The Professional Medical Journal

Metabolic syndrome in carpal tunnel syndrome patients.

Aiman Shafique, Khalid Sher — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine frequency of metabolic syndrome in patients with carpel tunnel syndrome (CTS). Study Design: Cross sectional study. Setting: Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: December 2024 to March 2025. Methods: A total of 54 diagnosed patients of CTS with duration ≤ 3 months having age between 18-70 years of either gender were included. The diagnostic criteria for CTS was patient with complaint of numbness, tingling sensation, weakness or pain of hand (on history and clinical evaluation) and was confirmed on electrodiagnostic test CTS showed demyelinating lesion of median nerve with conduction block at wrist. Metabolic syndrome was diagnosed as by existence of >3 of the below mentioned criteria; 1) Waist circumference (WC) > 102 cm for men & > 88 cm for women, 2) Blood Pressure (BP) > 130/85 mmHg 3) Fasting blood glucose (FBG) > 100 mg/dl 4) Fasting triglycerides > 150 mg/dl 5) Fasting HDL cholesterol < 40 mg/dl for men & < 50 mg/dl for women. SPSS version-26 was utilized for data analysis. Results: The mean age of individuals was 47.3 + 16.03 years, mean BMI was 27.69 + 5.06 kg/m² & mean duration of symptoms was 2.296 + 1.5 months. Male/Female ratio was same 50:50. 30 (54.5%) of the CTS patients had metabolic syndrome. Conclusion: Although small proportion of individuals with CTS was included, outcomes of this research revealed that metabolic syndrome seems to be highly prevalent in individuals with Carpel tunnel Syndrome.

Effectiveness of hydroxyurea in reducing the transfusion requirements in patients with beta-thalassemia major.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the effectiveness of hydroxyurea in reducing the transfusion requirements in patients with beta thalassemia major. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Medicine, Ghulam Muhammad Mahar Medical College (GMC), Sukkur, Pakistan. Period: January 2024 to January 2025. Methods: A total of 230 patients (115 in each group) aged 5-12 years with beta-thalassemia and receiving six or more annual blood transfusions were enrolled. In hydroxyurea group, oral hydroxyurea was given at 10-20 mg/kg/day along with standard treatment. Standard treatment group was maintained at normal blood transfusions and chelation therapy without giving them hydroxyurea. Both treatment groups were followed for six months to track their transfusion requirements, hemoglobin and serum ferritin levels. Data were analyzed using IBM-SPSS statistics, version 26.0. Results: In a total of 230 patients, 124 (53.9%) were male, and the mean age was 8.54±2.3 years. The mean baseline hemoglobin levels, serum ferritin levels, the number of PRBC transfusions, and transfusion intervals were 6.48±0.81 g/dl, 2536.18±1418.28 ng/dl, 3.09±0.67, and 2.94±0.88 weeks, respectively. After 6-months of treatment, patients receiving hydroxyurea demonstrated a significantly lower mean number of PRBC transfusions (1.27±0.45 vs. 2.50±0.50; p<0.001), longer transfusion-free intervals (3.66±0.70 vs. 3.17±0.75 weeks; p<0.001), higher hemoglobin levels (8.24±0.68 g/dl vs. 7.72±0.93 g/dl; p<0.001), and greater reduction in serum ferritin levels (1910.84±1019.46 ng/dl vs. 2229.72±1208.22 ng/dl; p=0.0365). Conclusion: Hydroxyurea significantly reduces transfusion requirements, prolongs transfusion intervals, increases hemoglobin levels, and lowers serum ferritin in patients with beta-thalassemia major.

Usefulness of validation of Evendo calculator in chronic liver disease patients in Liaquat National Hospital, Karachi, Pakistan.

Baby Anbreen, Shahid Karim, Punhal Khan, Mehreen Akmal, Baseer Ahmad — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To validate the EVendo score to predict esophageal varices (EV) by confirming the presence of EV on upper gastrointestinal (GI) endoscopy at tertiary care hospital, Karachi, Pakistan. Study Design: Cross-sectional, Validation study. Setting: Department of Gastroenterology at Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: October 2022 to June 2023. Methods: Total 412 patients with chronic liver disease (CLD) of any etiology who were underwent upper GI endoscopy for variceal screening were included. Demographic, laboratory and clinical information were recorded. By verifying the existence of EV on upper GI endoscopy, the validity and reliability of the EVendo score in predicting EV were assessed. SPSS V 22 was used for data analysis. Results: Out of 412 patients the ratio of men to women was 1.16:1. The average age was 55.67±11.21 years, and 191 patients (46.4%) had hepatic encephalopathy and 344 patients (83.5%) had ascites. The average score for EVendo was 7.26±3.05. Eighty-three percent of patients received positive findings for varices during upper GI endoscopy. The EVendo score's area under the curve for identifying variations was 0.908. 5.28 (sensitivity = 84.6%, specificity = 92.6%), 4.85 (sensitivity = 85.5%, specificity = 91.4%), and 5.71 (sensitivity = 84.3%, specificity = 92.6%) were the ideal cuff off values. The diagnostic accuracy for the EVendo score, using upper GI endoscopy as the gold standard, was 86.2%. Conclusion: The EVendo score showed excellent diagnostic accuracy, sensitivity, and specificity in predicting esophageal varices among patients with chronic liver disease.

