The Professional Medical Journal

Salt at the table: A blessing or a curse for cardiovascular disease among people 60-75-year-old aged Karachi, Pakistan. A case- control study.

2025-08-04T06:45:08-07:00

Objective: To examine the association between discretionary salt use—specifically adding salt at the table—and the risk of cardiovascular disease (CVD) among adults aged 60–75 years in Karachi, Pakistan. Study Design: Case-control study. Setting: Department of Community Health Sciences, Bahria University Health Sciences, Karachi, Pakistan. Period: June 2024 to November 2024. Methods: A total of 592 participants were enrolled, including 296 diagnosed CVD patients with chronic hypertension (cases) and 296 age- and gender-matched controls without CVD (controls). Data were collected using a structured, closed-ended questionnaire in English and Urdu via Google Forms. Participants' salt consumption behaviors, blood pressure readings, sociodemographic data, and beliefs about salt use were recorded. Data were analyzed using SPSS version 26. The chi-square test (p ≤ 0.05) was applied to determine associations between salt use and CVD, and odds ratios (ORs) were calculated to assess risk levels. Results: Participants who frequently added salt at the table had significantly higher odds of developing CVD. A total of 72% of CVD cases reported added salt intake compared to 28% of controls (p = 0.0001). The odds ratio for CVD among high salt users was 4.894 (95% CI: 3.395–6.926). Additional risk factors included higher blood pressure, lower education, smoking, and a family history of heart disease. Conclusion: The study reveals a strong link between discretionary salt use and increased cardiovascular disease risk in older adults. Targeted public health strategies, including dietary counseling and awareness campaigns, are recommended to reduce salt intake and prevent CVD in this age group.

Comparison of metformin plus modified release gliciazide with metformin plus sitagliptin for treatment of diabetes mellitus.

2025-11-03T04:17:34-08:00

Objective: To compare the efficacy of metformin plus modified-release gliclazide versus metformin plus sitagliptin in reducing HbA1c levels in patients with type II diabetes mellitus. Study Design: Randomized Controlled Trial. Period: August’2021 to January’2022. Setting: Medical Outdoor, Allied Hospital Faisalabad. Methods: Total 200 patients with type II diabetes mellitus of either gender of age 30-60 years were selected. Group A patients took combination of metformin (1000 mg/day) and modified release gliclazide (60 mg/day) for 12 weeks. Group B patients took combination of metformin (1000 mg/day) and sitagliption (100 mg/day) for 12 weeks. Results: The mean age of patients in group A was 43.43 ± 9.76 years and in group B was 45.83 ± 7.86 years. Out of 200 patients, 86 (43.0%) were males and 114 (57.0%) were females with male to female ratio of 1:1.3. In my study, mean HbA1c after 12 weeks of treatment with combination of metformin and Gliclazide was 6.53% ± 0.18 and with combination of metformin and sitagliptin it was 6.40% ± 0.10 (p-value = 0.0001). Conclusion: This study concluded that thecombination of Metformin and Sitagliptan is better than combination of Metformin and for modified release Gliclazid treatment of type II diabetes mellitus in terms of mean HbA1c.

Clinical significance of low HDL-C levels in managing acute coronary syndrome.

2025-12-31T04:27:41-08:00

Objective: To investigate the clinical relevance of low HDL-C levels in the management of ACS, focusing on their association with adverse outcomes. Study Design: Prospective Observational study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: December 2021 to May 2022. Methods: 384 patients diagnosed with ACS, admitted to a tertiary care hospital in Pakistan. HDL-C levels were measured within 24 hours of admission, and participants were stratified into low HDL-C (<40 mg/dL) and normal HDL-C (≥40 mg/dL) groups. Adverse outcomes, including 30-day mortality, recurrent myocardial infarction, heart failure, and hospital stay duration, were analyzed using multivariate logistic regression and Kaplan-Meier survival analysis. Statistical significance was set at p < 0.05. Results: Low HDL-C levels were observed in 210 patients (54.7%). These patients experienced significantly higher rates of 30-day mortality (21.4% vs. 6.9%), recurrent myocardial infarction (24.8% vs. 8.6%), and heart failure (31.9% vs. 13.2%) compared to those with normal HDL-C levels (p < 0.001 for all). Kaplan-Meier survival analysis showed reduced survival rates at 30 days (78.6% vs. 93.1%) and 90 days (65.2% vs. 88.7%) in the low HDL-C group (p < 0.001). Multivariate analysis identified low HDL-C as the strongest independent predictor of adverse outcomes (OR 2.85, 95% CI: 1.85–4.39, p < 0.001). Conclusion: Low HDL-C levels are a significant independent predictor of adverse outcomes in ACS patients, highlighting their importance in risk stratification and management. These findings emphasize the need for targeted therapeutic strategies to address low HDL-C levels, particularly in resource-limited settings.

Occurrence of anxiety and its scores in chronic obstructive pulmonary disease patients.

2025-10-01T05:06:33-07:00

Objective: To find out the frequency and severity of anxiety in patients presented with chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Setting: Accident and Emergency Medicine Department, Farooq Hospital, Islamabad. Period: March 2024 to September 2025. Methods: On chronic obstructive pulmonary disease patients was diagnosed with COPD using GOLD standard criteria with an age of 40 years and above were screened for anxiety by using Generalised Anxiety Disorder (GAD)-7 criteria. GAD-7 scores were distributed to classify anxiety severity into minimal (0-4), mild (5-9), moderate (10-14), and severe (15-21). Results: Of the 129 COPD patients, male patients were in the majority (82.2%, n=106), and female patients were in minority (17.8%, n=23). The mean age was 67.98±7.01 years. The overall mean GAD-7 score was 8.12±2.88. Anxiety severity was minimal in 3.1% (n=4), mild in 72.9% (n=94), moderate in 20.1% (n=26) and severe in 3.9% (n=5) COPD patients. Anxiety severity was significantly associated with gender (p-value<0.001) and age (p-value=0.006). Conclusion: The frequency of anxiety was high in patients presented with chronic obstructive pulmonary disease, with most of the patients suffering from mild anxiety, followed by moderate and severe anxiety.

