were documented on a structured proforma. Chi-square tests and logistic regression were performed in SPSS version 21.0 to identify predictors of early complications. Results: Males constituted 85.1% of participants (mean age 26.7 ± 5.4 years). Road traffic accidents caused 62.2% of injuries, followed by falls (27.1%), sports injuries (6.6%), and violence (4.1%). Cervical injuries predominated (52.2%), and 63.8% were complete (ASIA A). Complications developed in 67.9%, led by urinary tract infections (29.8%), pressure ulcers (26.0%), neurogenic shock (21.0%), and respiratory failure (18.8%). Cervical level strongly predicted respiratory failure (OR 6.2; 95% CI 3.8–10.1), and complete lesions were linked to pressure ulcers (OR 3.1; 95% CI 2.0–4.8). Conclusion: Traumatic spinal cord injury in young adults of southern Punjab is predominantly caused by road traffic accidents; most frequently involves the cervical spine, and carries a high early complication burden, underscoring the need for targeted prevention strategies and multidisciplinary rehabilitation.

Decoding death on roads: A forensic evaluation of injury patterns and associated factors in road traffic accident fatalities in Peshawar.

2026-04-21T05:42:15-07:00

Objective: To assess the frequency, pattern of injuries and its associated contributory factors in road traffic accidents cases at Peshawar. Study Design: Descriptive Cross sectional study. Setting: Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. Period: 01^stJan 2024 to 31^st Dec 2024. Methods: Included a total of188 candidates presented for autopsy at forensic medicine department, Khyber medical college from 01 jan 2024 to 31^st Dec 2024.all cases with complete documentation and underwent RTA were included in study and cases with incomplete documentation were excluded from study. Results: The subjects' ages ranged from 2 to 80 years, with a mean of 36.9 ± 20.7. The majority of the people were from urban areas, from low-income families, and had no education. 96.8% of subjects had multiple injuries, compared to 3.2% who had only one. Overall, 188 cases resulted in 606 injuries, with 90.76% being little, 7.92% being medium, and 1.32% being large, including all types of injuries. The most common presenting injury was laceration (87.2%), followed by abrasion (59.6%), contusion (51.1%), fracture (23.4%), and haematoma (2.1%). The most common region involved in RTA was the head and neck, accounting for 86.17%. Maximal deaths occurred within 3-6 hours of an RTA. The most common cause of death was harm to the brain and its related arteries. Conclusion: The study hereby identifies that the prevalence of RTAs in Peshawar is alarming, mainly in young adult males, including both urban and lower socioeconomic backgrounds. The majority of victims suffered from multiple types of injuries. The head and neck were the most frequently implicated. Major cause of death was due to injury to brain and related arteries-a lethal consequence of head trauma. These findings go in accordance with national and international research, pointing to critical preventive initiatives addressing behavioural, infrastructure, and enforcement aspects.

Clinical and radiological outcomes of posterior closing wedge osteotomy in post-tubercular thoracolumbar kyphosis.

2026-03-17T04:25:19-07:00

Objective: To critically evaluate the clinical, radiographic and neurological outcomes after posterior closing wedge osteotomy (PCWO) in persons suffering from post-tubercular kyphosis (PTK). Study Design: Quasi-experimental study. Setting: Department of Orthopaedic Surgery in the Lahore General Hospital. Period: February 2021 to January 2022. Methods: This was a quasi-experimental study in which thirty patients with Post-Tubercular Kyphosis were treated by Posterior Closing Wedge Osteotomy. Clinical function was measured by the Oswestry Disability Index (ODI), the neurological status was graded according to the Frankel classification, and radiologic correction was assessed according to Cobb's angle measured from lateral spinal radiographs. Results: The mean age of the cohort of patients was between 25 and 40 years, with a predominance of female patients 60%. Cobb's angle showed a statistically significant reduction from baseline to final follow-up (p < .05). Neurological recovery was noted in most patients, with most reaching Frankel grade E at final follow-up. ODI scores indicated a significant functional improvement over time (p < .05). Complications were mostly low-grade (Dindo-Clavien Grade I), with only one grade III in one patient (3.3%). Conclusion: Posterior closing wedge osteotomy is a safe and effective surgical modality for correction of post-tuberculous kyphosis with promising results in terms of significant deformity correction, neurological restitution and functional enhancement.

Risk factors associated with failed closed reduction and per-cutaneous pinning in supracondylar fractures of humerus in children.

2026-05-06T05:07:35-07:00

Objective: To determine the factors associated with failed closed reduction in supra condylar fractures of humerus in children. Study Design: Descriptive Cross-sectional study. Setting: Department of Orthopaedic, Lady Reading Hospital, Peshawar. Period: March 2025 to August 2025. Methods: Ninety-three children aged 2–12 years with supracondylar humerus fractures were enrolled using consecutive sampling. Demographic data, injury mechanism, clinical findings, and radiographic classification were documented. Failure of closed reduction was defined as inability to obtain and maintain satisfactory alignment under fluoroscopy after manipulation and pin fixation. Data were stratified and associations were assessed using the chi-square test, with a p-value of ≤0.05 considered statistically significant. Results: Mean age was 7.1±3.3 years; 73 (78.5%) were male. Right-sided injuries 58 (62.4%) and low-energy mechanisms 73 (78.5%) were most common. Delayed presentation occurred in 63 (67.7%), marked swelling in 19 (20.4%), and Gartland type III fractures in 10 (10.8%). Younger children (≤8 years) were significantly more likely to show swelling (p=0.019), while left-sided injuries had higher rates of delay (p=0.015). Conclusion: Delayed presentation, massive swelling, and severe fracture type were strongly associated with failure of closed reduction and percutaneous pinning, underscoring the importance of early evaluation and timely surgical management.

Postoperative complications of transpedicular screw fixation in spinal patients.

2026-08-08T07:28:19-07:00

Objective: To determine the frequency and pattern of postoperative complications following transpedicular screw fixation in patients with spinal pathology. Study Design: Descriptive (Cross-sectional) study. Setting: Department of Neurosurgery, Lady Reading Hospital, Peshawar. Period: 1st November 2025 to 30th April 2026. Methods: A total of 133 patients aged 15–80 years who underwent transpedicular screw fixation for spinal pathology were enrolled through non-probability consecutive sampling. Data were collected using a structured proforma, history, clinical examination and postoperative X-rays. Complications recorded included screw breakage, screw misplacement, surgical site infection and neurological deficit. Neurological status was assessed using Frankel Grading. Data were analyzed using SPSS v25; the chi-square test was applied to determine the association between age and complications, with p≤0.05 taken as significant. Results: Of 133 patients, 96 (72.2%) were male and 37 (27.8%) were female. The thoracolumbar region was the most common site of injury. Postoperative complications included back pain (26.3%), surgical site infection (6.8%), misplaced screws (2.3%), screw breakage (1.5%) and nerve root injury (0.75%). On Frankel grading, 61.6% of patients had no neurological deficit (Grade E) postoperatively. No significant association was found between age and postoperative complications (χ²=0.198, p>0.05). Conclusion: Transpedicular screw fixation performed under fluoroscopic guidance is associated with a high rate of favorable outcome and a low rate of technical and neurological complications, although postoperative back pain and surgical site infection remain notable challenges.

Hypomagnesemia and Its association with arrhythmia risk in patients with heart failure with reduced ejection fraction: A cross sectional analytical study.

2026-05-05T07:01:08-07:00

Objective: To evaluate the association between serum magnesium concentration and clinically significant arrhythmias in patients with heart failure with reduced ejection fraction. Study Design: Analytical Cross Sectional. Setting: Department of Biochemistry, Shahida Islam Medical and Dental College, Lodhran. Period: October 2025 to February 2026. Methods: Total of 185 adults with confirmed systolic dysfunction (left ventricular ejection fraction ≤40%). Hypomagnesemia was defined as fasting serum magnesium <0.70 mmol/L. Arrhythmia burden was ascertained using standardized electrocardiography and ambulatory rhythm monitoring. Multivariable logistic regression quantified independent associations after rigorous adjustment for demographic, renal, electrolyte, and guideline-directed pharmacological confounders. Statistical significance was considered at p value <0.05. Results: Hypomagnesemia affected 15.7% of participants, while 36.8% exhibited clinically significant arrhythmias, predominantly atrial fibrillation and frequent ventricular ectopy. Unadjusted analysis revealed markedly elevated arrhythmia prevalence (odds ratio: 2.89; p=0.009). Following comprehensive covariate adjustment, low serum magnesium remained independently associated with arrhythmia occurrence (adjusted odds ratio: 2.14; 95% confidence interval: 1.03–4.45; p=0.041). Concomitant reductions in estimated glomerular filtration rate and serum potassium emerged as additional independent predictors. Model diagnostics demonstrated acceptable discriminatory capacity and calibration. Subgroup evaluations confirmed consistent effect modification across renal and diuretic exposure categories. Conclusion: Hypomagnesemia independently predicts a substantially higher arrhythmia burden in systolic heart failure. Systematic magnesium surveillance and targeted repletion constitute pragmatic, cost-effective strategies for arrhythmia risk mitigation.