To compare the efficacy and safety profile of empagliflozin and sitagliptin as an add on therapy to metformin in T2DM patients.

Javed Iqbal, Haroon Aziz, Asif Hussain, Mazhar Hussain — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To compare the efficacy and safety and profile of empagliflozin and sitagliptin as an add on therapy to metformin in T2DM patients. Study Design: Randomized Controlled Trial. Period: January to March 2024. Setting: Sheikh Zayed Medical College & Hospital, Rahim Yar Khan. Methods: A total of 280 T2DM patients with inadequate glycemic control on metformin were randomly assigned to receive either empagliflozin or sitagliptin. The primary outcomes included changes in body weight (BW), body mass index (BMI), fasting blood glucose (FBG), HbA1c, systolic and diastolic blood pressure (SBP, DBP), and lipid profile. Secondary outcomes involved monitoring adverse effects throughout the study. Results: After 12 weeks, both groups showed significant reductions in BW and BMI, with empagliflozin showing greater improvements (BW: 92.5±13.5 to 79±14.5 kg, BMI: 29.4±4.2 to 27.5±3.8) compared to sitagliptin (BW: 89±16.6 to 81±12.5 kg, BMI: 28.5±5.6 to 27.3±4.2). Similarly, empagliflozin more effectively reduced FBG (240±60.5 to 130±35.5 mg/dL) and HbA1c (8.35±1.9% to 7.2±1.6%) compared to sitagliptin. Both drugs were well-tolerated with no major adverse effects. Conclusion: Empagliflozin demonstrated superior efficacy and safety compared to sitagliptin as an add-on therapy to metformin in T2DM management.

Role of computed tomography angiography for the diagnosis of cerebral aneurysm in patients with atherosclerosis.

Zara Javed, Rimsha Badar, Sheikh Daniyal Hanan, Sidra Inam — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the role of CT Angiography for the Diagnosis of Cerebral Aneurysm types in Patients with Atherosclerosis. Study Design: Retrospective study. Setting: Chughtai Lab of Diagnostic Centre Jail Road, Lahore. Period: September 2024 to December 2024. Methods: In this study 44 patients who fulfilled the criteria, were taken, out of which 16(36.4%) were males and 28(63.6%) were females. Out of these 44 patients, 34(77.2%) were found to have cerebral aneurysms as detected on CTA. The important measurements included the shape and size of types of cerebral aneurysm. Results: The study concluded that CTA was found accurate in diagnosing and differentiating all the anatomical types of cerebral aneurysm and the ruptured aneurysms. The mean age of study participants is 56.68 ± 12.22 years with age range 37 to 80 years. In this study the aneurysms are categorized into small sized aneurysm (<5mm), medium sized aneurysm (5-10mm), large sized aneurysm (10-25mm) and giant aneurysm (>25mm). 19 patients (43.2%) had small size aneurysm, 11 patients (25%) had medium size aneurysm, 3 patients (6.8%) had large sized aneurysm and 1 patient (2.3%) had a giant aneurysm. In these 34 patients who had cerebral aneurysms, 12 patients (27.3%) had saccular aneurysm, 9 patients (20.5%) had fusiform aneurysm, 6 patients (13.6%) had dissecting aneurysm and 7 patients (15.9%) had ruptured irregular shaped aneurysms which means intracerebral bleeding is also detected in my study. Conclusion: Computed Tomography Angiography is the safe non-invasive diagnostic modality to detect all the morphologies of cerebral aneurysms. CTA can also detect the ruptured intracranial bleeding of an aneurysm which is less likely to be clearly seen on other modalities i.e. DSA.