PIVKA‑II value in the diagnosis of hepatocellular carcinoma in patients with inconclusive imaging findings or AFP levels.

2025-09-09T07:17:48-07:00

Objective: To evaluate the diagnostic accuracy of Protein Induced by Vitamin K Absence-II (PIVKA‑II; des-γ-carboxy prothrombin) in patients with suspected HCC who had nondiagnostic AFP or atypical imaging findings. Study Design: Retrospective Cross-sectional study. Setting: Rehman Medical Research Institute, Peshawar. Period: May 2018 and September 2024. Methods: Among 128 patients with suspected HCC the patients were 106 men and twenty two women, average age 60.3 years. Data from electronic medical records including demographics, hepatitis status, imaging results, laboratory markers and biopsy results were collected. PIVKA-II levels were analyzed and diagnostic accuracy has been calculated (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy). The performance of PIVKA-II was evaluated by receiver operating characteristic curve analysis. Results: Of 128 patients, 86 (67.2%) had HCC confirmed on biopsy. PIVKA‑II was abnormal in 81/128 patients (71 HCC, 10 non-HCC). Using these counts, PIVKA‑II showed sensitivity 82.6%, specificity 76.2%, PPV 87.7%, NPV 68.1%, and accuracy 80.5%. AUROC was 0.776 (p = 0.002). Conclusion: PIVKA-II is a useful biomarker for diagnosis of HCC when AFP is non-diagnostic or imaging results are inconclusive. It demonstrates high sensitivity and reasonable specificity to justify its use for early detection and differentiation of HCC from other liver lesions. Future studies should address the limitations of this single-institution, retrospective study to confirm the clinical utility of PIVKA-II.

Relation of hypoalbuminemia with tumor parameters in hepatocellular carcinoma patients.

2025-12-24T06:43:12-08:00

Objective: To determine the frequency of hypoalbuminemia in patients with hepatocellular carcinoma (HCC) and its relation with tumor parameters. Study Design: Descriptive, Cross-sectional Study. Setting: Department of Medicine, Nishtar Hospital, Multan. Period: March 11^th, 2025, to September 10^th, 2025. Methods: A total of 118 cases of HCC of either gender were enrolled in the study. After informed consent and patient characteristics, all the patients underwent laboratory testing for serum albumin and tumor markers, and an ultrasound for the number of liver nodules and the size of the largest nodule. After descriptive statistics and prevalence of hypoalbuminemia, the relation of hypoalbuminemia with multifocality, tumor size groups, and serum alpha-fetoprotein groups was assessed through the chi-square test, and a p-value ≤0.05 was taken as significant. Results: The mean age was 56.58 ± 10.68 years. The mean duration of liver cirrhosis was 8.25±4.3 years. The average number of liver nodules was 2.94±1.44. Regarding the size of liver nodules, the mean size was 7.18±2.96 (cm). The mean serum AFP was 422.36±443.34 (ng/ml). The serum mean albumin was 3.26±0.72 (g/dl). The prevalence of hypoalbuminemia was present in 58.5% (n=69) of patients presenting with HCC. No statistically significant association was found between hypoalbuminemia and multifocality (p = 0.426), tumor size group (p = 0.716), or serum alpha-fetoprotein levels (p = 0.405), indicating that hypoalbuminemia was not significantly related to these tumor parameters in the study population. Conclusion: Hypoalbuminemia was frequent among patients with HCC in our setting. However, it showed no significant association with tumor multifocality, size, or AFP levels.

Clinical profile and predictors of outcomes of guillain-barré syndrome variants among patients admitted in tertiary care hospital.

2025-08-25T04:51:34-07:00

Objective: To evaluate the clinical profile, outcomes, and independent predictors of poor prognosis in patients diagnosed with Guillain-Barré Syndrome. Study Design: Cross-sectional Observational study. Setting: Department of Neurology, Nishtar Hospital, Multan. Period: November 2024 to April 2025. Methods: A total of 134 adult patients diagnosed with GBS were enrolled using non-probability consecutive sampling. Data were collected prospectively through structured clinical assessment, nerve conduction studies, and cerebrospinal fluid analysis. Outcome was measured using the Hughes Disability Score. Statistical analysis was performed in SPSS v26.0, applying chi-square test and binary logistic regression with p < 0.05 considered significant. Results: Among 134 Guillain-Barré Syndrome patients, 72.4% were aged 18–45 years and 63.4% were male. Gastrointestinal infection (40.3%) was the most common antecedent. Acute Inflammatory Demyelinating Polyradiculoneuropathy (43.3%) was the predominant variant; albuminocytologic dissociation was present in 79.1%. Symmetric ascending weakness (91.0%), quadriparesis (67.9%), and facial palsy (29.9%) were frequent. Mechanical ventilation (21.6%) and ICU admission (30.6%) were required. Good outcome occurred in 72.4% of cases. Poor outcome (27.6%) was significantly associated with older age (p < 0.001), subacute progression (p = 0.039), absent ACD (p < 0.001), neck weakness, ventilation, and ICU admission (p < 0.05). Conclusion: Favorable outcomes in GBS were associated with early presentation and AIDP subtype, while poor prognosis correlated with old age, delayed admission, absence of albuminocytologic dissociation, and ICU care.

To study the impact of poor glycemic control (Elevated HbA1c) on post-operative frequency of acute kidney injury after coronary artery bypass graft (CABG) surgery.

