The Professional Medical Journal

Evolving trends in the antibiotic susceptibility and resistance pattern of Salmonella species isolated from patients with suspected bloodstream infections in a clinical setting.

Amina Gul — 2026-04-07

Objective: To assess the evolving trends in Salmonella Typhi antibiotic susceptibility and resistance patterns from patients with suspected bloodstream infections in clinical settings. Study Design: Cross-sectional study. Setting: Department of Pathology, Khyber Teaching Hospital, Peshawar. Period: Over 6 months (January 2023 to June 2023). Methods: The study was conducted on blood culture and susceptibility samples received in the Department of Pathology, Khyber Teaching Hospital, Peshawar. The automated blood culture system VERSATREK was utilized for initial processing of the blood sample. Pathogens were labeled as Salmonella based on colony characteristics on Blood agar, McConkey agar, Salmonella Shigella agar, biochemical tests, and the API 20E kit. The antimicrobial resistance pattern was mapped out using the Disk Diffusion method as per CLSI M100-Ed33 guidelines version 23. In total, 1170 blood culture samples were analyzed. Results: The study revealed that Salmonella Typhi (96%) was the major pathogen, followed by Escherichia coli (2%), Citrobacter spps (1%), and Staphylococcus aureus (1%). Salmonella Typhi demonstrated resistance to Ampicillin (98%), Ciprofloxacin (94%), Chloramphenicol (95%), Ceftriaxone (92%), and Cotrimoxazole (62%). All Salmonella isolates were found sensitive to Meropenem (100%) and Azithromycin (100%). About 56% of the isolates were Extensively Drug-Resistant (XDR). Gender-wise distribution revealed an infection rate of 62% in male patients and 38% in female patients. Patients <20 years (82%) accounted for the majority as compared to those over 20 years (18%) of age. Conclusion: Future outbreaks of XDR typhoid are most likely to occur in Pakistan, and it continues to be the dominant circulating strain. While Cotrimoxazole is reemerging with comparatively improved sensitivity, azithromycin and meropenem continue to be available treatment options. The evolving susceptibility pattern of Salmonella isolates demands ongoing surveillance of antibiograms to optimize therapeutic protocols and control the emergence of resistant strains. Public health activities to track and mitigate the spread of XDR S. Typhi should be prioritized in this country.

To determine the factors associated with outcomes in organophosphate and carbamate poisoning.

Rabail Altaf — 2026-03-10

Objective: To determine factors associated with outcomes in organophosphate and carbamate poisoning remain crucial in understanding the clinical management and prevention strategies for these toxic exposures. Study Design: Prospective Observational study. Setting: Gambat Medical College. Period: January to July 2023. Methods: Involved 226 participants with organophosphate and carbamate poisoning. Sample size was calculated based on pre-hospitalization mortality rates. Data collection encompassed demographics, clinical presentation, and pre-hospitalization factors. Results: The majority of participants intended poisoning for suicide (91.0%), with no significant survival difference based on intention or previous suicide history. Age, educational status, and pre-hospital care significantly influenced survival chances. Clinical presentations varied, including vomiting, respiratory issues, and central nervous system toxicity. Conclusion: Factors such as age, educational status, and pre-hospital care significantly influence outcomes in organophosphate and carbamate poisoning. Clinical presentations vary widely, emphasizing the need for individualized management approaches. Understanding these factors is crucial for effective clinical management and preventive measures.

Transpupillary thermotherapy for choroidal melanomas: A systematic review and meta-analysis.

Anahita Jamil — 2026-04-07

Objective: This systematic review meta-analysis evaluates the efficacy and safety of transpupillary thermotherapy (TTT) for the management of choroidal melanaomas. Study Design: Systematic review and meta-analysis. Setting: Review of published international literature on transpupillary thermotherapy (TTT) for choroidal melanomas. Period: All available studies from database inception to January 2025. Methods: This study was registered in PROSPERO (ID: CRD420251141671). A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. Inclusion criteria were treatment-naïve small choroidal melanomas (<4.5 mm thickness, <12 mm basal diameter) treated with TTT and reporting at least one of the outcomes: tumor control, globe salvage, adverse effects, or metastasis. Studies with >12 patients and ≥12 months follow-up were included. Data were extracted independently by two reviewers, and risk of bias was assessed using RoB 2 and JBI tools. Pooled estimates were calculated using a random-effects model. Results: Eighteen studies comprising 1,296 eyes were included. Tumor thickness ranged from 0.78 mm to 4.5 mm, with a base diameter <12 mm, representing data on small-sized choroidal melanomas. Meta-analysis demonstrated a pooled tumor control rate of 0.81 (95% CI: 0.73-0.88). Globe salvage rate was 0.94 (95% CI: 0.91-0.96). The pooled adverse effects rate was 0.37 (95% CI: 0.22-0.54), while metastasis rate was 0.04 (95% CI: 0.02–0.06). Notable adverse effects included macular edema, epiretinal membrane, optic disc atrophy, retinal vein occlusion, vitreous hemorrhage, and serous retinal detachment. Conclusion: Transpupillary thermotherapy appears to be an effective treatment option for small-sized choroidal melanomas, with generally favorable tumor control and globe salvage outcomes. Adverse effects are more frequently reported in tumors involving the macula or peripapillary region. Overall, TTT provides outcomes comparable, to other treatment modalities.

Comparison between treatments of osteoarthritic knee pain with intra-articular injection of platelet-rich plasma versus hyaluronic acid.