Common organisms in urinary tract infections and their sensitivity to pharmacological treatment in the outdoor patients of Urology Department Sheikh Zayed Hospital.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To identify the most common organisms causing urinary tract infections (UTIs) and evaluate their sensitivity to pharmacological treatments. Study Design: Cross-sectional study. Setting: Out-patient Department of Urology, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 1 Nov 2024 to 1 April 2025. Methods: on 119 patients, both male/female, aged 18-60 years, diagnosed with UTIs and no history antibiotic intake. Urine samples were collected and sent for culture and sensitivity. Data was analyzed using SPSS 25.0 with P-value < 0.05 as statistically significant. Results: In the study, the mean age of male participants was 43.45 ± 9.01 years, while the mean age of female participants was 44.58 ± 12.94 years. Fever was significantly more common in males (36.5%) compared to females (11.9%) (p = 0.003). Escherichia coli was the most prevalent (35.3%), with high susceptibility to Amikacin (83.3%) and Colistin (95.2%), but high resistance to Amoxicillin (76.2%) and Cefotaxime (47.6%). Klebsiella pneumoniae was most susceptible to Colistin (94.9%) and Meropenem (92.3%) but resistant to Amoxicillin (87.2%) and Cefotaxime (61.5%). Pseudomonas aeruginosa showed high resistance to Amoxicillin (52.4%) but was highly susceptible to Colistin (88.9%) and Teicoplanin (100%). Conclusion: Escherichia coli was identified as the most prevalent pathogen, particularly in females. The findings highlight the concerning resistance of common pathogens, such as Klebsiella pneumoniae and Pseudomonas aeruginosa, to frequently used antibiotics

Comparison of postoperative infection rates by use of single-dose with multiple-doses of prophylactic antibiotics in thyroidectomy.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To compare the postoperative wound infection rates in thyroidectomy patients receiving single-dose prophylactic antibiotics and multiple-dose regimens. Study Design: Prospective, Randomized Controlled Trial. Setting: Surgical Ward, Narowal Medical College/DHQ Teaching Hospital, Narowal. Period: 1^st January 2024 to 31^st December 2024. Methods: Patients undergoing elective thyroidectomy were randomized divided into two groups: Group A (single-dose) received a single ceftriaxone (1.0 g IV) 30 minutes before incision, and Group B (multiple-dose) received the same initial dose followed by three additional doses every 8 hours for 24 hours after surgery. Postoperative infections were evaluated on days 3, 7, and 30. Statistical analysis was performed using chi-square tests for categorical variables and t-tests for continuous variables. Results: A total of 200 patients were enrolled, with 100 in each group. Among them 156 were females and 44 were male with male to female ratio was 78:22 percent (3.54: 1). The overall infection rate was 2% (4/200). Group A had an infection rate of 3% (3/100), while Group B had an infection rate of 1% (1/100), with no statistically significant difference (p = 0.312. The cost of antibiotic therapy was significantly lower in Group A (P < 0.001). Conclusion: Single-dose prophylactic antibiotics are as effective as multiple-dose regimens in preventing postoperative infections in thyroidectomy, and lower costs.

Comparison of surgical outcomes between consultant and residents general surgeons after elective abdominal procedures.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To compare surgical outcomes after elective abdominal surgeries between consultant and supervised resident general surgeons. Study Design: Cross Sectional study. Setting: Department of General Surgery, HMC, MTI Peshawar. Period: March 2023 to September 2023. Methods: Included 129 patients undergoing elective abdominal surgeries. Patients aged 18-70 years were included, while emergency procedures, pregnant patients, abdominal trauma cases, and surgeries by junior residents were excluded. Preoperative data, including patient demographics and clinical characteristics, were collected. Surgeries were performed by consultants or 4^th year resident under supervision. Postoperative complications were monitored for 30 days. Results: The study population comprised 55.8% females and 44.2% males, with a mean age of 39±10.9 years. Consultants performed 49.6% of surgeries, while residents performed 50.4%. Mesh hernia repair was the most common procedure (50.4%). Surgical site infection was the most frequent complication (13.2%), followed by readmission (3.1%) and return to OR (2.3%). No statistically significant differences in complication rates were found between consultant and resident surgeons (all p-values > 0.05). Conclusion: The study demonstrates comparable postoperative complication rates between consultant and resident surgeons, highlighting the effectiveness of supervised surgical training in maintaining high standards of patient care. Direct supervision plays a crucial role in developing residents' skills while ensuring patient safety.

