Journal of Fatima Jinnah Medical University
Journal of Fatima Jinnah Medical University is open access, peer-reviewed journal published regularly on a quarterly basis since the year 2000. The journal is recognized by the Higher Education Commission of Pakistan and the College of Physicians and Surgeons of Pakistan. The articles published in the journal are of interest to researchers in health professions, medical and biomedical sciences, and health professional education. Journal accepts original articles, review articles, and case reports in health sciences. The journal follows a double-blind peer-review system for all submissions and all the manuscripts are peer-reviewed by at least two subject experts. The Journal of Fatima Jinnah Medical University uses Open Journal System (OJS), an online open source journal management system, which allows authors to submit and track their submissions online in a real-time manner. The journal follows a strictly anti-plagiarism policy according to HEC guidelines. In this direction, all the manuscripts are screened for similarity index with Turnitin® software before forwarding them to the reviewers and before final acceptance for publication.
Fatima Jinnah Medical University, Lahore-Pakistan
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Silent Impact of Floods on Child Health in Pakistan
Pakistan is highly vulnerable to climate change effects despite being a non-contributor to global greenhouse gas emissions1. Extreme temperatures, water insecurities, droughts, landslides, and heat waves have not only left devastating impacts on economy but also compromised physical, social and mental well-being of population. During recent frequent episodes of flooding battered more than two thirds of its districts1. Moreover, it impacts individuals of all ages, with children being particularly vulnerable due to their weaker immune systems and dependence on caregivers2. Pakistan is currently grappling with its most severe flood disaster, which has submerged vast areas, notably in eastern Punjab, followed by Khyber Pakhtunkhwa (KPK), Sindh and Gilgit-Baltistan (GB). Their impact on child health is multifaceted, with immediate public health consequences as well as numerous enduring challenges 2. More than 40% of Pakistan's population is under 18 years of age (approximately 112 million), child health is a major concern during such catastrophes. UNICEF reported that an estimated 3.4 million children were affected by the 2022 flood tragedy in Pakistan3. The most immediate and evident causes of flood-driven child mortality and morbidity are physical injuries from debris, collapsing structures, drowning, electrocution and snake bites. Furthermore, floods inversely impact child health by increasing the incidence of water-borne diseases such as hepatitis A and E, typhoid, cholera and diarrhea due to widespread water contamination and the breakdown of sewer systems. Stagnant water acts as a breeding ground for mosquitoes, further leads to the spread of vector-borne diseases like malaria and dengue4. Skin problems and respiratory issues also emerge from mold growth in persistently damp environments5.
Histopathological Patterns of Gastric Mucosal Biopsies in Functional Dyspepsia in Tertiary Care Hospital
Methods: This experimental study was done in Combined Military Hospital Lahore and Fatima Jinnah Medical University over 18 months. Isolated tissues obtained from adult healthy rabbits and rats were used in the study. Sample size was calculated by OpenEPI formula. Animals were divided into 5 groups comprising 20 animals in each group. Strips of rabbit ileum and rat gastric fundus tissues were allowed to stand in an organ bath with an isotonic force transducer attached to powerlab (AD instruments). Increasing concentrations of serotonin, mosapride, and ondansetron were applied to tissues and their responses were recorded by the change in the mean force of contraction (grams). Increasing concentrations of serotonin and mosapride were administered in the presence of ondansetron and their responses were recorded. T-test and ANOVA followed by Post Hoc Tukey’s test were used for statistical analysis. Results: There was a dose-dependent increase in the mean force of contraction with Serotonin, mosparide and ondansetron on rabbit ileum and rat gastric fundus tissue. Increasing concentration of mosparide in the presence of ondansetron also showed a dose-dependent increase in response as depicted by the change in the mean force of contraction in grams. Conclusion: Mosapride has less stimulatory effect on gastrointestinal tissue as compared to when used in combination with ondansetron.
Copyright (c) 2025 Tahira Liaqat , Amna Jahan, Hira Kareeen, Roop-e-Zahra
Association of Glycemic Control with Diabetic Nephropathy among Patients with Type 2 Diabetes Mellitus in Pakistan
Background: Diabetic nephropathy is a common microvascular complication of diabetes mellitus and is a cause of significant morbidity and mortality. This study explores the relationship of HbA1c with diabetic nephropathy in Pakistani population. Patients and methods: A cross-sectional study was conducted at the Internal Medicine Department of Shaikh Zayed Medical Complex (SZMC), Lahore, on patients with type 2 diabetes. Mean HbA1C levels were compared between patients with and without diabetic nephropathy by applying independent sample t-test, while suboptimal glycemic control was compared using chi-square test. Pearson’s correlation was applied to assess the correlation of urinary albumin levels with duration of diabetes and HbA1c levels. Results: A total of 80 patients with type 2 diabetes mellitus were included in the study. The mean age of all the participants was 47 + 10 years. Out of these cases, 56.3% were male and 43.8% were female. Suboptimal glycemic control was present in 72.5% cases and 47.5% were diagnosed with diabetic nephropathy. Higher mean HbA1c levels were observed in the patients with nephropathy as compared to those without nephropathy (10.1 + 1.1% vs 7.2 + 0.8%, p < 0.001). All diabetic nephropathy cases (100%) had suboptimal glycemic control as compared to 47.6% of the cases without nephropathy (p < 0.001). The 24-hours urinary proteins had a strong correlation with HbA1c levels (r = 0.771, p < 0.001) and a moderate correlation with duration of diabetes (r = 0.638, p <0.001). In multivariate regression analysis, only obesity significantly predicted suboptimal glycemic control (OR: 4.346, 95% CI: 1.162 – 16.249, p = 0.029). Conclusion: There is a significant association between diabetic nephropathy and suboptimal glycemic control. The urinary albumin levels have positive correlation with HbA1c levels and duration of diabetes. Obesity is a significant predictor of suboptimal glycemic control in Pakistani population. There is need to explore the factors contributing towards diabetic nephropathy in patients with diabetes.