Mubashar Ahmed Bajwa — 2026-04-07

Objective: To compare the mean pain alleviation and mean improvement in physical function of intra-articular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for osteoarthritic knee pain. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedics & Spine Surgery, Rai Medical College & Teaching Hospital and Bajwa Trauma Centre & Teaching Hospital, Sargodha. Period: 1^st May 2024 to 30th November 2024 (6 Months). Methods: Following informed permission and institutional ethical committee approval, 314 patients between the ages of 40 and 80 who met the inclusion criteria and presented with osteoarthritic knee pain were enrolled. At baseline, treatment weeks two and three, and post-treatment weeks six, twelve, and twenty-four, patients were clinically assessed using both subjective and objective evaluations using VAS and WOMAC. SPSS version 23 was used to analyze the data. Results: Group 1 (PRP) patients had a mean age of 61.72 ± 9.14 years, as compared to group 2 (HA), 62.87 ± 8.47 years. Of 314 patients, 187 (59.55%) were female and 127 (40.45%) were male. Mean pain reduction (VAS score) in the PRP group was 4.84 ± 1.23, while in the HA group it was 2.76 ± 1.17 (p = 0.0001). The mean decrease in WOMAC score in the PRP group was 50.57 ± 11.22, whereas in the HA group it was 27.80 ± 7.93 (p = 0.0001). Conclusion: When treating osteoarthritic knee pain, intra-articular injections of platelet-rich plasma offer better pain relief and functional improvement than hyaluronic acid.

Outcome of Varus De-rotational osteotomy in patients of perthes disease.

Mehtab Ahmed — 2026-04-07

Objective: To evaluate the clinical and radiological outcomes of Varus De-rotational Osteotomy (VDRO) in children with unilateral Perthes disease using the Harris Hip Score (HHS), Mose's Index, and Stulberg Classification. Study Design: A prospective, observational, cohort study. Setting: The Orthopaedics Department of Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: October 2024 and August 2025. Methods: A total of 21 children of either gender, aged 5–12 years, having unilateral Perthes disease and planned to undergoing VDRO were analyzed. Clinical and radiological evlauations were performed. VDRO was performed adopting standard lateral approach with varus and derotation correction under fluoroscopy. Postoperative care involved immobilization, physiotherapy, and follow-up evaluations were made after 6 months. Data were analyzed using SPSS 26.0 with p<0.05 set as significance level. Results: In a total of 21 children, 12 (57.l%) were male, and the overall mean age was 8.24±2.23 years. The right hip was involved in 12 (57.1%) children. At presentation, hip pain was noted in 9 (42.9%), and limp in 5 (23.8%) patients. HHS improved across all stages, highest in Stage III (61.25→88.75). Outcome distribution included 28.6% excellent, 23.8% good, 33.3% fair, and 14.3% poor, with no significant association with stage (p=0.285). Pain improved in 17 (81.0%), limp resolved in 13 (61.9%), and abduction improved in 11 (52.4%) patients. Postoperative complications included infection in 9 (42.9%), non-union in 6 (28.6%), and limb length discrepancy in 5 (23.8%) patients. Conclusion: VDRO is an effective surgical option for improving clinical and radiological outcomes in Perthes disease, though postoperative complications remain a concern.

Frequency of temporomandibular joint ankylosis secondary to condylar fractures among patients presenting to Oral and Maxillofacial Department Ayub Teaching Hospital Abbottabad.

Jannat ul Mawa — 2026-04-07

Objective: Trauma, particularly condylar fractures, continues to be one of the most common etiological causes for TMJA. Condylar fractures if not treated well, they make patients prone to ankylosis by fibrosis followed by bony fusion. Early detection and proper management are, thus, essential for preventing ankylosis. Study Design: Prospective Observational study. Setting: Ayub Teaching Hospital, Abbottabad. Period: December 2024 to May 2025. Methods: We included 127 patients with clinically diagnosed condylar fractures by non-probability consecutive sampling. TMJ ankylosis was examined clinically with restricted or non-existent mandibular movements and firm end feel. Ankylosis and variables associated with the fracture were correlated with Fisher's exact test, with p < 0.05 regarded as statistically significant. Results: Traffic road accidents were the most common cause (59.1%). Intracapsular fractures were the most common (72.4%), and unilateral presentation was more common (56.7%). Limited mouth opening was the most common presenting feature (67.7%). TMJ ankylosis was present in 7.1% of the patients, which was more common in intracapsular fractures, bilateral presentations, and after traffic road accidents, although these trends were not statistically significant. There was a high correlation with duration of fracture (p < 0.001), as no ankylosis was seen in cases with presentation within ≤6 weeks, but the prevalence was 13.8% with presentation in 3–6 months and 38.5% after 6 months. Conclusion: Ankylosis of TMJ is a serious complication of delayed treatment of condylar fractures, the strongest predictor of which is the duration of fracture. Early treatment should be done to avoid ankylosis.

Prevalence of peripheral neuropathy in pre diabetic patients presenting to endocrinology department of DHQ Hospital Bannu.

Wajid Ullah Khan — 2026-04-07

Objective: To determine the prevalence of peripheral neuropathy in pre-diabetic patients. Study Design: Cross-sectional, Observational. Setting: Endocrinology Department DHQ Hospital Bannu. Period: 11^th April 2025 to 11^th July 2025. Methods: A total of 132 pre-diabetic patients (HbA1c 5.7-6.4%) were studied using a non-probability consecutive sampling method. Peripheral neuropathy was diagnosed in these patients by endocrinologist through standard clinical neurological examination using 128Hz tuning fork (vibration, proprioception), tendon reflux testing and 10gm monofilament (touch sensation). Results: Out of 132 prediabetic patients, 48 (36.4%) reported neuropathic symptoms only (mostly burning sensations), while 69 (52.3%) were asymptomatic. Symptoms duration mostly ranged from 1 to 6 months. However, only 15 patients (11.4%) had both positive symptoms and positive signs of Peripheral neuropathy. Conclusion: Prediabetic patients frequently report neuropathic symptoms especially burning sensations, but clinical signs of peripheral neuropathy are less common. Early detection of neuropathy in prediabetic patients may prevent irreversible nerve damage in future.

Correlation of thrombocytosis with markers of iron profile among patients diagnosed with iron deficiency anemia.

