The Professional Medical Journal

Respiratory epithelial adenomatoid hamartoma presenting as recurrent bilateral sinonasal polyposis: A case report.

Waqas Javaid — 2026-07-29

A rare benign sinonasal tract lesion called respiratory epithelial adenomatoid hamartoma (REAH) frequently resembles inflammatory polyposis and other sinonasal neoplasms. It commonly presents with nasal obstruction and is frequently associated with chronic rhinosinusitis and nasal polyposis. We report the case of a 52-year-old male with recurrent bilateral sinonasal polyposis and a history of previous nasal surgeries in 1997 and 2012, who presented with longstanding bilateral nasal obstruction. Endoscopic sinus surgery revealed extensive fleshy polypoidal disease involving both nasal cavities and paranasal sinuses with extension through a septal perforation. Histopathological examination confirmed respiratory epithelial adenomatoid hamartoma. It highlights the importance of considering REAH in patients with recurrent sinonasal polyposis and prior surgical interventions, as accurate diagnosis prevents overtreatment and unnecessary aggressive surgery.

The comparison of early outcomes in minimal invasive versus conventional mitral valve surgery.

Maria Noor — 2026-07-29

Objective: To compare early postoperative outcomes between MIMVS and conventional sternotomy at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, a tertiary care cardiac center in Pakistan. Study Design: Prospective Cohort study. Setting: Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore. Period: 1^st September 2025 to 28^th January 2026. Methods: Consecutive patients with degenerative mitral valve disease undergoing surgery were enrolled (N=240), including 145 patients undergoing MIMVS and 95 undergoing conventional sternotomy. Preoperative characteristics, intraoperative parameters, postoperative outcomes, and organ-specific biomarkers were documented. Data analysis was performed using SPSS. A p-value <0.05 was considered statistically significant. Results: Baseline variables were comparable between groups. Cardiopulmonary bypass time was significantly longer in the MIMVS group compared to sternotomy (140.9 ± 39.4 vs 95.7 ± 38.3 min; p<0.001), as was aortic cross-clamp time (88.7 ± 30.6 vs 60.2 ± 23.0 min; p<0.001). Frequency of solated annuloplasty was more in MIMVS patients (29.0% vs 13.7%; p=0.007). Valve replacement was more common in the sternotomy group (33.7% vs 11.0%; p<0.001), as was concomitant tricuspid valve surgery (36.8% vs 19.8%; p=0.001). Thirty-day mortality (3.4% vs 1.1%; p=0.392) and stroke rates (2.8% vs 3.3%; p=0.642) were comparable. Hospital stay (14 ± 4 vs 15 ± 4 days; p=0.18) and ICU stay (1.4 ± 1.8 vs 1.7 ± 2.1 days; p=0.371) were similar between groups. C-reactive protein levels on postoperative day two were significantly lower in the MIMVS group compared to sternotomy (18.5 ± 19.1 vs 168.3 ± 74.9 mg/L; p<0.001), while creatine kinase levels were higher (932.9 ± 796.1 vs 609.1 ± 633.9 U/L; p=0.001). Conclusion: Minimally invasive mitral valve surgery represents a safe and effective alternative to conventional sternotomy in appropriately selected Pakistani patients. Despite longer procedural times, MIMVS provides comparable clinical outcomes with reduced systemic inflammatory response, supporting its use as a viable surgical option in tertiary cardiac centers.

Comparison of efficacy of uterine gauze packing and intra uterine balloon tamponade in the management of postpartum hemorrhage (PPH).

Amina Shabbir — 2026-07-29

Objective: To compare the efficacy and safety of uterine gauze packing and intrauterine balloon tamponade in the management of postpartum hemorrhage unresponsive to medical therapy. Study Design: Comparative Cross-sectional study. Setting: Department of Obstetrics and Gynecology at AJK Medical College, Muzaffarabad, Period: August 2025 to January 2026. Methods: A total of 120 women with primary postpartum hemorrhage were included and divided into two groups. Group A included women in which uterine gauze packing was used and Group B included women in which intrauterine balloon tamponade technique was utilized. Outcomes assessed included successful control of hemorrhage need for additional surgical intervention, blood transfusion requirements, maternal complications and duration of hospital stay. Data was analyzed using appropriate statistical tests. A p-value < 0.05 was considered statistically significant. Results: Hemorrhage was successfully controlled in 48 patients (80.0%) in the uterine gauze packing group and 56 patients (93.3%) in the intrauterine balloon tamponade group (p = 0.03). The need for additional surgical intervention was significantly higher in the gauze packing group (20.0%) compared to the balloon tamponade group (6.7%). Patients managed with balloon tamponade required fewer blood transfusions and had lower rates of maternal complications and shorter hospital stays. Conclusion: Intrauterine balloon tamponade is more effective and safe technique than uterine gauze packing in the management of postpartum hemorrhage. Its use is associated with higher success rates, reduced need for surgical intervention, fewer complications and improved maternal outcomes. However, uterine gauze packing remains a useful alternative in resource-limited settings.

Frequency of vasoplegia after cardiac surgery at tertiary Care Hospital in Karachi

Aruba Khan — 2026-07-29

Objective: To determine the frequency of vasoplegia after cardiac surgery at tertiary care hospital in Karachi. Study Design: Descriptive Cross Sectional study. Setting: NICVD Karachi. Period: 30/07/2025 to 30/01/2026. Methods: Among 162 patients (18 to 65 years old) undergoing cardiac surgery. Patients with pre-existing vasoplegia, pregnancy, end stage dysfunction of organs or with chronic inflammatory diseases were excluded. Baseline demographic and clinical information were note down and the state of vasoplegia was evaluated with the help of a predetermined definition. The SPSS version 22.0 was used to analyze the data and the associations were compared using chi-square or Fisher exact test (p ≤0.05). Results: The mean age was 52.14 ± 11.64 years. Majority of the patients were older than 50 years (135; 64.9%), 163 patients (78.4% males), Patients with vasoplegia were 17 (8.2%). Age, gender, body mass index, comorbidities, residence status or type of surgery did not have significant association with vasplegia. Low mean arterial pressure at 24 hours (p = 0.002) and 48 hours (p = 0.044) was significantly associated with the formation of vasoplegia in the postoperative conditions. Conclusion: Vasoplegia in cardiac surgery affects 8.2% of patients and leads to lower mean arterial pressure after the procedure. Early identification of higher-risk patients via hemodynamic monitoring can enhance postoperative care.

Frequency of thyroid dysfunction in antenatal patients visiting the tertiary care hospital.