Copyright (c) 2025 Hafiz Muhammad Umar Masood , Muhammad Uthman, Uzma Iqbal
Effectiveness of Intravitreal Bevacizumab Monotherapy in the Treatment of Retinopathy of Prematurity: An Experience of a Tertiary Care Hospital in Central Punjab
ABSTRACT Background: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness especially in low- and middle-income countries where neonatal survival has improved but screening remains limited. Intravitreal anti VEGF agents offer a promising alternative to laser photocoagulation. The objective of this study was to determine the frequency of ROP in preterm neonates and assess the effectiveness of intravitreal bevacizumab IVB monotherapy for Stage 3 ROP. Methods: This prospective interventional study was conducted at Sir Ganga ram hospital Lahore from September 2021 to March 2023. A non-probability consecutive sampling was used to recruit eligible preterm neonates (<35 weeks gestation; 1000 to 2200 grams birth weight) referred from the neonatal unit. Data was collected through structured clinical assessments and standardized retinal examinations using indirect ophthalmoscopy using structured questionnaires. Neonates with Stage 3 ROP and Zones three were treated with 0.625 milligram IVB under topical anesthesia and followed weekly for regression descriptive analysis was performed. Results: Among 463 neonates screened, 115 (24.8%) had ROP. of these 31 (26.9%) met treatment criteria. IVB alone led to complete regression in 23 (74.2%) within 8 to 12 weeks. Eight (25.8%) required adjunct laser therapy, achieving 100% resolution. No adverse ocular or systemic outcomes or recurrences were reported at one year follow-up. Conclusion: IVB monotherapy was safe and effective for Stage 3 ROP in this low resource setting. These findings supported teams where laser treatment access is limited.
Copyright (c) 2025 Huma Kayani Saigol , Khurram Chohan , Abdul Rauf , Seemab Akbar , Maham Javed , Madeeha Nadeem, Muhammad Salman
Ties That Bind or Break: The Dual Role of Family in Youth Drug Addiction
The majority of Pakistan’s population consists of youth who are the fundamental resource. The rise of drug addiction among youth is a pressing concern globally and in Pakistan.1 Addiction among youth is often depicted as a personal weakening, a result of peer impact, or a consequence of societal experience and availability. The most consistent and unrecognized influence in a young person’s life is their family. The family's role in the development of drug abuse is unique, as family can be either a defensive shield or a risk amplifier, offering connection, direction, and resilience, or adding to emotional turmoil, anarchy, and escape into substance use. Furthermore, the family also suffer from the direct consequences of the abuse. The negative influence of dysfunctional family dynamics cannot be overlooked. Family stressors such as divorce, violence at home, mental illness of parents, or financial instability create a rich ground for emotional dysregulation in children. This often leads to poor coping strategies such as drug use, particularly when mental health support is deficient or stigmatized. Parental modeling plays a vital role. Adolescents whose parents use drugs are not only more likely to use drugs but may also inherit permissive attitudes toward drugs. Even where parents are abstinent, punitive criticism, overcontrol, or emotional unavailability can drive the child toward peer validation and escapism through substances. Furthermore feeling of being ignored by family also lead to use of substances.3
Pulmonary Embolism: Diagnostic Approach, Clinical Findings, and the Alarming Rise in Incidence – A Critical Review
Background: Pulmonary embolism (PE) is a potentially life-threatening condition resulting from the obstruction of pulmonary arteries, most commonly by thrombi originating from the deep veins of the lower limbs. In recent years, a notable rise in PE incidence has been observed globally, attributed to both improved detection and an increase in predisposing risk factors. Objective: To provide a comprehensive overview of the evolving epidemiology, diagnostic approach, clinical features, therapeutic options, and long-term outcomes of PE, with emphasis on the critical rise in incidence and implications for clinical practice. Methods: A narrative review was conducted using recent peer-reviewed literature and guideline-based recommendations. Studies were selected from indexed databases focusing on diagnostic algorithms, imaging modalities, treatment outcomes, and epidemiological trends related to acute PE. Results: PE incidence is increasing globally, driven by aging populations, cancer survivorship, and postoperative complications. Clinical presentation varies widely, often mimicking other cardiopulmonary conditions, making early diagnosis challenging. Risk stratification tools such as the Wells score, revised Geneva score, and Pulmonary Embolism Severity Index (PESI) are critical in guiding the use of D-dimer testing and imaging. Computed tomography pulmonary angiography (CTPA) remains the diagnostic gold standard. Treatment strategies are guided by risk categories—ranging from anticoagulation alone in low-risk cases to thrombolysis or surgical embolectomy in high-risk cases. Long-term complications such as chronic thromboembolic pulmonary hypertension (CTEPH) and post-PE syndrome significantly impact quality of life, underscoring the importance of follow-up and rehabilitation. Conclusion: The increasing incidence and variable presentation of PE demand heightened clinical vigilance. Early risk-adapted diagnosis and intervention are pivotal in reducing mortality and morbidity. Long-term monitoring and individualized therapy are essential for improving patient outcomes. Future strategies should emphasize prevention, early detection, and research into novel diagnostic and therapeutic tools.
Adult-Onset Still's Disease - A Rare Cause of Pyrexia of Unknown Origin
Adult onset still Disease is a multi-systemic auto inflammatory disorder manifesting as high fever spikes, evanescent rash and polyarthralgias. It has a bimodal age distribution with peak incidence in adults aged 15 to 25 and 36 to 45 years. Here we describe a case of a 35 year old male who presented in a tertiary care hospital with the complaints of fever, rash and joint pains, and negative rheumatoid factor and raised ESR and CRP levels. After excluding infectious and other autoimmune disorders, he was diagnosed as a case of Adult Onset Still Disease using the Yamaguchi and Fautrel Criteria. He showed a favorable response to steroid therapy and disease remission was attained. The patient was then started on a maintenance therapy of methotrexate. This case demonstrated the diagnostic challenges of AOSD and the importance of considering it as a differential while pyrexia of unknown origin (PUO) is encountered. While early diagnosis and treatment has a good prognosis.
Copyright (c) 2025 Shamas U Din, Fizza Khalid, Auj Sohail
Prognostic Role of Neutrophil to Lymphocyte Ratio (NLR) in Stage IV Non-Small Cell Lung Cancer
Background: Neutrophil to lymphocyte ratio has emerged as potential biomarker for cancer prognosis due to its accessibility and ease of calculation using routine blood- cell counts. Patients of non-small cell lung cancer (NSCLC) with higher neutrophil to lymphocyte ratio (NLR) before treatment have worse prognosis than those patients who have lower neutrophil to lymphocyte ratio (NLR). The objective of this study is to evaluate the prognostic role of neutrophil to lymphocyte ratio (NLR) in stage IV non-small cell lung cancer. Patients and methods: This prospective cohort study was conducted from 8th January to 8th July 2023 in the indoor Pulmonology Department at KEMU, Lahore, in collaboration with the Oncology Department. A total of 114 biopsy-confirmed, treatment-naïve stage IV NSCLC patients aged 40–80 years were enrolled using non-probability consecutive sampling. Patients with prior treatment or active infections were excluded. Study parameters included age, gender, baseline NLR (≤3.5 or ≥3.5), and survival at 6 and 12 months. Data were collected using a structured proforma from patient records and laboratory reports. NLR was calculated from baseline CBC. Statistical analysis was performed using SPSS v26; independent t-tests were used to compare survival outcomes, with p<0.05 considered significant. Disease-related survival was defined as the time from diagnosis to death due to NSCLC. Results: The majority of patients were male in both groups (77.2% in NLR ≤3.5; 78.9% in NLR ≥3.5). Treatment response differed significantly: in the NLR ≤3.5 group, 59.6% had partial response, 12.3% stable disease, and 28.1% progressive disease, whereas in the NLR ≥3.5 group, 89.5% showed progressive disease. At 6 months, the relative risk (RR) of mortality for patients with NLR ≥3.5 was 2.52 compared to those with NLR ≤3.5. At 12 months, mortality was 85.7% in the NLR ≥3.5 group vs. 62.3% in the NLR ≤3.5 group, with an RR of 2.64, indicating a significantly poorer prognosis in patients with elevated NLR. Conclusion: This study underscores the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in stage IV NSCLC, with elevated NLR linked to poorer survival and progressive disease. NLR could be a valuable biomarker for guiding prognosis and treatment in these patients.
