The Professional Medical Journal

Outcomes of delayed vs early cholecystectomy in individuals diagnosed with acute biliary pancreatitis caused by gallstones.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To conduct a comparative analysis of the outcomes associated with delayed cholecystectomy vs early cholecystectomy in individuals diagnosed with acute biliary pancreatitis caused by gallstones. Study Design: Randomized Clinical Trial. Setting: Department of General Surgery, Jinnah Postgraduate Medical Centre in Karachi, Pakistan. Period: March 2023 to August 2023. Methods: A total of 120 patients with mild to severe acute biliary pancreatitis were randomized into two groups: Group EC (early cholecystectomy) and Group DC (delayed cholecystectomy). Biliary leakage incidence and hospital stay duration were recorded. Chi-square and independent t-tests were used to analyze differences between groups, with a p-value <0.05 considered statistically significant. Results: The average age of the patients enrolled was 46.33 + 12.92 years. 62 (51.67%) were female, while 58 (48.33%) were male. The average dimension of gallstones was 6.65 x 2.37 mm. The average quantity of gallstones was 2.65 + 2.63. Patients who underwent delayed cholecystectomy spent an average of 5.47 days in the hospital, whereas those who underwent early cholecystectomy spent 4.351.18 days (p-value <0.0001). Biliary leakage was observed in three patients (5.0%) who underwent early cholecystectomy, compared to ten patients (16.7%) who underwent delayed cholecystectomy (p-value = 0.04). Conclusion: There is a correlation between early laparoscopic cholecystectomy and a reduced incidence of biliary leakage as well as a shorter duration of hospitalization. Patients with acute biliary pancreatitis may therefore safely undergo an early laparoscopic approach.

Frequency of malignancy in patients presenting with non-thyroidal neck swelling at a tertiary care hospital.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the frequency of malignancy in patients presenting with non-thyroidal neck swelling at a tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of ENT, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 27-8-2021 to 28-2-2022. Methods: Data was collected from 180 study subjects satisfying the inclusion criteria. The biopsy sample was taken and transferred to the institutional laboratory for histopathology. Malignant cases were labelled on the basis of histopathology and results were recorded on predesigned proforma. Results: Mean age of the patients was 40.55±5.95 years. Of the total 180 study subjects, 80(44.44%) were having benign lymph node swelling while 100(55.56%) were having malignant lymph node swelling. Among the malignant cases, 58(32.22%) were having metastatic lymphadenopathy while 42(23.33%) were diagnosed as having lymphoma. Statistically significant difference between the benign and malignant cases was observed with P value 0.02. Conclusion: On the basis of our study, it has been concluded that frequency of malignancy is high among individuals presenting with palpable lymph node swelling in the neck. Proper evaluation of these patients is important for early diagnosis and better management, to improve the prognosis and to reduce the morbidity and mortality.

Diagnostic accuracy of lung ultrasound in diagnosing interstitial lung disease taking HRCT as gold standard.

Naima Rauf, Nadeem Ibrahim, Iqra Aslam, Jahanzeb Javed, Amer Hayyat — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the diagnostic accuracy of ultrasonography for detection of interstitial lung disease (ILD) keeping high resolution computed tomography (HRCT) scan as gold standard. Study Design: Cross-sectional, Validation study. Setting: Department of Radiology, Combined Military Hospital, Gujranwala, Pakistan. Period: June 2024 to February 2025. Methods: A total of 95 patients of either gender, aged 18-75 years, and who presented with suspected ILD were analyzed. All patients underwent lung ultrasound (LUS) followed by HRCT. Data analysis was performed using IBM-SPSS Statisics, version 26.0. The diagnostic accuracy of LUS was calculated for ILD along with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: In a total of 95 patients, 68 (71.6%) were male. The mean age was 64.4±9.5 years, while 63 (66.3%) patients were aged between 61–75 years. Dyspnea, and chronic cough were reported in 85 (89.5%), and 76 (80.0%) patients, respectively. The HRCT confirmed ILD in 87 (82.7%) patients. LUS was positive for ILD findings in 72 (75.8%) patients. The sensitivity, and specificity of LUS for the detection of ILD were 81.6%, and 87.5%, respectively. The PPP, and NPV were 98.6%, and 30.4%, respectively. The overall diagnostic accuracy of LUS taking HRCT as gold standard was calculated as 82.4%. Conclusion: Lung ultrasound can be cost effective and safer investigation in initial evaluation of ILD with good diagnostic accuracy.

Diagnostic accuracy of elevated pro-calcitonin for predicting mortality in patients undergoing surgery for mechanical small bowel obstruction keeping actual mortality as gold standard.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To assess the diagnostic accuracy of high procalcitonin levels in predicting death among patients having surgery for mechanical small intestinal obstruction, using actual mortality as the gold standard. Study Design: Cross-sectional Validation study. Setting: Departments of Medicine and Surgery at KRL Hospital, Islamabad. Period: October 2023 to June 2024. Methods: After receiving approval from the institutional ethical review committee. Patients who provided consent and met the inclusion criteria were included from the medical and surgical units of KRL Hospital, Islamabad. Patients were evaluated upon admission by a researcher under the supervision of a specialist. Blood samples (5–10 mL) were obtained for PCT assessment. Patients were monitored for 14 days, with any fatalities recorded as mortality. Results: In this study of 203 participants, the mean age was 47.44±10.56 years, with a mean hospital stay of 13.51±2.13 days and a mean PCT level of 11.09±0.75 ng/mL. PCT levels ≥0.65 ng/mL were found in 88.7% of participants, while 11.3% had levels <0.65 ng/mL. The in-hospital mortality rate was 2.0%. The PCT threshold of 0.65 ng/mL had a sensitivity of 25%, specificity of 89%, PPV of 4.35%, and NPV of 98.33%. Conclusion: Elevated PCT levels are a useful biomarker for predicting mortality in mechanical SBO surgery due to high specificity. However, low sensitivity mean PCT should be combined with other diagnostic methods.