Saima — 2026-04-07

Objective: To correlate thrombocytosis with markers of iron profile (serum iron, total iron binding capacity, serum ferritin and transferrin saturation). Study Design: Cross-sectional Prospective study. Setting: The Hematology Out-patient Department, Noor Thalassemia Foundation. Period: August 10, 2024 to August 10, 2025. Methods: A total of 142 patients having iron deficiency anemia were enrolled in the study by consecutive sample technique. Blood samples were drawn and tested for complete blood count and markers of iron profile (serum iron, total iron binding capacity, serum ferritin and transferrin saturation). The correlation between marker of iron profile and platelet count was observed using Pearson correlation. Our study cohort was divided in two groups: group A (platelet count >450x10⁹/L) and group B (platelet count <450x10⁹/L). Independent T test was applied to find the hematological and chemical findings of patients of both groups. Results: Platelet count showed significantly inverse relationship with serum iron (r = -0.192, p = 0.022), transferrin saturation (r = -0.213, p = 0.011) and serum ferritin (r = -0.178, p = 0.049) while a significantly positive correlation with TIBC (r = +0.165, p = 0.034). Transferrin saturation differs significantly in both groups, group A (4.67%) vs. group B (6.63%) (p=0.014). Conclusion: The inverse association between platelet count and markers of iron status confirms that thrombocytosis in IDA is a reactive process secondary to iron deficiency. Thrombocytosis in iron deficiency anemia reflects the severity of underlying iron deficiency.

Clinical trends in maxillofacial trauma: A retrospective hospital-based study.

Jazib Pervez — 2026-04-07

Objective: To analyze trends in the management of maxillofacial fractures at a tertiary care hospital and identify demographic patterns to guide preventive strategies. Study Design: Retrospective observational study. Setting: Department of Oral and Maxillofacial Surgery, BAMDC. Period: March to December 2023. Methods: Data from 142 patients who underwent surgical management for maxillofacial fractures were analyzed. Information on demographics, etiology, fracture location, and treatment modality was recorded using a standardized form. Statistical analysis was conducted using SPSS v22.0, with p ≤ 0.05 considered significant. Results: The majority of patients were male (83.8%) with a mean age of 26.3 years. Road traffic accidents were the most common cause (51.5%), followed by sports injuries (21.1%), falls (19%), and interpersonal violence (8.4%). Mandibular fractures were most frequent (57.7%), followed by zygomatic complex (50.7%) and maxillary fractures (21.8%). Open reduction and internal fixation with intermaxillary fixation was the most used treatment (58.5%). A significant association was found between age groups and the incidence of mandibular versus mid-facial fractures (p = 0.0006). Conclusion: Young males are most affected by maxillofacial fractures, primarily due to road traffic accidents. Targeted preventive measures for high-risk groups are crucial for reducing incidence and improving outcomes.

Medication adherence in hypertensive patients - a cross-sectional study in a tertiary care hospital of Karachi.

Unaiza Khalid — 2026-04-07

Objective: To assess medication adherence among hypertensive patients visiting Indus Hospital, Karachi. Study Design: Cross-Sectional Study. Setting: Outpatient Clinics of the Department of Family Medicine at Indus Hospital, Karachi. Period: May to October, 2023. Methods: A total of 383 hypertensive patients were enrolled via non-probability consecutive sampling. Data were collected through face-to-face interviews using a structured questionnaire, which included sociodemographic details and the validated 8-item Morisky Medication Adherence Scale (MMAS-8). Adherence was categorized as high (score=8), medium (score 6-7), or low (score ≤6). Statistical analysis was performed using SPSS version 25. Results: Among the 383 participants, 79.6% (n=305) were female, with a mean age of 53.1 ± 10.86 years. Most were Urdu-speaking (64%) and had a lower socioeconomic background (97.4%), with a mean monthly household income of 35,000 PKRs. Educational levels varied, with 60% having primary or secondary education and 27.7% having no education. Medication adherence was low in 44% (n=170) of the participants, whereas 27% (n=110) showed high adherence, and 29% (n=103) had medium adherence. Significant associations were found between adherence and education level (p = 0.000), monthly income (p = 0.000), and socioeconomic status (p = 0.010). Conclusion: This study emphasizes the need for health education and awareness programs to improve adherence to antihypertensive medications.

The association between iron deficiency anemia and restless leg syndrome in dialysis-dependent patients.

Mehak Zaidi — 2026-04-07

Objective: To evaluate the association between iron deficiency anemia (IDA) and restless leg syndrome (RLS) in dialysis-dependent patients. Study Design: Descriptive Cross-sectional study. Setting: Department of Nephrology, Khyber Teaching Hospital, Peshawar. Period: 16th July to 30^thOctober 2025. Methods: A total of 108 patients undergoing maintenance hemodialysis for at least three months were included. Demographic, clinical, and laboratory parameters were recorded. IDA was defined as serum ferritin <100 ng/mL with transferrin saturation <20%. RLS was diagnosed using the International Restless Legs Syndrome Study Group (IRLSSG) criteria. Statistical analysis was performed using SPSS version 26. Chi-square and independent t-tests were applied, with p ≤ 0.05 considered significant. Results: The mean age was 49.8 ± 13.2 years, with a male predominance (58.3%). IDA was present in 59.3% of patients, and overall RLS prevalence was 41.7%. Patients with IDA had a significantly higher occurrence of RLS compared to those without IDA (62.5% vs. 13.6%, p < 0.001). Mean hemoglobin and ferritin levels were lower in the RLS group (p < 0.01). Additionally, lower serum albumin and longer dialysis duration were independently associated with increased RLS prevalence. Conclusion: IDA is strongly associated with RLS in dialysis-dependent patients, and hypoalbuminemia may further increase risk. Early identification and management of IDA and nutritional deficits may improve patient outcomes.

Safety and success of Vaginal Birth after Cesarean Section (VBAC) in low socio-economic countries.