Copyright (c) 2025 Mohsin Rasheed, Hafiz Kamal Din , Syed Ali Abbas Sherazi, Saad Bakhtawar `Khan , Izzah Javwed
Evaluation of HER2 Gene Amplification by FISH in Immuno-histochemically Equivocal Breast Cancer Cases
Background: Breast cancer is a global health concern, especially in Europe and America, with higher incidence and mortality rates. HER2-positive breast cancer accounts for 20-25% of diagnoses, known for its aggressive behavior. To assess HER2 status, various methods are available, including PCR, IHC, FISH, and CISH. Immunohistochemistry (IHC) and Fluorescence in Situ Hybridization (FISH) are the primary techniques for HER2 evaluation. IHC and FISH are the predominant methods employed for evaluating HER2 status. IHC gauges the expression of the HER2 protein on the cell surface, while FISH identifies HER2 gene amplification at the DNA level. The objective of this study is to know the prevalence of FISH positive cases in IHC , HER2 equivocal cases of breast cancer. Patients and methods: This descriptive cross sectional study was carried out in Al Hada, Armed Forces Hospital in Taif region for two years. The study includes individuals aged 18 or older classified as HER2-equivocal (IHC 2+) invasive breast cancer per ASCO/CAP guidelines within three months, who provide informed consent for tissue and clinical data use. Exclusions include confirmed HER2-positive or HER2-negative status, insufficient tumor tissue, prior neoadjuvant or HER2-targeted therapy, metastatic disease, severe comorbidities, life expectancy under six months, or inability to consent.. IHC testing was conducted on collected breast tissue with standard protocols. RESULTS: The study analyzed 100 patients aged between 22 and 80 years, with 89% being over the age of 41. The majority of the tumors were identified as ductal carcinoma. Among the patients with HER2-positive equivocal immunostaining, 78% of those results showed no HER2/neu gene amplification on FISH analysis. Conclusion: These findings emphasize the combination of IHC and FISH, to accurately assess HER2 status and guide appropriate treatment decisions
Copyright (c) 2025 Huma Aslam, Maria Qibtia , Shahla Pervez, Nowal, Rowan
Comparison of Postoperative Outcomes of Ureteroscopic Lithotripsy with and without Double J Stent in Patients with Upper Ureteric Stone
Background: Ureteroscopic lithotripsy with stent placement is a standard treatment for upper ureteric stones. However, the necessity of routine double J (DJ) stenting is debated due to potential postoperative discomfort. This study aimed to compare postoperative urinary symptoms and stone clearance in patients with and without DJ stent placement. Patients and Methods: A randomized controlled trial was conducted in the Urology Department of Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore, from January 2022 to February 2023. Sixty patients aged 18–45 years with a solitary upper ureteral stone (10–15 mm) confirmed on non-contrast CT scan were included. Patients were randomized into two equal groups: Group A (DJ stent) underwent ureteroscopy with intracorporeal lithotripsy and DJ stent placement; Group B (No stent) underwent the same procedure without stent insertion. Postoperative outcomes included urinary frequency (>8 voids/24h), urgency, dysuria, and stone clearance (≤3 mm residual stone on X-ray KUB at two weeks). Data were analyzed using SPSS v25.0; chi-square test was applied with a significance level of p≤0.05. Results: The mean age was 30.68±8.08 years, with 56.7% males and 43.3% females. Mean stone size was 13.03±1.66 mm. Right-sided stones were seen in 45% and left-sided in 55%. Group A reported significantly more urinary frequency (56.7% vs. 23.3%; p=0.008) and urgency (53.0% vs. 20.0%; p=0.007). Dysuria was also higher in Group A (33.3% vs. 16.7%; p=0.136). Stone clearance was 100% in both groups. Conclusion: Routine DJ stent placement after ureteroscopic lithotripsy results in significantly higher urinary frequency and urgency and relatively increased dysuria, with no difference in stone clearance.
Copyright (c) 2025 Muhammad Ejjaz Siddiqui, Hafiz Muhmmad Ahmed Zeheer , Faisal Ahmed Zaeem, Muhammad Zahid Ahmed
Clinical Spectrum and Treatment Outcomes of Osteoarticular Infections in Children at a Tertiary Care Hospital, Karachi
Background: Osteoarticular infections (OAI) in children, including septic arthritis (SA) and osteomyelitis (OM), cause significant morbidity and are commonly due to Staphylococcus aureus, including MRSA. Delayed diagnosis and antimicrobial resistance worsen outcomes. This study describes the clinical features, microbial profile, and outcomes of pediatric OAI at a tertiary care center in Karachi to guide local management. Patients and methods: This cross-sectional study was conducted at the Pediatric Infectious Disease Department, NICH Karachi, from June to December 2023. Children under 16 years with confirmed osteoarticular infections (OM or SA) were included. The diagnosis of osteomyelitis was based on clinical signs (pain, swelling, restricted movement), fever >37.5°C, leukocytosis (>13,000/µL), elevated ESR (>20 mm/hr), and supportive radiological or microbiological evidence. Data on clinical features, infection site, lab markers, diagnostics, interventions, culture results, and outcomes were collected using a structured proforma. Common complications included swelling, pain, fever, joint stiffness, infection recurrence, and the need for surgery. Patients with complications required surgery, antibiotics, physical therapy, follow-up, and repeat imaging. Data were analyzed in SPSS v26 using descriptive statistics, the Shapiro-Wilk test, and binary logistic regression, with p≤0.05 considered statistically significant. Results: 144 patients were enrolled with median age of 8 (IQR=2-12) years. Majority were males (62.5%). One third patents 44 (33.3%) were diagnosed with osteomyelitis Length of hospital days was 4 (IQR=3-7) days. 55.6% patients were completely treated, 3.5% expired, 1.4% developed complications and 39.6% needed further intervention. The final outcome was good among 55.6% and poor among 44.4%. Patient’s feature was found to be significantly associated with final outcome except those who had warmth and limited range on presentation. Conclusion: Septic arthritis was more common. There was higher burden of poor outcomes. Patients should be continuously under strict surveillance with evaluation of all possible laboratory biomarkers to early prediction and improvement of treatment outcomes.