Frequency of post-operative hypoparathyroidism after subtotal thyroidectomy for treating benign multinodular goiter.

Muhammad Ans, Saad Yaqub, Tanvir Ahmad, Sahabia Masood, Samina Ashfaq — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the frequency of post-operative hypoparathyroidism after subtotal thyroidectomy in benign multinodular goiter. Study Design: Descriptive Study. Setting: Department of Surgery, Madinah Teaching Hospital, Faisalabad. Period: 20^th March, 2024 to 19^th September, 2024. Methods: 140 patients of benign multinodular goiter fulfilling the inclusion criteria were enrolled. Patients with toxic goiter, recurrent goiter, any malignancy, pregnant females, autoimmune thyroiditis and vocal cord paralysis prior to the surgery were excluded. All patients underwent subtotal thyroidectomy performed by senior surgeon. Serum calcium and parathyroid hormone levels after 72 hours of surgery during the hospital stay were tested and reported by pathology laboratory of hospital. Post-operative hypoparathyroidism (serum calcium level < 2mmol/L (hypocalcemia) with parathyroid hormone < 15 pg/ml after 72 hours of the surgical procedure) was assessed. The data was analyzed in SPSS version 26. Chi-square test (p ≤ 0.05) was applied to test significance of statistics. Results: The study's age range was 25 to 75 years old, with a mean age of 49.31 ± 11.40 years. Majority of patients i.e. 57.86%, were between 25 to 50 years of age. Of these 140 patients, 80 (57.14%) were females and 60 (42.86%) were males with female to male ratio of 1.3:1. Frequency of post-operative hypoparathyroidism after subtotal thyroidectomy for treating benign multinodular goiter was found in 14 (10.0%) patients. Conclusion: Study concluded a higher chance of transient hypoparathyroidism and hypocalcemia following thyroid surgery more likely in young female patients. A cautious surgical approach is advised to lower the risk of postoperative-complications.

Complicated appendicitis in pediatric age group: The challenge of timely identification.

Muhammad Mughees Anjum, Samreen Jamil, Ikramullah Khan, Sadaqat Ali — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the frequency of factors associated with delayed presentation of complicated appendicitis in pediatric patients. Study Design: Prospective Cross-sectional study. Setting: Department of Pediatric Surgery, Allied Hospital Faisalabad, A Tertiary Care Hospital. Period: 23-08-2024 to 22-02-2025. Methods: Included 60 pediatric patients aged 3–12 years diagnosed with complicated appendicitis. Consecutive sampling was used based on predefined criteria. Data were collected through parental interviews and medical records. Factors analyzed included demographics, clinical presentation, misdiagnosis, mistreatment, socioeconomic barriers, parental refusal, and healthcare access. Results: Most patients (58.3%) were aged 8–12 years, and 63.3% were male. Low socioeconomic status (40.0%), misdiagnosis by physicians (60.0%) and pediatricians (23.3%), mistreatment by quacks (26.7%), and self-medication (35.0%) contributed to delays. Financial constraints (51.7%), parental refusal of surgery (33.3%), lack of awareness (36.7%), and unavailability of pediatric surgeons (36.7%) further delayed diagnosis. Complications included peritonitis (31.7%), perforation (25.0%), abscess/mass (23.3%), and gangrene (20.0%). Postoperative complications and prolonged hospital stays occurred in 28.3%, while 43.3% fully recovered. Conclusion: Delayed presentation of complicated appendicitis in pediatric patients is influenced by misdiagnosis, mistreatment, financial barriers, and healthcare access issues. Early recognition, improved care access, and parental education can reduce morbidity and financial burdens.

Electrolyte imbalance and its association with the severity of dengue fever.

Nimra Fatima, Muhammad Ashfaq, Wajid Hussain, Mariam Raza, Atiya Anwar — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To assess the electrolyte imbalance in the patients with dengue and severe dengue fever and correlate their abnormalities with the severity of illness in pediatric population. Study Design: Cross-sectional study. Setting: Department of Pediatrics, The National Institute of Child Health (NICH), Karachi, Pakistan. Period: November 2024 to April 2025. Methods: A total of 196 children aged 6 months to 12 years with dengue, confirmed by NS1 antigen or IgM ELISA, were enrolled using non-probability consecutive sampling. Data collected included demographic, clinical, and laboratory parameters, with patients classified according to WHO dengue severity criteria. Electrolyte disturbances were defined using standard cutoffs. Data analysis was performed using SPSS v24, applying the Chi-square test, with p < 0.05 considered significant. Results: In a totaof 196 children, the mean age was 4.9±3.6 years, while 50.5% children were male. There were 41 (20.9%) children who had dengue fever, 118 (60.2%) dengue with danger signs, and 37 (18.9%) had severe dengue. Hyponatremia was observed in 72 (36.7%) children, most frequent in dengue with danger signs (44.9%) and severe dengue (37.8%), while hypernatremia was seen only in severe dengue (24.3%). Hypokalemia and hypocalcemia were found in 19.4% and 58.2% of cases, respectively. All 17 (8.8%) deaths occurred in severe dengue and were associated with hyponatremia, hypernatremia, and hypocalcemia. Conclusion: Electrolyte imbalances are common in paediatric dengue, with hyponatremia, hypocalcemia, and hypernatremia strongly associated with increased severity and mortality.