Jawaria Anis — 2026-07-29

Objective: To determine the frequency of thyroid dysfunction and its subtypes among antenatal patients, and to analyze the relationship between thyroid dysfunction and selected sociodemographic, obstetric, and clinical parameters. Study Design: Cross-sectional Prospective study. Setting: Department of Obstetrics-Gynecology Unit-2 of Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan. Period: October 1^st, 2025, to March 31^st, 2026. Methods: A total of 177 pregnant women attending the outpatient department were recruited through consecutive sampling. A detailed clinical history and relevant demographic information were recorded in a pre-designed proforma. In addition, to routine antenatal investigations, thyroid profile including serum thyroid-stimulating hormone (TSH) levels, free triiodothyronine (FT3) and free thyroxine (FT4) levels were measured in all participants. Thyroid status was categorized using trimester-specific reference ranges. Data were analyzed via SPSS. A p-value of <0.05 is considered as significant. Results: The overall prevalence of thyroid dysfunction among pregnant women was found to be 14.1% (25/177), with the majority of cases being subclinical hypothyroidism (6.78%), followed by overt hypothyroidism (2.82%), subclinical hyperthyroidism (3.39%), and overt hyperthyroidism (1.13%). A significant association was observed between thyroid dysfunction and age (p=0.008) and pregnancy-induced hypertension PIH(p=0.012), while no significant associations were observed with education, occupation, trimester, gravida, BMI, anemia, or gestational diabetes mellitus. Conclusion: The study found a moderate prevalence of thyroid dysfunction. These findings highlight thyroid dysfunction as an important antenatal health concern and support targeted screening, particularly in older pregnant women and those with pregnancy-induced hypertension, to improve maternal outcomes.

Burden of reproductive tract infections among married women of South Punjab.

Saba Nadeem — 2026-07-29

Objective: To identify the frequency, etiology and risk factors of reproductive tract infections (RTIs) in married women who visit gynecology outpatient department at Bahawal Victoria Hospital, Bahawalpur, South Punjab. Study Design: Analytical Cross-sectional. Setting: Bahawal Victoria Hospital/Quaid-e-Azam Medical College, Bahawalpur. Period: June 2025 to December 2025. Methods: This study involved 428 married women aged 18-49. The participants were examined clinically, diagnosed by syndromic diagnosis by the WHO criteria, and laboratory tests were carried out, including wet mount microscopy, Gram staining, culture sensitivity, and rapid plasma reagin test. All the data analysis was done in SPSS version 26.0; chi-square test and multivariate logistic regression were used with the significance level of 0.05. Results: The prevalence of overall RTI was 38.6 (95% CI: 34.0-43.3). There were endogenous infections (24.3%), then sexually transmitted infections (8.9%), and finally iatrogenic infections (5.4%). The most prevalent one was bacterial vaginosis (15.7%), then comes vulvovaginal candidiasis (11.2%), trichomoniasis (6.8%), and cervicitis (5.1%). This was significant in low education (AOR=2.84, 95% CI: 1.76-4.58, p<0.001), household size >7 members (AOR=2.11, 95% CI: 1.32-3.37, p=0.002), husband being migrationed to work (AOR=1.97, 95% CI: 1.24-3.13, p=0.004), use of intrauterine. Conclusion: RTIs are a significant burden of the population health among the married women of South Punjab. There is need to integrate RTI screening in normal maternal health services and community based health education.

Comparison of efficacy, accuracy, and safety between axial and sagittal approaches of ultrasound guided transforaminal epidural injection for lumbar radiculopathy: A randomized controlled trial.

Adeel Shahid — 2026-07-29

Objective: To compare the clinical efficacy, parameters of intervention, and safety of axial versus sagittal ultrasound-guided TFESIs in patients with Lumbar radiculopathy. Study Design: Prospective Randomized Controlled Trial. Setting: Department of Anaesthesia and Pain Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: August 2025 and January 2026. Methods: Including 88 patients (44 in each group) diagnosed with Lumbar radiculopathy were enrolled in this trial and were randomly assigned by a lottery system to undergo either axial or sagittal US-guided TFESIs. The primary outcomes were measured at baseline, 2 weeks, 1 month, and 3 months. Secondary outcomes included procedure time and fluoroscopically confirmed accuracy and adverse effects. Results: Both groups demonstrated significant improvements in VAS and ODI (p < 0.001). The sagittal approach also had significantly reduced VAS at 2 weeks (3.8 ± 0.9 vs. 4.2 ± 1.1; p = 0.042) and 1 month (2.8 ± 0.8 vs. 3.1 ± 0.9; p = 0.038). The ODI was also significantly reduced for the sagittal approach compared with the axial approach at 2 weeks (p < 0.001) and 1 month (p < 0.001). The sagittal approach was also faster than the axial approach (10.2 ± 1.8 min vs. 15.4 ± 2.5 min; p < 0.001). The accuracy was comparable between the two approaches: sagittal, 95.5%, axial, 90.9%. Conclusion: The two US-guided approaches are safe and effective. The sagittal approach is superior in terms of procedural efficiency and short-term clinical outcomes for the lumbar TFESI.

Comparison of mean fall in systolic blood pressure in patients undergoing cesarean section under spinal anesthesia treated with norepinephrine bolus versus infusion.

Mehvish Pervaiz — 2026-07-29

Objective: To compare systolic blood pressure fall, lightheadedness, bradycardia incidence and Apgar scores between norepinephrine bolus and prophylactic infusion treatments. Study Design: Cross-sectional Analytical study. Setting: Bahawal Victoria Hospital. Period: January to December 2025. Methods: Involving 68 eligible participants undergoing cesarean section under spinal anesthesia. Patients were allocated into Group A (therapeutic bolus, n=34) or Group B (prophylactic infusion, n=34). Intraoperative hemodynamic variables, maternal side effects, and neonatal Apgar scores at one and five minutes were strictly documented and analyzed using SPSS version 23.0. Results: Baseline demographics were comparable. The mean systolic blood pressure reduction observed immediately post-block was significantly greater in the bolus group (11.76±7.97 mmHg) versus infusion (9.35±4.55 mmHg; p=0.007). Bradycardia occurred significantly more frequently among patients in Group A (20.6%) compared to Group B (2.9%; p=0.027). Neonatal Apgar scores at one and five minutes were significantly higher in the infusion group (p<0.001) respectively. Conclusion: Prophylactic norepinephrine infusion ensures better hemodynamic stability with fewer bradycardia episodes and enhanced neonatal results compared to therapeutic bolus administration. Based on findings, continuous infusion should be the preferred protocol for optimizing overall maternal and clinical safety during obstetric spinal anesthesia.

Perioperative intravenous lidocaine infusion for reduction of chronic postsurgical pain: A systematic review and meta-analysis.

Salman Naeem — 2026-07-29

Objective: To assess perioperative intravenous lidocaine’s effectiveness in reducing chronic and acute postoperative pain, opioid use, and adverse events versus control. Study Design: Systematic review and meta-analysis. Setting: Department of Anesthesiology and Perioperative Medicine, through a systematic review of RCTs identified from PubMed, Cochrane CENTRAL, and Web of Science. Period: Jan 2015 to 2026. Methods: Studies published between January 2015 and May 07, 2026 that met the inclusion criteria were included. A total of 16 studies were included in the final analysis. Data analysis was conducted using RevMan 5.4. Results: Perioperative intravenous lidocaine significantly reduced chronic postsurgical pain at ≥3 months compared with control (RR = 0.33, 95% CI: 0.18–0.60, p = 0.0003; I² = 0%). Acute postoperative pain at 24 hours was also significantly reduced (MD = -0.69, 95% CI: -1.26 to -0.12, p = 0.02; I² = 61%), with greater benefit in studies using Visual Analog Scale outcomes (MD = -0.96, 95% CI: -1.31 to -0.62, p < 0.00001). No significant reduction in opioid consumption was observed (MD = -1.06, 95% CI: -2.46 to 0.35, p = 0.14; I² = 97%). No significant increase in cardiovascular or neurological adverse events was found (RR = 0.55, 95% CI: 0.21–1.43, p = 0.22). Conclusion: Perioperative intravenous lidocaine significantly reduces chronic postsurgical pain and improves early postoperative analgesia without increasing adverse events, supporting its role in multimodal perioperative pain management.

