The Professional Medical Journal

Impact of antibiotic prophylaxis in post-radical cystectomy complications: Should it be enhanced? A systematic review article.

Musab Umair Khalid — 2025-07-01

Objective: To evaluate the efficacy and outcome of antibiotic prophylaxis (AP) in patients undergoing radical cystectomy. Study Design: Retrospective Review. Setting: Armed Forces Institute of Urology, Rawalpindi. Period: January 2020 to January 2021. Methods: On patients with bladder cancer undergoing radical cystectomy. Studies were selected irrespective of gender, published in English language in the last five years. PubMed data base is used to review articles. Results: This article attempted to formulate a seat of guidelines through reviews published in various journals regarding AP for post-radical cystectomy patients. Antibiotic prophylaxis is highly recommended for RC since infectious complications accounts for a major complication in postoperative period. The strategy of implementing AP in RC patients could result in the most favorable patient reported outcomes. Conclusion: Our review supports the policy of AP in all patients with bladder cancer undergoing radical cystectomy. Postoperative infections are the modifiable risk factors which can be prevented by antibiotic prophylaxis. Continued efforts are needed to establish an optimal preoperative management plan.

Efficacy of adjunctive use of vaginal progesterone after cervical cerclage for prevention of 2nd trimester miscarriage due to preterm labour.

Iqra Aftab — 2025-07-01

Objective: To assesses the effectiveness of adjunctive vaginal progesterone following cervical cerclage in preventing second-trimester miscarriages as a result of preterm labor (PTL). Study Design: Randomized Control Trial. Setting: Lady Wallington Hospital, King Edward Medical University, Lahore. Period: July to Dec, 2024. Methods: The trial group (vaginal progesterone + cervical cerclage) and the control group (cervical cerclage only) were randomized to two equal groups. In order to mitigate bias, double-blinding was implemented. The principal result was the absence of preterm labor during the pregnancy. The chi-square test was employed to analyze the data, with a p-value of less than 0.05 being considered significant. Results: At the time of cerclage application, the mean gestational age was 14.22 ± 3.85 weeks, and the mean maternal age was 29.83 ± 3.96 years. The trial group demonstrated a considerably higher efficacy (90%) than the control group (26.7%), with a p-value of less than 0.001. In comparison to the later application (16 ± 3.89 weeks, p=0.002), the efficacy of cervical cerclage was higher when applied at an earlier gestational age (12.94 ± 3.36 weeks). The trial group had a substantially higher gestational age at delivery (35.7 ± 1.72 weeks) than the control group (34.3 ± 2.65 weeks, p=0.003). The outcomes were influenced by parity (p=0.008), while there was no significant association between maternal age and previous cerclage history. Conclusion: Adjunctive vaginal progesterone significantly improves outcomes in preventing PTL when combined with cervical cerclage, particularly when applied earlier in pregnancy. Further large-scale, multi-center studies are recommended to confirm these findings and guide clinical practice.

Effect of seasonal variations on semen parameters.

Sana Saleem — 2025-07-01

Objective: To determine the correlation between semen analysis parameters and seasonal temperature changes to present the picture of how environmental factors are related to male reproductive health. Study Design: Cross Sectional. Setting: Department of Microbiology, Jinnah Hospital Lahore. Period: February 2024 to January 2025. Methods: The total 92 males were enrolled. The semen sample was collected in a sterilized container by participants as per standard collection protocol. After the semen sample collection, the container is immediately transported to the microbiology laboratory for the testing. The statistical data analysis was done through IBM SPSS V.27.0. Results: The total 92 males were enrolled. The age range was 16 to 45 years with the mean age of 30.7 ± 4.71. Temperature was noted at the time of ejaculation and six groups of seasons were made. Volume, sperm concentration, progressive motility, non-progressive motility, & immotile sperms showed significant statistical association with average high temperature of environment. Conclusion: The present study showed a definite seasonal effect on semen parameters, with summer being most obviously detrimental.

Comparison of oral versus vaginal misoprostol for medical management of early fetal demise at Akhtar Saeed Trust Hospital, Lahore.