Factors contributing to unplanned initiation of dialysis in chronic kidney disease patients: A prospective analysis.

2026-03-18T04:10:40-07:00

Objective: To determining risk factors for unplanned initiation of dialysis in advanced chronic kidney disease (CKD) patients. Study Design: Prospective Observational study. Setting: The Kidney Center, Karachi, Pakistan. Period: September 2024 to May 2025. Methods: Adults (≥18 years) with stage 5 CKD initiating maintenance haemodialysis were analyzed. Planned dialysis was defined as elective initiation via arteriovenous fistula (AVF) / arteriovenous graft (AVG), or planned catheter, while unplanned initiation referred to urgent inpatient dialysis. Demographic, clinical, laboratory, and vascular access data were recorded. Statistical analyses was performed taking p<0.05 as significant. Results: Of 73 patients, 23 (31.5%) initiated dialysis electively, and 50 (68.5%) unplanned. Overall, the mean age was 53.9±14.6 years, and 39 (53.4%) were male. Diabetes mellitus was significantly more frequent in unplanned dialysis patients (60.0% vs 30.4%, p=0.019). Late referral (<1 month) was significantly associated with unplanned dialysis (p<0.001). Unplanned dialysis patients had lower albumin (p=0.024), and higher potassium (p=0.001) levels. AVF use was 82.6% in elective vs none in unplanned dialysis patients (p<0.001). Logistic regression identified diabetes (OR 3.4), late referral (OR 2.9), hyperkalaemia (OR 2.4), volume overload (OR 7.7), and AKI on CKD (OR 42.7) as major risk factors for unplanned dialysis. Conclusion: The unplanned initiation of dialysis in advanced CKD is strongly associated with diabetes mellitus, late referral, inadequate dialysis education, hypoalbuminaemia, hyperkalaemia, metabolic acidosis, volume overload, and acute kidney injury on CKD.

Complications and management strategies in ultrasound-guided omental biopsies: A clinical cohort study of on-table interventions and outcomes in a Tertiary Care Hospital.

2026-07-14T05:59:23-07:00

Objective: To evaluate the frequency and nature of complications associated with ultrasound-guided omental biopsies and to assess the effectiveness of immediate on-table management strategies using a co-axial biopsy technique. Study Design: Prospective Observational Clinical Cohort study. Setting: Department of Interventional Radiology, Tertiary Care Hospital, Lady Reading Hospital, Peshawar. Period: June 2025 to June 2026. Methods: Included 115 consecutive patients undergoing ultrasound-guided omental biopsy using a co-axial core biopsy system. Demographic data, lesion characteristics, procedural details, complication rates, bleeding severity, and management strategies were recorded prospectively. Minor bleeding was managed using autologous clotted blood injection through the same c o-axial tract, whereas major bleeding was treated using Gel Foam slurry embolization followed by manual compression. Post-procedural ultrasound follow-up was performed to assess residual hematoma formation and delayed complications. Results: Among the 115 patients included in the study, 81 (70.4%) were female and 34 (29.6%) were male. Bleeding complications occurred in 12 patients (10.4%). Minor bleeding occurred in 9 patients (7.8%) and was successfully managed with autologous clot injection through the existing co-axial needle tract. Major bleeding occurred in 3 patients (2.6%) and was managed successfully using Gel Foam slurry embolization through the same tract followed by manual compression for 15 minutes. Technical success of hemostasis was achieved in 100% of complicated cases. No patient required surgical intervention, angiographic embolization, blood transfusion, or intensive care admission. Follow-up ultrasound demonstrated no residual hematoma or delayed bleeding complications. Conclusion: Ultrasound-guided omental biopsy using the co-axial technique is a safe, effective, and minimally invasive diagnostic procedure. Immediate management of bleeding complications through the same access tract significantly enhances procedural safety, minimizes patient morbidity, reduces resource utilization, and eliminates the need for additional invasive interventions.

Prevalence of microalbuminuria and associated factors in patients with type 2 diabetes mellitus.

2026-03-09T05:23:41-07:00

Objective: To determine the prevalence of microalbuminuria and identify associated demographic and clinical factors in type 2 diabetic patients. Study Design: Cross-sectional Analytical study. Setting: Department of Medicine, Combined Military Hospital Multan. Period: Nov-2024 to Apr-2025. Methods: A total of 126 patients diagnosed with type 2 diabetes mellitus for ≥2 years were enrolled in this study. Baseline demographics, clinical history, and results of laboratory parameters were recorded. Patients were defined as having microalbuminuria when urinary albumin-to-creatinine ratio was 30-300 mg/g. Demographic and clinical risk factors were compared between patients diagnosed with microalbuminuria and those without it to determine the factors associated with the development of microalbuminuria by applying chi-square tests and independent t-tests keeping p<0.05 as statistically significant. Results: The mean age was 51.34±7.53 years with nearly equal gender distribution. The prevalence of microalbuminuria was found to be 21.4%. Patients diagnosed with microalbuminuria had significantly higher age (54.67±7.22 vs 50.47±7.42 years, p=0.01), male predominance (70.37% vs 45.45%, p=0.02), longer diabetes duration (12.7±4.14 vs 9.41±4.61 years, p<0.01), uncontrolled diabetes (81.48% vs 60.61%, p=0.04), uncontrolled hypertension (51.85% vs 18.18%, p<0.01). These patients also had higher prevalence of hypertension (p=0.02) and obesity (p=0.04), higher BMI (p=0.04) and smoking rates (p=0.01). Conclusion: A notable proportion of type 2 diabetic patients also develop microalbuminuria. Older age, male gender, longer duration of diabetes, poor glycemic control, hypertension, obesity, and smoking are significantly associated factors in the development of microalbuminuria in these patients.

Association of raised level of high sensitivity CRP with complications after NSTEMI (non-ST-elevation MI).

2026-03-13T03:56:50-07:00

Objective: To determine the association of raised levels of high sensitivity CRP with complications after NSTEMI. Study Design: Cohort study. Setting: Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Wazirabad. Period: Six Months from January 14, 2025 to July 13, 2025. Methods: All patients were followed till 90 days and data regarding adverse cardiovascular events i.e. heart failure, repeat myocardial infarction and mortality were noted. All above data was noted from both groups and complications were noted. Data was entered and analyzed with SPSS-v23. Chi-square test was applied to compare heart failure, repeat myocardial infarction and mortality in both groups taking p≤0.05 as significant. Relative risk was also calculated. Results: Total 380 patients (190 exposed and 190 un-exposed) were selected for this study. Among exposed, there were 120(63.2%) males and 70(36.8%) females, while 114(60.0%) males and 76(40.0%) females among un-exposed. Among exposed, mean age was 44.5±11.9 year and 45.3±12.7 year among un-exposed. Among exposed, mean BMI was 28.5±2.9 kg/m² and 28.3±2.7 kg/m² among un-exposed. By comparing adverse cardiovascular events between groups, it was found that percentage of adverse cardiovascular events was 40.5% among exposed and 26.3% among un-exposed and the difference was significant (p=0.003, RR=1.357). Conclusion: High CRP is an indicator of poor result in patients with NSTEMI and is used to determine patients who might be vulnerable to cardiovascular complications.

Diagnostic accuracy of multidetector CT in predicting esophageal varices in cirrhotic patients: A comparison with endoscopy as the gold standard.