2025-03-14T07:52:50-07:00

Objective: To compare the frequency of acute kidney injury in diabetic patients with HbAlc ≥7% and HbA1c <7% undergoing CABG surgery and to determine the severity of AKI and adverse outcome in diabetic patients undergoing CABG surgery. Study Design: Comparative Cross-sectional study. Setting: The study was conducted in Cardiac Surgery Department, Faisalabad Institute of Cardiology, Faisalabad. Period: The duration of study was from 05/05/2023 to 04/05/2024. Methods: The present study involved 100 diabetic patients undergoing CABG surgery assimilated into two equal groups; Group-A (HbA1c ≥7.0%) and Group-B (HbA1c <7.0%). These patients were followed in the post-operative period and occurrence of AKI was noted along with its severity according to RIFLE criteria. These patients were managed as per department protocols and adverse outcome in the form of mortality was noted. Frequency of AKI, its severity and adverse outcome was compared between the groups. Results: The calculated mean age of the participants was 51.5 years, with a standard deviation of ±7.4 years. There was male predominance (M:F; 7.3:1). Following cardiac surgery, the mean of peak serum creatinine was significantly higher (1.25±0.36 vs. 1.03±0.24 mg/dl; p-value<0.001) while the mean glomerular filtration rate was significantly lower (66.14±21.17 vs. 75.96±17.52 mL/min/1.73m²; p-value=0.013) in patients with elevated HbA1c (≥7.0%). The frequency of post-operative AKI was significantly higher in patients with poor glycemic control (44.0% vs. 12.0%; p-value<0.001). Among the 28 patients having AKI, 15 (53.6%) patients were categorized as risk while 13 (46.4%) patients were categorized as injury under RIFLE criteria. Adverse outcome was noted in 4 (4.0%) patients. When compared the frequency of adverse outcome comparably higher in individuals with increased HbA1c ≥7.0% (8.0% vs. 0.0%; p-value=0.041) and AKI (14.3% vs. 0.0%; p-value=0.005). Conclusion: In diabetic patients undergoing CABG, poor preoperative glycemic control was identified as a key predictor of postoperative AKI and mortality. This emphasizes the importance of HbA1c in risk stratification and optimizing glycemic management for better patient outcomes.

Efficacy of Valsartan versus enalapril in lowering Proteinuria in patients with diabetic nephropathy.

2025-07-16T21:37:03-07:00

Objective: To compare the effectiveness of valsartan and enalapril in reducing proteinuria in diabetic nephropathy patients. Study Design: Randomized Controlled Trial. Setting: Medical Floor, Allied Hospital. Period: January 3, 2024, to January 9, 2024 (Six Months). Methods: The study involved patients enrolled after approval from the Institutional Ethical Review Committee at Punjab Medical College, Faisalabad. Participants were randomly divided into two groups: Group A received valsartan 80mg daily, and Group B received enalapril 10mg daily for 3 months. Patients were monitored for efficacy after 3 months. Results: Results show no significant difference between the efficacy of the two drugs, but validation through multicenter studies is needed. Conclusion:

Etiological spectrum of non-celiac malabsorption in pediatric population in a tertiary care hospital.

2025-12-13T04:45:40-08:00

Objective: To determine the etiological spectrum of non-celiac malabsorption in pediatric population at a tertiary care hospital. Study Design: Analytical, cross-sectional study. Setting: Department of Gastroenterology, National Institute of Child Health (NICH), Karachi, Pakistan. Period: July 2025 to November 2025. Methods: Children aged 2–10 years presenting with symptoms of malabsorption for more than two weeks were enrolled through consecutive sampling. Stool analysis were performed to confirm etiology. Data were analyzed using SPSS version 26.0. Results: In a total of 220 children, 124 (56.4%) were males, and median age of 6.0 years (IQR 4.0–8.0). Chronic diarrhea 194 (88.2%) and steatorrhea 107 (48.6%) were the most common clinical manifestations. Giardiasis was the most frequent etiology 72 (32.7%), followed by carbohydrate malabsorption 54 (24.5%), fat malabsorption 41 (18.6%), protein malabsorption 27 (12.3%), and chronic intestinal infection 26 (11.8%). Age (p=0.041), residence (p=0.021), parental education (p=0.029), and hemoglobin levels (p=0.004) showed significant associations with etiology of non-celiac malabsorption. Chronic diarrhea was most frequent in Giardiasis (95.8%) and chronic intestinal infection (96.2%) with a significant association (p=0.032). Steatorrhea was strongly linked to fat malabsorption (87.8%, p<0.001). Fatigue or pallor was more common in infective etiologies, seen in Giardiasis (45.8%) and chronic intestinal infection (42.3%) (p=0.018). Conclusion: Infectious causes, particularly Giardiasis, remain the leading etiology of non-celiac malabsorption among children. Infective etiologies were associated with anemia, chronic diarrhea, and nutritional compromise, whereas non-infective causes were linked with specific nutrient malabsorption profiles.

Incidence and risk stratification of pediatric acute respiratory distress syndrome in pediatric intensive care unit.