Etiological profile and clinical spectrum of delayed puberty in adolescents at a Tertiary Care Center.

Mariam Bibi — 2026-07-29

Objective: To determine the etiological profile and clinical spectrum of delayed puberty among adolescents presenting to a tertiary care center. Study Design: Descriptive, Cross-sectional study. Setting: Department of Paediatric Endocrinology, National Institute of Child Health (NICH), Karachi, Pakistan. Period: 1^st November 2025 to 15^th January 2026. Methods: A total of 125 adolescents aged 12–18 years with delayed puberty were included. Clinical assessment included Tanner staging, anthropometry, hormonal profiling, and bone age evaluation. Data were analyzed using SPSS v26, while chi-square test or fisher’s exact test was applied to determine association between categorical data, taking p<0.05 as significant. Results: Among 125 adolescents, the median age was 15.0 (14.0–16.0) years, and 74 (59.2%) were boys. Underweight was recorded in 30 (24.0%), short stature 78 (62.4%), family history of delayed puberty 61 (48.8%), growth faltering 44 (35.2%), and dysmorphic features in 21 (16.8%) adolescents. Etiologies included constitutional delay of growth and puberty (CDGP) in 43 (34.4%), hypogonadotropic hypogonadism 32 (25.6%), hypergonadotropic hypogonadism 28 (22.4%), chronic disease related delay 13 (10.4%), and hypothyroidism 9 (7.2%). CDGP was significantly more frequent among boys 33 (44.6%), than girls 10 (19.6%) (p=0.007). Family history had significant association with CDGP (p<0.001), systemic symptoms with chronic disease (p<0.001), dysmorphism with hypergonadotropic hypogonadism (p<0.001), and bone age delay ≥2 years with CDGP (p<0.001). Conclusion: Delayed puberty in adolescents presenting to tertiary care showed a heterogeneous etiological profile and a wide clinical spectrum, ranging from constitutional delay to hypogonadism, and secondary causes related to chronic systemic illness, and thyroid dysfunction.

Effectiveness of folic acid supplementation in acute watery diarrhea among children under 5 years of age.

Arbab Fatima — 2026-07-29

Objective: To compare the mean duration of diarrhea among children diagnosed with acute watery diarrhea and treated with folic acid versus placebo in addition to standard treatment. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Medicine, Allama Iqbal Memorial Teaching Hospital, Sialkot. Period: Oct 2025 to March 2026. Methods: 82 children aged 2 months to 5 years who were diagnosed with acute watery diarrhea as per operational definition and met the inclusion criteria and presented to the Department of Pediatric Medicine at Allama Iqbal Memorial Teaching Hospital Sialkot were included in this study. Results: The median age was 32 years (IQR: 20.5-51) in the folic acid group and 32 years (IQR: 14.5–45) in the placebo group. Mann–Whitney U test demonstrated a statistically insignificant difference between the two groups (p = 0.278). There were 24 (58.5%) male and 17 (41.5%) females found in Group A while 23 (56.1%) male and 18 (43.9%) females in Group B. The comparison of duration of diarrhea showed significant difference between both groups p-value 0.016. Conclusion: This study demonstrates that folic acid provides no additional therapeutic advantages to babies and young children suffering from acute watery diarrhea when given with hydration and electrolyte therapy. This information should assist healthcare providers and doctors in averting the unwarranted use of folate in the management of acute watery diarrhea in children.

Effect of physical activity to reduce stress in school-going children (aged 5-12 years).

Um-E-Aiman Jafri — 2026-07-29

Objective: To determine the effect of regular, structured physical activity sessions over a 12-week period on reducing perceived stress among school-going children aged 5-12 years. Study Design: Quasi-experimental study. Setting: Private Primary and Secondary Schools in Karachi, Pakistan. Period: 1^st September 2025 to 1^st February 2026. Methods: Children aged 5 to 12 years with baseline moderate stress and medically fit for physical activity were enrolled. Participants attended supervised 30-minute structured physical activity sessions three times weekly for 12-week period. Perceived stress was assessed at week-0 and week-12 using the 10-item Perceived Stress Scale for Children (PSS-C), scored 0 to 4 per item. Data were analyzed in IBM-SPSS version 26 using appropriate tests with p<0.05 as significant. Results: Out of a total of 239 children analyzed, 129 (54.0%) were males, and 110 (46.0%) females, with median age 8.0 (6.0 to 10.0) years. Baseline median PSS-C score was 20.0 (18.5 to 23.0). Attendance at least 75% occurred in 178 (74.5%) children, while adverse events included muscle soreness 23 (9.6%), fatigue 18 (7.5%), and bruises in 4 (1.7%) children. PSS-C decreased to 14.2 (11.6 to 18.3), median reduction 6.0 (3.0 to 9.0) (p<0.001). Low stress at week-12 was found in 111 (46.4%) children, moderate in 122 (51.0%), and high in 6 (2.5%) children. Conclusion: Twelve-week structured physical activity delivered through schools was associated with a significant reduction in perceived stress among children aged 5 to 12 years with moderate baseline stress.

Frequency of hypocalcemia in children aged 6 months to 5 years presenting with febrile convulsions at a Tertiary Care Hospital.

Aleena Asghar — 2026-07-29

Objective: To determine the frequency of hypocalcemia among children presenting with febrile seizures and to identify clinical predictors associated with low serum calcium levels. Study Design: Cross-sectional Observational study. Setting: Department of Pediatric, Pakistan Air Force Hospital, Sargodha. Period: 1^st September 2024 to 31^st August 2025. Methods: A total of 147 children aged 6 months to 5 years presenting with febrile seizures were enrolled using a non-probability consecutive sampling technique. Children with known neurological disorders, metabolic diseases, renal disease, or those receiving calcium/vitamin D supplementation were excluded. The demographic and clinical data including age, gender, weight, height, body temperature, and frequency of seizure episodes were recorded using a structured proforma. Serum calcium levels were measured in laboratory using Atomic Absorption Spectrometry and hypocalcemia was defined as serum calcium <8.5 mg/dL. Data were analyzed using SPSS version 25. Descriptive statistics and binary logistic regression were used to identify predictors of hypocalcemia. Results: Among 147 children 85 (57.8%) were males and 44 (29.9%) were female. Hypocalcemia was observed in 44(29.9%). Children with hypocalcemia were younger (median 2.5 vs. 3.5 years) and had lower median weight and height compared with normocalcemic children. Multiple seizure episodes and younger age were significant predictors of hypocalcemia (p = 0.001 and 0.024, respectively). Conclusion: Hypocalcemia is relatively common among children presenting with febrile seizures particularly in young children and those with recurrent seizure episodes. Early recognition and monitoring are essential to prevent complications. The need of early recognition and correction of hypocalcemia may help reducing seizure recurrence and associated complications.

Incidental pulmonary embolism in cancer patients undergoing routine CT chest.