2026-04-04T07:25:28-07:00

Objective: To determine the diagnostic accuracy of multidetector CT in predicting the presence of esophageal varices in patients with cirrhosis taking endoscopy as gold standard. Study Design: Cross-sectional study. Setting: Department of Radiology, Pakistan Kidney and Liver Institute and Research Centre (PKLI &RC), Lahore. Period: July 2025 to December 2025. Methods: Sample size (n) of 168 patients has been calculated with 95% confidence level taking prevalence of esophageal varices 10%, multidetector CT sensitivity of 98.9% and specificity of 100% in predicting presence of esophageal varices. Sampling Technique was non-probability consecutive sampling technique. Data selection included inclusion criteria as diagnosed case of Liver Cirrhosis on gray scale ultrasound, patients of both sex, patients of age 15 to 70 years. Results: In this cross-sectional study conducted at Pakistan Kidney and Liver Institute & RC over one year, 168 cirrhotic patients (mean age 52.3 ± 10.7 years; 61.3% male) underwent both multidetector CT (MDCT) and upper endoscopy for esophageal varices (EV) evaluation. Using endoscopy as the gold standard, MDCT demonstrated exceptional diagnostic performance: sensitivity 97.1% (95% CI: 92.3–99.2%), specificity 98.4% (94.1–99.8%), positive predictive value 97.7%, negative predictive value 97.9%, and overall accuracy of 97.6% (all p < 0.001). Inter-modality agreement for variceal grading was almost perfect (Cohen’s κ = 0.91, p < 0.001). Furthermore, MDCT-detected features including paraesophageal collaterals (OR 42.6, p < 0.001), gastric varices (OR 20.1, p < 0.001), splenomegaly (OR 14.8, p < 0.001), and portal vein dilation >13 mm (OR 13.2, p < 0.001) were strongly predictive of EV presence. These findings support MDCT as a highly accurate, noninvasive, and well-tolerated alternative to endoscopy for initial EV screening and risk stratification in cirrhotic patients, particularly where endoscopic resources are limited. Conclusion: This study demonstrates that multidetector computed tomography (MDCT) is a highly accurate, noninvasive, and patient-friendly imaging modality for the detection and grading of esophageal varices in patients with liver cirrhosis. With sensitivity and specificity exceeding 97%, and near-perfect agreement with endoscopy in variceal grading (κ = 0.91), MDCT proves to be a reliable alternative to upper gastrointestinal endoscopy particularly valuable in settings where endoscopic screening is limited by availability, cost, or patient tolerance. Future multicenter studies with larger cohorts are recommended to validate these findings across diverse populations and healthcare systems.

Comparison of AIMS65 vs pre-endoscopy Rockall score for the prediction of in-hospital mortality at a tertiary care hospital of Punjab, Pakistan: which one is better?

2026-05-02T07:40:32-07:00

Objective: To compare the AIMS65 score with the pre-endoscopy Rockall score among patients presenting with upper gastrointestinal bleeding for the prediction of in-hospital mortality. Study Design: Analytical Cross-sectional study. Setting: Medical Unit III, Sahiwal Teaching Hospital. Period: August 2025 to March 2026. Methods: 123 patients who presented with upper GI bleeding in the emergency department were enrolled. For each patient AIMS 65 and Pre-endoscopy Rockall score was calculated. Data analysis was performed using SPSS. Area under the Curve (AUC) was determined for both scores using Receiver Operating Characteristic (ROC) analysis. A p-value of <0.05 was considered statistically significant. Results: The mean age of the patients was 55.90 ± 14.7 years. Male patients were 56.1% in proportion. The total mortality rate in the hospital was found out to be 24.4%. AUC for AIMS65 and pre-endoscopy Rockall scores was 0.844 (95% CI: 0.772–0.917; p<0.001) and 0.834 (95% CI: 0.766–0.903; p<0.001), respectively. Both scores showed good predictive performance for in-hospital mortality. The difference between the two was minimal (0.010) and not statistically significant. Conclusion: AIMS 65 and Pre-endoscopy Rockall score are both equally effective for the prediction of in-hospital mortality among UGIB patients.

Relationship between Delirium, Acute Respiratory Distress Syndrome (ARDS), and In-hospital mortality to the patients in Intensive Care Unit (ICU).

2026-04-27T06:18:07-07:00

Objective: To risk of acute respiratory distress syndrome (ARDS) mortality in intensive care unit (ICU) and know the extent to which delirium and persistent coma influence the association between ARDS and in-hospital mortality issues of critical care infrastructure. Study Design: Prospective Observational Cohort study. Setting: Bakhtawar Amin Memorial Trust Teaching Hospital, Multan. Period: December 2025 to February 2026. Methods: Adult patients (≥18 years) admitted in ICU were enrolled. Daily delirium screening was performed using the Confusion Assessment Method for the ICU (CAM-ICU) combined with the Richmond Agitation–Sedation Scale (RASS). ARDS was diagnosed according to the 2012 Berlin Definition. Multivariable logistic regression was used to evaluate associations, adjusting for age, APACHE II score, duration of mechanical ventilation, sedative exposure, and comorbidities. Results: Of 612 enrolled patients, 57 (9.3%) were diagnosed with ARDS. Delirium occurred in 68% of intubated ARDS patients, compared to 49% in intubated non-ARDS patients and 19% in non-intubated patients (P < 0.001). After multivariable adjustment, ARDS was independently associated with a 5.8-fold increased odds of delirium relative to non-intubated patients (adjusted odds ratio [aOR] = 5.82; 95% CI: 1.42–23.85; P = 0.014), whereas mechanical ventilation without ARDS conferred a more modest increase (aOR = 2.04; 95% CI: 1.18–3.51; P = 0.011). In unadjusted analysis, ARDS was linked to a 9.7 fold higher odds of in-hospital mortality (OR = 9.71; 95% CI: 2.94–32.08). However, this association weakened considerably after adjusting for delirium and persistent coma (aOR = 4.96; 95% CI: 1.38–17.82), suggesting partial mediation by neurological complications. Conclusion: In ICU setting, ARDS is a significant independent risk factor for ICU delirium beyond the effects of mechanical ventilation alone. Moreover, delirium and coma appear to mediate a substantial portion of the mortality risk associated with ARDS. These findings emphasize the critical need for structured delirium prevention protocols including conservative sedation, early mobilization, and routine cognitive screening in ARDS management within Pakistan’s resource-limited critical care environments.

Clinical manifestations and antibody associations in systemic sclerosis: Insight from a single-center cohort.

2026-04-22T05:00:23-07:00

Objective: To describe the clinical manifestations and autoantibody associations in patients with systemic sclerosis (SSc) at a tertiary care center in Pakistan. Study Design: Prospective Cross-sectional Comparative Observational study. Setting: Department of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan. Period: January 2019 to December 2025. Methods: Forty-seven consecutive patients fulfilling the 2013 ACR/EULAR classification criteria for SSc were enrolled. Clinical subtypes (dcSSc vs lcSSc), organ involvement (HRCT for ILD, echocardiography for suspected PH), and SSc-specific autoantibodies were recorded. Data were analysed using SPSS. Results: Mean age was 41.2 ± 11.8 years; 61.7% had dcSSc. Raynaud’s phenomenon was universal (100%). ILD was present in 73.3% with no significant difference between dcSSc (75.0%) and lcSSc (70.6%) (p=0.746). Anti-Scl-70 was the most common autoantibody (40.4%) and anticentromere antibody (ACA) was exclusively seen in lcSSc (27.8% vs 0%, p=0.008). No significant antibody–organ associations were found. Conclusion: This Pakistani cohort showed a uniformly high burden of ILD across both cutaneous subtypes and the classical ACA–lcSSc association. Universal ILD screening is warranted irrespective of subtype or autoantibody profile.

Frequency and sonographic grading of non-alcoholic fatty liver disease (NAFLD) among Type 2 Diabetics presenting to a DHQ Hospital: A cross-sectional analytical study.

2026-05-05T06:54:28-07:00

Objective: To determine the frequency and sonographic grading of non-alcoholic fatty liver disease among adults with type 2 diabetes mellitus and evaluate associations with demographic, anthropometric and biochemical parameters. Study Design: Analytical Cross sectional. Period: June 2024 to December 2025. Setting: Department of Medicine, Bahawal Victoria Hospital Bahawalpur & Department of Radiology, District Headquarters Hospital Lodhran. Methods: Three hundred seventy-four eligible diabetic adults were enrolled via consecutive non random sampling. Exclusion criteria encompassed chronic alcohol consumption, viral hepatitis, and hepatotoxic medication use and body mass index exceeding 40 kg /m². Standardized anthropometric assessments and fasting laboratory evaluations were conducted alongside blinded abdominal ultrasonography. Hepatic steatosis severity was classified using the Saverymuttu echogenicity protocol. Multivariable logistic regression identified independent predictors. Results: The overall sonographically confirmed NAFLD frequency was 62.3% (95% CI: 57.2–67.2). Sonographic grading distribution included mild (24.1%), moderate (25.9%), and severe (12.3%) steatosis. Multivariable analysis confirmed elevated body mass index (adjusted OR: 1.28), hypertriglyceridemia (adjusted OR: 1.01), uncontrolled glycated hemoglobin (adjusted OR: 1.31), and comorbid hypertension (adjusted OR: 1.89) as significant predictors. Conclusion: Non-alcoholic fatty liver disease affects nearly two-thirds of type 2 diabetic patients in this district hospital setting, predominantly manifesting as moderate steatosis. Adiposity, dyslipidemia, glycemic instability and vascular comorbidities independently predict hepatic fat accumulation. Implementing systematic sonographic screening within routine diabetes management facilitates timely risk stratification and integrated metabolic care.