Copyright (c) 2025 Muhammad Ashfaq, Wajid Hussain , Badur Un-Nisa , Sumaira Waseem, Khatidja Pardhan , Hira Waseem
AI's Transformative Impact on Healthcare and Medical Research in Pakistan
Artificial intelligence (AI) has been emerged as a transformative force in the ever-evolving prospect of healthcare bringing unparalleled advancements in patient management and care.1 Rapid unfolded benefits have revolutionized the landscape of healthcare delivery system. Accuracy of diagnostics in clinical, pathological and radiological settings, remote patient monitoring, shared decision-making,1,2 precision medicine, biomedical literature, genomic, therapeutics and drug optimization, and health system management through algorithms, data analysis and predictions.2-3 What started as Enigma in 1942, was coined as ‘Artificial Intelligence in 1956 by John McCarthy in the Dartmouth Conference. However, initially it was limited to data computing and research, through neural networks and machine learning (ML), Natural Language Process (NLP), it found its way to daily lives of many through virtual assistants, such as Apple’s Siri and Amazon’s Alexa.1 Usage in health care system through automation and robotic surgery, its role in virtual health care assistant, physical and mental health support, patients’ education and mitigation of burn out in health care providers, paved the way for its generalization among end users. A recent study in the USA showed that although more than half of participants felt discomfort with care providers using AI, still 80% of them expressed their willingness to use AI-powered tools to help manage their health themselves.4
The Frequency of Postpartum Depression among Women with Placenta Accreta Spectrum with and without Hysterectomy
Background: Women with placenta accreta spectrum (PAS) are at increased risk for postpartum depression (PPD). Prevalence of postpartum depression in women with placenta accreta spectrum is 50% whereas the general prevalence is 21%. This suggests a significant impact of PAS on maternal mental health. The objective of this study is to evaluate the risk of PPD among women with and without hysterectomy in PAS. Methods: This comparative cross-sectional study was conducted at Department of Obstetrics & Gynecology, Jinnah Hospital, Lahore from June to December 2024. A total of 168 women with placenta accreta spectrum were included in the study. Hysterectomy was only done in those patients where all the uterine conservative techniques failed. The Edinburgh postpartum scale (EPDS) was used to assess the risk of postpartum depression in both groups. Data was analyzed in SPSS. Quantitative variables were presented as means + SD. Frequency and percentages were calculated for qualitative variables. Cross tabulation was made for EPDS for the independent variable. A chi-square test was applied, with p < .05 as statistical significance. Results: This study analyzed 168 women with placenta accreta spectrum, divided into hysterectomy and non-hysterectomy groups. Although the overall prevalence of depression was high in both groups, the severity of symptoms was greater in the hysterectomy group (p=0.043). Conclusion: The risk of postpartum depression is high in women with placenta accreta spectrum undergone hysterectomy as compared to those without hysterectomy.
Copyright (c) 2025 Raheela Danish , Fatima Saleem, Huma Aslam, Mona Ali, Tehreem Khan , Abu Bakar Siddique
Challenging Behaviors in Children with Down Syndrome: Prevalence and Associated Factors
Background: Children with Down syndrome often exhibit challenging behaviors that impact their daily functioning and social interactions. Identifying these behaviors and their associated factors is essential for developing targeted interventions to enhance their well-being and quality of life. The objective of this study was to identify and assess challenging behaviors in children with Down syndrome, determine their prevalence, and evaluate the influence of comorbidities, living environment, cognitive and communication abilities, mobility status, and socioeconomic status on behavioral functioning. Methods: A cross-sectional study was conducted with a sample size of 42 children with Down syndrome age range of 5-12 years, selected using a purposive sampling technique. Data were collected through caregiver-reported questionnaires assessing behavioral challenges, including tantrums, aggravation, aggression, separation anxiety, stubbornness, and adaptability to routines. Statistical analyses included chi-square, independent t-tests and ANOVA. Results: The findings revealed that tantrums and stubbornness were among the most prevalent challenging behaviors, reported by 48% and 59.52% of caregivers, respectively. Social interaction challenges, including aggravation, were noted in 42.86% of cases. A significant portion (80.95%) of caregivers felt confident managing challenging behaviors at home. Statistical analysis demonstrated that cognitive ability, communication ability, mobility status, and socioeconomic status significantly influenced behavioral functioning (p < 0.001). Higher adaptive behavior scores were associated with mild cognitive ability, verbal communication, independent mobility, and higher socioeconomic status. Conclusion: The identification of behavioral challenges during early development requires specific interventions and empowered parents to create effective outcomes for children with Down syndrome and their families.
Copyright (c) 2025 Muhammad Bilal Abid, Sultan Badar, Fareeha Latif Randhawa, Muneeba Malik, Fatima, Munawar Ghous
Predictive Accuracy of Ultrasound to Detect Medial Meniscal Tear in Patients Presenting with Knee Injuries Taking Magnetic Resonance Imaging as Gold Standard
Background: Knee injuries like medial meniscal tears impair mobility. Magnetic Resonance Imaging (MRI) is the gold standard but costly and less accessible. This study evaluates ultrasound’s predictive accuracy as a more affordable, real-time, non-invasive alternative to MRI. The objective of this study was to find out predictive accuracy of ultrasound to detect medial meniscal tear in patients presenting with knee injuries taking MRI as gold standard. Methods: The study at Sir Ganga Ram Hospital enrolled 100 knee injury patients over six months w.e.f. March to August, 2021 using non-probability purposive sampling as per inclusion criteria. Patients underwent ultrasound with a 7.5 MHz transducer and MRI with a 1.5 T machine. Radiologists were blinded to each other’s findings. Data were analyzed using SPSS to calculate ultrasound’s sensitivity, specificity, predictive values, and accuracy against MRI as the gold standard. Results: Ultrasound detected medial meniscal tears in 83% of patients, predominantly in the posterior zone (80%). MRI showed similar findings, with 85% posterior zone tears. Comparing ultrasound to MRI, ultrasound demonstrated high diagnostic performance: sensitivity of 94.67%, specificity of 93.33%, and overall accuracy of 95.94%. The positive predictive value was 98.60%, and the negative predictive value was 84.41%, indicating ultrasound is a reliable tool for detecting medial meniscal tears. Conclusions: Ultrasound showed 96% accuracy in detecting medial meniscal tears, slightly less than MRI, which had higher sensitivity and specificity. However, ultrasound remains a useful, non-invasive option when MRI is unavailable or contraindicated.