Therapeutic role of imatinib mesylate in chronic myeloid leukemia.

Asma Khan, Zabiullah, Faizan Rasheed, Zarafshan Bader, Imrana Aamir — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the impact of demographic (age, gender) and genetic (rs683369) factors on the therapeutic response to Imatinib Mesylate. Study Design: Prospective, Non-interventional Observational Study. Setting: Islamic International Medical College and Holy Family Hospital, with Genetic Testing at KRL Hospital, Islamabad. Period: January 2019 to December 2022. Methods: Included 106 CML patients aged 18–75 years, receiving 400 mg/day of Imatinib Mesylate. Response was assessed after three months based on hematological markers and Philadelphia chromosome presence. rs683369 genotyping was performed using PCR-RFLP, and plasma Imatinib levels were measured after one month. Statistical analysis included chi-square tests and binary logistic regression using SPSS. Period: January 2019 to December 2022. Results: Gender was significantly associated with treatment response, with females showing a higher response rate (p < 0.001). Older patients (≥51 years) exhibited higher plasma drug levels. The CC genotype of rs683369 was significantly associated with a favorable response compared to CG and GG genotypes (p = 0.04). Conclusion: Age, gender, and rs683369 genotype significantly influence Imatinib response in Pakistani CML patients. These findings support the application of pharmacogenetics in developing personalized treatment strategies.

Mycophenolate mofetil versus cyclophosphamide as induction therapy in lupus nephritis at one year- a prospective cohort study.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To compare efficacy of mycophenolate mofetil to intravenous cyclophosphamide as inductive therapy for lupus nephritis at 1 years after induction. Study Design: Observational Prospective Cohort study. Setting: Department of Rheumatology, Fauji Foundation Hospital Rawalpindi, Pakistan, Period: 26th Jan, 2024 to 28th Feb 2025. Methods: Sixty two LN patients of both genders and at least 18 years of age were recruited into MMF & CYC groups with equal numbers in each group. Induction therapy with MMF & IV CYC were given for 6 months in the respective group followed by MMF for next 6 months. CRR, PRR and TRR were obtained at 1 year after induction. Excel software was used to analyse the data obtained. Results: The mean age of the patients in MMF group was 39.68±5 years while the mean age of the patients in CYC group was 37.45±4.87 years. Female gender outnumbered in both the groups. At 1 year of induction therapy, complete renal remission (CRR) in MMF group was observed in 77% patients while in CYC group it was observed in 29% patients. Partial renal remission (PRR) in MMF group was observed in 16% patients while in CYC group it was observed in 16% patients. Total renal remission (TRR) in MMF group was observed in 94% patients while in CYC group it was observed in 45% patients. Conclusion: MMF is more affective as induction therapy for lupus nephritis as compared to IV CYC. Moreover it is more safe and tolerable.

Comparison of efficacy of narrow band ultraviolet b phototherapy with emollients in uremic pruritus patients at tertiary care hospital.

Humaira Kousar, Zahid Rafiq, Shahana Hoor, Amina Mehmood, Faizan Alam — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To compare mean pruritus score (5 -d itch score) between Narrow Band UVB verses topical emollients in patients of uremic pruritus. Study Design: Quasi-Experimental Study. Setting: Departments of Dermatology and Nephrology, Sahiwal Teaching Hospital Sahiwal. Period: March to August 2024. Methods: A total of sixty patients of end-stage renal disease on hemodialysis having uremic pruritus with 5-d itch score >15 were selected and randomly divided into two groups through lottery method. Group A patients were treated with twice weekly sessions of Narrowband UVB Phototherapy and Group B with emollients (liquid paraffin and white soft paraffin mixed in 1:1) applied topically on body twice daily. Patients of both groups were assessed after treatment at 12 week by using 5-D itch score at baseline and 12 week. Results: Majority of the patients belonged to 36 to 55 years of age and female gender outnumber male among study participants in both groups. The final 5D itch score decreased from baseline was recorded in both groups, but significant mean decrease in 5D itch more than half (53%) from its baseline was seen in group A patients treated with narrowband UVB phototherapy (10.76±3.25) compared to group B treated with emollients (4.23±2.95).Intergroup comparison results showed a statistically significant difference between the mean 5 D itch scores of both groups. (p-value <0.001). Conclusion: Narrow band UVB phototherapy is more effective as compared to emollients in the treatment of Uremic pruritus.

Endoscopic findings in patients with different breakfast timings and their short Leeds score.