Microbial profile and antimicrobial susceptibility pattern in diabetic foot ulcer patients attending a tertiary care hospital.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the frequency of culture-positive DFUs, identify the microbial profile, and analyze the antimicrobial susceptibility patterns among diabetic patients at Ghulam Muhammad Mahar Medical College (GMMMC) Hospital, Sukkur. Study Design: Cross-sectional study. Setting: Department of Medicine, Ghulam Muhammad Mahar Medical Teaching Hospital, Sukkur. Period: January 2024 to June 2024. Methods: 150 diabetic patients with DFUs. A non-probability consecutive sampling technique was used. Culture and sensitivity testing were performed on tissue samples collected from infected ulcers. Frequencies, percentages, means, and standard deviations were calculated. Results: Of the 150 DFU cases, 72 (48.0%) were culture-positive. The most commonly isolated organisms were Escherichia coli (29.2%), Klebsiella pneumoniae (25.0%), Staphylococcus aureus (23.6%), and Pseudomonas aeruginosa (22.2%). The highest antibiotic sensitivity was observed for cephalosporins (60.7%), followed by vancomycin (12.7%). The highest resistance was noted against cephalosporins (39.3%) and penicillin (37.5%). Conclusion: The study highlights a high burden of MDR infections in DFUs, necessitating improved antibiotic stewardship and infection control measures. Routine culture-based sensitivity testing should be integrated into clinical practice for targeted antibiotic therapy. Further research on biofilm formation and novel antimicrobial therapies is recommended to enhance DFU management and reduce complications.

Lumbar disc herniation: Outcomes of Unilateral Bi-Portal Endoscopic Technique: At a Tertiary Care Hospital, Pakistan.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To measure the clinical outcome of unilateral bi-portal endoscopic technique for lumbar disc herniation. Sudy Design: Prospective Cohort study. Setting: Department of Orthopaedics & Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: October 01, 2023, to December 30, 2024. Methods: The study included 60 patients between the age of 20-60 years diagnosed with lumbar disc herniation and lumbar canal stenosis. All the p-values ≤ 0.05 were considered to be statistically significant. Results: In our study, the majority, 39 (65.0%), were male patients with a mean age of 40.94±8.76 ranging from 29 to 60 years. The mean ODI score significantly decreased among patients. 83.3% of patients were very satisfied, indicating no pain, no restriction of mobility, and a return to regular work and level of activity; 10.0% of patients reported good levels. 3.3% of cases were found to be fair, and 3.3% of cases were found to have poor satisfaction levels. Conclusion: Our results showed that this technique is as safe and effective as other MIS techniques, and most of our patients showed significant improvement after surgery. However, a comparison of UBE and other MIS techniques must be assessed to demonstrate this technique's effectiveness.

Incidence of knee pain after intra-medullary nail for close tibia fracture.

Majid Hussain, Muhammad Arif Khan — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the incidence of knee pain following intramedullary locking nail (ILN) insertion for closed tibia shaft fractures. Study Design: Descriptive study. Setting: Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Period: 24^th September 2024 to 24^th February 2025. Methods: A sample size of 151 participants was calculated using the WHO sample size calculator with a 95% confidence level and a 5% margin of error. Non-probability consecutive sampling was used to recruit patients aged 18-65 years undergoing ILN for closed tibia fractures (AO type A and B). Data were collected using the Visual Analog Scale (VAS) for pain intensity and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional outcomes after follow up of 45 days post ILN. Statistical analysis was performed using IBM SPSS version 23. Results: The mean age of participants was 34.47 ± 16.32 years, with 76.8% being male. Functional outcomes were good in 69.5% of participants, fair in 21.9%, and poor in 8.6%. Pain assessment revealed 37.7% with no pain, 34.4% with mild pain, 19.2% with moderate pain, and 8.6% with severe pain. Significant associations were found between functional outcomes and gender, age, education, diabetes, and fracture type (p < 0.001). Males, younger patients (18-40 years), those with higher education, non-diabetic patients, and those with Type A fractures had better outcomes. Pain levels were similarly influenced by these factors. Conclusion: Functional outcomes were predominantly good (69.5%) with significant pain-free status (37.7%) in patients undergoing ILN for closed tibia fractures. Younger age, male gender, higher education, absence of diabetes, and Type 1 fractures were significant predictors of superior functional outcomes and reduced pain scores.

Frequency of dyslipidemia in children with Type 1 diabetes.