Copyright (c) 2025 Saman Chaudhry, Nosheen Ahmad, Humaira, Muhammad Bilal, Mahreen Rasool, Adnan Maqbool, Shazia Shoukat
Role of Reproductive Factors on the Risk of Endometrial Cancer in Nineveh Province, Iraq: A Case-Control Study
ABSTRACT Background: Endometrial cancer (EC) is the sixth most common cancer worldwide. This study aimed to evaluate the associations between reproductive risk factors and EC in Nineveh Province, north Iraq, due to limited research. Methods: The study was conducted from September 2024 to the end of the year, using a case-control design. It included 100 cases of histologically diagnosed EC from 2022 to 2024 and 200 age-matched controls admitted to hospitals in the same catchment area for non-neoplastic and non-gynecological conditions. Informed consent was obtained before the interviews. The association between risk factors and EC development was measured using odds ratios (OR) and 95% confidence intervals (CI), with P-values ≤ 0.05 considered statistically significant. Results: The study found that nulliparous women were present in 12/94 (12.77%) cases and 10/194 (5.15%) controls, with a risk nearly three times significantly higher than that of parous women (OR, 2.69; 95% CI, 1.12–6.48, P = 0.032). The mean number of children in cases (5.16 ± 2.45) was significantly lower (P = 0.001) than that in controls (6.51 ± 2.66), and the mean age at first birth was significantly higher in cases (23.13 ± 5.50, P = 0.001). However, there was no significant difference in the age at menarche and menopause between the cases and controls. Conclusion: Parity and first-age delivery differed significantly among study participants. However, the age of menarche and menopause is not associated with increased EC risk
Copyright (c) 2025 Zahraa Dheyauldin Abdulwahhab, Humam Ghanim Ibrahim Zubeer
Comparison of the Effect of Rectally Administered Misoprostol Versus Intramuscular Oxytocin in Addition to Oxytocin Infusion for the Prevention of Post-Partum Hemorrhage in Cesarean Section
Background: Post-partum hemorrhage (PPH) is known in to occur in more than 10% of cesarean sections. Generally intravenous or intramuscular oxytocin is commonly used for prevention of PPH, nevertheless, in some studies rectally administered misoprostol has been shown to be superior to oxytocin in this regard. This route is also linked with fewer side effects and longer half-life. This study was designed to compare the outcome of per rectal misoprostol versus I.M oxytocin in the prevention of post-partum hemorrhage in cesarean section. Patients and methods: A randomized controlled trial was conducted at the Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore from 1st November 2021 to 30th April 2022. Women undergoing cesarean section were either given 10 IU of injection oxytocin intramuscularly or 800 micrograms Misoprostol per rectally in addition to IV oxytocin infusion in all patients. Difference in hemoglobin levels before and after the cesarean section were compared. Pre-designed data collection performa were used for data collection and the data were analyzed using SPSS version 25.0. Results: A total of 88 patients were randomized in to two groups of 44 patients each. The mean age of participants in misoprostol group was 30 ± 4 years and in oxytocin group was 29 ± 5 years. The most common indications for cesarean sections were fetal distress due to multiparity, which was present in 33 (37.5%) cases, followed by prolonged labor in 22 (25%), polyhydramnios with fetal malpresentation in 20 (22.7%), and multiple gestation with malpresentation of first fetus in 13 (14.5%) cases. The mean change in hemoglobin was lower in the misoprostol group (0.7 ± 0.26 g/dL) than the oxytocin group (1.17 ± 0.45 g/dL) and the results showed statistical significance (p = 0.000). Conclusion: Rectally administered misoprostol is superior to intramuscular oxytocin in the prevention of post-partum hemorrhage and can be used as an alternative in patients undergoing cesarean section.
Copyright (c) 2025 Rabbia Afzal, Noreen Akmal
Exploring the Interplay of HIF-1α Expression and its Correlation with Selected Biomarkers in Acute Kidney Injury Patients
Background: Acute Kidney Injury (AKI) is a complex and heterogeneous clinical syndrome, characterized by the sudden decline in renal function, and has greatly contributed to worldwide mortality and morbidity. Its incidence is 68.55% in Pakistan and is still on the rise. The study intended to the analysis of gene expression of HIF-1α and correlate it with the expression of a chosen kidney injury biomarker panel comprising of NGAL, KIM-1 and L-FABP in AKI patients. Materials and methods: Out of blood samples of 50 patients enrolled with AKI in our study, 14 patients with superimposition of acute-on-chronic kidney injury (males n=5; females n=9) were selected along with blood samples of 4 healthy controls (males n=2; females n=2). Their RNA was isolated and mRNA gene expression was quantified by RT-PCR. Results: Analysis showed that HIF-1α expression significantly correlated positively with NGAL (r=0.8829, p=<0.0001) and KIM-1 (r=0.9199, p=<0.0001) mRNA gene fold expression in all male and female AKI on CKD patients, whereas, only the expression of L-FABP in males (r=0.9535, p=0.012) positively correlated with HIF-1α and there was no correlation of it in females (r=0.4067, p=0.2774). Conclusion: We concluded that a positive correlation of all these kidney injury biomarkers in all patients and L-FABP in males suggested that comorbidities such as heart disease, hypertension, diabetes mellitus, sepsis and liver disease produce hypoxic cellular conditions in the sensitive medulla of the kidney, damaging it easily, and can worsen renal function unless treated properly.
Copyright (c) 2025 Khadijah Fiaz , Arsalan Khalid, Asad Ullah , Dr Adnan Arshad
Diagnostic Accuracy of Complicated Pleural Effusion Score to differentiation between Tuberculous Pleural Effusion and Complicated Parapneumonic Effusions
Background: In tuberculosis-endemic areas, the complicated pleural effusion score aids in distinguishing between CTPE and CPPE, which present with similar symptoms. The aim of this study was to assess the diagnostic accuracy of the complicated pleural effusion score to distinguish between CTPE from CPPE Patients and methods: This was a cross-sectional study conducted at the Institute of Tuberculosis and Chest Medicine (outdoor and indoor locations), Mayo Hospital Lahore. The study included 70 patients aged 18–80 years with patients with clinical suspicion of complicated Parapneumonic pleural effusion and Tuberculous Pleural effusion were included in current study complicated parapneumonic or tuberculous pleural effusion. Exclusions were empyema, suspected/confirmed pleural malignancy, bleeding diathesis, and pregnancy. After taking informed written consent, I/V line was passed and diagnostic pleural tap was done under Ultrasound guidance with 50cc Disposable syringe under aseptic measures and pleural fluid was sent for complete analysis including PH, Glucose, Total leukocyte count with differential cell count and ADA levels estimation. After that, COMPLES score was calculated. Patients with a COMPLE score <12 were presumptively diagnosed with tuberculous pleural effusion, while those with a score >12 were presumptively diagnosed with parapneumonic pleural effusion. Results: Mean COMPLES score was 12.05±4.91. As per cut point of COMPLES score 36 (51.4%) patients had been diagnosed with tuberculous pleural effusion and 34 (48.6%) had been diagnosed with parapneumonic pleural effusion. Sensitivity and specificity of COMPLES score was 100% and 81.82%. While the respective values for positive and negative prediction accuracy were 76.74% and 100%. Conclusion: The COMPLES score proved highly effective in differentiating tuberculous pleural effusion from complicated parapneumonic effusions. A score >12 identified tuberculous pleural effusion with 100% sensitivity and 81.82% specificity. The positive predictive value was 76.74%, the negative predictive value was 100%, and the overall diagnostic accuracy was 88.57%.