2025-12-09T04:57:16-08:00

Objective: To determine the incidence and risk stratification of pediatric acute respiratory distress syndrome (PARDS) in mechanically ventilated (MV) patients admitted at the pediatric intensive care unit (PICU). Study Design: Prospective Observational study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: April 2024 to March 2025. Methods: A total of 200 children aged 1 month to < 18 years admitted to the PICU with PARDS, and undergoing MV were included. Risk stratification was done on the basis of oxygenation index (OI) categorizing as mild (4 ≤ OI < 8), moderate (8 ≤ OI < 16), and severe (OI ≥ 16). Duration of MV, use of inotropes, PICU stay duration, and mortality were documented and compared with respect to PARDS severity using chi-square test, and Kruskal-Wallis test, taking p<0.05 as significant. Results: Among 200 children, 111 (55.5%) were female, and overall median age was 8.00 (IQR, 4.00–12.00) years. Regarding PARDS categorizations, 24 (12.0%) had mild, 82 (41.0%) moderate, and 94 (47.0%) severe PARDS. Inotropic support was required in 84 (42.0%) patients. Median duration of MV, and PICU stay were 8.00 (5.00–11.00), and 16.00 (12.00–23.00) days, respectively, increasing significantly with severity (p<0.001). Mortality was highest in severe PARDS (21.3%) compared to moderate (2.4%) and mild cases (4.2%) (p<0.001). Conclusion: The PALICC definition and stratification system for PARDS effectively categorize mechanically ventilated pediatric patients into distinct severity groups associated with clinically meaningful differences in ventilator requirements, PICU stay, and mortality.

The short-term beneficial effect of Zinc Supplement in preterm neonates having neonatal sepsis.

2025-08-16T04:15:04-07:00

Objective: To assess the short-term effect of oral zinc supplementation on mortality in preterm neonates with bacterial sepsis. Study Design: Randomized Controlled Trial. Setting: The Neonatal Unit of Sharif Medical City Hospital, Lahore. Period: December 20, 2021 to June 20, 2022. Methods: A total of 250 preterm neonates with gestational age between 28–36 weeks and diagnosed with sepsis were enrolled using non-probability consecutive sampling technique. They were randomly distributed into two groups. Group A received zinc supplementation orally (3 mg/kg twice daily), while Group B received distilled water as a placebo. Both groups received standard antibiotic treatment. Neonates were monitored in the NICU until discharge or death, and 7-day mortality was recorded. Chi-square test was applied to associate mortality rates. The p value of ≤ 0.05 was considered statistically significant. Results: The mean age of neonates in Group A was 41.19 ± 19.10 hours, while in Group B, it was slightly lower at 39.24 ± 19.63 hours. Group A had a significantly lower 7-day mortality rate of 9(7.2%) compared to Group B at 26(20.8%) (p = 0.002). No deaths occurred in the 6–18 hour age subgroup of Group A, while Group B had 8(6.4%) deaths (p = 0.005). Mortality was significantly lower in Group A among neonates with higher birth weights: 3(2.4%) vs. 12(9.6%), (p = 0.007) and gestational ages of 31–33 weeks: 5(4.0%) vs. 19(15.2%), (p < 0.001). Conclusion: Oral zinc supplementation significantly decreased short-term mortality in preterm neonates with sepsis. Zinc may serve as an effective adjunct therapy in managing neonatal sepsis.

Medical thoracoscopy: An effective tool for diagnosis of pleural tuberculosis.

2025-09-16T04:55:14-07:00

Objective: To assess the diagnostic yield, safety, and outcomes of medical thoracoscopy in patients with suspected pleural tuberculosis. Study Design: Cross sectional study. Setting: Department of Pulmonology, Shaikh Zayed FPGMI, Lahore. Period: January 2015 and December 2024. Methods: This is a retrospective study. A total of 119 patients who underwent medical thoracoscopy for suspected pleural tuberculosis between January 2015 and December 2024 were included. Data were analyzed using descriptive statistics. Results: Tuberculosis was confirmed in the majority of cases, demonstrating a high diagnostic yield. Pleural adhesions were seen in over half of the patients; most were managed successfully during thoracoscopy, while a few required additional interventions. No major complications occurred. Minor events included post-procedural pain (35.3%), surgical emphysema (4.2%), air leak (4.2%), and wound site infection (0.8%). Three patients required surgical referral. Conclusion: Medical thoracoscopy is a safe, reliable, and effective procedure for diagnosing pleural tuberculosis, with minimal complications and added therapeutic benefit in managing pleural adhesions.

Evaluation of intraocular pressure changes following Nd: YAG laser posterior capsulotomy.

2025-11-17T06:48:48-08:00

Objective: To evaluate the change in intraocular pressure (IOP) one week after Nd: YAG laser posterior capsulotomy in patients with posterior capsular opacification. Study Design: Quasi-experimental study. Setting: LRBT Free Eye Hospital, Lahore. Period: 5th August 2025 to 5^thNovember 2025. Methods: Using purposive sampling, 110 pseudophakic patients aged 40–85 years with visually significant PCO were included. Pre-laser IOP was recorded, Nd: YAG capsulotomy was performed using standard protocols, and post-laser IOP was reassessed one week after the procedure. Data were analyzed with SPSS v23, using chi-square testing with p < 0.05. Results: The mean age of participants was 63.2 ± 10.1 years. The average IOP increased from 15.12 ± 2.45 mmHg pre-laser to 16.98 ± 3.28 mmHg post-laser, reflecting a mean rise of 1.86 ± 1.52 mmHg (12.31% ± 8.17%). Younger patients (<60 years) showed a significantly higher incidence of IOP elevation greater than 5 mmHg compared to older individuals (38.9% vs. 17.6%; p = 0.0085). Male patients also exhibited significantly greater IOP increases compared to females (33.9% vs. 13.7%; p = 0.023). Conclusion: Nd: YAG laser posterior capsulotomy is associated with a measurable increase in intraocular pressure, with younger age and male gender serving as significant predictors of larger IOP elevation. Routine monitoring of post-laser IOP is recommended, particularly in high-risk groups, to prevent potential optic nerve damage.

Evaluation of hearing outcomes in ossicular chain reconstruction: A comparison between total and partial ossicular replacement prostheses.