Comparison of frequency with pattern of thrombocytopenia and prevalence of dengue hepatitis in patients with dengue fever and dengue hemorrhagic fever: A cross-sectional study from Rawalpindi Medical University.

2026-02-03T05:30:41-08:00

Objective: To assess frequency and severity of thrombocytopenia and evaluate prevalence and severity of dengue hepatitis among patients with DF and DHF. Study Design: Comparative Cross-Sectional Study. Setting: Department of Medicine, Rawalpindi Teaching Hospital (RTH), affiliated with Rawalpindi Medical University, Rawalpindi, Pakistan. Period: One Year from September 2024 to September 2025. Methods: A comparative cross-sectional study involving 200 serologically confirmed dengue patients (100 DF, 100 DHF) admitted to a Rawalpindi Medical University Teaching Hospital. Platelet counts were classified as per severity and dengue hepatitis was confirmed from noted elevations in ALT and AST. Chi-square tests and correlation were used to ascertain associations between fever type and laboratory variables. Statistical significance was robust at p<0.05. Results: Thrombocytopenia was common among all patients and severe thrombocytopenia (<40×10³/µL) was slightly more frequent among DHF. However, the association between fever type and platelet levels did not show significant correlation (p>0.05). On the other hand, Dengue Hepatitis Was Higher In Prevalence And Severity Among DHF Patients With Increased ALT Levels (P=0.011). Higher AST elevations were seen in most patients. A significant negative correlation was identified between hepatic enzyme levels and disease severity (Spearman r = –0.232, p=0.001), suggesting transaminase levels progressively rise then fall during the course of ill clinical status. Conclusion: Although thrombocytopenia occurred frequently in both DF and DHF without a significant difference, dengue hepatitis was substantially more common and severe in DHF. Elevated liver enzymes, particularly ALT and AST, serve as reliable indicators of Severe Dengue and may aid in early risk stratification.

Clinicohematological characteristics and treatment outcome of diffuse large B-Cell lymphoma -single center experience from Pakistan.

2025-10-28T06:20:37-07:00

Objective: To assess the clinicohematological characteristics and treatment outcome in Diffuse Large B-cell Lymphoma (DLBCL) patients. Study Design: Cross Sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD-BMT). Period: January 2024 to March 2025. Methods: This study included DLBCL patients who were treated at NIBD-BMT. The disease staging was done according to Ann Arbor staging. The IPI and Revised IPI (R-IPI) were employed for prognostic evaluation. All treatment naïve patients received 6 cycles of R-CHOP. Relapse/refractory patients were offered salvage regimen (R-ICE/R-DHAP/R-Lenalidomide/DHAP). The clinical and laboratory findings were evaluated on follow-up visits every 3 months. The statistical analysis was done by using SPSS version 25. Results: A total of 21 DLBCL patients were included and 57.1% were males. The median age of participants was 52 years; ranging from 32 to 58 years. Among the total, 52.4% of patients had hemoglobin levels <10.5 g/dl,81% had low TLC of <11 × 10⁹/L and platelet counts >100 × 10⁹/L in 71.4%.The R-IPI indicated that 82.4% of patients had a poor prognosis. The Ann Arbor staging system revealed that 52.9% had stage 4B.The 57 months overall survival (OS) was 62.5% for the entire cohort. In primary patients, the OS was 69% and in patients with relapsed lymphoma at the initial presentation OS was 50% with log rank test p-value 0.89. Conclusion: The study revealed the clinical characteristics, risk stratification and treatment outcomes in DLBCL in resource limited country. Furthermore, multicenter studies with large sample size are needed to validate the outcome of treatment in DLBCL patients.

Comparative analysis of outcomes: Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric obstructive hydrocephalus.

2026-04-20T05:31:02-07:00

Objective: To compare outcomes of hospital stay, infection rates, reoperation rates and success rates in pediatric patients between ETV and VPS. Study Design: Quasi-experimental study. Setting: Lady Reading Hospital, Pakistan. Period: 17 September 2025 to 17 March 2026. Methods: A total of 226 patients (aged 1 month to 16 years) with obstructive hydrocephalus participated in the study. Clinical judgement was used to divide patients into the ETV (n=113) and VPS (n=113) groups. 3 months after surgery, such parameters as hospital stay (days), infection (surgical site or CSF), re-operation rate and success rate (clinical and radiological improvement without revision) were recorded. Multivariable logistic regression identified factors that predicted unfavorable outcomes. T-tests, chi-square tests, and 95% confidence intervals (CIs) were used for comparative analyses. Results: Mean hospital stay in the ETV group (3.1 ± 1.2 days) was significantly shorter than that of VPS (6.9 ± 1.4 days; p<0.001, mean difference 3.8 days, 95% CI 35 to 35-1). Infection rates were lower in ETV (4.4%, 5/113) versus VPS (13.3%, 15/113; p=-0.018, OR 0.30, 95% CI 0.10-0.89). Re-operation rate was 8.8% (10/113) in ETV but 22.1% (25/113) in VPS (p=0.005, OR 0.34, 95% CI 0.15-0.75). Success rate was higher with ETV (70.8%, 80/113) than with VPS (50.4%, 57/113; p < 0.001, OR 2.42, 95% CI 1.46-4.02). In multivariable regression, VPS (OR 3.12, 95% CI 1.72-5.66, p<0.001) and young age (<1 year; OR 2.45, 95% CI 1.28-4.69, p=0.007) were both independent of re-operation. Stratified analysis confirmed that, despite the age and social standing of a child s parents, the benefits from ETV were consistent (p < 0.05 on all primary outcomes). Conclusion: Among children with obstructive hydrocephalus who underwent VPS, ETV achieved a better outcome, with shorter hospital stays, fewer infections and reoperations, a greater success rate. However, given that the study is non-randomized, it should be interpreted cautiously. These findings support ETV as the preferred option in LMICs, suggesting the need to develop better training procedures and allocate resources more rationally to address all surrounding complications with shunt placement.

Association between Screen Time and Attention Deficit Hyperactivity Disorder (ADHD).

2026-05-19T05:19:35-07:00

Objective: To determine the association between daily screen time duration and ADHD symptom severity. Study Design: Analytical Cross Sectional study. Period: May to October 2025. Setting: Department of Community Medicine, Quaid-e-Azam Medical College, Bahawalpur. Methods: Total of 194 children aged 8-12 years were included in the study through stratified random sampling technique was used to enroll 194 children aged 8–12 years. Media Use Questionnaire was used to quantify Digital exposure. Conners-3 Parent Rating Scale was used to evaluate ADHD symptoms. Pearson correlations and multivariable linear regression was used for analysis by SPSS version 25.0, adjusting for socioeconomic status, sleep, physical activity, and parental ADHD history. Results: The average daily screen time was 3.8 ± 1.6 hours. Bivariate analysis revealed positive correlation between total screen time and both hyperactivity/impulsivity (r=0.19, p-value=0.008) and inattention (r=0.21, p=0.003). Regression analysis showed that each additional hour of screen time was independently associated with 1.82-point increase in Inattention T-scores (95% CI: 0.47–3.17, p=0.009) and 1.48-point increase in Hyperactivity scores (p=0.023). Interactive gaming showed stronger associations than educational content. Conclusion: Excessive screen time especially interactive gaming and social media is strongly associated to increased severity of ADHD symptoms. To reduce potential neurodevelopmental concerns, immediate treatments centered on sleep hygiene and content control are required.

Incidence of excess oxygen use in critically ill children and its impact on in-hospital mortality.

2026-03-04T04:07:22-08:00

Objective: To evaluate excess oxygen incidence and the prognostic value of Cumulative Excess Oxygen Exposure (CEOE), by using non-invasive SpO2, for in-hospital mortality in a Pakistani Pediatric intensive care unit (PICU). Study Design: Prospective observational cohort study. Setting: Department of Pediatrics and Child Health, Liaquat National Hospital, Karachi, Pakistan. Period: May 2024 to April 2025. Methods: Using non-probability consecutive sampling, this study included all children aged 1 month to 15 years admitted in PICU and requiring invasive or non-invasive respiratory support within the first 24 hours of the admission. Children with cyanotic heart diseases and who had a stay of <24hrs were excluded. CEOE was calculated as the mean hourly FiO2 exceeding 0.21, for the hours in which corresponding SpO2 was ≥95%, over the first 24 hours of respiratory support. Primary outcome was CEOE, secondary was in-hospital mortality. Results: Among 197 children for analysis, 98.5% experienced excess oxygen exposure of varying severity. In-hospital mortality was 10.7%. Median CEOE was 29.00 (IQR 19.08-40.87). CEOE of >39.46 showed 71.45 sensitivity and 77.8% specificity. CEOE significantly predicted mortality (AUC 0.754; 95% CI 0.687-0/812; p<0.0001). Higher CEOE was significantly associated with invasive mechanical ventilation (MV), prolonged PICU stay, mortality and Multi-Organ Dysfunction Syndrome (MODS) (all p<0.01). Shorter PICU stay (adjusted OR 0.202; p=0.017) and High-flow nasal cannula (HFNC) (adjusted OR 0.123; p<0.001) use were independently protective against high CEOE. Conclusion: Nearly all critically ill children experienced excess oxygen exposure. CEOE, a potentially modifiable risk factor, predicts in-hospital mortality. This highlights the significance of oxygen titration, practicable in resource-limited settings like ours by using non-invasive SpO2.