Copyright (c) 2025 Hafiz Kamal Din, Qasim Raza, Mohsin Rasheed, Syed Ali Abbas Sherazi, Hafiz Muhammad Faisal Nadeem, Muhammad Bilal Ashraf
Symptom Severity of Obsessive-Compulsive Disorder Post COVID-19 Pandemic in Psychiatry Department of Tertiary Care Hospital
Background: There has been considerable speculation regarding the detrimental effects of the COVID-19 pandemic on mental health. The prevalence of mental disorders is thought to increase during pandemics, and the unique circumstances of the COVID-19 pandemic may have a direct impact on obsessive-compulsive disorder (OCD) manifestation clinically. The objective of the study was to find a mean change in symptom severity of obsessive-compulsive disorder post-COVID-19 pandemic. Patients and methods: A Qausi-experimental study was conducted at the Department of Psychiatry, Jinnah Hospital, Lahore from 05-01-2022 to 05- 07-2022. After approval of the Ethical Review Board and obtaining informed consent, data was obtained from patients focused on available Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores at the start of the COVID-19 pandemic in Pakistan. These patients were re-evaluated using the YBOCS scale to determine any changes in OCD severity, defined as a 50% increase from the baseline (YBOCS) score. All data were recorded on a proforma. All data were recorded on a proforma. Data analysis was performed using IBM SPSS 21. Before and mean change in (YBOCS) was determined by paired sample t-test with a significance level of p≤0.05. Results: The mean age was 36.65±3.892 years. There were 56.7% (n=34) males whereas 43.3% (n=26) were females. Distribution of duration of disease, pre-COVID YBOC score, Post- COVID (YBOCS), and change in (YBOCS) was calculated as 3.52+1.0 years, 18.07+1.9, 28.30+2.149 and 10.33+3.001, respectively. Conclusion: In the current study we found the mean change in symptom severity of obsessive-compulsive disorder post-COVID-19 pandemic using (YBOCS) score. The rise in symptoms and overall severity observed in individuals with OCD may largely stem from the stress induced by the ongoing pandemic.
Copyright (c) 2025 Ammara Butt, Quart Ul Aan Butt , Abu Bakr Siddique
Comparison of Outcome among patients undergoing Vesicovaginal Fistula Repair through Transabdominal approach with and without Interposition Omental Flap
Background: Vesicovaginal fistula (VVF) is an abnormal connection between the bladder and vagina, causing urinary incontinence. It often results from surgical injury or malignancy. Interposition flaps, including the omentum flap in trans-abdominal repairs, help close the defect and improve outcomes. Objective: To compare the outcome among patients undergoing vesicovaginal fistula repair through transabdominal approach with and without interposition omental flap. Patients and Methods: A randomized controlled trial was conducted from July 2021 to January 2022 at the Urology Department, Sir Ganga Ram Hospital, involving 44 patients with supratrigonal vesicovaginal fistulas (VVF) ≤2 cm and ≤2 openings. Patients with malignancy, radiotherapy, recurrent or infratrigonal VVF, ureterovaginal fistula, or localized infection were excluded. The experimental group underwent VVF repair with an interposition omental flap, while the control group underwent repair without the flap. SPSS version 24 was used for data analysis. The comparison between groups for proportions of fistulous openings, peri-operative complications and treatment success by chi-square test. P-value of ≤0.05 was considered as significant Results: The experimental group (mean age 36.5 ± 7.4 years) and control group (mean age 39.1 ± 10.1 years) showed similar peri-operative wound infection rates (9.1%). Complications in the experimental group included bleeding (9.1%), bowel perforation (4.5%), and higher fistula recurrence (22.7% vs. 18.2%). Treatment success at 2 weeks was 81.8% with the graft and 90.9% without it. Conclusion: In conclusion, using an interposition graft in VVF repair did not significantly improve success rates or reduce morbidity compared to repairs without a graft.
Copyright (c) 2025 Muhammad Ejaz Siddiqui, Zabish Mahmood , Shazmina Rehman , Shahida Rehman
Evaluating Quality of Life across Different Stages of Rheumatoid Arthritis
Background: Rheumatoid arthritis is a chronic, progressive inflammatory disease that causes pain, swelling, and disability, severely affecting up to 50% of patients' quality of life. Objective: To find out the association between disease severity of Rheumatoid Arthritis and QOL among patients. Methods: The present study was conducted at Sir Ganga Ram Hospital, Lahore from January to March 2024 A total of 120 patients with RA were enrolled by convenient sampling technique in this descriptive cross-sectional study. All patients with age >18 years, all genders and no mental illness or disturbance of consciousness were included. Pregnant females, and patients with severe co morbidities such as cancer or end stage organ failure were excluded. Demographic details, presenting symptom, disease severity assessed by Disease activity score-28 (DASS-28) and Quality of Life were recorded using a pre-designed proforma. The collected data was analyzed by using SPSS V24.0 software. The association between QOL and pain with disease severity was compared by using chi-square test. P-value ≤ 0.05 was considered as significant. Results: The association between quality of life (QOL), pain levels, and disease activity was significant(P-value<0.05); 90.0% of participants with high disease activity reported poor QOL, and severe pain was more prevalent (64.6%) in this group compared to those with low disease activity (33.3%). Conclusion: The study revealed a significant association between disease severity, pain, and overall patient quality of life. These findings indicate that higher disease activity correlates with increased pain severity and a diminished quality of life among participants.