Namrah Khalid — 2026-07-29

Objective: To determine the frequency of incidental pulmonary embolism in cancer patients undergoing routine CT chest. Study Design: Cross-Sectional study. Setting: Department of Radiology, Shifa International Hospital, Islamabad. Period: Eleven months (January to November ‘25). Methods: Included 650 adult cancer patients aged 18–60 years who underwent contrast-enhanced CT chest for diagnostic evaluation, treatment response assessment, or routine surveillance. Patients with suspected or previously diagnosed pulmonary embolism were excluded. Incidental pulmonary embolism was defined as an intraluminal filling defect within the pulmonary arterial vasculature detected on CT performed for indications unrelated to pulmonary embolism. All scans were interpreted by an experienced consultant radiologist. Results: Incidental pulmonary embolism was detected in 20 patients, yielding a frequency of 3.1%. Although a higher proportion of pulmonary embolism was observed in patients aged 31–60 years and in males, no statistically significant association was found with age or gender. Similarly, incidental pulmonary embolism showed no significant association with cancer type, disease stage, or treatment modality. Conclusion: Incidental pulmonary embolism was identified in a small but clinically important proportion of cancer patients undergoing routine CT chest. Given its potential prognostic implications, careful radiological evaluation and appropriate clinical management of incidental pulmonary embolism are essential to reduce morbidity and mortality in oncology patients.

C-reactive protein as a predictor of acute kidney injury in ICU patients: A prospective observational cohort study.

Muhammad Ahmad Ali — 2026-07-29

Objective: To evaluate baseline C-reactive protein (CRP) as a predictor of acute kidney injury (AKI) in critically ill ICU patients. Study Design: Prospective Observational Cohort study. Setting: ICU of Shifa Hospital Islamabad. Period: 1^st November 2025 to 28^th February 2026. Methods: A total of 194 patients aged 16-92 years were enrolled using consecutive sampling. Baseline CRP was measured within 12 hours of ICU admission. Mann–Whitney U test compared CRP levels between AKI and non-AKI groups. ROC curve analysis determined predictive accuracy. Binary logistic regression identified independent predictors of AKI. A p-value ≤0.05 was considered statistically significant. Results: AKI occurred in 66 patients (34.0%). Baseline CRP was significantly higher in patients who developed AKI (mean rank 116.52 vs. 88.45, U = 3002.0, p = .020). ROC analysis demonstrated acceptable discriminatory ability (AUC = 0.645). On multivariate logistic regression, age (OR = 1.034, p = .036), male gender (OR = 4.024, p = .012), APACHE II score (OR = 1.099, p = .027), and baseline CRP (OR = 1.006, p = .031) were independent predictors of AKI. AKI was significantly associated with ICU mortality (p = .003) and mechanical ventilation (p = .030), but not with length of ICU stay (p = .069). Conclusion: Elevated baseline CRP is independently associated with development of AKI in critically ill ICU patients. However, its discriminatory ability is modest (AUC 0.645), suggesting that CRP should be interpreted in conjunction with established severity scores such as APACHE II rather than used as a standalone predictor.

Comparison of mean post-treatment HBA1C levels among patients using sitagliptin plus metformin versus empagliflozin plus metformin for treatment of Type II diabetes mellitus.

Saddam Hussain — 2026-07-29

Objective: To compare of mean post-treatment hba1c levels among patients using sitagliptin plus metformin versus empagliflozin plus metformin for treatment of type II diabetes mellitus. Study Design: Analytical Cross Sectional study. Setting: Department of Medicine, Shaikh Zayed Hospital, Rahim Yar Khan. Period: June and December 2025. Methods: Total 200 patients aged 30-70 years with T2DM with HbA1c >6.5% three months prior were included by nonprobability consecutive sampling and randomly allocated in two groups equally. Group A was taking Sitagliptin and Metformin 50/1000 mg and group B Empagliflozin and Metformin 12.5/1000 mg for 12 weeks. HbA1c levels were compared at baseline and after taking medicines for 12 weeks. Data were analyzed by using SPSS version 23.0, using an independent sample t-test with p <0.05 considered as significant. Results: Baseline HbA1c was 8.29±0.74% in Sitagliptin group and 8.00±0.82% in Empagliflozin group (p=0.098). After 12 weeks, post treatment HbA1c was significantly lower in Empagliflozin group (6.66±0.81%) compared to Sitagliptin group (7.76±1.82%) (p=0.001). Stratified analysis across gender, age, disease duration, hypertension, obesity and residence showed consistent results favoring Empagliflozin. Conclusion: Empagliflozin plus Metformin showed higher efficacy in the reduction of HbA1c levels than Sitagliptin plus Metformin in patients with type 2 diabetes mellitus.

Assessment of physicians practice regarding guidelines recommended antithrombotic therapy in patients with atrial fibrillation.

Gul Nazar — 2026-07-29

Objective: To quantify adherence to guideline-recommended antithrombotic therapy among physicians managing AF and to identify prescribing trends. Study Design: Cross-Sectional study. Setting: Department of Cardiology, Indus Hospital, Karachi. Period: Three Months (13^th November, 2025 to 13^th February, 2026). Methods: Ninety physicians were enrolled via consecutive sampling. Adherence was defined per ESC 2024: OAC indicated for CHA₂DS₂-VA ≥2, considered at 1; antiplatelet therapy not recommended as an alternative to OAC; AF temporal pattern not used to decide anticoagulation. Demographics and prescribing were abstracted from records; associations with adherence were tested using chi-square with p≤0.05. Results: Overall, 72% of physicians adhered to guidelines. Adherence did not differ by patient age or gender; hypertension and family history of AF were associated with lower adherence, with anemia showing a non-significant association. DOACs (notably apixaban and rivaroxaban) were the most prescribed agents; DOAC use did not differ between adherent and non-adherent groups, while dual antiplatelet therapy (aspirin+clopidogrel) was more frequent among non-adherent physicians. Conclusion: In this study 72% physicians showed adherence to guideline-directed antithrombotic therapy, with specific patient factors (hypertension, family history, anemia) linked to under treatment. Reducing inappropriate reliance on dual antiplatelet therapy and reinforcing risk-based anticoagulation through focused education, standardized protocols, and structured bleeding-risk assessment may close the evidence-to-practice gap.

Quantifying the systemic and oral symptoms of Long COVID: A comprehensive cross-sectional survey analysis.

Hina Shabir — 2026-07-29

Objective: To determine the frequency and pattern of systemic and oral manifestations of Long COVID. Study Design: Cross-sectional study. Setting: The study was conducted in Peshawar, Khyber Pakhtunkhwa, Pakistan. Period: January 2023 to June 2023. Methods: A total of 344 participants with a history of confirmed COVID-19 infection were included. Data were collected using a structured questionnaire modified from previously published Long COVID symptom checklists and validated through expert review. The questionnaire measured demographic characteristics, presence of persistent post-COVID systemic symptoms, and oral manifestations. Descriptive statistics were used to calculate frequencies and percentages. Results: The most commonly reported systemic symptoms were hair loss (48.3%), headache (43.6%), fatigue (38.1%), lack of concentration (34.3%), and muscle pain (33.7%). Common oral manifestations comprised loss of taste (28.8%), dry mouth (20.3%), mouth sores (19.5%), and swollen or bleeding gums (18.9%). Pattern analysis showed a predominance of neuro-systemic and general systemic manifestations, with hair loss, headache, fatigue, and lack of concentration forming the most common systemic cluster. Conclusion: Long COVID is associated with an extensive range of systemic and oral manifestations in this population, affecting individuals across different demographic groups. Identification of oral symptoms is also crucial and should be incorporated into post-COVID assessment and care.