Zermina Azhar — 2025-07-01

Objective: To compare the efficacy, safety, and clinical outcomes of oral versus vaginal misoprostol for medical management of first-trimester missed abortion at Akhtar Saeed Trust Hospital, Lahore. Study Design: Randomized Controlled Trial. Setting: Akhtar Saeed Trust Hospital, Lahore. Period: 15 November 2024 to 15 February 2025. Methods: A total of 110 female patients aged 18–45 years with a confirmed diagnosis of first-trimester missed abortion (gestational age <14 weeks) were enrolled. Participants were randomly assigned into two groups: Group A received oral misoprostol (400μg every six hours, up to three doses), and Group B received vaginal misoprostol (400μg soaked in normal saline, every six hours, up to three doses). Primary outcomes included treatment efficacy (complete uterine evacuation within 24 hours) and the need for surgical evacuation. Secondary outcomes included the mean time to expulsion and adverse effects such as bleeding, pain, vomiting, fever, and diarrhea. Data were analyzed using SPSS version 25.0, with a chi-square test used to compare efficacy between groups. Results: The efficacy of vaginal misoprostol (93.1%) was significantly higher than oral misoprostol (75.0%) (p=0.009). The mean time to expulsion was shorter in the vaginal group (10.87±2.0 hours) compared to the oral group (13.24±2.0 hours). The need for surgical evacuation was significantly higher in the oral group (25.0%) than in the vaginal group (6.9%) (p=0.009). Adverse effects, including bleeding, abdominal pain, vomiting, fever, and diarrhea, were comparable between groups, with no statistically significant differences. Conclusion: Vaginal misoprostol is more effective, results in faster expulsion, and significantly reduces the need for surgical evacuation compared to oral misoprostol. Given its superior clinical outcomes, vaginal misoprostol should be considered the preferred method for the medical management of first-trimester missed abortion.

An aberrant or functional perineal pain in otherwise psychological disturbed women: A thought provoking study.

Ambreen Mannan — 2025-07-01

Objective: To provide update about increase frequency of aberrant perineal pain among women with Psychological disorders. Moreover, to signify the practicing health services about prevention of injudicious and on demand perineal operative interventions. Study Design: Prospective and descriptive. Period: Surgery OPD from January 2023 to July 2024. Methods: Female patients with perineal pain along with Psychological disorders with constipation, disturbed sleep and appetite. All male and female who had obvious perineal pathology. All patients biodata, personal history, socioeconomic status, number of children, marietal status, dietary, sleep, bowel habits recorded in the preset approved Performa from hospital’s ethical review committee. In addition, perineal pain and its onset, characteristics, nature, duration and intensity by Visual analogue scale (VAS) scale also recorded and data compiled in SPSS version 17. After confirming the unremarkable clinical examination on follow-ups, the patients’ Psychological status inquired by detailed personal history, and referred to psychiatric services for evaluation of aberrant perineal pain. Psychological disturbance marked when they found anxious and depressed. Detailed history revealed sedentary living (no marriages), post puerperal stress, weird life style (frequent use of junk food, excessive use of screen), low finances and high expenditure, increase work load at home (increase number of children, joint family system) are the contributory factors. Consequently, conservative local initial treatment started with acknowledgement of symptoms, reassurance, 0.2 % GTN, Sitz bath and psycho education about reschedule of routine, nutritious rich fiber diet, and advice of good thinking lead to good performance. Psychiatrist intervention with selective serotonin receptor inhibitor (SSRI) found helpful in refractory cases. Results: Total 200 female patients having Psychological disorders included in the study. Age range from 16 to 75 years studied about their aberrant perineal pain with no any organic cause. Conclusion: Although aberrant perineal pain in women without any organic cause but with Psychological disorders is, frequent and important to update the practicing contemporary health professionals to prevent future injudicious and on demand perineal operative interventions. The Psychological disorders manifested as aberrant perineal pain, postpartum depression and constipation found interlinked each other. This pain entity is frequent and successfully reverse with conservative measures.

Outcome of treatment with letrozole versus gonadotrophins stimulated IUI (Intrauterine Insemination) in the management of unexplained infertility.

Nadia Sharif — 2025-07-01

Objective: To compare the outcome of treatment in patients with primary unexplained infertility with gonadotrophin v/s letrozole stimulated IUI (intrauterine insemination). Study Design: Prospective Experimental study. Setting: Obstetrics and Gynaecology Department of Al- Shifa Healthcare Group, Al- Shifa Multi Speciality Medical Centers, Sharjah, United Arab Emirates. Period: October 2022 till April 2023. Methods: 110 patients of primary unexplained infertility were included in this study who were randomly divided into 2 groups and were treated with stimulated IUI. One group was stimulated with Gonadotrophin, Gonal-f, while, the other was treated with letrozole, an oral anti-estrogen. Ovarian response was noted in the form of 2 dominant follicles of 18-22 mm in diameter, in whom, ovulation was triggered with 250 mcg of choriogonadotrophin-alpha. Patients who did not had menstruation on the expected date, were tested for pregnancy 1 week after missing the due date of menstruation. Statistically significant parameters were recorded between the 2 groups (serum AMH value, FSH value, BMI and Age) with and without ovulation and pregnancy. Results: In the letrozole treated group; 28 out of 55 patients responded in the form of adequate ovarian response, whereas 27 patients did not attain adequate ovarian response. Among the 28 ovulating patients 12 got pregnant being 21.8 % of total letrozole treated women. Regarding gonadotrophin group, 44 out of 55 patients had an adequate ovarian response, being 80 % and only 11 patients could not attain an adequate ovarian response. Out of ovulating patients, pregnancy was achieved in 27 patients being 49.09%. Conclusion: Among the women with unexplained infertility of primary origin, treated with stimulated Intra-Uterine Insemination with gonadotrophins and letrozole, ovulation as well as pregnancy rates were significantly higher among the patients who were treated with gonadotrophins for controlled ovarian stimulation, in terms of ovulation as well as pregnancy rates, as compared to letrozole treated patient. Moreover, regarding the outcomes measured in this study; ovulation as well as pregnancy, both are seen to be higher among the younger ages, high AMH, low FSH, low basal LH and low BMI patients.