Sumayya Asif — 2026-04-07

Objective: To assess the safety and success rate of VBAC in women from low socio-economic backgrounds. Study Design: Prospective Observational Design. Setting: Gynecology and Obstetrics Unit of Hayatabad Medical, Complex. Period: October 2024 to March 2025. Methods: A total of 149 women with a history of one previous cesarean section were observed. A non-probability purposive sampling technique was used to recruit participants for this study. Demographic data, gestational age, and delivery outcomes were analyzed. The primary outcome was the success rate of VBAC, while secondary outcomes included fetal health indicators and complications. Results: The majority of participants were aged between 20–30 years (n=109, 73.2%), with most at a gestational age of 37–39 weeks (n=107, 71.8%). Out of 149 women, 93 (62.4%) achieved a successful VBAC. Fetal outcomes were generally favorable: 82 newborns (88%) had uneventful postnatal periods. Adverse outcomes included 2 cases of low birth weight, 3 cases each of APGAR scores <7 at 1 and 5 minutes, and 3 intrauterine deaths. Conclusion: VBAC can be a safe and effective option in low socio-economic settings, particularly among well-selected candidates. Despite some adverse fetal outcomes, the majority of births were successful and uneventful, suggesting the feasibility of promoting VBAC to reduce surgical burden in resource-limited healthcare systems.

Prevalence of Iron Deficiency Anemia and its causes in pregnant women visiting OPD of CHK.

Dur-e-shahwar — 2026-04-07

Objective: To determine the frequency and causes of iron deficiency anemia in pregnant women, visiting OPD of CHK. Study Design: Descriptive, Cross-sectional study. Setting: OPD, Department of Obstetrics & Gynecology, Civil Hospital, Karachi. Period: 6 months from October 2020 to April 2021. Methods: A total of 169 women who visited antenatal clinic in 1st, 2nd and 3rd trimesters were included in this study. Then 5ml blood sample was taken by the researcher herself and sent to pathology laboratory for presence or absence of iron deficiency anemia. All the data was recorded on the pre-designed proforma. Results: The average age of the women was 30.01±4.62 years. The frequency of iron deficiency anemia in women was 65.09%. Rate of IDF was significantly high in pregnant women who had age >30 years (78.8%; p=0.0005), uneducated (84.6%; p=0.0005), lower socio-economic class (78.9%; p=0.0005), rural area (73.1%; p=0.006) and multigravida (82.7%; p=0.0005) and tea/coffee consumption (75.9%; p=0.0034) while red meat consumption was not statistically significant. Conclusion: It can be concluded from this study that anemia due to iron deficiency is highly prevalent in our study population. It was observed that the etiology of iron deficiency remains the same over the decades. Multiparty, poor socio-economic status, lack of education and poor dietary habits were responsible for high prevalence of IDA. Providing long term iron supplementation and dietary modification starting from adolescence may improve the hemoglobin levels and later on prevent anemia in pregnancy.

Comparison of efficacy of metformin in obese versus non-obese women of PCOS presenting with menstrual irregularities.

Ammara Sanam — 2026-04-07

Objective: To compare the efficacy of metformin in obese and non-obese women with polycystic ovarian disease presenting with menstrual irregularities. Study Design: Quasi Experimental study. Setting: Department of Gynecology and Obstetrics, Sargodha Medical College at Maula Bukhsh Teaching Hospital under Dr Fasal Masood Teaching Hospital Sargodha. Period: July 2022 to August 2023. Methods: Total 156 patients (78 in each group) were selected based on predefined inclusion and exclusion criteria. Patients were randomized in 2 groups according to their BMI. Group A consists of obese women while Group B had non obese women according to predefined operational definition. All patients were given tablet metformin 500mg twice a day and followed up for total of 06 months at every 03 month interval consecutively. On each visit patients were asked about their menstrual cycle regarding duration of bleeding days and length of menstrual cycle. Data entry was done by SPSS version 26. Independent sample t-test was applied to compare mean of numeric data between both groups. A p< 0.05 was considered statistically significant. Results: Result showed that metformin was significantly more effective in non-obese women as compared to obese women i-e obese 34.62% vs non obese 50% p value 0.051. Conclusion: Results of this study showed that metformin is more effective in treating non obese patients as compared to obese patients in terms of menstrual irregularities.

Outcome of tract dilation techniques in mini PCNL: Saldinger Technique vs. Single-Step Dilator 18 Fr.

Imran Qadir — 2026-04-07

Objective: To compare the outcomes of Mini PCNL performed using Saldinger technique versus single-step dilator 18 Fr in terms of procedure time, per-operative blood loss, hospital stay, postoperative pain, and postoperative hematuria. Study Design: Prospective Analytic Research. Setting: Children Hospital, Faisalabad. Period: January 2023 to the December 2024. Methods: Total of 80 patients were randomly assigned to two groups: The Group A (Saldinger technique) and The Group B (single-step dilator 18 Fr). Outcomes were assessed and analyzed. Results: Total of 80 patients were equally divided into the “Saldinger” and “Single-Step dilation” groups. Mean age was similar between groups (Saldinger: 9.24 ± 2.09 years; Single-step: 9.27 ± 1.73 years). Gender distribution showed no significant difference (p = 0.361). The mean operative time was noted significantly longer in the Saldinger group (67.89 ± 9.82 min) compared to the Single-Step group (44.65 ± 4.75 min, p < 0.001). Conversely, mean preoperative blood loss was significantly lower in the Saldinger group (101.44 ± 14.90 ml) versus Single-Step (155.76 ± 9.63 ml, p < 0.001). Hospital stay was slightly longer in the Saldinger group (3.05 ± 0.43 days) than in Single-Step (2.79 ± 0.43 days, p = 0.009). Postoperative pain scores (VAS) and analgesia requirement were comparable between groups (p = 0.225 and p = 0.251, respectively). Hematuria grading showed no significant difference (p = 0.385). Conclusion: The Single-Step dilation technique significantly reduces procedure time and the hospital stay compared to the Saldinger technique, although which is associated with higher intraoperative blood loss. We did not find significant differences in post-operative pain, analgesia requirements, or hematuria severity between the two groups. These findings suggest that the Single-Step technique may be preferred for its efficiency, while the Saldinger technique offers advantages in reducing blood loss.