Short-Term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with significant left main coronary artery disease.

Muhammad Zia ur Rehman — 2026-07-29

Objective: To evaluate the short-term results of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with severe left main coronary artery disease (LMCAD). Study Design: Prospective Cohort study. Setting: Department of Cardiology and in association with the Department of Cardiothoracic Surgery, Punjab Institute of Cardiology (PIC), Lahore. Period: 2^nd October, 2025 to 2^nd March, 2026. Methods: Three hundred patients having considerable LMCAD of either sex were enrolled in this study. After informed consent, patients were equally allocated into two groups: 1) PCI and 2) CABG. The short-term Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) were assessed at 3-month follow-up in both groups. Chi-square test was used to compare the outcome variables of both groups. A p-value of ≤0.05 was considered significant. Results: The mean age of the study population was 62.11 ± 12.92 years, with 81.7% being male. Both groups were comparable in terms of demographic and co-morbid conditions, with statistically insignificant differences. PCI groups experienced more MACCEs overall, but it was statistically non-significant (32% PCI vs 22% CABG; p >0.05). Mortality was also found to be lower in the CABG group (14.7% vs 10%; p-value=0.219). Conclusion: This study concluded that in patients with LMCAD, there were statistically insignificant differences in the occurrence of short-term MACCEs.

From concussion to control: Evaluating antiepileptic drug use in mild to moderate traumatic brain injury.

Muhammad Nawaz — 2026-07-29

Objective: To assess the effectiveness of prophylactic AEDs in preventing early and late post-traumatic seizures in patients with mild to moderate TBI. Study Design: Randomized Control Trial study. Setting: Department of Accident and Emergency, Farooq Hospital Islamabad. Period: March 2024 to September 2024. Methods: A total of sixty-two patients were selected from the department of Accident and Emergency with mild to moderate TBI (Glasgow Coma Scale [GCS] 9–15) admitted within 24 hours of head injury. Participants were divided into two groups: Group A (n=31) received prophylactic AEDs (levetiracetam 500 mg twice a day) for 7 days, while Group B (n=31) patients did not receive prophylaxis. Patients were followed for 7 days for early PTS and 3 months for late PTS. Data were analyzed using chi-square and independent sample t tests. Results: Post-traumatic seizure was common in both groups, affecting 3 patients (9.7%) in each. In Group A (prophylactic), all patients were improved and neurologically stable at discharge and after three months of follow-up. In group B (non-prophylactic), 28 (90.3%) patients were improved and neurologically stable at discharge and after three months of follow-up, while 3 (9.7%) patients had deteriorated and had mild neurological deficits. Conclusion: It was concluded that the overall incidence of post-traumatic seizure was low in mild to moderate traumatic brain injury. The incidence was similar for both prophylactic and non-prophylactic groups, with three patients in each group experiencing seizures.

The effectiveness of weekly use of foot selfcare checklist in preventing foot ulcers in patients with type 2 Diabetes Mellitus.

Zun Noor Ahmad — 2026-07-29

Objective: To assess the effectiveness of weekly use of a foot self-care checklist in preventing diabetic foot ulcers in patients with type 2 diabetes mellitus. Study Design: Quasi-experimental study. Setting: Khyber Teaching Hospital, Peshawar. Period: 12 April 2025 to 12 October 2025. Method: 140 patients with type 2 diabetes mellitus, divided equally into an intervention group and a control group. Both groups received standard diabetic care, while the intervention group additionally used a foot self-care checklist weekly. Patients were followed for three months. Effectiveness was defined as the absence of foot ulcer development, assessed clinically. Results: Out of 140 participants, 109 (77.9%) did not develop a diabetic foot ulcer, whereas 31 (22.1%) developed an ulcer. The incidence of ulcer formation was significantly lower in the intervention group compared with the control group (14.3% vs 30.0%, p = 0.025). No significant associations were found between ulcer development and gender, diabetes treatment modality, glycaemic control, education status, residence, prior knowledge of foot self-care, comorbidities, age, or duration of diabetes (all p > 0.05). Conclusion: Weekly use of a foot self-care checklist significantly reduces the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus and should be incorporated into routine diabetic management.

Factors associated with long length of stay in an inpatient psychiatric facility in Lahore, Pakistan.

Asma Suleman — 2026-07-29

Objective: To describe the clinical and socio-demographic characteristics of long-stay psychiatric inpatients and to identify factors associated with prolonged hospitalization within this cohort. Study Design: Hospital-based Descriptive Cross-sectional. Setting: Punjab Institute of Mental Health (PIMH), Lahore, Pakistan. Period: June to November 2025. Methods: A total of 128 consecutive long-stay inpatients (length of stay >90 days) were included using non-probability consecutive sampling. Socio-demographic variables (age, gender, marital status, education level, family support), clinical diagnoses, and documented psychiatric and behavioural symptoms were extracted from medical records. Length of stay (LOS) was highly skewed; therefore, Mann–Whitney U tests were used to compare LOS between groups for each binary variable, with significance set at p < 0.05. Analyses were done using SPSS version 25.0. Results: The median length of stay (LOS) was 1,825 days (interquartile range [IQR] 1,095–2,555 days), and the mean was 2,368 days (approximately 6.4 years), showing a highly skewed distribution with LOS ranging from 146 to 16,425 days (0.4–45 years). The median patient age was 45 years, and 94 (73%) were male. Older age (p < 0.001), low education level (p = 0.027), family refusal to take the patient home (p = 0.001), comorbid chronic medical illness (p = 0.014), and cognitive impairment (p = 0.018) were significantly associated with longer LOS. In contrast, male gender, unmarried status, schizophrenia diagnosis, intellectual disability, mandatory care, treatment resistance, medication non-compliance, substance use disorder, sleep disturbance, suicidal ideation, and violent behaviour were not statistically significantly associated with LOS (all p ≥ 0.05). Notably, the absence of statistical significance does not eliminate potential clinical relevance, particularly in subgroups with limited statistical power. Conclusion: Among long-stay psychiatric inpatients, social vulnerability (older age, low education, absent family support), medical complexity (comorbid chronic illness), and cognitive impairment were the strongest correlates of prolonged hospitalization. The exceptionally prolonged stays observed in this cohort indicate systemic deficiencies in community mental health services and persistent social barriers to discharge, rather than acute psychiatric symptoms alone. Targeted discharge planning, family engagement programs, and investment in community mental health infrastructure are essential to reduce unnecessary institutionalization.

Association between Socioeconomic status and delay in seeking care for diabetes mellitus.