Baby Anbreen, Shahid Karim, Punhal Khan, Raheela Khalid, Baseer Ahmad — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To see endoscopic changes in patients with different breakfast timings and their short Leeds dyspepsia score, visiting outpatient clinics in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Outpatient Clinics of Gastroenterology Department, Liaquat National Hospital, Karachi, Pakistan. Period: November, 2024 to April, 2024. Methods: A total of 450 patients of 18-65 years of either gender with at least past two months history of dyspeptic symptoms were analyzed. Short‐Form Leeds Dyspepsia Questionnaire (SF‐LDQ) was used to identify severity of dyspepsia and gastroscopy was performed in symptomatic patients to see endoscopic findings. Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 450 patients, 239 (53.1%) were males, and 211 (46.9%) females. The mean age was 43.01±15.83 years (ranging between 18-65 years). The mean breakfast time was 9.0am±1.8hr (ranging between 5:30am to 11.45am). Endoscopic features like frequency of esophagitis (50.0%), moderate to severe gastritis (38.7%, and 65.4%, respectively), and duodenitis (69.9%) were higher in patients having breakfast after 9-10 am. Frequency of dyspeptic symptoms was 86.5%, 75.3%, 45.3%, and 42% for indigestion, heartburn, nausea and regurgitation, respectively. Mean SF Leeds score was 14.04±5.61. Regression analysis showed that there was increase of 2.03 units in SF Leeds score with one-unit increase in breakfast timing. Conclusion: Significant relationship of breakfast timing was found with endoscopic severity of inflammation in gut and increase SF Leeds score, particularly in patients having breakfast after 10:00 O’ clock in the morning.

Effect of counselling on stress level of parents of neonates admitted in neonatal intensive care unit (NICU) of a tertiary care hospital.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To check the stress level and the effect of counseling on stress level among parents of neonates admitted in NICU. Study Design: Interventional Study. Setting: University of Child Health Sciences, Children’s Hospital Lahore, A Tertiary Care Pediatric Hospital. Period: December 2024 to May 2025. Methods: Total 100 parents participated through purposive sampling according to specific participant requirements. The research used questionnaire derived from the Parental Stressor Scale: NICU, to measure stress levels in two phases: before and after counseling. The paired t-tests was used for statistical analysis to measure parent stress baseline levels against post-counseling measurements. Results: Prior to counseling, the overall stress score was 30.03 ± 1.71, which significantly reduced to 11.24 ± 2.47 after counseling (p < 0.001). All subdomains of stress, including NICU environment, baby's appearance, parent-child relationship, and staff attitude, showed statistically significant reductions in stress levels post-counseling. Conclusion: Counseling significantly reduces parental stress levels in NICU settings. These findings highlight the need for integrating structured counseling programs into NICU care to support parents emotionally and psychologically.

Clinical outcomes following containment procedures for patients with Legg-calvé-perthes disease.

Asad Amin, Shahan Raza, Uzair Rashid, Sadaf Saddiq, Junaid Mazhar, Atiq uz Zaman — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To assess short-term functional outcomes following surgical containment in children with Legg-Calvé-Perthes disease (LCPD) classified as Herring group B or C. Study Design: Prospective Observational study. Setting: Department of Orthopaedics & Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: August 01, 2024 to January 31, 2025. Methods: Fourteen children aged 4–10 years with LCPD (Herring B or C) underwent surgical containment. Patients with comorbidities affecting hip function were excluded. Functional status was evaluated using the Harris Hip Score (HHS) preoperatively and six weeks postoperatively. Statistical analysis was performed using SPSS v23, with significance set at p ≤ .05. Results: The mean HHS improved significantly from 35.5 ± 7.88 preoperatively to 89.0 ± 3.62 postoperatively (p < .05). Subgroup analysis by age, gender, laterality, and Stulberg classification showed no statistically significant differences; however, greater improvements were observed in unilateral cases and those with Stulberg grades IV–V. Conclusion: Surgical containment significantly improves short-term functional outcomes in children with moderate-to-severe LCPD. Although subgroup differences were not statistically significant, observed trends support better recovery in unilateral and radiologically severe cases. Larger multicenter studies with longer follow-up are recommended.

Dorzolamide / timolol and brinzolamide / brimonidine fixed combination topical drug therapy tn the management of intraocular pressure in primary open angle glaucoma.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To compare the mean change in intraocular pressure (IOP) achieved with dorzolamide/timolol versus brinzolamide/brimonidine fixed combination topical therapy in patients diagnosed with primary open-angle glaucoma (POAG). Study Design: Randomized Control Trial. Setting: Department of Ophthalmology, Mayo Hospital, Lahore. Period: May’2024 to October’2024. Methods: A total of 60 cases aged 40–70 years with primary open-angle glaucoma were included and randomly assigned to receive either dorzolamide/timolol (Group X) or brinzolamide/brimonidine (Group Y). IOP was measured weekly for four weeks using Goldman tonometry, with the primary outcome being mean IOP reduction at week four. Results: The mean baseline IOP was comparable in both groups (p=0.947). After 4 weeks, IOP reduction was significantly greater in Group Y (6.84 ± 2.34 mmHg) than Group X (5.37 ± 2.16 mmHg) (p=0.014). Stratified analysis showed a significant IOP reduction in older patients (56–70 years) and in females treated with brinzolamide/brimonidine (p=0.006 and p=0.049, respectively). Conclusion: Brinzolamide/brimonidine fixed combination therapy was more effective in reducing IOP than dorzolamide/timolol, especially in older patients and females, suggesting a potential demographic influence on drug response.