Comparison of the results of monopolar and bipolar transurethral resection of prostate.

Mudassar Saeed Pansota — 2026-04-07

Objective: To compare the results of using bipolar versus monopolar diathermy during TURP. Study Design: Comparative, Cross-sectional study. Setting: Department of Urology, Shahida Islam Teaching Hospital, Lodhran. Period: January 2025 to June 2025. Methods: Total 98 male patients weighing 40 to 80 grams who have an enlarged prostate and mild to severe LUTS were all included. Exclusion criteria were uremia, bleeding disorders, untreated urinary tract infections, prostate cancer (Abnormal DRE), and prior prostate surgery. Forty-nine patients had monopolar TURP treatment using 1.5% glycine as an irrigating solution in group A, and forty-nine patients received bipolar TURP treatment using normal saline as an irrigating solution in group B. Hemoglobin levels from blood samples obtained before to spinal anesthesia and six hours after surgery were subtracted to determine the drop in hemoglobin levels. By deducting the sodium level from blood samples obtained prior to spinal anesthesia and six hours after surgery, the difference in serum sodium levels was evaluated. If the postoperative serum sodium content was less than 125 mmol/l, or if the clinical symptoms were evaluated, TURP syndrome was diagnosed. Results: In our investigation, the bipolar group experienced a drop in hemoglobin (g/dl) of 0.73 ± 0.19 and a mean operative time of 32.49 ± 7.05 minutes and 1.69 ± 0.35 (g/dl) compared to 25.63 ± 5.38 minutes and 0.73 ± 0.19 (g/dl) for the monopolar group. The mean decrease in serum sodium levels (mEq/L) for the bipolar group was significantly less than that of the monopolar group (3.46 ± 0.74 vs. 1.06 ± 0.22 mEq/L). The B-TURP group did not exhibit TUR syndrome (p = 0.153), but 02 (4.08%) individuals in the M-TURP group exhibited TUR syndrome in our study. Conclusion: According to this study, TUR-P syndrome, a decline in serum sodium levels, and hemoglobin levels are less common after bipolar TURP than after monopolar TURP.

Comparison of ureteral stent related symptoms among patients with ureteral stents of 4.7Fr and 6Fr diameter.

Muhammad Mosa Ayub — 2026-04-07

Objective: To compare the severity of stent-related LUTS between 4.7 Fr and 6 Fr DJ ureteral stents using the validated International Prostate Symptom Score (IPSS). Study Design: Randomized Controlled Trial. Setting: Department of Urology, National Hospital & Medical Centre, Lahore. Period: 23rd July 2025 to 23^rd Oct 2025. Methods: A total of 124 patients (aged 16–60 years) requiring unilateral DJ stent placement were randomized into two groups: Group A (4.7 Fr, n = 62) and Group B (6 Fr, n = 62). On postoperative day 7, participants completed the IPSS questionnaire. Data were analyzed using SPSS v22.0, with p < 0.05 considered significant. Results: Baseline demographics were comparable between groups. Patients with 6 Fr stents reported significantly higher total IPSS scores (22.4 ± 5.2) compared to those with 4.7 Fr stents (13.5 ± 4.0; p < 0.001). All symptom domains—including frequency, urgency, nocturia, and incomplete emptying—were worse in the 6 Fr group. Age, gender, and comorbidities were not significantly associated with mean IPSS scores. Conclusion: Larger diameter DJ stents (6 Fr) are associated with significantly greater LUTS compared to smaller 4.7 Fr stents. Use of smaller stents should be preferred where clinically feasible to minimize morbidity.

BISAP Versus Ranson's scores in predicting the severity of acute pancreatitis.

Eesha Sattar — 2026-04-07

Objective: To determine the diagnostic accuracies of BISAP and RANSON’s scores in predicting the severity of acute pancreatitis, taking the Revised Atlanta classification as a gold standard. Study Design: Cross-sectional Study Validation study. Setting: Department of Emergency and ICU, Mayo Hospital, Multan. Period: May 20^th, 2025, to November 19^th, 2025. Methods: This research included 200 acute pancreatitis (AP) patients of either gender. After informed consent and patient characteristics, all patients received laboratory tests, chest X-ray, USG abdomen, and CT scan to diagnose acute pancreatitis and compute BISAP and RANSON scores. The Revised Atlanta Classification (RAC) determined the AP severity. Severe AP patients with Atlanta, BISAP, and RANSON scores >3 were labeled as True Positive. The diagnostic accuracy of both criteria was determined using a 2x2 table. Results: The mean age of the study population was 44.3±15.9 years, comprising 60% females. Biliary etiology was the cause of AP in 72.5% of patients. According to the RAC, 64 patients (32%) had severe AP. Compared to the BISAP criteria, RANSON correctly identified actual positive cases (96.9% vs 68.8%). The overall diagnostic accuracy of the RANSON criteria was better than the BISAP criteria (95% vs 85%). Conclusion: The diagnostic accuracy of the RANSON criteria surpassed that of the BISAP score in forecasting the severity of acute pancreatitis, using the Revised Atlanta classification as the gold standard.

Effectiveness of systemic voriconazole in reducing post-surgical recurrence of aspergillus mycotic rhinosinusitis.