Comparison between Bupivacaine alone and bupivacaine plus buprenorphine using ultrasound guided supraclavicular block at a tertiary care hospital.

Munazza Imdad — 2025-07-01

Objective: To compare ultrasound-guided supraclavicular block with bupivacaine versus those receiving bupivacaine combined with buprenorphine. Study Design: Randomized Control Trials. Setting: Department of Anesthesia, Nishtar Hospital Multan. Period: 14^th April 2023 to 13^th October 2023. Methods: In total, 60 patients between the ages of 18 and 60 under brachial plexus block, appointments for elective elbow, forearm, and hand procedures were included. Local site infections, drug allergies, and coagulopathy (INR>1.5) were excluded. A brachial plexus block was performed on Group B using 35 ml, which included 30 ml of 0.5% bupivacaine and 5 ml of saline. Group A was given a brachial plexus block with 3μg/kg buprenorphine and 0.5% bupivacaine. The study assessed hemodynamic changes, the initiation of sensory and motor blockade, and the duration of the block in patients. Results: In this work, the average duration of sensory and motor block in bupivacaine alone vs bupivacaine plus buprenorphine were 285.67 ± 15.28 min vs 1149.43 ± 59.69 min and 225.27 ± 9.10 min vs 866.53 ± 26.17 min with p-value < 0.0001 respectively. Conclusion: In patients undergoing upper limb surgery, the comparison of sensory and motor blockade duration demonstrated that bupivacaine plus buprenorphine is superior than bupivacaine alone in supraclavicular block.

Correlation of inflammatory marker and endoscopic score crohn’s disease in patients having crohn’s inflammatory bowel disease.

Shereen — 2025-07-01

Objective: To determine the correlation between inflammatory markers (fecal calprotectin and CRP) and Simple Endoscopic Score for Crohn's Disease (SES-CD) in patients with Crohn's disease. Study Design: Cross-sectional study. Setting: Department of Medicine, Liaquat University of Medical and Health Sciences. Period: 24^th August 2024 to 24^th February 2025. Methods: Thirty-three patients with endoscopically diagnosed Crohn's disease were enrolled. Blood samples for CRP and first-morning stool samples for fecal calprotectin were collected. SES-CD was calculated during endoscopic evaluation. Demographic and clinical data were recorded using standardized proformas. Spearman's correlation coefficient was used to assess relationships between variables. Results: The study included 33 patients with a median age of 44.00 years (IQR: 34.00-52.50) and mean BMI of 25.86 ± 2.30. The median SES-CD score was 8.00 (IQR: 6.00-13.00), and mean CRP level was 14.00 ± 6.48 mg/L. Spearman correlation analysis revealed strong positive correlations between SES-CD and both fecal calprotectin (ρ = 0.994, p < 0.001) and CRP levels (ρ = 0.993, p < 0.001). A significant correlation was also found between SES-CD and BMI (ρ = 0.882, p < 0.001). No significant correlations were observed between SES-CD and age (ρ = 0.048, p = 0.791), gender (ρ = -0.102, p = 0.571), or disease duration (ρ = -0.017, p = 0.925). Conclusion: Both fecal calprotectin and CRP demonstrated strong correlations with endoscopic disease activity in Crohn's disease, suggesting their potential utility as reliable non-invasive biomarkers for monitoring disease severity and guiding treatment decisions.

Accuracy of D-Dimers to diagnose aortic dissection and its different types keeping CT angiogram as gold standard.

Saqib Qayyum — 2025-07-01

Objective: To determine diagnostic accuracy of D-dimers levels to diagnose aortic dissection and its different types keeping computed tomographic angiogram as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi. Period: 1^st December 2023 to 31^st May 2024. Methods: Patients presenting with acute onset “tearing” chest pain with suspicion of aortic dissection were included in the study. Their D-dimer levels and CT angiography were performed in all patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of D-dimers to diagnose aortic dissection were calculated. Data was analyzed using SPSS 22. Results: A total number of 74 patients were included in this study. In this study, sensitivity of D-dimer levels to diagnose aortic dissection was 90.00% while specificity was 71.43%. For aortic dissection diagnosis positive predictive value, negative predictive value and accuracy of D-dimers levels were 93.10%, 62.50% and 86.49%, respectively. Based on CT Angiogram, there were 47 (63.51%) Stanford type A – Aortic dissection patients while 27 (36.49%) patients were of Stanford type B – Aortic dissection. In Stanford type A – Aortic dissection patients’ sensitivity and specificity were 95% and 41% while in Stanford type B – aortic dissection patients’ sensitivity and specificity were 80% and 22.22%. Accuracy of D-dimers levels to diagnose Type A – Aortic dissection and Type B – Aortic dissection was 70.27% & 37.84% respectively. Conclusion: D-dimers levels can serve as an effective tool to diagnose aortic dissection, in particular for Stanford Type A – Aortic dissection.