Fariya, Zulqarnain Dilawar, Fazal Rabbi — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the frequency of dyslipidemia in children with type 1 diabetes presenting to tertiary care hospital. Study Design: Cross-sectional study. Setting: Ayub Teaching Hospital Abbottabad, Khyber Pakhtunkhwa, Pakistan. Period: October 2024 to January 2025. Methods: A total of 125 children aged 1 to 15 years with T1DM were included. Dyslipidemia was defined based on established lipid thresholds. Demographic data, diabetes duration, and fasting lipid profiles were collected and analyzed. Results: The average age of the individuals was 8.5 years, accompanied with an average diabetic period of 4.6 years. The prevalence of dyslipidaemia was 20.8%, notably higher in children over 10 years (32.6%) than in those between 1–10 years (13.9%) (p = 0.013). No notable correlations were detected between dyslipidaemia and gender (p = 0.645) or the duration of diabetes (p = 0.156). Conclusion: This study underscores a significant prevalence of dyslipidaemia in children with Type 1 Diabetes Mellitus, especially in older children.

Effect of physiotherapy on number of casts in treatment of congenital talipes equinovarus (Club Foot).

Hassan Ahmed, Kashif Mahmood, Aisha Jabeen, Pervez Ali, Mehtab Ahmed, Ammar Baig — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To evaluate the effectiveness of pre-casting physiotherapy in reducing the number of casts required for correction in congenital talipes equinovarus (CTEV) using the Ponseti method. Study Design: Prospective, Interventional Trial. Setting: Orthopedic Outpatient Department, Jinnah Postgraduate Medical Centre, Karachi. Period: January 2024 to June 2024). Methods: A total of 102 patients with idiopathic CTEV were recruited and divided into two groups: Physiotherapy group (n=51): Received pre-casting physiotherapy followed by standard Ponseti casting. Control group (n=51): Underwent standard Ponseti casting without physiotherapy. The primary outcome was the number of casts required for correction, while secondary outcomes included final correction rates, compliance, and relapse rates. Results: The physiotherapy group required significantly fewer casts for correction compared to the control group (mean: 4.3 vs. 5.8 casts, p = 0.005). Both groups achieved a similar final correction rate of 88.2% (p = 1.000). Compliance was higher in the physiotherapy group, with 78.4% showing excellent adherence compared to 51% in the control group, (p = 0.002). Relapse rates were lower in the physiotherapy group (7.8%) than in the control group (13.7%), but this difference did not reach statistical significance (p = 0.338). Conclusion: Pre-casting physiotherapy significantly reduces the number of casts required for correction in the Ponseti method, potentially improving patient compliance and reducing treatment burden without compromising final correction outcomes. These findings suggest that physiotherapy may be a valuable adjunct in optimizing CTEV management. Further randomized controlled trials are recommended to validate these findings.

Frequency of rectal polyps among children presenting with rectal bleeding.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the frequency of rectal polyps among children presenting with rectal bleeding. Study Design: Cross Sectional study. Setting: Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar. Period: 22^nd October 2022 till 22^nd April 2023. Methods: Male and female patients in the age range 2 to 16 years presenting with lower GI bleed were enrolled. Patients were evaluated for cause of the bleeding. Presence of polyps on proctoscopy was considered confirmatory for the presence of rectal polyps. Results: A total of 236 patients were enrolled. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 2:1. Rectal polyps were observed in 80 patients (33.9%) patients. Conclusion: Rectal polyps are a common cause of lower GI bleed in children in our local population. Proctoscopy evaluation is a simple clinical tool for evaluation, diagnosis and management of rectal polyps.

Spectrum of psychosomatic disorder in children at the children hospital and the institute of child health Multan.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To explore the Spectrum of Psychosomatic Disorders in Children Presenting to CH & ICH Multan. Study Design: Descriptive Cross Sectional. Setting: Developmental- Behavioral Pediatric, Out Patient Department (OPD) at CH & ICH Multan. Period: September 2022 to September 2023. Methods: After informed consent of participants & approval of ethical committee, (306/22) total of 80 Patients, age group 5-15 years, of both genders were recruited in this study according to inclusion criteria. After detailed history and examination by Physician and Psychologist, evaluated the presenting complaints, underlying stress factors and consequences of these stressor in these children. The information was entered into pre-formed Performa. Data were analyzed through SPSS 21. Results: Total study participants were 80, male [59 (73.2%)] with male to female ratio of 1.3:1and age group 5-10years [62(76.8%)] were prominent. Most common presenting complaints were headache 80 (100%), dizziness 76 (95%), Fits like activity 78 (96%), limbs Pain 75 (87.6%), Pain Abdomen 72 (84%) & Nausea 58 (72%). These symptoms occur isolated or combination of two or more. Psychosomatic disorder found mainly in families with low Socioeconomic status 52 (64.5), & school attending students 68 (84%). Children who left school due to these stressors were 71 (88.8%). Other consequences were depression, low self-esteem and irritable behavior. Conclusion: Psychosomatic disorder is commonly present in children particularly in age group 5-10 years, male gender with headache as most common presentation. Pre dominant results are School dropout, Depression, Low Self-esteem & Irritable behavior.