Preventive effect of dorzolamide- timolol combination on intraocular pressure hikes after intravitreal bevacizumab (Avastin) injection.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the preventive effect of the dorzolamide-timolol fixed combination on intraocular pressure (IOP) spikes following intravitreal bevacizumab (Avastin) injection in patients with proliferative diabetic retinopathy (PDR). Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, LRBT Tertiary Teaching Eye Hospital, Multan Road, Lahore. Period: July 2023 to December 2023. Methods: In this study we enrolled 60 cases equally divided in 2 groups: Group A (trial group) received prophylactic dorzolamide-timolol fixed combination eye drops 30 minutes before intravitreal bevacizumab injection, while Group B (control group) received no prophylaxis. Baseline IOP (T0) and post-injection IOP (T30) were measured using a Perkins applanation tonometer to know the mean IOP changes between groups. Results: There was a statistically significant difference in baseline IOP between the trial (9.08 ± 1.60 mmHg) and control (14.08 ± 2.00 mmHg) groups (p < 0.001). Post-injection IOP also remained significantly lower in the trial group (9.20 ± 1.60 mmHg) compared to the control group (15.37 ± 2.13 mmHg, p < 0.001). These findings indicate that prophylactic dorzolamide-timolol effectively prevents IOP elevation following intravitreal bevacizumab injection. Conclusion: Dorzolamide-timolol prophylaxis significantly reduces IOP spikes following intravitreal bevacizumab injection, highlighting its potential as a preventive strategy for patients at risk of ocular hypertension. Given the widespread use of anti-VEGF therapy, routine prophylactic IOP control may be beneficial, particularly for high-risk patients.

Comparison of frequency of obstetrical and neonatal outcomes in teenage versus adult pregnancy.

Zirwa Younas, Saira Majeed, Shehreen Khan, Sehrish Maqsood, Shazia Shaheen — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine and compare the frequency of maternal anemia, lower segment caesarian section and low birth weight in teenage and adult pregnancy. Study Design: Analytical Cohort study. Setting: Department of Obstetrics and Gynecology, Allied Hospital Faisalabad. Period: June 2024 to December 2024. Methods: After approval from ethical review committee, a total of 124 pregnant females up to the age of 35 years and fulfilling selection criteria were selected from outdoor department, labor room and operation theatre of Allied hospital Faisalabad. Based on the age of the pregnant females they were included in one of the two equal numbered groups having 62 participants in each i.e. “exposed teenagers group” if aged ≤19 years and “unexposed adults group” if aged 20-35 years. Informed consent and demographic information was obtained. Participants were screened for anemia defined as hemoglobin levels of <11g/dl and were assessed for mode of delivery i.e. caesarian section or normal vaginal delivery. All the neonates of the participants were weighed upon birth to screen for low birth weight defined as birth weight of ≤2500g. All the data was entered in the study pro forma and was analyzed using SPSS version-25. P value of ≤ 0.05 was taken as significant. Results: Data analysis showed that the frequencies of maternal anemia, lower segment caesarian section and low birth weight in exposed group were 51.6% (n=32), 69.4% (n=43) and 61.3% (n=38) respectively, while in the unexposed group the respective frequencies were 14.5% (n=9), 40.3% (n=25) and 24.2% (n=15). Comparison showed that the frequencies of maternal anemia, lower segment caesarian section and low birth weight were significantly high in exposed group as compared to those of in unexposed group as the calculated P values for these outcomes were 0.000, 0.001 and 0.000 respectively. Conclusion: There is a strong association of adverse obstetrical and neonatal outcome with teenage pregnancies when compared with adult age pregnancy.

Comparison of outcomes and safety of concurrent chemoradiotherapy with weekly cisplatin and paclitaxel verses cisplatin alone in locally advanced cervical cancer.

Aalia Bashir, Anam Siddque, Muhammad Junaid Hassan — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the outcome, survival and safety of weekly combination therapy with cisplatin and paclitaxel chemoradiotherapy in comparison with cisplatin alone in locally advanced cervical cancer. Study Design: Prospective study. Setting: Oncology Department of Nishtar Hospital, Multan. Period: May 2024 to May 2025. Methods: A total of 100 women with locally advanced epithelial cell cervical carcinoma, KPS score of ≥70 and normal bilirubin, urea, creatinine and nitrogen were selected. Patients were divided into control group and study group consisting of 50 patients each. Control group was administered 40 mg/m2 of IV cisplatin once a week with a maximum weekly dose of 70 mg. Study group was administered 50 mg/m2 paclitaxel and 30 mg/m2 cisplatin once a week. External beam radiotherapy was performed in all patients at the same time of chemotherapy targeting cancer site, internal and upper external iliac, uterus, presacral and common iliac lymph nodes. Results: At the last follow-up, 80% patients in control group and 88% in study group survived. 17 patients (34%) in control group and 10 (20%) in study group had a recurrence so the disease-free survival was 66% and 80%, respectively. 12 patients (24%) in control group had local recurrence and 5 (10%) had distant recurrence. 5 patients (10%) in study group had local recurrence and only one (2%) had distant recurrence. No treatment related deaths occurred but 14 patients (28%) in control group and 27 patients (54%) suffered grade 3 or 4 toxicities, the difference was significant (p=0.02). Significantly higher number of patients in study group had gastrointestinal toxicities than control group. Conclusion: Concurrent cisplatin and paclitaxel chemoradiotherapy had better outcomes with increased but manageable toxicities than cisplatin chemoradiotherapy alone.

Assessment of fluoride ions concentration in novel toothpastes containing fluoridated bioactive glass fillers.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To measure and compare fluoride release in elutes and suspensions of fluoride doped bioglass (F-BG) enriched novel and commercial dentifrices and to assess effect of filler loading on fluoride release of novel toothpastes. Study Design: In vitro study carried out in triplicates (n=3). Setting: Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan. Period: 3/2020 to 04/2023. Methods: Novel dentifrices were prepared by adding F-BG nanoparticles and zinc oxide as active ingredients to basic dentifrice formulation. Sensodyne F toothpaste was taken as control group. Fluoride release analysis of both suspensions and elutes of dentifrices was carried out via ion selective electrode potentiometry. Collected data was statistically analyzed via SPSS version 22. Results: All novel dentifrices exhibited greater fluoride elusion from Sensodyne F in both elutes and suspensions. In elute and suspension, the observed fluoride release exhibited statistically significant difference within and between all groups where p > 0.05 was taken as significant. Conclusion: In toothpastes, type of fluoride source directs fluoride release behavior. Direct proportionality of fluoride release of novel dentifrices to filler loading was observed.