Short term outcomes of primary percutaneous coronary intervention in patients presenting with first acute ST elevation myocardial infarction.

Aftab Gohar — 2025-07-01

Objective: To determine the frequency of various short term outcomes of primary percutaneous coronary intervention in patients presenting with first acute ST elevation myocardial infarction. Study Design: Descriptive study. Setting: Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur. Period: March 2024 to Aug, 2024. Methods: Evaluated Short-term Outcomes of Primary PCI in 124 STEMI patients at Bahawal Victoria Hospital, Bahawalpur. Patients aged 20-65 years were included, while those with prior thrombolysis, stroke, or comorbid conditions were excluded. Outcomes such as cardiogenic shock, post-PCI angina, and mortality were assessed within 48 hours using t-tests and chi-square/Fisher’s exact tests. Results: The demographics and co-morbidities of 124 patients. Most patients were male (84.7%), with females comprising 15.3%. The age distribution showed 52.4% of patients were between 20-50 years and 47.6% were aged 51-65 years. Common co-morbidities included diabetes mellitus (75%) and hypertension (58.9%), while 51.6% of the patients were smokers. Conclusion: Our study confirms PPCI's efficacy in treating STEMI, emphasizing the need for continued risk management and lifestyle interventions to improve long-term outcomes.

Clinical, hematological and cytogenetic analysis of Chronic Myelomonocytic Leukemia in Pakistan: A single-center cross-sectional study.

Zoya Ziad — 2025-07-01

Objective: The study was done to outline clinical, hematological, and cytogenetic profile of chronic myelomonocytic Leukemia (CMML) in Pakistani population. Study Design: Cross Sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD), Karachi, Pakistan. Period: January 2022- December 2023. Methods: All baseline investigations and clinical parameters of CMML patients were recorded. Bone marrow biopsy samples were taken and cytogenetic analysis was performed. Descriptive statistics were reported by using SPSS version 25.0. Association between two categorical variables was evaluated using Chi-square test and Fisher exact test. Results: A total of 29 patients were included in the study having median age 62 (5-85) years with male predominance (62.1%). The most common presenting complaint was lethargy in 29 (100%) patients, followed by weight loss in 22 (75.9%) and fever in 21 (72.4%). The median hemoglobin levels were 9.3 (ranging 5.4-14.2) g/dL, total leucocytes count (TLC) 39.4(ranging 3.4-145.8x10⁹/L and absolute monocyte count (AMC) of 5.5 (ranging1.14-61.54) x10⁹/L. Twenty-two (75.9%) patients had normal karyotype and 04(13.8%) had an abnormal karyotype. There was no statistical difference in patient outcomes in decitabine users and non-users. Conclusion: This was one of the first studies conducted on CMML Pakistani patients. The clinical and hematological demographics were similar to those reported by international studies. Further clinical follow up and treatment analysis would be important addition to the existing data done prospectively. Future longitudinal studies with inferential statistics are needed in this context at national level.

Clinical profile and outcome of Guillian Barre Syndrome in children.

Huma Mehmood — 2025-07-01

Objective: To evaluate the clinical profile and outcome of Guillian Barre Syndrome (GBS) in children admitted in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics of National Institute of Child Health, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 45 children aged between 1 month up to 16 years, presenting and admitted with GBS were analyzed. Demographical and clinical characteristics of children were noted. Children were treated as per standard institutional protocols. Final outcome was recorded as survived or expired. Effect modifiers were controlled through stratification, and post-stratification chi-square/fisher’s exact test was applied taking p<0.05 as significant. Results: In a total of 45 children, 27 (60.0%) were males. The mean age was 6.27±2.49 years. The mean duration of symptoms was 3.6±2.7 days. The most common presentations were weakness of limbs, and fever, documented in 38 (84.4%), and 24 (53.3%) patients, respectively. Nerve conduction velocity evaluation revealed AMSAN as the most common GBS subset, found in 32 (71.1%) patients. Mortality was observed among 10 (22.2%) children, while the remaining 35 (67.8%) children improved and discharged successfully. Mortality was significantly associated with admission in PICU at the time of enrollment (p<0.001), need for ventilatory support (p<0.001), and inotropic support (p<0.001). Conclusion: Lower limb weakness and fever emerged as the most common initial symptoms, with AMSAN being the predominant subtype. Mortality was significantly associated with PICU admission, need for ventilatory support, and inotropic support.

Frequency of iron deficiency anemia in children presenting with helicobacter pylori infection at a Tertiary Care Hospital, Karachi, Pakistan.