Zahra Sarwar — 2026-04-07

Objective: To determine voriconazole efficacy in postoperative FESS patients to prevent or minimize recurrence of Aspergillus associated rhinosinusitis. Study Design: Observational Prospective Analytical. Setting: Department of ENT and Head & Neck Surgery, KRL Hospital Islamabad. Period: 01.07.2021 to 30.06.2022. Methods: 57 patients (selected by simple random sampling technique) who underwent FESS for mycotic disease caused by Aspergillus species were followed prospectively as per the department’s follow up protocols while receiving post-operative voriconazole. The initial dose and duration of oral drug advised depended on the severity and extent of disease at the time of surgery and the dose was adjusted on subsequent OPD reviews based on endoscopic nasal examination findings, visual analogue score for total nasal sinus symptoms as well as radiological findings where necessary. The success of treatment was monitored to check the efficacy of voriconazole in preventing post-surgical recurrence and the importance of response-based dose adjustments in patients suffering from mycotic rhinosinusitis. Data analysis was done using SPSS version 20. Results: Among 57 patients (mean age 32 years), systemic voriconazole after FESS showed high efficacy, with 89.5% remaining relapse-free at one year. Only six patients (10.5%) developed recurrence, mostly after tapering therapy, and three (5.3%) discontinued treatment due to adverse effects or noncompliance. Serial VAS, CT, and endoscopy scores demonstrated progressive improvement, with 35.1% achieving complete recovery by 12 weeks. Conclusion: We would like to conclude that voriconazole has proven highly effective in the treatment of sinonasal aspergillosis and has been proven to be the drug of choice to compliment thorough surgical clearance. Re-administration of voriconazole may be warranted at the slightest hint of recurrence noted on nasal endoscopic or radiological examination which may need to be biopsy proven.

Comparative study between “Desarda and Lichtenstein repair of inguinal hernia”.

Aminah Manahil — 2026-04-07

Objective: To compare Desarda and Lichtenstein’ s technique of inguinal hernia repair in terms of early post-operative complications like pain, bleeding, infection and hospital stay. Study Design: Randomized Comparative Study. Setting: Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan. Period: January 2025 to June 2025. Methods: This including 164 patients with uncomplicated inguinal hernia. Patients were randomly assigned to Group A (Desarda repair) and Group B (Lichtenstein repair). Baseline demographics were recorded. Outcomes measured included operative duration, postoperative pain (VAS), hospital stay, complications (bleeding, infection, hematoma), recurrence at follow-up, and treatment cost. Results: The mean operative time was significantly shorter in the Desarda group compared to the Lichtenstein group (p<0.05). Postoperative pain scores were lower in Desarda patients at 72 hours (p<0.05). Hospital stay was shorter in Desarda patients (mean 2.1 vs. 3.0 days, p<0.001). Complication rates were comparable between groups, though seroma and wound infection were slightly higher in the Lichtenstein group. No significant difference in recurrence was observed during the follow-up period. Treatment costs were substantially lower in the Desarda group. Conclusion: Desarda repair found to be effective, safe and economical alternative to Lichtenstein mesh hernioplasty for primary uncomplicated inguinal hernia. It offers shorter operative time, less postoperative pain, shorter hospital stay, faster recovery, and lower cost, without increasing the risk of recurrence or complications.

Pattern of gall stone size in patients presenting with acute biliary pancreatitis.

Muhammad Hassan Saeed — 2026-04-07

Objective: To forecast the likelihood of severe pancreatitis and make more informed treatment decisions if they comprehend the pattern of gallstone size in ABP. Study Design: Descriptive, Cross Sectional study. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: April 2025 to September 2025. Methods: Total 200 patients between the ages of 20 and 85 years who had acute biliary pancreatitis were included, regardless of gender. Patients with a history of trauma, pregnancy-related gallstone-induced pancreatitis, acute pancreatitis from reasons other than gallstones, concomitant conditions such diabetes, hypertension, or heart disease, or those with features of chronic pancreatitis or cancer were excluded. Common bile duct (CBD) diameter, number of gallstones, size of the largest and smallest gallstones, and presence or absence of CBD stones were recorded. Gallstones smaller than 10 mm were classified as tiny gallstones, and those larger than 10 mm were classified as large gallstones. Results: The study's age range was 20 to 85 years old, with a mean age of 58.25 ± 9.30 years. With a male to female ratio of 1:4.6, 34 (17.0%) of the 200 patients were men and 166 (84.0%) were women. In our study, the average length of illness was 5.71 ± 2.18 months. The mean BMI was 27.44 kg/m²-2.98. There were 9.43 ± 4.56 gallstones on average, with the largest gallstone measuring 24.33 ± 5.43 mm and the smallest measuring 5.63 ± 3.13 mm. The diameter of the CBD was 5.78 ± 0.87 mm. In our study, 186 individuals (93.1%) had little gallstones and 14 patients (7.0%) had large gallstones. Conclusion: The GS were more frequent and smaller in patients with acute biliary pancreatitis. Incorporating the size and quantity of GS into the decision-making process may be beneficial given the uncertainties surrounding the referral of patients with non-specific symptoms for cholecystectomy.

Efficacy of low-pressure versus high-pressure pneumoperitoneum in restoration of bowel sounds after laparoscopic cholecystectomy.

Asif Lateef — 2026-04-07

Objective: To compare the effectiveness of low-pressure versus high-pressure pneumoperitoneum in facilitating the return of bowel sounds within six hours following laparoscopic cholecystectomy. Study Design: Randomized Controlled trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: November’2020 to April’2021. Methods: Sixty patients aged 25–70 undergoing elective laparoscopic cholecystectomy were randomly assigned to two groups: Group A (low-pressure CO₂, <10 mmHg) and Group B (high-pressure CO₂, 14 mmHg). Patients with complicated gallbladder disease or comorbidities like CRF and CLD were excluded. Results: The mean ages in Groups A and B were 43.17 ± 11.20 and 45.20 ± 10.76 years, respectively. The majority (83.33%) of participants were female. Return of bowel sounds within six hours postoperatively occurred in 30% of Group A patients versus 3.33% in Group B (p = 0.006), indicating a statistically significant difference favoring low-pressure pneumoperitoneum. Conclusion: Low-pressure pneumoperitoneum significantly enhances early return of bowel function after laparoscopic cholecystectomy compared to high-pressure pneumoperitoneum.

Adherence to Enhanced Recovery after Surgery (ERAS) protocols in cardiac surgery in Pakistan: A cross-sectional survey of current practices.