2025-10-15T04:35:15-07:00

Objective: To evaluate and compare postoperative hearing outcomes in patients who have undergone ossicular chain reconstruction using partial and total ossicular replacement prostheses. Study Design: Prospective Non-randomized Clinical study. Setting: Department of Otorhinolaryngology, Shifa International Hospital, Islamabad. Period: April 2024 to April 2025. Methods: Patients undergoing ossiculoplasty were enrolled consecutively and categorized into two groups based on prosthesis used: total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP). The selection of prosthesis was determined intraoperatively based on extent of ossicular chain damage. All patients were followed post-operatively. Pre-operative and post-operative hearing thresholds were assessed using pure tone audiometry. Results: The TORP group had a higher preoperative air-bone gap (ABG) at 31.77 ± 10.05 dB, compared to the PORP group at 26.31 ± 10.67 dB. After surgery, ABG improved in both groups, reaching 17.54 ± 10.83 dB in the TORP group and 19.69 ± 10.34 dB in the PORP group. Both results met the criteria for successful ossiculoplasty. The analysis within the TORP group showed significant hearing improvement, with a p-value of less than 0.01. This group had a mean ABG gain of 14.23 dB and a large effect size. In contrast, the PORP group showed a moderate improvement of 6.62 dB, with a p-value of 0.05. However, the differences between the two groups were not statistically significant, with a p-value of 0.185 and a Hedges’ g effect size of -0.519 favoring TORP. Conclusion: Both TORP and PORP effectively treat conductive hearing loss. TORP may provide more benefit for patients with severe preoperative hearing loss or significant ossicular damage. Choosing a prosthesis should depend on what is found during the operation instead of past practices.

Significance of hemogram and peripheral smear in diagnosis of suspected cases of thalassemia.

2025-10-31T05:39:06-07:00

Objective: To estimate the significance of hemogram and peripheral smear in diagnosis of suspected cases of thalassemia presented to the Farooq Hospital Lahore. Study Design: Cross-sectional study. Setting: Department of Pathology, Farooq Hospital, Westwood Lahore. Period: December 2023 to December 2024. Methods: Patients from all branches of Farooq hospital Lahore visiting for hemoglobin electrophoresis testing were included. Complete blood count was performed on automated hematology analyzer and blood smears were examined by Hematologist. The hemoglobin electrophoresis was performed on electrophoresis automated system. The IBM SPSS version 27.0 software used to analyze the collected data. Results: From total (n=473), majority of the patients were females (73.78%) then males (26.21%). The mean age was 19.99+14.731. The beta thalassemia trait was the most prevalent among the other variants. A substantial number of patients exhibited low MCV levels and moderate hemoglobin deficiency, as well as microcytic hypochromic, anisocytosis, poikilocytosis, and target cells. The beta thalassemia trait was associated with statistically significant red blood cells (p=0.024), poikilocytosis (p=0.001), and target cells (p=0.001). Conclusion: These results emphasize the significance of peripheral smear and hemogram in the diagnosis of thalassemia. This study also underscores the importance of targeted screening and diagnostic strategies to effectively identify carriers and manage affected individuals, particularly in light of the high female representation and young mean age of patients.

Clinicohematological profile and treatment outcomes of Hodgkin’s Lymphoma- a single center experience from Pakistan.

2025-04-03T07:29:43-07:00

Objective: To evaluate the epidemiological and clinical characteristics, along with treatment outcomes of Hodgkin’s lymphoma patients in Pakistan. Study Design: Prospective Cross Sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD), Karachi, Pakistan. Period: January to December 2024. Methods: This was a cross sectional study comprising 22 patients diagnosed with HL as per WHO Classification who presented at National Institute of Blood Diseases and BMT Karachi Pakistan from January to December 2024. The quantitative variables were represented as mean (SD), while nominal variables were presented as frequency and percentages by using SPSS 25 version and STATA 15 version. The Kaplan Meier analysis and log rank test was done for survival analysis. Results: A total of 22 HL patients were included in the study. The mean age of the study participants was 31.7±18.7 years. In the study, 63.6% of the patients were male, while 36.4% were female. B symptoms were present in 86.4% of the patients. Hepatomegaly, was noted in 27.3, while splenomegaly, was observed in 45.5% of patients. The Hb level in the cohort was above 10.5 g/dl in the majority (63.7%), while 36.3% had anemia. LDH is a marker of tissue damage, and in this cohort, 63.7% of patients had LDH levels higher than 220 U/L, indicating ongoing cellular breakdown or tissue damage. The site of tissue diagnosis in the study primarily involved cervical lymph nodes (72.8%), followed by Axillary (13.7%) and inguinal (9.1%) lymph nodes. The 90 months overall survival in 22 patients was 73.5%. Conclusion: The present study revealed the detailed clinical hematological and treatment outcome of HL patients in Pakistan. However, multicenter studies with larger sample size are needed to validate the findings and enhance treatment strategy especially for relapse patients.

The outcome of Sublay vs Onlay mesh hernioplasty in obstructed paraumbilical hernia.

2025-09-01T05:37:32-07:00

Objective: To compare the results of sublay mesh repair vs onlay mesh repair in patients with obstructed paraumbilical hernia in terms of post operative pain, wound infection and recurrence rates after 2 years. Study Design: Comparative prospective study. Period: 3 years from 1^st January 2022 to 30^th December 2024. Setting: department of General Surgery of CMA teaching and research hospital which is teaching hospital of Azra Naheed Medical College Lahore Pakistan. Methods: Sample size of this study is 112 patients and patients were divided into 2 groups Group A and Group B with 56 patients in each group. Inclusion criteria include all the patients with age between 18 years and 70 years diagnosed with obstructed paraumbilical hernia. Outcomes were measured in terms of post operative pain, wound infection, seroma hematoma formation and recurrence of hernia after 1 and 2 years. All the data was entered and processed by using SPSS 26. Results: The most common age group who presented with obstructed paraumbilical hernia is 40 to 49 years of age. post operative pain 24 hours surgery, wound infection after 48 hours of surgery, seroma/hematoma formation 24 hours of surgery and recurrence of hernia after 1 and 2 years is significantly higher in patients who underwent onlay mesh hernioplasty. Post operative pain has no significant relation with diabetic or BMI of patient while wound infection was more in diabetic patients. Conclusion: Sublay mesh hernioplasty is superior even for obstructed paraumbilical hernia as compared to onlay mesh repair.