Faryal Waheed — 2026-07-29

Objective: To examine associations between SES indicators and patient delay duration prior to type 2 diabetes mellitus diagnosis. Study Design: Analytical Cross Sectional study. Setting: Bahawal Victoria Hospital/Quaid-e-Azam Medical College, Bahawalpur. Period: June to December 2025. Methods: Total 274 adults with physician confirmed type 2 diabetes diagnosed within prior 6–12 months were included. Patient delay was defined as days from symptom recognition to first healthcare consultation (≥30 days=substantial delay). SES was assessed via household income (tertiles), education, occupation, and asset-based wealth index. Multivariable logistic regression adjusted for demographic, clinical and health system factors; stratified analyses explored effect modification. Results: Median patient delay was 28 days (IQR:14–52). A pronounced socioeconomic gradient existed: 64.1% of low-SES participants experienced delay ≥30 days versus 26.4% of high-SES (p<0.001). After adjustment, low income (aOR=2.84, 95% CI: 1.49–5.42) and minimal education (aOR=2.31, 95% CI: 1.22–4.38) independently predicted delay. Associations were stronger among women (aOR=4.12) than men (aOR=2.18; p=0.038) and in rural (aOR=3.67) versus urban settings (aOR=1.94; p=0.047). Financial constraints and agricultural labor demands predominated as barriers for disadvantaged groups. Conclusion: Socioeconomic disadvantage substantially prolongs patient delay in diabetes diagnosis with compounded vulnerabilities for women and rural populations. Multilevel interventions financial protection for outpatient services, gender-sensitive community outreach, transportation support and context-specific health education are urgently required to mitigate diagnostic delays and prevent complications.

Effect of biliopancreatic limb length on Glycemic control following Roux-EN-Y Gastric bypass.

Nazish Ali — 2026-07-29

Objective: To compare the effect of short versus long biliopancreatic limb length (BPL) on glycemic control following Roux-en-Y gastric bypass (RYGB) in patients with type 2 diabetes mellitus. Study Design: Quasi-Experimental Clinical Study. Setting: Department of Surgery, Shifa International Hospital, Islamabad. Period: October 2025 to January 2026. Methods: A total of 140 patients aged 30–60 years with type 2 diabetes mellitus undergoing Roux-en-Y gastric bypass were considered. Patients were non-randomly allocated into two groups based on biliopancreatic limb length: Group A underwent short biliopancreatic limb bypass, while Group B underwent long biliopancreatic limb bypass. Baseline demographic and clinical characteristics were recorded. HbA1c levels were measured preoperatively and six months postoperatively. The primary outcome was mean reduction in HbA1c at six months. A P-value of less than 0.5 was considered as significance following analysis through SPSS. Results: The two study groups didn’t differ significantly in terms of baseline clinical characters. The mean preoperative HbA1c was 8.1 ± 1.0 in the short limb group and 8.3 ± 1.4 in the long limb group (p = 0.58). At six months postoperatively, mean HbA1c decreased to 6.5 ± 0.9 in the short limb group and 6.1 ± 0.8 in the long limb group (p = 0.01). The mean HbA1c level was significantly reduced in the long biliopancreatic limb group versus the short limb group (2.2 ± 0.8% vs. 1.9 ± 0.7%; p = 0.002). Significantly high number patients of long limb control reported glycemic control (HbA1c < 6.5%) when compared with short limb group (84.2% vs 60%, p = 0.01). Conclusion: A longer BPL length in RYGP was associated with a significantly greater reduction in HbA1c and improved glycemic control at six months postoperatively compared to a shorter biliopancreatic limb.

Combined laser hemorrhoidoplasty and mucopexy for grade 4 piles: Is it the way forward?

Abdullah Bin Saeed — 2026-07-29

Objective: To evaluate the efficacy, safety, and outcomes of combined laser hemorrhoidoplasty and mucopexy in the management of grade IV hemorrhoidal disease. Study Design: Prospective Observational Cohort study. Setting: Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan. Period: January 1, 2023, to January 1, 2026. Methods: A total of 193 patients with grade IV hemorrhoids underwent combined laser hemorrhoidoplasty (LHP) using a 1470-nm diode laser system and mucopexy with absorbable 2-0 polyglactin sutures. Non-probability consecutive sampling was employed. Operative parameters, symptom resolution, complications, and patient outcomes were systematically recorded and analyzed. Follow-up assessments were conducted at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively to evaluate complete symptom resolution, partial improvement, and postoperative complications including hemorrhage, fistula formation, fecal soiling, and pain. Results: The mean operative time was 19 ± 3.8 minutes (range: 16–35 minutes). Complete resolution of symptoms was achieved in 85.5% of patients (n=165), while 14.5% (n=28) experienced partial improvement. Among patients with complete resolution, 32.1% (n=53) encountered postoperative complications: secondary hemorrhage (n=10, 5.2%), fistula-in-ano (n=3, 1.6%), transient fecal soiling (n=17, 8.8%), and pain/discomfort (n=23, 11.9%). All patients with partial resolution had residual mucosal prolapse despite alleviation of other symptoms. The mean age was 45.2 ± 8.6 years, mean BMI was 27.5 ± 3.4 kg/m², and mean symptom duration was 18.3 ± 6.7 months. Conclusion: Combined laser hemorrhoidoplasty and mucopexy demonstrates high efficacy for grade IV hemorrhoidal disease with short operative time and acceptable complication rates. However, residual mucosal prolapse in 14.5% of patients suggests that patient selection and surgical technique refinement remain critical for optimal outcomes.

Frequency of surgical site infections in prolene suture and staples in midline laparotomy wound closure.

Mateen Shanawar — 2026-07-29

Objective: To compare the frequency of surgical site infection (SSI) between Prolene sutures and skin staples for closure of midline laparotomy wounds. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied-II Hospital, Faisalabad. Period: 29-10-2025 to 29-01-2026. Methods: Ninety patients between the ages of 18 and 60 who were having emergency midline laparotomies were recruited and divided into two equal groups at random. Staples were used to close the skin in Group A, and Prolene sutures were used in Group B. Individuals with a history of laparotomy scarring, chronic steroid use, or immunocompromised status were not included. To ensure consistency, all procedures were carried out by consultant surgeons. In accordance with CDC criteria, patients were monitored for the development of SSI for fourteen days following surgery. SPSS 25 was used to analyze the data; the chi-square test was used, and p≤0.05 was deemed significant. Results: Mean age was 40.79±8.48 years with male predominance (65.6%). Baseline characteristics, including age, gender, BMI, ASA class, and indication for surgery, were comparable between groups (p>0.05). SSI occurred in 14 patients (31.1%) in the staples group compared with 25 patients (55.6%) in the Prolene group (p=0.019). Stratified analysis showed significantly higher SSI with Prolene among males (p=0.047), patients aged 46–60 years (p=0.048), overweight patients (p=0.049), and diabetics (p=0.015). Mean duration of surgery was similar in both groups (p=0.335). Conclusion: Skin closure with staples is associated with significantly lower frequency of surgical site infection compared to Prolene sutures after midline laparotomy. Staples may be considered a safer and more effective method for wound closure, particularly in high-risk patients.

Comparison of uncomplicated thyroidectomy with and without drain.