Frequency of cardiac dysfunction in severely malnourished children.

Ramsha Mehmood, Arit Parkash, Sadaf Asim — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the frequency of cardiac dysfunction in children having severe acute malnutrition (SAM). Study Design: Cross-sectional study. Setting: In-patient Department of Pediatric Medicine, National Institute of Child Health (NICH), Karachi, Pakistan. Period: May 2024 to October 2024. Methods: A total of 188 children aged 6-59 months with severe acute malnutrition (SAM) were analyzed. Demographics, anthropometric data, and vital signs were documented. Echocardiography assessed ejection fraction (EF), right ventricular mass (RVM), and left ventricular mass (LVM). Data were analyzed using IBM-SPSS Statistics, version 26.0. Results: In a total of 188 children, 101 (53.7%) were female. Cardiac dysfunction was noted among 45 (23.9%) children. The most common cardiac dysfunction findings were diastolic dysfunction, and left ventricular hypertrophy, identified in 24 (53.3%), and 13 (28.9%) children, respectively. The mean WHZ-score was significantly lower in children with cardiac dysfunction (-3.38±0.52 vs. 3.09±0.30, p<0.001). Bilateral pedal edema (53.3% vs. 17.5%, p<0.001), dyspnea (57.8% vs. 40.6%, p=0.043), abnormal fast breathing (40.0% vs. 20.3%, p=0.008), difficulty in breathing (66.7% vs. 44.8%, p=0.010), weight loss (40.0% vs. 20.3%, p=0.008), and hepatomegaly (40.0% vs. 20.3%, p=0.008) were significantly associated with cardiac dysfunction. Echocardiographic findings showed that children with cardiac dysfunction had a significantly lower mean ejection fraction (58.67±4.82 vs. 62.80 ± 3.87%, p<0.001), higher right ventricular mass (18.27±4.34 vs. 17.10±3.03 g, p=0.045), and lower left ventricular mass (21.09±11.30 vs. 27.45±8.30 g, p<0.001). Conclusion: This study highlights the significant burden of cardiac dysfunction in children with SAM.

Early avastin (Bevacizumab) Administration for acute retinal vein occlusion: A key strategy for improved patient outcomes.

Amna Iqbal, Sidra Zafar, Hassam Mukhtar, Zukhruf Ijaz, Talha Nafees, Farhan Ali — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To find the mean change in BCVA and CMT after intravitreal injection Avastin administration in patients with acute retinal vein occlusion with macular edema. Study Design: Quasi-experimental study. Setting: LRBT Eye Hospital, Lahore. Period: June 2023 to November 2023. Methods: 60 Patients with acute retinal vein occlusion (RVO) and macular edema, diagnosed within three months of symptom onset. Patients received monthly intravitreal injections of bevacizumab (1.25 mg in 0.05 mL) over three months. Bevacizumab, a widely used anti-VEGF agent, is known to reduce macular swelling and improve vision. The primary outcomes were changes in best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT, µm), reflecting vision clarity and macular edema, respectively. Both were monitored using high-resolution optical coherence tomography (OCT), a non-invasive imaging modality. Baseline characteristics were analyzed to assess correlations between demographics, disease duration, and treatment response. Results: The study demonstrated significant improvements: mean baseline BCVA improved from 1.09 ± 0.17 to 0.56 ± 0.19 (p < 0.001), and mean CMT decreased from 455.48 ± 52.05 µm to 300.66 ± 63.96 µm (p < 0.001) after three months. No systemic or ocular adverse events were recorded, supporting bevacizumab’s efficacy and safety for RVO-associated macular edema. Conclusion: We found Intravitreal bevacizumab is a safe and effective method of treatment while dealing with macular edema secondary to RVO in our population, providing significant improvements in VA and MT.