Kanchan Samtani — 2025-07-01

Objective: To determine the frequency of iron deficiency anemia (IDA) in children presenting with Helicobacter pylori (H. pylori) infection at a Tertiary Care Hospital, Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Memon Medical Institute Hospital, Karachi, Pakistan. Period: April 2024 to September 2024. Methods: A total of 184 children of either gender, aged 2-14 years, and presenting with H. pylori were analyzed. Brief history including symptoms of the disease were taken along with demographic data which included parent’s information (educational status and socioeconomic status). IDA was labeled as hemoglobin<11 g/dl, serum ferritin<10 ng/ml and transferrin saturation< 12%. Data were analyzed using IBM-SPSS version 26.0. Results: In this study of 184 children, 97 (52.7%) were male and 87 (47.3%) female. The mean age was 7.78±3.40 years. There were 65 (35.3%) children who had pallor, 50 (27.2%) fatigue, 37 (20.1%) difficulty concentrating at school, and 31 (16.8%) presented with headache. IDA was identified in 88 (47.8%) children. IDA was significantly associated with pallor (p<0.001), fatigue (p<0.001), headache (p<0.001), atrophic glossitis (p<0.001), dry hair (p=0.001), and koilonychia (p=0.029). Employed mothers were more likely to have children with IDA (28.4% vs. 6.3%, p<0.001), and children with mothers who were illiterate or had only primary education had higher IDA rates (p<0.001). Low family income was also significantly associated with IDA (79.5% vs. 35.0%, p<0.001). Conclusion: High prevalence of IDA was observed among children with H. pylori infection. Maternal employment, lower maternal education, and low family income were identified as key associated factors.

Impact of maternal rheumatic diseases on fetal and neonatal outcomes delivering in a Tertiary Care Hospital.

Fahad Iqbal — 2025-07-01

Objective: To determine the impact of rheumatic diseases on fetal and neonatal outcomes. Study Design: Prospective, Observational study. Setting: Department of Obstetrics and Gynecology, Neonatology, and Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan. Period: January 2023 to January 2024. Methods: A total of 61 pregnant women aged 20-40 years, with rheumatological illnesses, and having gestational age of 12 weeks or more were analyzed. Maternal demographics, clinical characteristics, and gestational age at time of study entry were documented. The neonatal outcomes such as birth weight, gestational age, NICU stay, and mortality were documented. Data analysis was performed using IBM-SPSS Statistics, version 26.0. With the significance level set at p < 0.05, the chi-square test or Fisher's exact test were utilized to evaluate associations between categorical data. Results: In a total of 61 females, the mean age, gestational age, and duration of rheumatic illness at the time of enrollment were 30.13 ± 4.50 years, 25.45±9.19 weeks, and 25.48±5.29 years, respectively. The most common rheumatic disease were systemic lupus erythematosus (SLE), rheumatoid arthritis, and syndrome of antiphospholipids, found in 24 (39.3%), 11 (18.0%), and 8 (13.1%) females, respectively. The mean birth weight was 2492.13±820.0 grams while, 20 (32.8%) newborns had low birth weight. Live-birth was reported in 55 (90.2%) cases. Conclusion: Systemic lupus erythematosus, rheumatoid arthritis, and syndrome of antiphospholipids were the most common rheumatic diseases among pregnant females. The risk of adverse outcomes in pregnant females with rheumatic diseases seems high.

Efficacy of magnesium sulphate treatment in children with acute asthma.

Hina Rashid — 2025-07-01

Objective: To determine the effectiveness of magnesium sulphate (MgSO₄) in improving lung function parameters in children presented with acute asthma (AA). Study Design: Quasi-experimental study. Setting: Department of Emergency, National Institute of Child Health, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: Children of either gender, aged between 6-13 years, presenting with respiratory complaints due to AA were included. Demographic and clinical details of each child were obtained. Presenting complaints including wheezing, short ness of breath, cough chest tightness was asked from children and their parents/guardians. Dose of MgSO₄ was calculated according to body weight of child and infusion was prepared in 100 mL normal saline by on duty senior nurse. Spirometry of each child was performed by trained experienced spirometry technician before and after 15 minutes of MgSO₄ infusion. Results: In a total of 82 children with AA, 47 (57.3%) were boys. The mean age was 9.87±1.72 years. The most frequent associated conditions were dust allergy, and fragrance allergy, noted in 34 (41.5%), and 32 (39.0%) children, respectively. Wheezing, and cough were the most frequently noted symptoms, observed in 65 (79.3%) children each. Significant improvement in FEV1 (p<0.001), FVC (p<0.001), PEF (p<0.001), and FEF 25-75 (p<0.001) were observed after treatment with MgSO₄. Conclusion: These findings suggest that IV MgSO₄ may serve as an effective adjunct therapy for acute pediatric asthma exacerbations, leading to improved clinical outcomes.

(Superior Gluted Artery) S-GAP V-Y rotation advancements flap for large sacral pressure sores.