Shahbaz Ahmad Khilji — 2026-04-07

Objective: To assess the level of adherence to Enhanced Recovery After Surgery (ERAS) protocols among cardiac surgery teams in Pakistan. Study Design: Descriptive Cross-sectional Survey. Setting: Public and Private Cardiac Surgery Centers Across Pakistan. Period: June 2024 to Dec 2024. Methods: Using a 20-item questionnaire based on established ERAS guidelines. The survey was distributed electronically to healthcare professionals involved in cardiac surgery, including surgeons, anesthesiologists, critical care physicians, and residents. Responses were analyzed to evaluate compliance across the preoperative, intraoperative, and postoperative phases. Results: A total of 65 responses were received. Overall awareness of ERAS protocols was limited, with only 15.4% of participants reporting comprehensive familiarity. High adherence was observed for fasting protocols (92.3%), early extubation (92.3%), chest tube management (96.9%), and goal-directed fluid therapy (84.6%). Moderate adherence was seen in functional status evaluation (70.8%) and postoperative thromboprophylaxis (73.9%). Areas of low adherence included carbohydrate loading (40% never implemented), antifibrinolytic use (47.7% rarely or never used), and delirium assessments (26.2% never performed). Rigid sternal fixation was largely absent (90.8% not utilized). Common barriers included limited resources, lack of institutional protocols, and insufficient training. Conclusion: Adherence to ERAS protocols in cardiac surgery within Pakistan is variable, with strong uptake in certain areas and notable deficiencies in others. Improving awareness, standardizing protocols, and addressing infrastructural constraints may enhance the integration of ERAS principles in cardiac surgical care across resource-limited settings.

Correlation of peripheral perfusion index and mortality of patients with shock in Pediatric Intensive Care Unit of NICH, Karachi, Pakistan.

Muhammad Sami — 2026-04-07

Objective: To investigate the correlation between peripheral perfusion index (PPI) and mortality among pediatric shock patients admitted to the pediatric intensive care unit (PICU). Study Design: Prospective, Observational study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: March 2024 to February 2025. Methods: A total of 64 children aged between 1 month to 18 years and admitted to the PICU with a diagnosis of shock were analyzed. The PPI was categorized as mild (≥1.4), moderate (>0.6 to <1.4), and critical (≤0.6). At the time of admission, demographic, clinical parameters and vitals were documented. Saturation and perfusion index were noted on admission and during the course of illness in PICU. PPI was measured using pulse oximeter. Results: In a total of 64 children, 38 (59.4%) were female, with an overall mean age of 7.39±4.57 years. The mean baseline PPI was 0.97±0.66. Critical perfusion was found to have significant association with higher heart rate (p=0.036), lower systolic (p=0.007) and diastolic blood pressures (p=0.043), higher PRISM III scores (p<0.001), increased need for mechanical ventilation (p=0.014), longer PICU stays (p=0.006), and higher mortality rates (p=0.036). Lower PPI values were significantly correlated with higher heart rate (r=–0.407; p=0.001), lower systolic blood pressure (r=0.352; p=0.004), lower diastolic blood pressure (r=0.289; p=0.021), higher PRISM III scores (r=–0.676; p<0.001), and longer PICU stays (r=–0.296; p=0.018). Conclusion: Lower baseline PPI values (<0.6) were significantly associated with adverse hemodynamic parameters, increased severity of illness scores, greater need for mechanical ventilation, and higher mortality rates.

Comparison of doctor and patient’s assessment of asthma control at a Paediatric Tertiary Care Setup of Karachi, Pakistan.

Noshaba Noor — 2026-04-07

Objective: To compare doctor and patient/caregiver assessment of asthma control in children attending a tertiary pediatric care center in Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: January 2025 to June 2025. Methods: A total of 263 children aged 6–12 years with physician-diagnosed asthma were enrolled through consecutive sampling. Sociodemographic data and physician-documented asthma severity were recorded. Asthma control was assessed using the Childhood Asthma Control Test (C-ACT), Parent Proxy ACT (PP-ACT), and physician evaluation. Data were analyzed in SPSS 26.0 using Mann–Whitney U, Chi-square, Cohen’s kappa (κ), and McNemar’s test with significance set at p<0.05. Results: In 263 children, the median age was 8.0 years (IQR 7.0–10.0), 151 (57.4%) were males, and the median duration of asthma was 3.0 years (IQR 2.0–4.0). Physician assessment classified 148 (56.3%) as well controlled and 115 (43.7%) as uncontrolled, while C-ACT classified 134 (51.0%) and 129 (49.0%), and PP-ACT classified 113 (43.0%) and 150 (57.0%), respectively. Agreement was 72.2% for physician vs C-ACT (κ=0.41, p=0.214), 67.7% for physician vs PP-ACT (κ=0.34, p=0.012), and 75.3% for C-ACT vs PP-ACT (κ=0.53, p<0.001). Uncontrolled asthma was associated with higher age, longer duration, lower maternal education, and greater severity. Conclusion: The study demonstrates that discordance exists between physician assessment and both child and caregiver reported evaluations of asthma control. Physician assessments tended to classify higher levels of control compared with patient or caregiver measures.

Clinical profile and etiology of headache in children presenting to a tertiary care hospital.

Zahira Khalid — 2026-04-07

Objective: To determine the clinical profile and etiology of primary headache and secondary headache in children. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 179 children aged 5–15 years presenting with headache were analyzed after enrollment through non-probability consecutive sampling approach. Headache was categorized as primary or secondary according to “International Classification of Headache Disorders, 3rd Edition (ICHD-3)” criteria. Data were analyzed using SPSS version 26, applying appropriate statistical tests with p<0.05 taken significant. Results: Among 179 children, 96 (53.6%) were male and 83 (46.4%) female, with median age 10.2 years, (IQR 8.0–13.0). Headache duration was <3 months in 63 (35.2%) children. Primary headache was observed in 143 (79.9%) and secondary in 36 (20.1%). In children with primary headache, migraine occurred in 91 (50.8%), and tension-type headache in 52 (29.1%) children. In children with secondary headache (n=36), common causes were upper respiratory tract infection 12 (6.7%), sinusitis 8 (4.5%), meningitis 6 (3.4%), intracranial lesions 5 (2.8%), and trauma 5 (2.8%). Primary headache was linked with older age (p=0.012), urban residence (p=0.012), longer duration (p<0.001), and family history (p=0.017). Conclusion: Primary headache was the predominant type among children and was associated with older age, urban residence, positive family history, and longer symptom duration. Secondary headaches were more frequent in younger and underweight children and were mainly attributed to infectious or structural causes.