Association between diarrhea-related complications and severity of dehydration in children aged 2–59 months at a tertiary care hospital.

2026-04-28T05:38:15-07:00

Objective: To examine the relationship between the severity of dehydration and the complications associated with diarrhea in children aged 2–59 months. To evaluate the range of complications observed in pediatric patients with diarrhea admitted to a tertiary care hospital, focusing on different dehydration levels. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Children's Hospital and University of Child Health Sciences (UCHS), Lahore. Period: June 2023 to December 2023. Methods: Inclusion criteria consisted of previously healthy children aged between 2 -59 months of either gender, exhibiting symptoms of acute watery diarrhea, including loose motions and vomiting. Patients diagnosed with chronic diarrhea, immunodeficiency, neuromuscular impairment, or congenital heart disease were excluded. Non-probability purposive sampling technique was used and a total of 120 pediatric patients meeting the inclusion criteria were enrolled in the study. Following parental consent, data was collected using a pre-designed form, and all eligible patients received treatment. The data was analyzed using SPSS version 22. Results: The majority (58.3%) were aged between 2 to 6 months. Complications associated with diarrhea included hypokalemia (35%), acute kidney injury (10%), and metabolic acidosis (55%). Severe dehydration was observed in 39.2% of patients. Conclusion: Metabolic acidosis was the most common complication, present in 55% of cases. A significant correlation was found between the severity of dehydration and the occurrence of metabolic acidosis.

Pediatric liver abscess: A study of risks, interventions, and outcomes at a Tertiary Care Centre.

2026-01-05T03:35:51-08:00

Objective: To analyze the risk factors, clinical characteristics, management, and outcome of liver abscess in pediatric patients. Study Design: Retrospective Observational study. Setting: Department of Pediatric Surgery, Liaquat University Hospital, Hyderabad. Period: January 2018 to October 2025. Methods: Inclusion criteria included all children aged 14 years or younger who had a diagnosis of liver abscess. Results: A total of 72 patients with liver abscess were analyzed. The mean age was 6.8 ± 3.4 years. Males were predominant (Male : Female = 1.4:1). The most common symptoms were fever (95.8%), abdominal pain (84.7%), and hepatomegaly (69.4%). Nutritional deficiencies were observed in 31.9% of patients. There was predominant involvement of the right lobe in 70.8% patients. Solitary abscess was found in 68.1%. There was 62.5% of pyogenic origins. Amebical (30.6%) and mixed (6.9%) were the next most common origins. K. pneumoniae was the predominant organism (34.7%). The treatment methods were conservative (23.6%), needle aspiration (27.8%), percutaneous catheter drainage (41.7%), and open surgery (6.9%). Success rates were 94.4% overall. Mortality was 2.8%. Multiloculated abscess and complications of the disease were significant. Conclusion: Pediatric liver abscesses can be managed well using a protocol-based approach such as antibiotics and image-guided drainage. Early identification of high-risk signs helps implement proper management, and this leads to a favorable outcome.

The Analgesic effects of Gabapentin after Total Abdominal Hysterectomy.

2026-03-18T04:13:09-07:00

Objective: To assess the effectiveness of Gabapentin in reducing postoperative pain after abdominal hysterectomy. Study Design: Cross-sectional Observational study. Setting: Department of Anesthesiology and Gynecology/Obstetrics, Taj Medical Complex, Karachi, Pakistan. Period: September 15, 2024, to March 15, 2025. Methods: This study was conducted over three months using convenience sampling. It included 73 females between 35 and 65 years of age scheduled for elective total abdominal hysterectomy with salpingo-oophorectomy, and with American Society of Anesthesiologists I-II status. Patients received 1200 mg of Gabapentin orally two hours before surgery. Postoperative pain was assessed at multiple intervals up to 24 hours using the Visual Analog Scale (VAS). Side effects, such as nausea and respiratory issues, were also recorded. Data were analyzed with SPSS 23.0 using a paired-samples t-test to compare VAS pain scores, with p<0.05 set as the significance threshold. Results: The study found a mean age of 50.54 ± 8.06 years and a BMI of 31.13 ± 2.76 kg/m². Gabapentin provided effective pain relief in the first 4 hours (VAS: 0.30 ± 0.72 at 1 hour and 0.86 ± 1.15 at 4 hours), but pain increased significantly at 8 hours (2.38 ± 1.12) and peaked at 20 hours (5.12 ± 0.68). Heart rate rose from 82.61 ± 12.77 bpm at 1 hour to 92.60 ± 7.35 bpm at 20 hours, while systolic BP increased from 124.3 ± 11.71 mmHg to 134.05 ± 13.9 mmHg at 16 hours. Common side effects were headache (31, 42.5%) and nausea/vomiting (23, 31.5%), with no cases of respiratory depression. Conclusion: Gabapentin effectively reduced postoperative pain in the initial hours after abdominal hysterectomy, but pain increased over time, suggesting the need for additional analgesics. It was generally well tolerated, with headache and nausea as the most common side effects.

Frequency of post-dural puncture headache with median versus para-median approach in females who underwent cesarean section under spinal anaesthesia.

2026-02-24T03:43:37-08:00

Objective: To evaluate the frequency of post-dural puncture headache (PDPH) using the median versus paramedian approaches. Study Design: Prospective Comparative study. Setting: Department of Anesthesiology, Combined Military Hospital Bahawalpur. Period: 5^th August 2024 to 4^th February 2025. Methods: A total of 128 women who underwent spinal anesthesia for cesarean section between 16-40 years of age were included in study. Group M (Median Approach) women were undergone spinal anesthesia by median approach while Group P (Para-Median Approach) were undergone spinal anesthesia by para-median approach. All patients were assessed for development of post-dural puncture headache. Results: Mean ages were comparable between Group M (28.09 ± 5.52 years) and Group P (27.77 ± 5.88 years). The majority of subjects, 64.84% (n=83), were aged 16–30 years. Mean gestational age was 38.57 ± 1.31 weeks with a mean parity of 3.07 ± 1.07. Post-dural puncture headache occurred in 21 women (32.81%) following the median approach, versus only 4 women (6.25%) following the paramedian approach. Conclusion: This study concluded that the paramedian approach for spinal anesthesia is associated with a significantly lower occurrence of post-dural puncture headache compared to the median approach in cesarean section patients.

Comparison of dexamethasone versus dexmedetomidine as an adjuvant to 0.25% bupivacaine in ultrasound-guided transversus abdominis plane block on postoperative analgesia duration in patients undergoing laparotomy.

2026-04-21T05:18:03-07:00

Objective: To compare the efficacy of dexamethasone and dexmedetomidine as adjuvants to bupivacaine in TAP block in patients receiving laparotomy. Study Design: Prospective Comparative study. Setting: Department of Anaesthesia, Sahiwal Teaching Hospital, Sahiwal. Period: 2^nd October 2025 to 2^nd March 2026. Methods:
Ninety-six patients undergoing laparotomy were equally distributed into two groups. Group A were treated with 0.25% bupivacaine with dexamethasone (8 mg), while Group B received 0.25% bupivacaine with dexmedetomidine (1 µg/kg) in ultrasound-guided TAP block. Postoperative pain was determined using Visual Analogue Scale (VAS) at different timepoint from 0 to 24 hours. Additional parameters such as first rescue analgesia timepoint, total analgesic intake, and hemodynamic parameters were also recorded. Results: Baseline characteristics were comparable and difference were statistically insignificant. However, intensity of pain reduced significantly in Group B patients from 2 to 24 hours (p < 0.05). Participants in Group B required survived longer without the need of first rescue analgesia (11.4 ± 2.1 vs. 6.9 ± 1.5 hours; p < 0.001), and total ketorolac use was lower (51.3 ± 15.6 mg vs. 79.6 ± 18.2 mg; p < 0.001). Similarly, other evaluated postoperative parameters such as mean arterial pressure, heart rate, nausea and vomiting scores were also significantly lower in Group B (p < 0.05). Conclusion: Dexmedetomidine is a more effective adjuvant than dexamethasone in TAP block, providing prolonged analgesia and reduced analgesic requirements after laparotomy.