Asif Aziz — 2025-07-01

Objective: To stress the superb utility and easy movement of gluteal soft tissue in reconstruction of sacral pressure sores, while preserving further options for future use, in multiply moribund patients. Study Design: Retrospectively analyzed. Setting: Department of Plastic Surgery, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan. Period: November 2019 till March 2022. Methods: Twenty-seven patients were retrospectively analyzed, who underwent coverage of moderate to large grade III and IV, sacral pressure sores with 28 V-Y rotation advancement flaps based on superior gluteal artery perforator. The cause of injury, demographic details, and wound characteristics were obtained from patient records. Results: The study included 24 men and 3 women, with mean age of 31 years, including three children. Spinal injury secondary to road traffic accident was the most common cause of spinal injury followed by firearm injury and meningomyelocele. Patients were followed for 6 months to one year. All flaps survived completely, with one incidence of dehiscence which was managed by delayed closure, with readvancement. Conclusion: Among the many strategies for sacral pressure sore coverage, perforator-based movement of gluteal soft tissue is very reliable, easy to master and lends itself to reuse in future circumstances.

The feasibility and efficacy of TIPP (Trans inguinal preperitoneal repair) versus (TAPP) Transabdominal preperitoneal repair for inguinal hernia.

Muhammad Najam Iqbal — 2025-07-01

Objective: To compare the feasibility and efficacy of TIPP versus TAPP in terms of operating time, postoperative acute and chronic inguinal pain, complication rate, recurrence rate and hospital stay. Study Design: Prospective Comparative study (RCT). Setting: Bahawal Victoria Hospital, Bahawalpur. Period: 01-02-21 to 30-11-24. Methods: 100 patients were equally divided into group A and group B by simple random sampling. In Group A, the trans inguinal preperitoneal (TIPP) repair was performed, and in group B trans abdominal preperitoneal (TAPP) repair was performed. Mean operating time, postoperative acute and chronic inguinal pain, complication rate, recurrence rate and hospital stay were recorded. Pain was evaluated by visual analogue score ranging from 0-10. Data was collected on a pro forma and analysed using SPSS Statistics version 27. The Pearson chi-squared test was used for the categorical variables and t tests for continuous variables. Results: Mean operating time in TIPP group was significantly shorter than TAPP group (59.54 ± 11.71 versus 95.40 ±15.81 and p-value <0.001). Acute postoperative pain score after 24 and 48 hours was significantly was higher in TIPP group than TAPP group (4.98± 0.99 vs.4.92 ± 0.92, p-value 0.05 and 2.36± 0.96 vs.1.94± 0.93 p-value 0.029 respectively). Complication rate was lower in TAPP than TIPP (9% vs.15%). However, recurrence rate was equal in both groups (1% vs. 1%) but hospital stay was significantly shorter in TIPP than TAPP (.1.26± 0.69 vs1.66± 0.68, p-value 0.005). Conclusion: Both TIPP and TAPP repair are effective for the treatment of inguinal hernia. TIPP repair has higher feasibility in terms of significantly shorter operating time than TAPP repair where as TAPP has higher efficacy in terms of lower post operative pain (acute and chronic) and complication rate than TIPP repair. TIPP may be a better approach in older patients who are unfit for general anesthesia and TAPP for the younger patients.

Frequency and outcomes of liver resection in patient presenting with complex bile duct injury following cholecystectomy in hepatobilliary unit: A cross-sectional study.

Abubakar Siddiqui — 2025-07-01

Objective: To assess frequency of hepatectomy for bile duct injuries at a hepatobiliary unit and post-operative outcomes. Study Design: Cross-sectional Comparative study. Setting: Hepatobiliary Unit, Shaikh Zayed Hospital, Lahore. Period: January 2022 to July 2022. Methods: Nonprobability consecutive sampling method included diagnosed 79 BDIs patients. Ultrasound and MRCP aided injury site identification, with surgical decisions made by consultants. Outcomes, like postoperative bile leaks, surgical site infections, and in-hospital deaths, were followed for six months. SPSS 23 handled statistical analysis. Results: Among 79 BDIs, mean age was 39.9±9.96, with 81% females and 19% males. 51.9% of BDIs had previous open cholecystectomy procedure while 44.3% had laparoscopic cholecystectomy. Most cases (88.6%) had no arterial injuries; 11.4% had right hepatic artery injuries. Hepatectomy was done in 22.8%, and 77.2% had hepaticojejunostomy. No hepatectomy-related deaths were observed. Both procedures had 12.5% SSIs. Hepatectomy had 12.5% post-operative leaks, but no strictures in the 6-month follow-up. Conclusion: 22.8% of BDI cases received liver resection, mainly with concomitant arterial injuries. Post-operative complications, including SSIs and leaks, were comparable. Surgical history influenced procedure choice, but in-hospital mortality was low, with no strictures reported within six months post-surgery.

Comparison of new injury severity score and revised trauma score for mortality prediction in adult trauma patients.