Zahid Sattar — 2026-07-29

Objective: To compare uncomplicated thyroidectomy with drain and without drain in terms of postoperative hematoma, wound infection and hospital stay. Study Design: Prospective study. Period: January 2024 to 30 June 2024. Setting: Department of Surgery, Sahiwal Teaching Hospital. Methods: A total of 72 patients with 36 patients in group (with drain) and 36 patients in group (without drain) were included in the study. Inclusion criteria were patients with diagnosed thyroid swelling, age 18-60 years, both genders. Comparison of outcome between both groups were using chi square test and independent t test. Results: The study included 72 patients, with 36 in each group undergoing uncomplicated thyroidectomy. Post-operative hospital stay was significantly longer in the drain group (2.47 ± 0.61 days) compared to the without drain group (1.62 ± 0.55 days). Hematoma incidence showed a higher percentage in the drain group (38.8%) compared to the without drain group (27.7%). On the other hand, post-operative infection was significantly higher in the drain group (42.6%). Conclusion: Our study indicates that using drains in uncomplicated thyroidectomy prolongs post-operative hospital stays and increases the risk of post-operative infection. While hematoma rates show no significant difference, these findings question the routine use of drains in such surgeries.

Suction drain has no role in decreasing postoperative wound infection and hematoma in lumbar decompression surgery.

Ammar Dogar — 2026-07-29

Objective: To determine the frequency of postoperative hematoma and wound infection in patients undergoing lumbar disc excision through fenestration without closed-suction drainage, thereby evaluating suction drains (or lack thereof) in reducing these complications. Study Design: Prospective Observational study. Setting: Orthopaedic & Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: July 2025 and December 2025. Methods: Four hundred twenty-three patients aged 15–60 years undergoing lumbar disc excision through fenestration (without inserting a closed-suction drain) were enrolled. Exclusion criteria included prior spinal surgery, canal stenosis, cauda equina syndrome, uncontrolled diabetes or hypertension, and bleeding disorders. A single experienced surgeon performed all operations. Patients were observed for seven days postoperatively for signs of hematoma (clinical new or progressive neurological deficit, or MRI evidence) and wound infection. Quantitative variables (age) were expressed as mean ± SD; categorical variables (gender, hematoma yes/no) as frequency and percentage. Stratification for age groups and gender was performed. Results: The mean age was 44.53 ± 11.42 years; 27.66% (n=117) were aged 15–30, and 72.34% (n=306) were aged 31–60. Males comprised 74.94% (n=317) and females 25.06% (n=106). Postoperative hematoma occurred in 2.13% (n=9) of patients; 97.87% (n=414) had no hematoma. Among the hematoma cases, 33.33% (n=3) were 15–30 years old and 66.67% (n=6) were 31–60. By gender, 55.56% (n=5) of hematoma cases were male, and 44.44% (n=4) were female. No wound infections requiring intervention were recorded. Conclusion: In this large series of lumbar disc excisions via fenestration without closed-suction drainage, the incidence of postoperative hematoma was very low (2.13%), and no wound infections necessitating intervention were observed. These results promote an individualized rather than routine approach to drain use, supporting the mounting evidence that routine suction drain placement in lumbar decompression surgery offers no discernible reduction in hematoma or infection rates.

Diagnostic accuracy of ultrasound in diagnosis of rotator cuff injuries keeping MRI as gold standard.

Muqaddas Fatima — 2026-07-29

Objective: To determine Diagnostic accuracy of ultrasonography in diagnosis of rotator cuff injuries keeping MRI as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, DHQ Hospital, Gujranwala. Period: September, 2025 to February, 2026. Methods: A total of 184 patients aged 18–60 years presenting with clinical suspicion of rotator cuff injury were enrolled through consecutive non-probability sampling. All patients underwent US examination using a high-frequency (7–12 MHz) linear probe followed by MRI on a 1.5 Tesla scanner. Ultrasonographic findings for full-thickness tear, partial-thickness tear, and tendinopathy were compared with MRI results considered as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: Among 184 participants, 55% were female and the mean age was 39 years (range 18–60 years). MRI detected full-thickness tear in 32.6%, partial-thickness tear in 27.2%, and tendinopathy in 21.7% of cases, while 18.5% had normal findings. Ultrasound identified full-thickness tears in 30.4%, partial-thickness tears in 25.0%, and tendinopathy in 19.6%. When compared with MRI, ultrasonography demonstrated a sensitivity of 90.2%, specificity of 89.5%, PPV of 91.1%, NPV of 88.3%, and an overall diagnostic accuracy of 90.0%. Conclusion: Ultrasonography is a highly accurate, accessible, and cost-effective imaging modality for evaluating rotator cuff pathology. Its strong concordance with MRI supports its use as a first-line diagnostic tool, particularly for full-thickness tears. MRI remains essential in equivocal cases or when detailed pre-operative assessment is required.

Outcome of incisional biopsy under local anesthesia in palpable musculoskeletal tumors in an outdoor setting in terms of conclusive evidence of pathology.

Izhar ul Haq — 2026-07-29

Objective: To determine frequency of conclusive results of OPD based incisional biopsy under local anesthesia in patients of palpable musculoskeletal tumors. Study Design: Cross-sectional Descriptive study. Setting: Department of Trauma and Orthopedic Surgery, Allied Hospital, Faisalabad. Period: Five months (September’25 to January’26). Methods: A total of 65 patients aged 18–55 years of either gender presenting with clinically and radiologically confirmed palpable musculoskeletal tumors of the upper and lower limbs were included using non-probability consecutive sampling. Patients with previously biopsied lesions, non-palpable or small lesions, pelvic or spinal tumors, infected or fungating masses, bleeding disorders, or contraindications to local anesthesia were excluded. Incisional biopsy was performed in the OPD under strict aseptic conditions using 2% lignocaine. Tissue samples were submitted for histopathological examination. A biopsy yielding a definitive benign or malignant diagnosis was considered conclusive. Data were analyzed using SPSS version 25, and results were expressed as frequencies, percentages, mean, and standard deviation. Stratification was applied to control effect modifiers. Results: Among the 65 patients, 36 (55.4%) were aged 18–40 years and 29 (44.6%) were aged 41–55 years. Males constituted 36 patients (55.4%), while females accounted for 29 patients (44.6%). Lower limb lesions were observed in 48 patients (73.8%), and upper limb lesions in 17 patients (26.2%). Conclusive biopsy results were obtained in 59 patients (90.8%), whereas 6 patients (9.2%) had inconclusive results. Of the conclusive biopsies, benign tumors were identified in 43 patients (72.9%) and malignant tumors in 16 patients (27.1%). No statistically significant association was found between biopsy outcome and age, gender, lesion site, comorbidities, or histopathological diagnosis. Conclusion: OPD-based incisional biopsy under local anesthesia provides a high rate of conclusive histopathological diagnosis in patients with palpable musculoskeletal tumors and represents a reliable and practical diagnostic approach in resource-limited settings.

Reliability and minimal detectable change of the timed up and go test and the two-minute walk test in total hip arthroplasty.