Comparative diagnostic accuracy of sonourethrography and retrograde urethrography in anterior urethral strictures.

2026-04-27T06:07:53-07:00

Objective: To evaluate the diagnostic accuracy of retrograde urethrography and sonourethrography making cystourethroscopic findings as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology and Urology, Gujranwala Teaching Hospital, Gujranwala. Period: April to October 2025. Methods: Over the course of six months (April to October 2025), fifty four patients with a clinical suspicion of anterior urethral strictures were enrolled in this cross sectional validation study and equally assigned to the RGU and SUG groups. Cystoscopy findings were used to compare diagnostic accuracy, sensitivity, specificity and stricture length. Results: Using intra-operative stricture length as the reference, sonourethrography (SUG) shows better diagnostic performance, with a sensitivity of 96.9%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 95.7%. Retrograde urethrography (RUG) showed a sensitivity of 93.8%, specificity of 95.5%, PPV of 96.8%, and NPV of 91.3%. Overall diagnostic accuracy was higher for SUG (98.1%) compared with RUG (94.4%). Conclusion: When evaluating anterior urethral strictures, SUG shows better assessment of stricture as compared to RGU in terms of diagnostic performance. As such, it should be used as an auxiliary or alternative imaging modality in clinical practice.

Comparison of autologous serum versus artificial tears in the management of dry eyes syndrome.

2026-06-15T05:35:37-07:00

Objective: To compare the reduction in ocular surface disease index (OSDI) score from baseline by using autologous serum and artificial tears in managing dry eye syndrome. Study Design: Quasi-experimental study. Setting: Department of Ophthalmology, Federal Government Polyclinic Hospital, Islamabad, Pakistan. Period: June-2025 to November-2025. Methods: A total of 70 patients with dry eye syndrome were included and divided into groups 1 and 2 without randomization in alternating fashion. Group-1 was given autologous serum eye drops for 3 months and Group-2 was given artificial tears for 3 months. Comparison of pre- and post-intervention median OSDI score within the groups was done using Wilcoxon signed rank test. Intergroup comparison of median OSDI score and median % reduction in OSDI score from baseline was done using Mann Whitney U-test. Analysis was done with SPSS software version 25. Results: Composite median age of DES sufferers was 41.50 (22.00) years. There were 41 (58.60%) male and 29 (41.40%) female patients. In Group-1, median pre-intervention OSDI, post-intervention OSDI score and % reduction in OSDI score from baseline was 61.00 (17.00), 32.00 (36.00) and 47.54 (44.76) % while in Group-2, these were 64.00 (15.00); (p = 0.400), 34.00 (12.00); (p = 0.184) and 52.50 (10.82) %; (p = 0.025), respectively. There was no significant difference of post-intervention DES severity among the study groups (p = 0.628). Conclusion: Autologous serum provides comparable results to artificial tears in dry eyes syndrome with significantly increased reduction in OSDI score.

Role of optical coherence tomography in early detection of glaucoma suspect.

2026-06-15T05:38:20-07:00

Objective: To evaluate role of OCT in early detection of Glaucoma Suspect by measuring inferior retinal nerve fiber layer thickness by Optical Coherence Tomography in relationship with visual field analysis by Humphery visual field analyser. Study Design: Prospective Cross-sectional Observational Analytical Study. Period: 15 May 2024 to 15 May 2026. Setting: Department of Eye, Independent University Hospital and Ibrahim Eye Centre, Faisalabad. Methods: 50 patients aged between 18 to 50 years with best corrected snellen visual acuity of 6/24 or better and with no secondary ocular or neurological ailments or any retinal problems were enrolled from out patient eye department of independent university Hospital and Ibrahim eye centre, Faisalabad. The enrolled patients were suspected having un-diagnosed primary open angle Glaucoma. The complete systemic systemic including history of diabetes, hypertension, arthritis, trauma, family history and medical history was recorded. Slit-lamp examination was done for status of cornea, anterior chamber, lens, iris, pupil, vitreous and fundus. Applanation tonometry was perfomed and recorded. Pachymetry, Gonioscopy, humphery visual field analysis and then OCT was done for Optic disc analysis, Ganglian Cell Complex and retinal nerve fiber layer thickness analysis. The whole record of history, examination and investigations was saved in a specific proforma. Results: Total 50 patients, aged between 18 to 50 years (mean 41.00+9.48), Male patients were 35 while Female were 15. The family history of glaucoma was 57.14 % while cup-to-disc ratio (CDR) was from 0.4 to 0.8 (mean 0.59+0.10) and intraocular pressure was from 14 to 25 mmHg (mean 20.09 +2.11). The pachymetry ranged between 470 to 572 mm (mean 520.20+22.82) and inferior RNFL from 36.40 to 96.10 um (mean 69.32+12.52). Conclusion: This study proved that RNFL thickness by OCT has a significant and potential diagnostic role in detection of early glaucoma and glaucoma suspect. At the same time, the OCT proved to be equally effective in monitoring progression of glaucoma. While considering the other OCT parameters as measuring GCC, analysing ONH and measuring RNFL thickness are also important in detection and monitoring of glaucoma but we proved that thickness of RNFL at inferior quadrant was more important in detection of glaucoma suspect. The OCT derived RNFL and particularly inferior RNFL thickness is a sesitive, and objective indicator for identifying the glaucoma suspect while detecting it at preclinical stage even before visual fields loss by perimetry.

Effect of anesthetic choice on perioperative inflammatory markers and postoperative pulmonary infections in cardiac surgery patients.

2026-08-03T06:30:28-07:00

Objective: To evaluate whether specific anesthetic selection significantly impacts perioperative systemic inflammatory responses and subsequent postoperative pulmonary infections in adult patients undergoing cardiac surgical procedures. Study Design: Cross Sectional study. Period: November 2025 to April 2026. Setting: Sahiwal Institute of Cardiology, Sahiwal. Methods: Total of 120 adult patients undergoing elective cardiopulmonary bypass cardiac surgery was evaluated. The patients were divided into two equal groups, allocating 60 to inhalational sevoflurane and 60 to propofol-based total intravenous anesthesia. We measured C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and procalcitonin preoperatively, immediately postoperatively, and at 24 hours. Additionally pulmonary infections, mechanical ventilation duration, intensive care and hospital lengths of stay and overall mortality were monitored. Results: Baseline demographic and clinical characteristics were comparable. Postoperative inflammatory markers significantly elevated in both groups; however, the sevoflurane group exhibited significantly lower C-reactive protein, interleukin-6, tumor necrosis factor-alpha and procalcitonin levels compared to the propofol. Pulmonary infection rates were significantly reduced with sevoflurane administration versus propofol. Moreover, the sevoflurane group experienced significantly shortened mechanical ventilation duration, intensive care unit stays, and total hospital lengths of stay, while in-hospital mortality remained statistically equivalent between both patient study groups. Conclusion: Compared to propofol-based total intravenous anesthesia, sevoflurane significantly attenuates perioperative systemic inflammation, decreases pulmonary infection incidence, and accelerates overall postoperative recovery. Anesthetic selection is crucial for optimizing perioperative outcomes and minimizing postoperative clinical complications in this specific patient population.

Etiology of acute pancreatitis in a tertiary care teaching hospital.

2026-07-09T06:50:20-07:00

Objective: To determine the frequency of etiological factors of acute pancreatitis at a tertiary care hospital, and their association, particularly gallstone disease, with demographic/clinical characteristics. Study Design: Descriptive, Prospective Observational study. Setting: General Surgery, MTI–Lady Reading Hospital, Peshawar. Period: Six Months (1st July–31st December 2025). Methods: Patients aged 30–70 with abdominal pain plus amylase >300 U/L and lipase >480 U/L were enrolled after consent, differing from the Revised Atlanta Classification; duct dilation, pseudocyst, bleeding disorders, and end-stage renal/liver disease were excluded. Gallstones, idiopathic disease, autoimmune disease, dyslipidaemia, and smoking were assessed (alcohol excluded); gallstone etiology was compared by Chi-square/Fisher's exact test (p<0.05). Results: Of 140 screened, 101 met the case definition (mean age 45.75±9.03 years; 54, 53.5% female). Gallstone disease was leading (54, 53.5%, 95% CI 43.8–62.9%; 61, 60.4% overall), followed by idiopathic disease (16, 15.8%), smoking alone (10, 9.9%), dyslipidaemia (16, 15.8%), autoimmune disease (2, 2.0%), and multiple factors (12, 11.9%); no significant demographic/clinical association emerged. Conclusion: Gallstone disease was commonest, followed by idiopathic disease, smoking, and dyslipidaemia. As the case definition differs from the Revised Atlanta Classification and alcohol history was unrecorded, findings warrant cautious interpretation.