Physiological effects of standard versus gradual pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

2025-10-01T03:45:18-07:00

Objective: To compare the physiological effects of standard versus gradual open pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Study Design: Prospective Comparative study. Setting: Operation Room, Tertiary Care Hospital Jizan, Saudi Arabia. Period: Sep 2024 to Aug 2025. Methods: Hundred patients recruited for study were randomly divided in two Groups. In Group A, a pressure of 14mmHg was achieved by creating open pneumoperitoneum by CO2 in a standard fashion, while in the intervention Group B, pressure of 5, 10, and 14 mmHg was achieved gradually. At different time intervals, BP, heart rate, SpO2 and EtCO2 were measured. Results: Mean heart rate in group A and B was 77.66±8.21and 76.41±7.47 respectively (P-value=0.051). Mean systolic BP in group A and B was 117.7±12.13 and 119.14±7.75 respectively (P-value=0.082). Mean diastolic BP in Group A and B was 77.96±6.45 and 77.38 ± 5.01 respectively (P-value=0.023). Mean SpO2 in group A and B was 99.59 ± 0.53 and 99.6±0.76 (P-value=0.8). Mean EtCO2 in group A and B was 36.86±2.38 and 36.6±2.35 respectively (P-value=0.17). Mean VAS score in group A and B was 2.34±0.72 and 2.06±0.24 respectively (P-value=0.01). In Group A, 13 (26%) patients received injection pethidine due to pain while in Group B only 4 (8%) patients received pethidine (P-value=0.017). Conclusion: Gradual open pneumoperitoneum results in more stable physiological and hemodynamic parameters compared to standard rapid open insufflation, without compromising surgical conditions. This is particularly beneficial in patients with cardiovascular compromise.

Comparative study of Lichtenstein and darn repair surgery in obstructed hernia repair.

2025-12-08T05:48:18-08:00

Objective: To compare postoperative outcomes between Lichtenstein and Darns repairs in obstructed inguinal hernias. Study Design: Prospective quasi-experimental study. Setting: General Surgery Department, Arif Memorial Teaching Hospital. Period: September 2023 to February 2024. Methods: Sixty patients with obstructed inguinal hernia were recruited through non-probability purposive sampling and non-randomized into two groups of 30 each. Group 1 underwent Lichtenstein repair, while Group 2 underwent Darn repair. Postoperative pain, wound infection, seroma formation, and recurrence were assessed over a 6-month follow-up. Data were analyzed using SPSS version 25, applying independent t-tests and likelihood ratio tests, with p ≤ 0.05 considered significant. Results: The mean age was 43.5 ± 11.6 years in the Lichtenstein group and 42.8 ± 10.4 years in the Darn group (p = 0.797). Seroma formation was noted in 13.3% of Lichtenstein versus 23.3% of Darn repairs, postoperative pain in 36.7% versus 46.7%, and wound infection in 10% versus 16.7%. No recurrences were observed during follow-up. None of the outcome differences were statistically significant (p > 0.05). Conclusion: Lichtenstein and Darn repairs demonstrated comparable short-term outcomes in obstructed inguinal hernia. Lichtenstein repair remains preferable where mesh is available, while Darn repair provides a suitable alternative in settings with limited resources.

Frequency of Hypoxia in patients handed over between operating room team and post anesthesia Care Unit team using PATH (Post-Anesthesia Team Handover) Checklist.

2025-10-06T06:06:18-07:00

Objective: To determine the frequency of hypoxia in patients handed over from Operating Room (OR) team to Post-Anaesthesia Care Unit (PACU) team using Post-Anesthesia Team Handover (PATH) checklist. Study Design: Observational Study. Setting: Department of Anesthesiology & Pain Medicine, Shifa International Hospital. Period: 6 months from 25^th March 2025 to 25^th September 2025. Methods: A total of 2016 patients were included. Data was collected for Pre and Post Implementation phase when patients were handed over using institutional practices and PATH Checklist respectively. Frequency of hypoxia was noted as primary outcome. Data was entered and analyzed using SPSS v27.0. Results: Mean SpO2 was 94.0±4.7% in Pre Implementation phase in contrast to 94.9±2.9% in Post Implementation phase. Frequency of Hypoxia was noted to be 11.2% during the whole study period. Before implementation of PATH Checklist, it was 16.2% while after implementation of PATH Checklist for handover in PACU, it was reduced to 6.9%. The decline in frequency of hypoxia was statistically significant. (p<0.001). Conclusion: Use of PATH checklist significantly reduces frequency of Hypoxia in PACU.

Risk of deep venous thrombosis in abdomino pelvic surgeries.