Bella Virk — 2025-07-01

Objective: To compare the revised trauma score (RTS) and new injury severity score (NISS) in predicting mortality in adults presented with trauma. Study Design: Cohort Research Setting: Emergency Department, Ziauddin University Hospital's, Karachi. Period: November 12, 2022, to May 11, 2023. Methods: A consecutive sampling technique was used to select 384 adult patients with traumatic brain injury (TBI), aged ≥ 18 years and who visited the emergency department (ED). After obtaining vitals, Glasgow Coma Scale (GCS), RTS and NISS were measured. Each TBI patient was treated according to standard procedures and followed until discharge or death. Results: Of the total, 53.1% were females and 46.9% were male with an average age of 44.21 years. Predicted mortality with RTS and NISS was 13.0% and 29.7% respectively, while mortality was 22.7%. The optimal cut-off score for predicting mortality in adult TBI patients using the RTS was a score of ≤7 (sensitivity 57.5%, specificity 100.0%, positive predictive value 100.0%, negative predictive value 89.0%, diagnostic accuracy 90.4%, area under ROC curve 0.014), and similarly cut-off score under the NISS was a score of ≥16 (100.0%, 91.0%, 76.4%, 100.0%, 93.0%, 0.934). There was a significant difference (p-value <0.001) between RTS and NISS with respect to the area under the ROC curve. Conclusion: In adult traumatic brain injury patients, NISS was the most accurate predictor of mortality when compared to RTS.

Role of tranexamic acid in reducing blood loss in bipolar hemiarthroplasty in the first 48 hours.

Awais Nawaz Khan — 2025-07-01

Objective: To find out the efficacy of Tranexamic acid in decreasing intraoperative and postoperative bloodloss in patients going through bipolar hemiarthroplasty (BHA) within the first 48 hours. Study Design: Randomized Controlled Trial. Setting: Ghurki Trust and Teaching Hospital, Lahore, Pakistan. Period: September 15, 2024, to December 15, 2024. Methods: Sixty-six patients with femoral neck fractures were randomized into two groups: Group A (TXA, 15 mg/kg intravenously) and Group B (placebo). Bloodloss was measured during and after surgery at 12, 24, and 48 hours using drain volumes. Data were analyzed using SPSS version 27, with Student's t-tests applied to compare outcomes between groups. Results: Group A demonstrated significantly lower intraoperative blood loss (534.85 ± 118.48 mL) than Group B (633.64 ± 127.94 mL, p = 0.002). Postoperative drain volumes were also lower in Group A at 12 hours (188.79 ± 71.80 mL vs. 225.76 ± 53.97 mL, p = 0.021), 24 hours (115.76 ± 43.16 mL vs. 167.58 ± 47.30 mL, p < 0.0001), and 48 hours (67.88 ± 39.19 mL vs. 102.12 ± 35.33mL, p < 0.0001). Total bloodloss over 48 hours was much lower in Group A (900.91 ± 222.74 mL) compared to Group B (1126.06 ± 216.97 mL, p < 0.0001). Subgroup analysis showed consistent benefits across gender, age, and BMI categories, particularly in females and older patients. Conclusion: Tranexamic acid significantly decreases intraoperative and postoperative bloodloss in patients goingthrough bipolar hemiarthroplasty (BHA) for the neck of femur fractures. These findings support the inclusion of TXA in surgical protocols to minimize blood loss, lower transfusion requirements, and reduce associated morbidity.

Assessment of diagnostic accuracy of Ziehl-Neelsen microscopy and GeneXpert MTB/ RIF assays from pulmonary and extra pulmonary specimens in a tertiary care hospital setting.

Nadia Wali — 2025-07-01

Objective: To compare the diagnostic accuracy of GeneXpert over ZN microscopy in pulmonary and extra pulmonary suspected tuberculosis samples. Study Design: Retrospective Cross-sectional study. Setting: Tertiary Care Hospital, Rawalpindi. Period: January 2024 to June 2024. Methods: All suspected tuberculosis cases from pulmonary and extra pulmonary samples were subjected to ZN microscopy and Gene Xpert MTB/RIF. Samples irrespective of age and gender were included in the study and spot specimens were excluded. Frequency and percentages were calculated for variables using SPSS v.26. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ZN microscopy and GeneXpert were also analyzed. Results: Out of total 813 suspected pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) specimens, 467(57.4%) were males while 346(42.5%) were females. Among all the samples, 695 (85.48%) were pulmonary and 118 (14.51%) were extra-pulmonary samples. The total number of samples stained positive with ZN were 106 (13.03%) whereas, sample detected postive on GeneXpert MTB/RIF were found to be 124 (15.25%). Out of all ZN postive samples detected by ZN staining method, 103 (97%) were PTB and 3 (03%) were EPTB samples. Whereas the positive samples detected by GeneXpert MTB/RIF comprised of 109 (88%) PTB and 15 (12%) were EPTB samples. Furthermore, sensitivity and specificity of Gene Xpert MTB/RIF was found to be 85.48% and 100% respectively, with a 100% PPV and 97.4% NPV in this study. Conclusion: GeneXpert MTB/RIF has a higher sensitivity and specificity compared to conventional ZN smear microscopy. GeneXpert has detected more positive cases from both PTB and EPTB specimens.