Copyright (c) 2025 Zia ul Haq, Bilal Azeem Butt , Nouman Zafar , Muhammad Yasir Imran, Faizan Ahmad , Sumbal Saleem
Preventing Mpox Importation: Strengthening Public Health Surveillance in Pakistan
Pakistan, a total of eight Mpox cases have been reported in 2024 with the most recent case reported on 20 December.13 So far Pakistan has imported 17 Mpox cases (nine in 2023 and eight in 2024) from the Kingdom of Saudi Arabia and UAE, with one mortality. The sequencing of Mpox samples by the National Institute of Health, Islamabad detected less severe Clade IIb and lineage A.2.1 in all cases.12 Thus far, no case of human-to-human local transmission has been detected from Pakistan. However, in the absence of effective border screening programs, lack of surveillance, non-existent nationwide diagnostic facilities, a shortage of trained workforce, a weak case reporting system, and stigma associated with the disease, it cannot be confidently claimed that no Mpox cases exist in the country. Moreover, the presence of asymptomatic cases and similarities with other diseases further make detection of the cases challenging. The global cases are declining over time due to increased awareness and vaccination efforts, localized outbreaks, asymptomatic transmission, and limited surveillance remain critical barriers to eradication. Therefore, there is a need to strengthen public health surveillance, diagnostic services, trained manpower, and public health systems to prevent future outbreaks. A collective response from international and national bodies is required to stop the spread of the disease and to reduce associated morbidity and mortality.
Incidence of Metformin-Induced Lactic Acidosis in Diabetic Patients
Background: Metformin is a common treatment for diabetes, yet it poses a risk of lactic acidosis, especially in patients with underlying conditions such as heart failure or liver dysfunction. This study investigates the impact of metformin on lactate levels, evaluates its role as a risk factor for lactic acidosis, and examines key patient characteristics associated with elevated lactate levels. Subjects and methods: This study was a cross sectional study at August 15, 2524 to November 15, 2024 of the occurrence of lactic acidosis in patients treated with metformin at Buriram Hospital. The study tracked outcomes from day 0 to day 90, taken with metformin Abnormal laboratory values ​​(blood lactic acid, blood bicarbonate, blood acidity and kidney function. inclusion criteria for the study sample encompassed patients diagnosed with the following conditions: insulin-dependent diabetes mellitus with ketoacidosis and Blood oxygen level SpO2 is lower than 95%, And study outcome involved 150 diabetic patients, whose creatinine, eGFR, and HbA1c levels were measured before and after receiving standard treatments, including metformin. Lactate levels were assessed using Enzymatic Colorimetric Assay and Biosensor techniques. Blood lactate levels above 4.4 mmol/L were used as a threshold for evaluating lactic acidosis. And analyze the results using t-test by Stata version 14 program. Results: Patients receiving metformin, especially at doses exceeding 2,550 mg/day, exhibited significantly elevated lactate levels (p < 0.001). Elevated lactate was more prevalent among patients with specific conditions, including insulin-dependent diabetes mellitus with ketoacidosis, hypoglycemia, and acute renal failure. Patients treated with glipizide showed statistically significant changes in creatinine and HbA1c levels (p < 0.05), confirming its impact on these parameters. Conclusion: Elevated lactate levels associated with metformin use may indicate a risk of lactic acidosis, particularly in high-risk patient groups or those receiving high doses. Lactate thresholds of 4.4 mmol/L may serve as a diagnostic criterion for lactic acidosis. Close monitoring and tailored dosing of metformin are essential for minimizing risks.
Copyright (c) 2025 Anurak Ampawan, Sakchai Sriklang
Comparative Effects of Hibiscus rosa Flower Extract and Silymarin on Lead Acetate Induced Hepatotoxicity in Male Albino Rats
Background: Lead, a pervasive pollutant, induces liver toxicity through oxidative stress, inflammation, and enzyme disruption. Hibiscus rosa-sinensis and silymarin possess hepatoprotective properties, mitigating oxidative damage, stabilizing hepatocyte membranes, and promoting liver regeneration. Objective of this study is to examine the protective effects of a combination of Hibiscus rosa-sinensis flower extract and silymarin against lead acetate-induced liver toxicity in male albino rats. Subjects and methods: An experimental animal study was conducted at PGMI and LGH, Lahore (July 2023–July 2024) after ethical approval. Fifty albino rats were divided into five groups: Group A (control) received distilled water, while Groups B–E were given 500 mg/kg lead acetate alone or with 300 mg/kg Hibiscus rosa-sinensis extract, 200 mg/kg silymarin, or both for 30 days. Body and liver weights, serum ALT, AST, and glutathione peroxidase levels were measured. Liver sections were analyzed using H&E and Masson’s Trichrome staining. Histological toxicity indicators included hepatic architecture, portal triad inflammation, and fibrosis, assessed via the Histology Activity Index (HAI). Hepatic lobules were classified as normal (0) or abnormal (1), portal triad inflammation was scored from 0 to 4, and fibrosis ranged from 0 (none) to 4 (cirrhosis). Data were recorded, stratified according to toxicity indicators, and analysed using SPSS 25, with significance set at p ≤ 0.05.Results: Lead exposure caused weight loss (180.7 ± 6.2 g), hepatomegaly (10.6 ± 0.7 g), and liver damage (ALT: 80.3 ± 12.3 U/L, AST: 164.4 ± 8.3 U/L, GPX: 76.3 ± 7.0 U/L, p < 0.05), indicating toxicity. Hibiscus rosa-sinensis and silymarin reduced these effects, with the combination (190.7 ± 8.1 g, 7.5 ± 0.5 g, ALT: 28.1 ± 3.9 U/L, AST: 60.9 ± 9.3 U/L, GPX: 124.4 ± 3.9 U/L) suggesting the hepatoprotective effect. Conclusion: The combination of Hibiscus rosa-sinensis flower extract and silymarin exhibited the strongest hepatoprotective effects against lead acetate-induced liver damage in male albino rats, effectively preserving body and liver weight, reducing ALT and AST levels, and restoring GPX levels more effectively than either treatment alone.
Copyright (c) 2025 Shazia Gul , Saima Abdul Waheed , Muhammad Yasoob
Effect of Different Doses of Sea Buckthorn (Hippophae rhamnoides L.) Seed Extract (Oil) on Histology of Islets of Langerhan of Pancreas in Alloxan Induced Diabetic Male Wistar Rats
Background: Sea buckthorn seed oil extract contains saturated and unsaturated fatty acids. Alloxan monohydrate is oxygenated pyrimidine derivative, it produces diabetes in experimental animals. The objectives of this study was to determine the histological changes of sea buckthorn extract (seed oil) on Alloxan induced diabetic β-cells of pancreatic tissue in male Wistar rats. Method: 32 male Wistar rats were divided into 4 groups: A, B, C and D. Alloxan monohydrate in dose of 130mg/kg body weight was given as a single dose to experimental groups B, C and D. From each group half of the group the rats were sacrificed at day 4 of study and the rest on 25th day after administration of Sea buckthorn seed oil extract. Results: In comparison with the control group on the 4th day of the sacrifice all the rats in the experimental groups showed a decrease in diameter of islets of Langerhans, number of beta cells and an increase in number of beta cells pyknosis and vacuolization. On the 25th sacrificial day, only high dose Sea buckthorn (4ml) treated group D showed an increased in diameter of islets of Langerhans very close to that of controls while low dose (2ml) treated group C showed late recovery as compared to control group. Conclusion: The study assesses Sea buckthorn’s (seed oil) effects on serum glucose levels by using glucometer and histological parameters (diameter of islet, beta cell pyknosis, number of inflammatory cells) of islets of Langerhans of pancreas. It focuses on animal models, but human clinical trials are required to validate its efficacy and safety.