Efficacy and safety of apremilast in patients with moderate to severe chronic plaque psoriasis.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To measure efficacy and safety of apremilast in patients with moderate to severe chronic plaque psoriasis. Study Design: Non Randomised Clinical Trial. Setting: Department of Dermatology Lahore Medical and Dental College / Ghurki Trust and Teaching Hospital, Lahore and Services Institute of Medical Sciences, Lahore. Period: 6^th April 2022 to 31^st July 2023. Methods: It was a non-randomized single group clinical trial in which patients were enrolled according to inclusion criteria for 6 months duration. This study was conducted at LMDC/ Ghurki Trust and Teaching Hospital, Lahore and Services Institute of Medical Sciences, Lahore with ethical letter no LM&DC/ 4961-62. Apremilast was given in 30mg twice daily dosage for 16 weeks and follow up was done after a treatment gap of 8 weeks. PASI score and body surface area was calculated before and after treatment. Data was analysed by SPSS version 22.0. Results: 30 patients were enrolled for the trial. Out of them, 12 patients achieved PASI 90, 5 patients achieved PASI 75, 8 patients achieved PASI 50, 7 patients had less than 50% reduction in PASI at the end of 16 weeks. After a treatment gap of 8 weeks 100% patients returned with relapse of psoriasis, with average PASI score of 6.04. Reported side effects included nausea, vomiting, abdominal pain and mild weight loss. Five patients left treatment due to severe nausea, vomiting and abdominal pain. Conclusion: Apremilast significantly reduces signs and symptoms of psoriasis with a good safety profile.

Comparison of neonatal outcome in laboring patients with fetal distress on cardiotocography having clear liquor versus meconium-stained liquor.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To compare neonatal outcomes in laboring patients with fetal distress on CTG who had either clear or meconium-stained amniotic fluid. Study Design: Comparative Cross-sectional study. Setting: Department of Gynecology, MNCH Hospital Faisalabad. Period: July 2024 to December 2024. Methods: Included 158 laboring patients diagnosed with fetal distress on CTG, divided into two groups: Group A (clear liquor, n=79) and Group B (meconium-stained liquor, n=79). Fetal distress was defined by CTG abnormalities, and neonatal outcomes were assessed based on the Apgar score (<7 at 5 minutes) and NICU admission within 12 hours of birth. Stratified analyses were performed to evaluate the impact of demographic and clinical variables. Results: The groups were comparable in terms of age, gestational age, parity, duration of labor, and mode of delivery. Poor Apgar scores were observed in 59.5% of Group A and 57.0% of Group B (p = 0.747). NICU admissions were slightly higher in Group B (69.6%) compared to Group A (65.8%), but the difference was not statistically significant (p = 0.610). Stratified analyses showed no significant differences in neonatal outcomes based on demographic or clinical factors. Conclusion: This study found no significant differences in neonatal outcomes between patients with fetal distress on CTG and clear or meconium-stained liquor. The findings emphasize the importance of individualized labor management and suggest that MSAF, while a potential risk factor, does not independently dictate adverse outcomes when CTG abnormalities are present.

Prophylactic Intravenous administration of ondansetron for prevention of spinal anesthesia induced hypotension in elderly patients.

Wed, 30 Jul 2025 00:00:00 -0700

Objective: To evaluate the efficacy of intravenous Ondansetron in reducing the incidence of spinal anesthesia-induced hypotension in elderly patients undergoing elective surgery. Study Design: Cross-sectional study. Setting: Independent University Hospital Faisalabad. Period: February 1, 2024, to July 31, 2024. Methods: One hundred elderly patients (aged 50-80 years) undergoing elective surgical procedures under spinal anesthesia, meeting the inclusion and exclusion criteria, were enrolled after obtaining informed consent. Ondansetron (8 mg) was administered intravenously five minutes before spinal anesthesia. Blood pressure was monitored at three-minute intervals for 30 minutes post-procedure to assess the incidence of hypotension, defined as a systolic blood pressure drop exceeding 20% from baseline or below 90 mmHg. Statistical analysis included chi-square tests for associations between demographic variables and hypotension incidence. Results: The study found hypotension in 39% of patients despite Ondansetron administration. Stratification by age, gender, and body mass index (BMI) showed no significant associations with hypotension incidence. Conclusion: Ondansetron demonstrated partial efficacy in reducing spinal anesthesia-induced hypotension. Future research with control groups and larger cohorts is recommended to confirm these findings and explore optimal preventive strategies.

Comparison of different treatment options of diabetic macular edema: A systematic comparison via Meta-Analysis.