Ergonomic injuries in endoscopic doctors, nurses and technicians.

Aisha Saleem, Lubna Kamani — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the frequency of ergonomic injuries in endoscopic and non-endoscopic healthcare professionals and clinical staff. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: Enrolling 120 healthcare professionals (60 endoscopic, 60 non-endoscopic). Inclusion criteria were age 25–60 years, ≥6 months of clinical service, and ≥20 work hours/week. Data on demographics, comorbidities, ergonomic injury, and work patterns were collected via structured questionnaires. Endoscopy-related variables were assessed in the endoscopic group. Chi-square test, t-test, and logistic regression were applied using IBM-SPSS, v26. Results: Among 120 participants, 63 (52.5%) were male. Male representation was significantly higher in endoscopic doctors (56.7%) and staff (81.3%) compared to non-endoscopic groups (p<0.001). Musculoskeletal injuries were more frequent in endoscopic doctors (70.0%) and staff (56.3%) than non-endoscopic counterparts (p=0.012), with thumb pain notably higher in endoscopic doctors (26.7% vs 10.0%, p=0.016). Endoscopic staff had longer procedural experience (50.0% with 6–10 years; p=0.006) and were more often unit-based (75.0%, p<0.001). Endoscopic work increased injury risk (OR 3.1 doctors, 5.6 staff), while formal training was protective (OR 0.3 doctors, 0.1 staff). Conclusion: The incidence of ergonomic injuries is much higher among endoscopic physicians and clinical personnel in comparison to individuals who do perform endoscopic procedures. There is a higher probability of endoscopy-related injuries occurring when the frequency of procedures is increased and the duration of procedures is prolonged.

Sonographic evaluation of rotator cuff muscles injuries keeping MRI shoulder as gold standard.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the diagnostic performance of ultrasonography (USG) compared to magnetic resonance imaging (MRI) in diagnosing rotator cuff muscles injuries. Study Design: Cross-sectional, Validation study. Setting: Department of Radiology, Combined Military Hospital (CMH), Gujranwala, Pakistan. Period: April 2023 to September 2024. Methods: A total of 91 patients aged 18 to 75 years, referred for imaging due to clinical suspicion of rotator cuff muscle injury were analyzed. All patients underwent shoulder USG, as well as MRI within a two-week interval, and findings were compared. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of USG were calculated using MRI findings as the reference standard. Concordance between USG and MRI findings was assessed using Cohen’s kappa coefficient (κ). A p-value < 0.05 was considered significant. Results: Among the 91 patients, 48 (52.7%) were female. The mean age was 48.85±14.85 years. USG analyzing full-thickness rotator cuff tears demonstrated sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 68.4%, 97.2%, 86.7%, 92.1%, and 91.2%, respectively, with substantial agreement (κ=0.712, p<0.001). For partial-thickness rotator cuff tears, USG showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 89.7%, 90.3%, 81.3%, 94.9%, 90.1%, respectively, with substantial agreement (κ=0.778; p<0.001).USG detecting rotator cuff tendinopathy, yielding a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 96.2%, 96.9%, 92.6%, 98.4%, 96.7%, respectively, with very substantial agreement (κ=0.920; p<0.001). Conclusion: This study demonstrated high-resolution ultrasound as a reliable and effective modality for diagnosing rotator cuff muscle injuries.

Effect of physiotherapy on frequency of achilles tendon tenotomy in treatment of congenital talipes equinovarus (Club Foot).

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To evaluate the effect of physiotherapy on frequency of Achilles tendon tenotomy in the treatment of congenital talipes equinovarus (club foot). Study Design: Prospective, Interventional, Cross-sectional study. Setting: Orthopedic Club-Foot Outpatient Department, Jinnah Postgraduate Medical Center, Karachi. Period: June 2024 to November 2024. Methods: Included 50 children (100 feet) under six months of age diagnosed with idiopathic CTEV. Patients were divided into two groups: one receiving structured physiotherapy before casting and the other receiving standard Ponseti treatment. The primary outcome was the frequency of Achilles tendon tenotomy. Results: Among feet that did not require tenotomy, 62.1% were from the physiotherapy group (p = 0.009). Single tenotomy was more common in the control group (63.4%) compared to the physiotherapy group (36.6%), while all repeat tenotomies occurred in the control group. Subgroup analysis showed significant reduction in tenotomy in patients aged 0–12 weeks, males, unilateral cases, and those with or without family history. Conclusion: Pre-casting physiotherapy significantly reduces the need for Achilles tendon tenotomy in infants with idiopathic CTEV. Its integration into routine Ponseti protocol may enhance treatment outcomes and reduce surgical burden, particularly in resource-constrained settings.