Comparison of the postoperative pain outcomes with bilateral ultrasound guided transversus abdominis plane block versus local anesthetic wound infiltration in patients undergoing laparoscopic cholecystectomy At Tertiary Care Hospital, Karachi.

2026-04-30T04:39:38-07:00

Objective: To compare the postoperative pain outcomes of bilateral US-guided TAP block versus LA wound infiltration in patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis at a tertiary care hospital in Karachi. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesiology, Surgical ICU and Pain Management, Dr, Ruth K. M. Pfau Civil Hospital Karachi. Period: Six months April 21, 2022, to October 21, 2022. Methods: Two groups of sixty patients were randomly assigned based on their fulfilment of inclusion and exclusion criteria. Quantitative & qualitative data were collected, presented, and analyzed using SPSS. Statistical significance was determined using post-stratification chi-square and independent t-tests, with a p-value of less than or equal to 0.05. Results: In Group T, which received TAP blocks, the average pain score is 4.38 ± 2.35, but in Group L, which received LA blocks, it was 6.4 ± 2.58 (p = 0.001). Mean analgesic consumption was 6.89 ± 3.87 mg in Group T versus 9.78 ± 4.78 mg in Section L (p = 0.001). Group T's mean duration of analgesia (515.9 ± 150.41 min) was noticeably greater than Group L's mean duration (290.7 ± 67.03 min) (p = 0.001). Conclusion: After surgery, bilateral US-guided TAP blocks offer better pain management & longer analgesic duration than LA wound infiltration. On the other hand, LA is still easier to get and cheaper.

Preoperative predictors of challenging laparoscopic cholecystectomy.

2026-05-06T03:24:59-07:00

Objective: To assess the predictability (probability) of the preoperative score in identifying difficult cases and to uncover preoperative characteristics that indicate difficult laparoscopic cholecystectomy. Study Design: Prospective Interventional study. Setting: Department of General Surgery, Sahara Medical College Narowal. Period: May 2023 and April 2024. Methods: One hundred patients whose cholecystectomy procedures were categorized as easy, tough or very difficult based on two factors: intraoperative results and preoperative assessment system were included. Results: Preoperative difficulty prediction score and intraoperative data were significantly correlated (k=0.858, P<0.001). Hospitalization (P<0.001), prior supraumbilical surgeries (P=0.004), prior acute cholecystitis (P<0.001), prior jaundice (P=0.049), prior endoscopic biliary clearance (P=0.022), increased gallbladder wall thickness (P=0.001), and pericholecystic fluid collection (P=0.014). In six cases (6%), conversion to the open method was required. Procedure difficulty was not substantially affected by age, sex, BMI, or impacted stone (P>0.05). Conclusion: Multiple preoperative characteristics have been linked to increased difficulty during laparoscopic cholecystectomy. Proper identification of these criteria and their incorporation into a scoring system would be extremely beneficial in determining challenging cases during the preoperative stage.

Clinico-pathological analysis of testicular and para-testicular lesions: A single center study.

2026-05-06T07:43:44-07:00

Objective: To determine the distribution spectrum and frequency of testicular and para-testicular lesions, including both neoplastic and non-neoplastic types from one of the diagnostic centres of Pakistan. Study Design: Cross-sectional study. Setting: Chughtai Institute of Pathology, Lahore. Period: August 2025 to February 2026. Methods: A total of 396 cases of testicular and paratesticular lesions, including 204 orchidectomy specimens and 192 testicular biopsies received over a period of 1 year were studied retrospectively. Results: Overall, non-neoplastic conditions were predominant. The most frequent non-neoplastic diagnosis was non-granulomatous epididymo-orchitis (40 cases, 19.60%), followed closely by atrophic testes (34 cases, 16.66%). Undescended testis (cryptorchidism) was identified in 12 specimens (5.88%). Among the neoplastic lesions from the 204 surgical cases, mixed germ cell tumors were the most common tumor type (35 cases, 17.15%), followed by seminoma (21 cases, 10.29%). Yolk sac tumors were observed in 9 cases (4.41%), predominantly in the pediatric age group (6 cases in the 0-10-year age bracket). Histopathological findings of the 192 testicular biopsies varied from normal spermatogenesis and maturation arrest to Sertoli-cell-only syndrome and hyposermatogenesis, providing critical diagnostic information for managing male infertility. Conclusion: The study shows that the non-neoplastic lesions predominate among the testicular and para-testicular pathologies with epididymo-orchitis and testicular atrophy being the most common findings. Within the malignant lesions, germ cell tumors are most frequently followed by mixed germ cell tumors and seminoma.

Assessment of junior doctors attitude toward professionalism.

2026-03-14T05:00:14-07:00

Objective: To assess the attitudes of junior doctors toward key domains of medical professionalism in a tertiary care setting in Pakistan. Study Design: Quantitative, Cross-sectional study. Setting: Department of Community Medicine, Gomal Medical College, Dera Ismail Khan. Period: April to October 2025. Methods: A validated, self-administered questionnaire called the Learners Attitude of Medical Professionalism Scale (LAMPS) was used to gather data from 542 junior doctors (house officers and postgraduate trainees) using a non-probability convenience sampling technique. Five professional domains were evaluated by the instrument: duty/accountability, excellence/autonomy, honor/integrity, altruism, and respect for others. SPSS 27 trial version software was used for statistical analysis. Independent t-tests and descriptive statistics were used to assess the data. Results: The highest mean scores were observed for Duty/Accountability (3.734 ± 0.43) and Excellence/Autonomy (3.63 ± 0.51), while the lowest score was for Respect for Others (3.134 ± 0.42). Significant associations were found between gender and Duty/Accountability (p = 0.014) as well as Altruism (p = 0.014), and between marital status and Excellence/Autonomy (p = 0.015). Honor/Integrity showed moderate scores (3.19 ± 0.25) with no significant demographic associations. Conclusion: Junior doctors show strong procedural competency and knowledge-based excellence but marked deficits in the domains of integrity and respect. These findings highlight the need for integrated educational reforms and systemic changes to foster a culture of transparency and collaboration, which are essential for patient safety and a sustainable healthcare workforce.

Attention span crisis: Factors affecting focus during medical lectures among medical students of Nishtar Medical University — A cross-sectional study.

2026-05-22T05:27:46-07:00

Objective: To identify and quantify the factors associated with reduced attention span during lectures among medical students at Nishtar Medical University, focusing on students, pedagogy, teaching methods and determinants related to environment. Study Design: Cross-sectional Survey. Setting: Nishtar Medical University, Multan. Period: March 2026 to October 2026. Methods: A structured questionnaire was used, we assessed eleven factors affecting attention span. Students also rated their perceived concentration over the course of a typical lecture. Descriptive statistics characterized the prevalence of these distractors; multivariate logistic regression was used to examine associations between these factors and self-reported attention decline during lectures. Results: A large proportion among the respondents reported declining attention during lectures which is by the various distractors which we have studied. Key student-related factors significantly associated with concentration loss included psychological factors such as lack of personal interest and post lunch meal status and peer distraction. Negative emotional background is also correlated with reduced focus. Regarding pedagogical variables, insignificant use of audiovisual aids and passive lecturing style and teaching methodologies were linked to lower sustained attention. Environmental factors, particularly noise pollution and poor lighting or ventilation, were also significant predictors of concentration decline. In regression analysis, for example, students who reported distractions from noise pollution had greater attention decline as compared to those who did not, controlling for various other variables. In our study of 219 medical students, attention-span difficulties were highly prevalent, with major contributors including impaired concentration (89.04%), emotional impact (86.76%), environmental noise (83.56%), diet (81.28%), lack of interest (73.06%), teaching method (72.15%), study material (61.64%), and prior knowledge (54.79%). Conclusion: Our study indicates that a multifactorial “attention span crisis” affects medical students during lectures, encompassing individual environmental, and pedagogical contributors. To mitigate or eradicate this decline, medical educators should consider more interactive teaching, improvements needed in teaching styles, optimized classroom environments, and scheduling considerations (e.g., meal timing) to maintain and improve student engagement.

Lecture-based teaching in medical education: reform is the need of time.