Efficacy of biodentine as a direct pulp capping agent in reversible pulpitis.

Qurat Ul Ain — 2025-07-01

Objective: To determine the efficacy of Biodentine as a direct pulp capping agent in reversible pulpitis.

Study Design: Longitudinal Observational study. Setting: Department of Operative Dentistry, Ibn-e-Siena Hospital Multan. Period: 25^th July 2023 to 24^th January 2024. Methods: A total of 114 patients, aged 18-55 years with reversible pulpitis in permanent teeth were selected through consecutive sampling. Patients with irreversible pulp conditions, developmental anomalies, or handicaps were excluded. Pain was assessed using a visual analogue scale (VAS), and direct pulp capping with Biodentine was performed under local anesthesia. Efficacy was determined 24 hours post-procedure, defined as no pain (VAS=0). Data were analyzed using SPSS version 23. Descriptive statistics were run and factors influencing efficacy were assessed through Fischer’s exact at 5% significance level. Results: The mean age of participants was 27.4 ± 9.3 years, with 57% males. Pre-operatively, 76.3% had mild pain. Post-operatively, 89.5% of patients reported no pain, with only 10.5% experiencing mild pain. Efficacy was significantly higher in patients ≤25 years (98.5%) compared to >25 years (77.6%, p<0.001) and in those with mild to moderate pre-operative pain (98.9% and 65%, respectively) versus severe pain (42.9%, p<0.001). Conclusion: Direct pulp capping with Biodentine was highly effective in managing reversible pulpitis, particularly in younger patients and those with mild to moderate pre-operative pain. Age and pre-operative pain severity significantly influenced treatment outcomes.

Efficacy and safety of combined oral propranolol, oral prednisolone, and topical timolol versus combination of oral propranolol plus topical timolol in treating infantile hemangioma.

Aqsa Rafique — 2025-07-01

Objective: To determine the efficacy and safety of combined oral propranolol, oral prednisolone, and topical timolol in treating infantile hemangioma. Study Design: Randomized Clinical Trial. Setting: Department of Dermatology, Allied II (DHQ) Hospital Faisalabad Medical University, Faisalabad. Period: October 23 to August 24. Methods: A total of 68 infants aged 1 month to 5 years with clinically diagnosed infantile hemangiomas (IHs) were enrolled through non-probability consecutive sampling. Infants with comorbidities such as asthma, cardiac disease, or prior treatment were excluded. Participants were randomized into two groups: Group D (dual therapy) received dual therapy (oral propranolol and topical timolol only) while Group T (Triple) received triple therapy (oral propranolol, oral prednisolone, and topical timolol). Patients were followed biweekly for the first month and monthly thereafter for three months. Treatment efficacy was assessed based on lesion regression, while secondary outcomes included side effects and parental satisfaction. Results: Improvement (25–100% reduction) was observed in 88% of patients in Group D and 97% of patients in Group T, But not statistically significant. However, the incidence of mild-to-moderate side effects was notably higher in Group D (32%) compared to Group T (6%), which was statistically significant. Conclusion: Both the combinations of oral propranolol, oral prednisolone, and topical timolol and the combination of oral propranolol and topical timolol demonstrated high efficacy, but triple therapy had better results with less complications.

Diagnostic accuracy of Itransfontanelle sonography as compared to computed tomography of brain in the detection of hydrocephalus.

Kaleemullah — 2025-07-01

Objective: To determine diagnostic accuracy of trans fontanelle ultrasound for detection and diagnosis of hydrocephalus in terms of sensitivity, specificity, Positive predictive value and Negative predictive value by keeping CT brain as gold standard. Study Design: Cross-sectional study. Setting: Department of Diagnostic Radiology, MTI/Hayatabad Medical Complex, Peshawar. Period: August 01, 2024 to January 1, 2025. Methods: The study included 34 patients (aged 1 day to 6 months) with increased head circumference, using non-probability consecutive sampling. Trans fontanelle ultrasound was performed to diagnose hydrocephalus, with CT scans serving as the reference standard. Data were analyzed using SPSS software, and sensitivity, specificity, and predictive values were calculated. Results: The study included 33 patients (72.72% boys, 27.27% girls) with a mean age of 29.45 ± 7.31 days. Trans-frontal ultrasound was used to measure the lateral ventricle diameter and compared with CT scan findings. The ultrasound demonstrated a sensitivity of 66.70%, specificity of 88.90%, a positive predictive value of 83.30%, and a negative predictive value of 76.20%. Conclusion: The study highlights trans-fontanelle sonography to be a useful, non-invasive diagnostic tool for diagnosis of hydrocephalus in infants, especially when compared to the standard CT scan.