Reasons for choosing medical profession as a career / other purposes – a perspective of Pakistani undergraduate medical students.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the primary reasons for choosing a medical career, with a particular focus on the role of a medical profession in facilitating marriage prospects. The other objectives were Carrier choice and decision of post-graduation. Study Design: Cross-sectional study. Setting: Medical Colleges across Pakistan. Period: October 1, 2023, and March 31, 2024. Methods: Data were collected randomly using a self-constructed Google form questionnaire based on a Likert scale. A total sample size of 270 participants was collected and was analyzed using SPSS version 26. Results: A total of 270 students were invited to participate in the study. Mean age of participants was 21.78 ± 2.42. Majority of the students were female 70.7 % (191) including 70 from public medical colleges and 121 from private medical colleges. 73.85% female agreed that medical degree facilitate marriage (P<0.00). 78 % study participant replied that career choice was done by themselves (P < 0.05). About 76 % were in favour of doing post-graduation. Conclusion: Medical education is a challenging yet highly sought-after career choice. This study highlights the evolving trends in selecting medical education, particularly for its dual benefits of professional and social advantages.

Prevalence and risk factors of Type II diabetes under the age of 30 years in district of Faisalabad.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To identify key sociodemographic and clinical factors associated with hypertension and obesity among adults using multivariate logistic regression. Study Design: Cross-sectional Survey. Setting: Allied Hospital, Faisalabad. Period: June 2024 to December 2024. Methods: Collected data on sociodemographic and clinical variables, including sex, residence, blood glucose type, age, smoking, and income. Logistic regression models assessed their associations with hypertension and obesity, with model fit evaluated via Deviance, Pearson, and Hosmer-Lemeshow tests. Results: The hypertension model was significant (p=0.023), with a deviance R-squared of 23.76%. Females had lower odds of hypertension (OR=0.113; p=0.006), while urban residents had over five times higher risk than rural residents (OR=5.125; p=0.023). Participants with fasting blood glucose were less likely to be hypertensive compared to those with random blood glucose (OR=0.243; p=0.021). The obesity model was also significant (p=0.006), with a deviance R-squared of 34.2%. Sex was the sole significant predictor (p<0.001), indicating males had a higher risk of obesity. Conclusion: Gender was a consistent predictor for both conditions, with male predominance. Urban residence and blood glucose type significantly influenced hypertension risk. These findings suggest the need for targeted interventions and emphasize the importance of fasting glucose monitoring in hypertension screening.

Role of antibiotic lock in the prevention of catheter induced infection in patients undergoing hemodialysis.

Nargis Abid, Ghulam Abbas — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To determine the role of antibiotic lock in the prevention of catheter related infection in patients undergoing hemodialysis at a tertiary care hospital. Study Design: Descriptive Case Series. Setting: Department of Nephrology, Nishtar Hospital in Multan. Period: 1^st March 2021 to 31^st May 2021. Methods: Following approval from the ethics review committee, 136 patients who presented to the Department of Nephrology at Nishtar Hospital in Multan and met the inclusion criteria were selected after informed consent. After each session of dialysis, catheter lock solution (CLS) containing 1.35% taurolidine and 4% sodium citrate was fed into both catheter lumens. This solution was then withdrawn prior to the beginning of the second session, and these patients were observed for a period of ninety days. Results: Of 136 patients, 66.9 % (n=91) were male, their mean age was 53.04 ± 9.60 years. Of these 136 patients, 38.2 % (n = 52) were from poor social background. Diabetes was noted in 25.7 % (n = 35) and hypertension in 47.8 % (n = 65). Obesity was noted in 14.0 % (n = 19). Infection free survival of the catheter was noted in 89.7 % (n = 122) of our participants. Infection prevention was significantly higher in ≤ 50-years old (p-value 0.023), from urban population (p-value 0.001), poor socioeconomic status (0.002) and non-diabetic patients (0.048). Conclusion: Non-Diabetics, age ≤50-years, urban residence, and poor socioeconomic standing were significantly related with prevention of catheter infection using antibiotic lock. It is recommended to use taurolidine based lock solutions in dialysis facilities.

Frequency of hypokalemia in pediatric ICU patients with diarrhea and their outcome in a tertiary care pediatric hospital in Lahore, Pakistan.

Nida Ahmad, Abid Rafiq Chaudhary, Muhammad Usman, Muhammad Rashid Ayub — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To provide comprehensive insight into this issue and determine the frequency of hypokalemia, ultimately offering recommendations for reducing its occurrence among patients suffering from diarrhea. Study Design: Cross sectional study. Setting: Pediatric Intensive Care Unit (PICU) of Fatima Memorial Hospital in Lahore. Period: June 25, 2022 to September 24, 2023. Methods: A total of 175 children, encompassing both genders and aged between 1 month to 12 years, who were admitted to the PICU for a minimum duration of 48 hours, were included in the study. The data pertaining to the children's basic demographic information, diagnosis, length of stay, and outcomes were documented on a proforma. The analysis of the data was conducted using SPSS v25, wherein all variables underwent a descriptive analysis. By implementing stratification, we were able to control for potential confounding variables, such as age and gender. Following stratification, Chi-square and Independent t-tests were performed, with a p-value of 0.05 indicating statistical significance. Results: Gender distribution showed that 112(64.0%) were males and 63(36.0%) were females. The mean age of the children was 26.32±32.02 months. The mean serum potassium level was 3.19±0.80 mEq/L. Among 175 children with diarrhea, 110(62.9%) had hypokalemia. According to outcome of children, 33(18.9%) were discharged home, 128(73.1%) discharged to the ward, and 14(8.0%) expired. The mean stay in the PICU was 4.69±3.852 days and the mean stay in the hospital was 5.87±3.729 days. Conclusion: Hypokalemia, a frequently encountered electrolyte disturbance in pediatric patients afflicted with acute bouts of diarrhea, necessitates the utmost vigilance on the part of the attending physician. To avert the potentially dire consequences of severe hypokalemia, it is imperative for healthcare providers to engage in diligent and sequential surveillance of serum potassium levels while concurrently implementing potassium supplementation for affected children amidst episodes of acute diarrhea.