2025-10-31T06:08:14-07:00

Objective: To determine the frequency and associated risk factors of deep venous thrombosis (DVT) among patients undergoing abdomino-pelvic surgeries and to evaluate their risk stratification according to the American College of Chest Physicians (ACCP) guidelines. Study Design: Descriptive Case Series. Setting: Surgical Unit, Hayatabad Medical Complex (HMC), Peshawar, Pakistan. Period: 1^st July 2021 to 31^st December 2021. Methods: A total of 174 hospitalized patients aged 15–70 years with duplex ultrasound–confirmed lower limb DVT were enrolled through consecutive convenience sampling. Patients with chronic or ambiguous DVT findings were excluded. Data on demographics, clinical characteristics, comorbidities, mobility, hospital stay, and surgical details were recorded. Risk stratification was performed as per ACCP guidelines into low, moderate, high, and very high-risk groups. Data were analyzed using SPSS version 22, applying chi-square tests for associations, with p ≤ 0.05 considered statistically significant. Results: Among 174 patients, the majority were males (62.1%) with a predominant age group of 41–50 years. High and very high-risk categories accounted for 40.8% and 37.4% of patients, respectively. Obesity (33.3%), limited mobility (72.4%), and comorbidities (66.1%) were the most significant risk factors. Statistical analysis revealed strong associations between DVT risk level and age (p < 0.001), BMI (p = 0.001), comorbidities (p < 0.001), and mobility status (p < 0.001). Most patients (72.4%) had a hospital stay of ≤7 days, and 89.1% underwent surgeries lasting ≤1 hour. Conclusion: DVT risk in abdomino-pelvic surgical patients is strongly associated with age, obesity, immobility, comorbidities, and prolonged hospitalization. Regular risk assessment and adherence to thromboprophylactic guidelines are essential to reduce preventable morbidity and mortality.

Preterm birth in women with asymptomatic bacteriuria.

2025-09-01T05:28:36-07:00

Objective: To determine the frequency of preterm birth in women with asymptomatic bacteriuria. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynaecology Liaquat University Hospital Hyderabad. Period: Six Months from June 2020 to November 2020. Methods: A total of 151 women fulfilling the inclusion criteria was enrolled in the study. All the pregnant ladies with asymptomatic bacteriuria were recruited. The data was collected on pre-designed proforma, and all such manoeuvres were performed. Results: The average age of the patients with asymptomatic bacteriuria was 27.95±5.66 years. Frequency of preterm birth in women with asymptomatic bacteriuria was 17.88% (27/151). Conclusion: We conclude that asymptomatic bacteriuria during pregnancy has a significant impact on pregnancy outcome, mainly premature labour. By early screening and treatment of asymptomatic bacteriuria the unwanted sufferings of the pregnant mothers and their offspring could easily be reduced and even prevented. In light of our results, we recommend that, health education sessions about personal hygiene should be emphasized by the healthcare provider during antenatal care to all pregnant females, specifically those of low socio-economic level.

Frequency of large for gestational age fetus in females presenting with increased maternal body mass index.

2025-04-08T07:51:22-07:00

Objective: To investigate the prevalence of large-for-gestational-age (LGA) fetuses among obese pregnant women and explore the relationship between LGA and maternal characteristics such as BMI, age, gestational age, and parity. Study Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, HBS Medical & Dental College, Islamabad. Period: Six months October 1^st, 2023 to March 30th, 2024. Methods: Ninety-five pregnant women with a gestational age of 30 weeks and above, and a BMI of 30 or higher, were recruited through non-probability consecutive sampling. Maternal demographic details, gestational age, BMI, and parity were recorded, and LGA diagnosis was made using ultrasound assessment. Data analysis was done using SPSS version 23. Results: Among 145 participants, 72 (49.66%) had LGA fetuses. However, no significant correlations were found between LGA and maternal age (p = 0.810), gestational age (p = 0.056), parity (p = 0.812), or BMI categories (p = 0.698). Maternal obesity emerged as a significant determinant of LGA. Conclusion: The high prevalence of LGA fetuses among obese pregnant women highlights the need for clinical consideration of maternal obesity's impact on pregnancy outcomes. This study emphasizes the importance of developing targeted intervention strategies to reduce maternal obesity and its effects on fetal weight.

Determinants of high cesarean section rates in resource-constrained healthcare system, Peshawar, Pakistan.

2025-08-11T03:03:24-07:00

Objective: To investigate the key determinants of high CS rates in Peshawar’s resource-constrained healthcare system, exploring both demand-side (patient-related) and supply-side (healthcare provider and facility-related) factors. Study Design: Mixed-method approach. Setting: Three Major Hospitals from Peshawar Including Lady Reading Hospital, Hayatabad Medical Complex and Rehman Medical General Hospital. Period: January 2023 to December 2023. Methods: A hospital-based mixed-methods study was conducted across three major public and private facilities (N=221 CS cases). Quantitative data from medical records were analysed using multivariate logistic regression to identify independent predictors. Complementary in-depth interviews with providers (n=15) and mothers (n=15) explored decision-making processes. Results: The CS rate among study facilities was 48.6%, far exceeding WHO recommendations. Key independent predictors included: private hospital delivery (aOR=3.24, 95% CI:1.87-5.61), previous CS (aOR=4.83, 95% CI:2.42-9.65), low-income status (aOR=2.67, 95% CI:1.51-4.72), and primiparity (aOR=2.15, 95% CI:1.25-3.71). Qualitative data revealed three major themes: (1) defensive medical practices in private sectors, (2) inadequate labour monitoring leading to "failure to progress" diagnoses, and (3) socioeconomic perceptions of CS as superior care. Paradoxically, low-income women had higher CS rates despite typically facing access barriers. Conclusion: Multiple modifiable factors drive unnecessary CS in Pakistan's resource-constrained setting, particularly in private facilities and among disadvantaged populations. Targeted interventions should include: VBAC protocol implementation, provider training on labour management, and policy reforms addressing perverse financial incentives. The inverse socioeconomic gradient warrants particular attention in future research and programming.

Frequency of pre-analytical errors in chemical pathology section of tertiary care hospital.