Prevalence of iron deficiency anemia in children with febrile fits.

Muhammad Khalid Khan — 2026-04-07

Objective: To investigate the prevalence of IDA with febrile fits in children. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Kyber Teaching Hospital, Peshawar. Period: September 1^st, 2021 to March 1^st 2022. Methods: A total of 149 children of both gender presenting with febrile fits were included in the study whereas, subjects with the history of electrolyte imbalance, hypoglycemia, meningitis, encephalitis, shigellosis, neurological deficiencies and seizures were excluded from the study. 5cc BD syringe was used by duty staff to drawn blood sample to access Hb, MCV level and serum ferritin levels. Hospital reports were analyzed and discussed with pathologist to access for IDA. Results: The average age of study participants was 2.590 ±1.12 years and range from 6 months to 5 years with male and female ratio is 76.5 % and 23.5% respectively. Mean duration of symptoms was 13.76±4.52 hours and 60.4% was the study participants were having IDA. Conclusion: The study highlights, 60.4% of study participants with febrile fits were have IDA, stressing on the need for early screening and intervention to treat this condition. Targeted nutritional strategies and further study are crucial to understanding the causal relationship and improving health outcome in children.

Imaging spectrum of spinal dysraphism in pediatric patients in a Tertiary Care Hospital in Sargodha.

Fakhar Tariq — 2026-04-07

Objective: To determine frequency of different types of spinal dysraphism in pediatric patients in a Tertiary Care Hospital in Sargodha. Study Design: Retrospective observational study. Setting: Tertiary Care Hospital Sargodha. Period: January-2024 to December-2024. Methods: Medical records of 97 patients with suspected spinal dysraphism who underwent magnetic resonance imaging were included in the study. Radiology records of all these patients who underwent magnetic resonance imaging was assessed to determine ex act etiology and type of spinal dysraphism, based on characteristic imaging findings. Data was analyzed using SPSS version 22. Results: Mean age was 3.20 ± 2.02 years. There were 31 (31.96%) male and 66 (68.04%) female patients. Most common type of spinal dysraphism in present study was Spina bifida 27 (27.84%) followed by meningomyelocele 22 (22.68%), diastematomyelia 12 (12.37%), tethered cord 8 (8.25%), sacral agenesis 7 (7.22%), dorsal dermal sinus 7 (7.22%), lipomyelomeningocele 6 (6.19%), myelocele 5 (5.15%), syrinx 2 (2.06%) and filar lipoma 1 (1.03%). Conclusion: Most common type of spinal dysraphism was spina bifida while least common was filar lipoma.

Stress among caregivers of patients with substance use disorder (SUD).

Nimra Mir — 2026-04-07

Objective: To determine the frequency of stress among caregivers of patients with substance use disorder. Study Design: Cross-sectional Study. Setting: Punjab Institute of Mental Health, Lahore. Period: February to July 2024. Methods: 94 caregivers providing support for at least six months to SUD patients was selected. Data was collected through interviews using semi-structured questionnaires. Stress was measured in terms of anxiety and depression and was labelled if any of these were present. Anxiety defined as HAM-A ≥10 and depression as HDRS ≥8. Data analyzed using SPSS 26. Quantitative variables were summarized as mean±SD, and qualitative as frequencies & %. Data was stratified for effect modifier and chi-square test was applied for stress incidence, p ≤ 0.05 considered as significant. Results: Out of 94 caregivers, 46 (48.9%) experienced stress, depression was present in 41.5%, and anxiety in 24.5%. Stress incidence among caregivers found to be significantly related to job status and substance used nature, p 0.01 & 0.02, respectively. Conclusion: This study finding suggests that nearly half caregivers of patients with SUD experienced stress, with depression being more prevalent than anxiety. These findings highlight substantial psychological burden on caregivers, emphasizing the need for mental health support and interventions to mitigate stress and improve their well-being.

Department of medical education requirements in a developing country: A qualitative study.

Syeda Sanaa Fatima — 2026-04-07

Objective: To investigated what is needed to standardize and enhance Medical education departments in Pakistan, specifically focusing on faculty qualification, departmental organization, and policy guidelines. Study Design: An Exploratory Qualitative Design. Setting: Twenty-two faculty members trained in MHPE from Pakistan's public-sector institutes were purposively sampled. Period: 2021 and 2023. Methods: Was used, grounded in the professional identity framework and institutional theory. Twenty-two faculty members trained in MHPE from Pakistan's public-sector institutes were purposively sampled. Semi-structured interviews were done between 2021 and 2023 through one-to-one interviews. Data were transcribed, coded, and analysed thematically with triangulation by more than one researcher to establish rigour and credibility. Results: Five overall themes were identified:(1) Eligibility: Medical Educationists need to have appropriate medical or dental degrees, supported by appropriate clinical and teaching experience, and DME backgrounds. (2) Think Global, Act Local: Global patterns should guide but not supplant local approaches, with contextualization being a must. (3) Autonomy: Autonomous DMEs with well-defined organograms and job specifications are a necessity, backed by regulatory authorities like PM&DC. (4) Training and Traits: In addition to formal credentials, faculty need effective communication, teamwork, flexibility, and a lifelong learning attitude. Designated national training frameworks are necessary. (5) Pure vs. Dual Degree Holders: Full-time DME faculty should take leadership roles, while dual-degree holders make supportive contributions that enhance departmental operation. Conclusion: Strengthening DMEs necessitates policies prioritizing appropriate qualifications, guaranteeing formal autonomy, and encouraging lifelong training. Contextualized reforms, facilitated by regulatory agencies, can empower the Department of Medical Education to assume a transformative role in shaping medical and dental education in Pakistan.