2026-05-15T05:16:31-07:00

Objective: To assess medical students’ perceptions of lecture-based teaching and the need for modification of traditional lectures with more effective instructional strategies. Study Design: Cross-sectional mixed method study. Setting: MBBS Students of Nishtar Medical University, Pakistan. Period: May 2025- July 2025. Methods: 374 MBBS students were given hard copy of a structured questionnaire to explore students’ perceptions of lecture-based teaching and active learning methods. It consisted of biodata, 15 close ended and two open ended questions. Responses were measured on a three-point Likert scale ranging from disagree to agree. Quantitative data were analyzed using SPSS version 26. Descriptive statistical measures, including frequencies and percentages were computed to summarize the data. Qualitative data were examined through thematic analysis. Results: 340 students returned the filled questionnaire. The vast majority (85.3%) agreed that the lectures are helpful for understanding the fundamental concepts related to medical education and this is complemented by audio-visual aids used during delivery of lectures. Majority were of the opinion that the lecture-based teaching mainly promotes passive learning. However, a greater number agreed that the inclusion of interactive components improves engagement during lectures. About 71.5% students commented that the attention tends to decline during 45-60 minutes lecture duration. Conclusion: Lectures continue to play a vital role in medical education but require modernization to meet evolving learner needs. Emphasizing interactivity, clarity, and integration with active learning strategies can optimize their effectiveness and relevance in contemporary medical curricula.

Premenstrual syndrome and its impact on quality of life: a comparative study of hostelites and day scholar medical students.

2026-04-30T04:53:51-07:00

Objective: To compare the impact of premenstrual syndrome on the quality of life of hostelites and day scholar students of Faisalabad Medical University. Study Design: Cross-sectional study. Setting: Faisalabad Medical University, Pakistan. Period: September 2024 to March 2025. Methods: A total of 340 female students; 170 hostel residents and 170 day scholars experiencing regular menstrual cycles and symptoms of premenstrual syndrome were recruited through non-probability convenience sampling. Individuals with gynecological issues or a prior history of gynecological surgeries were excluded. Information was obtained via a self-completed printed survey consisting of 26 questions, each offering five responses. The WHOQOL-BREF scoring system was used to determine the effect of PMS on quality of life. It was rated on 5-point Likert scale. The WHOQOL-BREF scoring system was categorized as follows: Poor quality of life (scores 1-26); Fair quality of life (scores 27-52); Good quality of life (scores 53-78); Very good quality of life (scores 79-104); Excellent quality of life (scores 105-130). Results: PMS was found to be more severe in hostelites, resulting in significantly poorer quality of life, p<0.001. Hostelites reported significantly higher levels of dissatisfaction with their physical environment, transportation, health, personal relationships, living conditions, and leisure activities, with p<0.01 each. Satisfaction with health, personal relationships, and living conditions had a positive association with the outcome, with odds ratios of 1.40, 1.43, 1.66 and p-values of 0.01, 0.02, and 0.008, respectively. Conclusion: Results revealed poor quality of life due to premenstrual syndrome in hostelites as compared to day scholars.

Pattern of interstitial lung disease in connective tissue disease.

2026-08-31T07:24:28-07:00

Objective: To identify the pattern of interstitial lung diseases in connective tissue diseases (CTD-ILD) presenting in a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Rheumatology, Madina Teaching Hospital, Faisalabad. Period: July 2025 to December 2025. Methods: Patients between the ages of 18 and 80 who had been diagnosed with ILD based on their clinical presentation and radiological characteristics were included in the trial for six months. ILD was confirmed by high-resolution computed tomography (HRCT), whereas clinical criteria were used to diagnosis connective tissue disease. Comorbidities, clinical characteristics, demographic information, and HRCT results were documented. SPSS version 25 was used to analyze the data. The mean ± SD, percentages, and frequencies were computed. Results: Rheumatoid arthritis was the most common underlying condition among 54 CTD-ILD patients (mean age 51.9 ± 12.4 years, 70.4% female). Septal thickening (75.9%) and honeycombing (87.0%) were the most common HRCT abnormalities. Conclusion: Honeycombing and septal thickening were important HRCT patterns, and RA was the primary etiology of CTD.

A prospective observational study of weight loss and change in the modified ferriman-gallwey score in polyendocrine metabolic ovarian syndrome.

2026-10-12T06:13:11-07:00

Objective: To determine whether the magnitude of weight loss over six months was associated with improvement in Modified Ferriman–Gallwey (mFG) score among women with Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly Polycystic Ovary Syndrome (PCOS). Study Design: Prospective Observational Cohort study. Setting: Combined Military Hospital (CMH), Kharian. Period: December 2025 to June 2026. Methods: Twenty-seven women with PCOS/PMOS who achieved weight loss during six-month follow-up were analyzed. Weight, BMI, and mFG score were recorded monthly. Baseline-to-month-6 changes were assessed using paired tests, longitudinal changes using Friedman tests, and associations between weight loss and mFG improvement using Spearman rank correlation. Results: Mean weight decreased from 82.00±3.46 to 76.00±3.61 kg and BMI from 31.11±2.25 to 28.80±1.99 kg/m² (both p<0.001). Mean mFG score decreased from 18.19±3.06 to 13.67±2.79, with a median improvement of 5 points (IQR 2–6; p<0.001). Mean percentage weight loss was 7.30±2.67%, and 81.5% achieved ≥5% weight loss. Longitudinal changes in weight, BMI, and mFG score were significant (all p<0.001). Percentage weight loss was weakly and non-significantly correlated with mFG improvement (ρ=0.250, p=0.208). Conclusion: Weight, BMI, and mFG scores improved during follow-up; however, greater percentage weight loss was not significantly associated with greater mFG improvement, providing no evidence of a dose-response relationship or causal effect.

Frequency of gestational trophoblastic disease at GMMMC Teaching Hospital, Sukkur.

2026-08-17T07:31:41-07:00

Objective: To determine the frequency of gestational trophoblastic disease at GMMMC Teaching Hospital, Sukkur. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynecology, GMMMC Teaching Hospital, Sukkur, Pakistan. Period: June 2024 to May 2025. Methods: All clinically or ultrasonographically suspected cases with histopathological confirmation of gestational trophoblastic disease were included. Unconfirmed cases, non-gestational trophoblastic tumors, and records with insufficient data were excluded. Data were collected on a structured proforma and analyzed using IBM SPSS version 26. Frequency was calculated from the total obstetric workload and reported with a 95% confidence interval. Results: Among 4,865 obstetric patients, gestational trophoblastic disease was diagnosed in 68 women, giving a frequency of 1.40% (95% CI: 1.10-1.77), equivalent to approximately 1 in 71 obstetric patients. The mean age was 26.7 ± 5.4 years. Most patients were 20-30 years of age (61.8%) and 55.9% were multigravida. Complete hydatidiform mole was the predominant diagnosis (67.6%), followed by partial hydatidiform mole (25.0%) and gestational trophoblastic neoplasia (7.4%). Vaginal bleeding was the commonest presentation (89.7%). A snowstorm appearance on ultrasonography was noted in 64.7% of cases. Suction evacuation was performed in 92.6% of patients; three women received methotrexate-based chemotherapy and two underwent hysterectomy. No maternal death was recorded. Conclusion: The frequency of gestational trophoblastic disease at GMMMC Teaching Hospital, Sukkur was 1.40%. Early ultrasound assessment, routine histopathological confirmation, timely uterine evacuation, and documented beta-human chorionic gonadotropin surveillance are essential for safe management and follow-up.

Systemic complications of (Chimeric Antigen Reoeptor T-Cell therapy) CAR-T cell therapy: What internal medicine specialists should recognize and manage.

2026-06-23T06:29:16-07:00

Objective: To integrate current evidence on systemic complications of CAR-T therapy that are most pertinent to internal medicine physicians, specifically regarding recognition, differentiation, early stabilisation, and co-management in the wards and intensive care units. Study Design: Evidence Acquisition (Secondary Search, 202026). Setting: PubMed/MEDLINE and Google Scholar were used as sources of secondary literature review of studies published. Period: January 2020 and December 2026. Methods: The search terms consisted of the combination of the terms CAR-T, chimeric antigen receptor, toxicity, cytokine release syndrome, ICANS, infection, cardiotoxicity, coagulopathy, and tumour lysis syndrome. Priority was given to clinical guidelines, consensus statements, systematic reviews, and large observational studies. Case reports and strictly preclinical studies were excluded. Results: The most frequent acute complications are The most frequent acute complications are typically early hyperinflammatory toxicities, including CRS and ICANS. Subsequent risks include infections associated with cytopenias and B-cell aplasia, hematologic/coagulation disorders, metabolic emergencies such as TLS, acute kidney injury, and cardiopulmonary instability. Other conditions that are not common but are severe in nature, including hemophagocytic lymphohistiocytosis-like hyperinflammation, demand extra attention. Conclusion: Internal medicine specialists are considered to be crucial in the early detection and stabilisation of systemic complications in CAR-T. Time-dependent patterns of toxicity, systematic assessment plans, and escalation levels are familiarity requirements that should optimise outcomes in the high-risk population.