2025-11-01T05:27:30-07:00

Objective: To determine the frequency of Pre-Analytical Errors in the Chemical Pathology Section of Tertiary Care Hospital. Study Design: Descriptive study. Setting: Central Diagnostic Laboratory (CDL), KEMU/, Mayo Hospital, Lahore. Period: May 2022 to May 2024. Methods: The pre-analytical errors were noted out of 135,000 samples sent to Chemical pathology section both from indoor and outdoor. All the collected data was analysed by SPSS version 23. The frequency and percentage of errors were calculated. Results: A total of 12,852 (9.52%) laboratory errors including pre-analytical, analytical and post-analytical errors were observed. Out of the total errors, 8919 (69.4%), 1607 (12.5%), 2326 (18.1%) were pre-analytical errors, analytical and post-analytical errors, respectively. Haemolysis, unlabelled vial, quality not sufficient (QNS), EDTA, IV contamination, wrong vial, illegible hand writing, empty vial, spillage was 69, 20.4, 4.1, 2.6, 2.3 1.1, 0.3, 0.2, 0.1% respectively. Conclusion: The pre-analytical errors were the most common followed by post-analytical and analytical errors. The pre-analytical errors were more common in IPD samples than samples received from OPD and hemolysis was the most common pre-analytical error.

Association of mobile usage with Depression Disorder.

2025-12-19T03:09:09-08:00

Objective: To evaluate the association of mobile usage with depression disorder. Study Design: Case Control study. Setting: Private medical university and schools of Karachi. Period: Jan 2022 to June 2022. Methods: Mobile phone user depression level was assess with the help of Patient Health Questionnaire (PHQ-9) Score. Statistical analysis was done by version 25 SPSS and all data was expressed using mean and standard deviation. Results: Out of 258 participants, 172(66.7%) were male and 86(33.33%) female with male to female ratio of 2:1 with mean 32.85±10.85 years. Most of the participants were single 231(89.5%) cases and followed by married 27(10.5%) cases. The participants were student 159(61.6%) cases and followed by house hold 26(10.1%) cases, jobless 7(2.7%) cases and shop keeper 6(2.3%) cases. According to language majority participants were sindhi 159(61.6%) cases and followed by balochi 60(23.3%) cases, pashto 13(5%) cases, panjabi 7 (2.7%) and Urdu 6(2.3%) cases. Majority of the participants 150(58.1%) were used more than 3 hours, followed by 1 to hours 46(17.8%) and 2 to 3 hours 42(16.3%) and 20(7.8%) used were less than one hour (Table-I and II). Majority of the participants suffering the mild depression observed in 168(65.1%) due to mobile used, followed by moderate depression in 20(7.8%). Conclusion: Our study concludes that excessive mobile phone usage is associated with increased anxiety, stress, and mild depression symptoms.

An audit of pre-analytical errors and specimen rejection in the haematology laboratory of a tertiary care transplant center: Clinical and financial impact: Root cause analysis of specimen rejection in haematology laboratory.

2025-10-18T06:34:56-07:00

Objective: To identify specific problems regarding pre-analytic processes susceptible to errors and their impact on sample rejection in a haematology laboratory. Study Design: A retrospective audit. Setting: The study was conducted at the Haematology laboratory of the Pakistan Kidney and Liver Institute and Research Center (PKLI&RC). Period: The audit covered a four-year period from 2019 to 2022. Methods: A retrospective audit of all samples rejected in the Haematology laboratory was performed. The reasons for rejection and the potential clinical impact of these rejections were investigated. The study was approved by the Institutional Review Board (IRB) of PKLI&RC (Ref No.: PKLI-IRB/AP/110, Approval date: 28 March 2023). Results: Out of 250,000 samples received, 568 specimens were rejected, yielding a rejection rate of 0.22%. The most common reasons for rejection were clotted samples (n=274, 48%), results not matching the patient's given history (n=142, 25%), hemolyzed samples (n=40, 7%), insufficient quantity (QNS) (n=34, 5.9%), vial defects (n=15, 2.6%), patient identification errors (n=6, 1%), and sample switches (n=4, 0.7%). Conclusion: The implementation of a barcoding system and positive patient ID can help prevent mislabelling and patient ID issues. Proper training and continuing education for all healthcare professionals involved in collecting, handling, and transporting patient samples is crucial to the mitigation of pre-analytical errors. Standardization of processes and procedures can efficiently prevent pre-analytical errors.

Prevalence of adult ADHD: A cross-sectional analysis using the self-report scale (ASRS) among undergraduate and post-graduate medical students in Peshawar, Pakistan.

2025-08-27T07:28:48-07:00

Objective: To determine the prevalence of adult ADHD among undergraduate and postgraduate medical students in Pakistan, explore gender and academic-level differences, and assess the relationship between symptom severity and ADHD medication use. Study Design: Descriptive Cross-sectional study. Setting: Northwest School of Medicine, Peshawar. Period: May 2023 to September 2023. Methods: Was conducted among 394 medical students (227 undergraduates, 167 postgraduates) in Peshawar, Pakistan. Participants completed the Adult ADHD Self-Report Scale (ASRS). Using stratified random sampling from medical colleges and teaching hospitals in Peshawar. The ASRS (Urdu-translated and pre-validated version; Cronbach’s α = 0.84) was employed. Data were analyzed using SPSS 27, with chi-square tests used to evaluate associations among ADHD severity, gender, academic status, and medication use. Results: Overall, 53.3% of students screened positive for mild ADHD and 18.8% for severe ADHD. Females reported higher symptom severity than males (p = 0.039 (Cramér’s V = 0.13, 95% CI 0.04–0.23)”), and undergraduates more than postgraduates (p = 0.003 (Cramér’s V = 0.17, 95% CI 0.07–0.27)). Common symptoms included procrastination (78.2%), organizational difficulties (73.4%), and restlessness (77.9%). Students using ADHD medication (primarily modafinil) had a significantly lower prevalence of severe ADHD (37.83%) compared to those unmedicated (62.17%; p < 0.001), though side effects such as insomnia (62%) and anxiety (38%) were frequent. Conclusion: ADHD is prevalent among Pakistani medical students, especially females and undergraduates. While medication appears to reduce symptom severity, adverse effects may limit adherence. Early identification and targeted academic support are critical for improving outcomes in this population.