Bilal Khan, Nuzhat Rahil, Rahil Malik, Muhammad Arib — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To compare the efficacy, safety, durability, and cost-effectiveness of different treatment modalities for clinically significant macular edema, including anti-VEGF agents, corticosteroid implants, subthreshold laser therapy, and combination treatments. Study Design: Systematic Review and Meta-analysis. Setting: Department of Ophthalmology of MTI, Lady Reading Hospital, and Khyber Teaching Hospital. Peshawar. Period: January 1, 2024, and April 30, 2025. Methods: Following the PRISMA 2020 guidelines, this systematic review and meta-analysis were conducted. Relevant studies were identified through PubMed, Embase, Cochrane, and Web of Science databases. Randomized control trials and comparative studies were included. Primary outcomes included changes in Best Corrected Visual Acuity (BCVA), central retinal thickness (CRT), injection frequency, and incidence of adverse events. Statistical analysis included pooled weighted mean differences, risk ratios, heterogeneity measures, and funnel plots. Results: Thirty-five studies were included in the qualitative synthesis, and thirty met criteria for meta-analysis. Anti-VEGF agents showed the greatest gains in BCVA and reduction in CRT, with faricimab requiring fewer injections. Corticosteroids demonstrated moderate efficacy but higher rates of intraocular pressure elevation and formation of cataract. Combination therapy with anti-VEGF and subthreshold laser reduced treatment burden without compromising outcomes, though recent high-quality studies remain limited. Bevacizumab remained the most cost-effective option. Heterogeneity across studies was moderate. Conclusion: Anti-VEGF therapy continues to be the mainstay for DME management. Corticosteroids and laser-based combination approaches serve as important alternatives in select populations.

Frequency of patients classified as Pre-COPD in tertiary care chest clinic.

Raj Kumar, Faisal Faiyaz Zuberi, Arif ul Islam — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To determine the frequency of pre-COPD among patients attending a tertiary chest clinic. Study Design: Cross-sectional study. Setting: The Chest Clinic of Ojha Institute of Chest Disease (OICD), Dow University of Health Sciences Karachi, Pakistan. Period: December 2024 to March 2025. Methods: A total of 185 patients aged ≥ 18 years, having history of smoking and/or exposure to biomass fumes, and presenting with cough, sputum production, and/or shortness of breath were analyzed. Demographic information, along with cough, sputum production, and shortness of breath, were documented. Smoking status, and history of biomass exposure were noted. Spirometry of each patient was performed and pre-COPD was diagnosed. Data analysis was done using IBM-SPSS Statistics, version 26.0. Results: In a total of 185 patients, the mean age was 45.3±14.3 years, and 115 (62.2%) were male. Cough, shortness of breath, and sputum production were reported in 151 (81.6%), 109 (58.9%), and 36 (19.5%) patients, respectively. History of biomass exposure, and smoking were reported in 96 (51.9%), and 94 (50.8%) patients, respectively. Pre-COPD was identified in 47 patients (25.4%). There was a statistically significant difference in the prevalence of pre-COPD by increasing age (p<0.001). Patients with pre-COPD more frequently reported sputum production (40.4% vs. 12.3%, p<0.001). All patients with pre-COPD demonstrated abnormal chest radiographs (100% vs. 21.0%, p<0.001). Conclusion: This study revealed a substantial prevalence of pre-COPD (25.4%) among patients at risk in a tertiary chest clinic setting. Pre-COPD was found to have significant associations with middle-aged groups, presenting with sputum production, and abnormal radiological findings.

Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department.

Kiran Azhar, Rubina Zulfqar, Sohail Aslam, Sadaf Khan, Hira Hameed, Kamran Ullah — Wed, 30 Jul 2025 00:00:00 -0700

Objective: To assess the diagnostic accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants taking urine culture as gold standard. Study Design: Cross sectional, validation. Setting: Pediatric Department, Dr. Akbar Niazi Teaching Hospital, Islamabad. Period: October 2024 to March 2025. Material and Methods: After fulfilling the inclusion criteria, 336 patients were enrolled in the study. A urine sample was collected and then divided into two portions. One was tested with a dipstick and other sent for culture. Infants were labelled positive or negative based on each result. Data is analyzed using SPSS version 25. Results: The mean age of the patients was 12.23±6.74 months, 176(52.4%) patients were male and 160(47.6%) patients were females and 130(38.7%) patients were from rural area and 206(61.3%) were from urban area. The sensitivity, specificity, PPV< NPV and diagnostic accuracy of dipstick method for detection of UTI was 95.21%, 93.24%, 94.71%, 93.88% & 94.35% respectively taking urine culture as gold standard. Conclusion: Dipstick urinalysis is reliable and useful method with high diagnostic value for diagnosing urinary tract infection in febrile infants taking urine culture as gold standard