Faisal Muteeb — 2026-07-29

Objective: To find out the reliability and low detectable change (MDC) of the Timed Up and Go (TUG) test and 2-Minute Walk Test (2MWT) in study participants after total hip arthroplasty (THA). Study Design: Prospective Observational study. Setting: Indus Hospital and Health Network in Karachi. Period: From June and November 2025. Methods: The proposed pre-post intervention study took place within a sample population comprising of 37 adults (18-60 years) undergoing primary total hip arthroplasty at least 6 months prior to the study. The TUG and 2MWT reliability and minimal detectable change (MDC) were calculated and responsiveness measured using the Cohen d. SPSS vol.26 was used to analyze data <0.05 was to be significant value. Results: The study was accomplished by a total of 37 participants. The TUG test and 2MWT were found to be highly reliable tests with regard to the test-retest reliability (ICC: 0.92 and 0.94, respectively). TUG and 2MWT had minimal detectable changes (MDC95) of 2.1 s and 14.7 m respectively. Large responsiveness was suggested by the standardized effect sizes (Cohen d: 1.05 TUG, 0.98 2MWT). After rehabilitation, functional performance was significantly improved as well as pain. Conclusion: The TUG and 2MWT are valid, responsive and clinically pertinent instruments in measu0ring restoration of function following total hip arthroplasty. The MDC values developed during this research can serve as objective standards of determining real changes in mobility and endurance.

Comparison of operative versus non-operative management in Grade III acromioclavicular joint injuries.

Huzaifa Asif — 2026-07-29

Objective: To compare functional and radiological outcomes of operative versus non-operative management in Rockwood Grade III AC joint injuries. Study Design: Prospective Comparative study. Setting: Ghurki Trust & Teaching Hospital, Lahore. Period: 2^nd January 2026 to 20^th April, 2026. Methods: The number was 94 patients with 2 equal groups (n=47). Group A was treated conservatively with sling immobilization and physiotherapy, whereas Group B was treated with ORIF using a clavicular hook plate. The Constant score was used to measure functional outcome and coracoclavicular (CC) distance to evaluate radiological outcome at 3 months follow-up. SPSS version 27 was used to analyze data. Results: The mean Constant score was significantly higher in the conservative group (86.4 ± 6.8) compared to the operative group (80.9 ± 7.5) (p = 0.0003). In contrast, the operative group demonstrated significantly better radiological reduction with a lower CC distance (9.8 ± 1.9 mm) compared to the conservative group (12.1 ± 2.3 mm) (p = 0.0001). Stratified analysis showed no significant effect of age, side affected, or presence of arthritis on outcomes (p > 0.05). Conclusion: Non-operative management provides superior functional outcomes, whereas operative fixation achieves better anatomical restoration. Both approaches demonstrate acceptable outcomes, and treatment selection should be individualized based on patient-specific factors.

Evaluating radiation exposure from a C-Arm fluoroscopy device during neurosurgery procedures, an essential to balance effective imaging.

Aurangzeb Kalhoro — 2026-07-29

Objective: To evaluate the radiation exposure on surgeons during different neurosurgical procedures. Study Design: Observational Cohort study. Setting: Liaquat University of Medical and Health Science, Jamshoro. Period: October 2023 to October 2024. Methods: Three surgeons were recruited and performed different neurosurgical procedures that required usage of C-arm per-operatively. The chest and right arm was selected for dosimeter readings. The fluoroscopy time, number of films was calculated with the help of residents that were observing the case. Results: Total number of 43 procedures were performed and most of patients were male (88.4%). The pedicel Screw fixation was the most common procedure (44.2%). The surgical level was dorsolumber spine (60.5%). The C arm was used in continuous fashion (41.9%) with mean of 10.69 ± 7.6 number of films were taken out. The mean fluoroscopy time was 7.6 ± 7.47. The mean of 241 ± 123 µSv on the chest and 479 ± 298 µSv on the right hand was found on dosimeter. The radiation exposure is significantly associated with the type of surgery (p 0.02) and Surgeries that required instrumentation is positively correlated with radiation exposure, increase fluoroscopy time (p- 0.001). Conclusion: Instrumentation surgery is associated with higher radiation exposure due to its association with higher fluoroscopy time and higher number of films.

Factors related to poor visual outcomes in open globe injuries.

Abdul Hanan Zahid — 2026-07-29

Objective: To identify clinical and injury-related factors associated with poor visual outcomes in patients presenting with open globe injuries, Study Design: Analytical Cross-sectional study. Setting: Department of Ophthalmology, Nishtar Hospital, Multan. Period: February 2025 to December 2025. Methods: This analytical cross-sectional study was conducted in the Department of Ophthalmology at Nishtar Hospital, Multan. Patients with clinically diagnosed open globe injuries who underwent primary surgical repair and completed a minimum follow-up of six months were included. Demographic data, mechanism and zone of injury, presenting visual acuity, associated ocular findings and management details were recorded. Visual acuity was assessed at presentation and at final follow-up. Factors associated with poor visual outcomes were analyzed using appropriate statistical methods. P value of <0.05 was considered statistically significant. Results: A total of 120 patients with open globe injuries were analyzed, with a mean age of 32.6 ± 14.8 years and a male population (76.7%). Laceration injuries were slightly more common than rupture injuries (54.2% vs. 45.8%). More than half of the patients (56.7%) presented with visual acuity worse than 6/60. Zone III injuries were observed in 30.0% of cases. Common associated ocular findings included lens injury (48.3%), vitreous hemorrhage (43.3%), retinal detachment (28.3%), intraocular foreign body (18.3%) and endophthalmitis (11.7%). At final follow-up, poor visual outcomes were significantly associated with rupture-type injuries, Zone III involvement, poor presenting visual acuity, retinal detachment and endophthalmitis (p < 0.05). Conclusion: Poor visual outcomes following open globe injuries are primarily determined by the severity and anatomical extent of the injury at presentation. Poor presenting visual acuity, rupture mechanism, posterior segment involvement, retinal detachment and post-traumatic endophthalmitis are the most important predictors of unfavorable visual prognosis. Early surgical intervention and preventive strategies remain essential to reduce visual morbidity associated with open globe injuries.

Comparison between soft tissue profile in patient with Class II division I and Class II Division II malocclusion.

Nisha Azhar — 2026-07-29

Objective: To assess effect of class II division I and class II division II malocclusion on facial profile by utilizing soft tissue paradigm of modern orthodontics for efficient clinical diagnosis and treatment planning. Study Design: Analytical Cross-sectional study. Setting: Ibn-e-Siena Hospital, Multan. Period: July-December 2025. Methods: A total of 114 orthodontics patient between 16-40 years were enrolled. Patients with complete maxillary anterior teeth, non restored maxillary anterior teeth, presenting with class II division I and class II division II malocclusion for orthodontic treatment were included. Patient’s profile, nasolabial angle, facial angle, type of nose, chin prominence and lip position was compared between class II division I and class II division II using chi-square test p-value <0.05 was considered significant. Results: The study revealed statistically significant differences (p < 0.05) in soft tissue profile characteristics between Class II Division I and Class II Division II malocclusion. Class II Division I patients predominantly exhibited convex facial profile, acute nasolabial angles, upward-sloping nose form, retrusive chin and higher frequency of protrusive or retrusive lip positions. In contrast, Class II Division II patients more commonly displayed straight profile, normal nasolabial angles, straight nose form, prominent or normal chin and normal lip position relative to Steiner’s S-line. Conclusion: This study confirms distinct soft tissue phenotypes between Class II divisions, with Division I exhibiting convexity and retrusion versus Division II's straighter, balanced profiles. Consequently, orthodontic management requires tailored treatment planning based on specific soft tissue analyses to ensure optimal aesthetic and functional outcomes.