To compare the outcomes of endoscopic septoplasty and conventional septoplasty for deviated nasal septum in terms of symptomatic improvement and post-operative complications.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To compare the outcomes of endoscopic septoplasty and conventional septoplasty for deviated nasal septum in terms of symptomatic improvement and post-operative complications. Study Design: Randomized Controlled Trial (RCT). Setting: Department of ENT Unit 2, Sir Ganga Ram Hospital, Lahore. Period: January 15, 2025 and July 14, 2025. Methods: A 60-case sample size, 30 cases in 2 groups was included. In group A, patients underwent surgery by endoscopic method under general anesthesia by using a 0-degree endoscope. In group B, patients underwent surgery by conventional method with illumination by headlight, nasal speculum and frees dissector after surgery, nasal cavity was packed with nasal pack soaked with bismuth iodoform paraffin paste. On weekly basis, for 4 weeks, all the patients were monitored in ENT opd. Results: 4^th week follow up: in endoscopic group the nasal obstruction was found in 1(3.3%) patient and in conventional group it was found in 7(23.3%) patients (p-value=0.023). Endoscopic group the nasal discharge was found in 3(10.0%) patients and in conventional group was found in 10(33.3%) patients (p-value=0.028). In endoscopic group the persistent septal deviation was found in 7(23.3%) patients and in conventional group it was found in 15(50.0%) patients (p-value=0.032). Conclusion: This study concluded that endoscopic septoplasty is significantly more effective compared to conventional septoplasty for deviated nasal septum for outcomes in terms of symptomatic improvement and complications after surgery.

Role of Nasal CPAP in reducing the need of mechanical ventilation in premature newborns with gestational age less than 37 weeks in resource limited setting.

Thu, 02 Oct 2025 00:00:00 -0700

Objective: To ascertain the incidence of favorable outcomes resulting from the utilization of CPAP in preterm neonates. Study Design: Descriptive, Cross-sectional study. Setting: Department of Pediatrics, Madinah Teaching Hospital, Faisalabad. Period: 30^th June 2023 to 29^th December 2023. Methods: Our study included 316 preterm neonates of both genders who were treated with CPAP and had a gestational age of fewer than 37 weeks. Patients diagnosed with neuromuscular illness, congenital malformations, grade III hypoxic-ischemic encephalopathy (HIE), syndromic newborns, and congenital heart disease were not included. The factors reported on the performa included gestational age, birth weight, time of initiating CPAP after birth, administration of surfactant, and duration of CPAP treatment. The outcome was assessed based on two criteria: successful outcome, defined as the patient achieving complete recovery after CPAP treatment without needing mechanical ventilation, and treatment failure, defined as the patient requiring mechanical breathing after CPAP treatment. Results: The average gestational age was 30.08 ± 2.75 weeks. Among the 316 patients, 161 (50.95%) were male and 155 (49.05%) were female, resulting in a male to female ratio of 1.1:1. The average birth weight was 2.50 ± 0.73 kg. The mean Apgar score was 5.46 with a standard deviation of 1.45. The average time for initiating CPAP after birth was 17.46 ± 9.04 hours. The study revealed that 233 out of 315 preterm neonates (73.73%) experienced successful outcomes with the use of CPAP. Conclusion: This study determined that the rate of favorable outcomes in the use of Continuous Positive Airway Pressure (CPAP) for preterm newborns is exceptionally high.

Comparing Doppler indices of umbilical artery in pregnancy-induced hypertension and normal pregnant women during the third trimester of pregnancy.

Shamoona Rashid, Sadia Zafar, Hafiza Shagufta Batool, Anusha Khalid — Thu, 02 Oct 2025 00:00:00 -0700

Objective: To compare Doppler indices of umbilical artery - resistance index (RI), pulsatility index (PI), and systolic to diastolic (SD) ratio between pregnancies complicated by pregnancy induced hypertension (PIH) and normotensive pregnancies in the third trimester. Study Design: Comparative Cross-Sectional Study. Setting: Aziz Fatimah Hospital, Faisalabad, Pakistan. Period: June 2024 to December 2024. Methods: In this study, 100 singleton pregnancies (50 PIH, 50 normotensive) underwent ultrasound Doppler assessment at 32‑38 weeks’ gestation. Mean PI, RI, and S/D ratio were calculated for each group. Independent t-test and Mann-Whitney U test were applied, with significance at p < 0.05. Results: All Doppler indices were significantly higher in the PIH group (PI 1.26 ± 0.25; RI 0.72 ± 0.06; S/D 4.08 ± 0.58) than in normotensive controls (PI 0.81 ± 0.13; RI 0.55 ± 0.06; S/D 2.08 ± 0.27) (p < 0.001 for each). Elevated indices indicate increased placental vascular resistance consistent with impaired fetoplacental perfusion. Conclusion: Pregnancy‑induced hypertension is associated with significantly raised umbilical‑artery PI, RI, and S/D ratio, corroborating previous evidence of placental insufficiency in hypertensive pregnancies. Routine third‑trimester Doppler surveillance and serial monitoring of these indices may facilitate early intervention and improve perinatal outcomes.