Copyright (c) 2025 Mehreen Salahuddin, Godfrey Paul William, Saira Munawar, Arooj Nawaz, Shagufta Nasreen, Fozia Farzana
A Descriptive Case Series Study to Evaluate the Association of Hepatitis C Virus Infection with Insulin Resistance
Hepatitis C virus (HCV) infection is a common problem worldwide, affecting millions of people across all populations. In some previous studies, HCV infection was associated with an increased risk of diabetes mellitus or insulin resistance (IR).Insulin Resistance is calculated by Homeostasis Model Assessment (HOMA). Aim: The objective of our study was to evaluate the association between HCV and Insulin Resistance (IR) Setting and Design: A single center, Descriptive case series study which was conducted at Division of Gastroenterology and Hepatology, Medical Unit I, Lahore General Hospital/Post graduate Medical Institute, Lahore. Material and Methods: Total duration of study was about one year conducted from June 2012 to July 2013.HOMAR IR was calculated in all eligible candidates who had detectable HCV RNA PCR level. The cut off value for HOMA IR was taken as 3.8. Statistical Analysis: Was performed using SPSS-release 17, standard version. Results: 300 patients were enrolled and analyzed.154 (51.3%) were female and 146(48.7%) were male and M: F was 1:1.05.Mean BMI was 25.08 kg/m2 .The Mean HOMA IR was 2.62 with S.D 1.76 and S.E. 0.1018. 253(84.33%) patients had HOMA IR <3.7 and 47(15.66%) had HOMA IR 3.8 ≥. No significant Correlation was observed between HOMA IR and BMI. Conclusion: There is significant risk of development of Insulin Resistance in Chronic Hepatitis C infected patients. HCV infection should be taken as systemic disease and Blood glucose level should be regularly monitored in Chronic Hepatitis C patients.
Copyright (c) 2024 Muhammad Asif Gul , SHAFIQ MUHAMMAD, AMJAD MUHAMMAD MUHAMMAD, TOOR ISRAR H, KHAN MUHAMMAD I H, HASSAN GHIAS U, NASIR MUHAMMAD B, TAYYAB GHIAS U
Effect of Resected Gastric Volume on Postoperative Excess Body Weight Loss after Laparoscopic Sleeve Gastrectomy
Background: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure for achieving weight loss and improving obesity-related comorbidities. While the resected gastric volume (RGV) is thought to influence weight loss outcomes, its precise role remains uncertain. This study aimed to evaluate the relationship between RGV and % excess body weight loss (%EBWL) six months post-LSG. Patients and Methods: This prospective cross-sectional study was conducted in the General Surgery Department at Shifa International Hospital, Islamabad, from June 2023 to June 2024. Adult patients undergoing primary LSG were included, excluding those with prior bariatric surgery or incomplete follow-up data. Data collected included demographics, comorbidities, pre- and postoperative BMI, RGV, and %EBWL. RGV was measured intraoperatively by creating a gastrotomy at the antral end of the resected stomach, filling it with water via a Toomey syringe until maximum capacity, and measuring the volume in a graded container. %EBWL was calculated as [(initial weight − postoperative weight) ÷ (initial weight − ideal weight)] × 100. Procedures were performed by experienced surgeons, and patients were followed up for six months. Results: Among 41 patients (mean age 35.3 ± 12.9 year) 51% (21) were male and 49% (20) were female, mean preoperative BMI was 40.9 ± 7.3 kg/m², decreasing to 32.9 ± 5.7 kg/m² postoperatively. Comorbidities included diabetes (49%), hypertension (41%), and sleep apnea (73%). Mean RGV was 891.8 ± 187.6 mL, and mean %EBWL was 52.1 ± 31.1%. A weak, inverse correlation between RGV and %EBWL (r = -0.085, p = 0.793) was observed, indicating no significant association. Conclusion: The findings suggest that RGV does not significantly predict short-term weight loss after LSG. Further research is needed to explore other determinants of weight loss, including patient characteristics and postoperative behaviors.
Copyright (c) 2025 Humza Farooq, Saher Khurshid , Muhamamd Awais , Kinza Farooq, Ghulam Siddiq , Muhammad Uneeb
Association between Uric Acid Changes during Hemodialysis and Severity of Left Ventricular Diastolic Dysfunction in ESRD Patients
Background: Hyperuricemia has been implicated in cardiovascular disease, the leading cause of mortality in dialysis patients. Elevated SUA can contribute to <a href="https://www.google.com/search?q=left+ventricular+hypertrophy&sca_esv=af69388857e2a179&rlz=1C1CHBF_enPK1146PK1146&sxsrf=AE3TifOWi4bjixoO0xGHnoUmQGpdH-_Jsw%3A1757328643670&ei=A7W-aP_VKJCLi-gPqPqByAs&ved=2ahUKEwjd_57F_8iPAxV73AIHHdwiHgkQgK4QegQIARAD&uact=5&oq=serum+uric+acid+%28SUA%29+in+left+ventricular+diastolic+dysfunction+%28LVDD%29+&gs_lp=Egxnd3Mtd2l6LXNlcnAiR3NlcnVtIHVyaWMgYWNpZCAoU1VBKSBpbiBsZWZ0IHZlbnRyaWN1bGFyIGRpYXN0b2xpYyBkeXNmdW5jdGlvbiAoTFZERCkgMgQQIxgnSIMGUPkCWPkCcAF4AJABAJgBvwKgAb8CqgEDMy0xuAEDyAEA-AEBmAIBoALHApgDAIgGAZIHAzMtMaAHjwOyBwMzLTG4B8cCwgcDMi0xyAcG&sclient=gws-wiz-serp&mstk=AUtExfDP7kyg0xybtfhptMX9qC8MpXLAnoJKLbtBsC4MWeFCUSCzx1p7w1xFDNoHY9moai6UPbkwRBY9y1Sre0knzBOE1KWLJI8vV_HDLbOvDIu9M7dFD7q6uoisyG2TYthHEUTSdHnXVrm8suIan-B2868Ga5cVomy00LrdMplGtA1wwDHTeTfVcpG3NoRDemJ6yF8DnFgGzWJSLHXravGKc9Ynrip-qQ3DW0BPZ2Wr_MHieJKStVMVzHymIanJqy_-E3HyAhATwd513pHx3juuZSmkdGEHxNPgWvY1Gyn2xw6TLA&csui=3">left ventricular hypertrophy and diastolic dysfunction through <a href="https://www.google.com/search?q=pro-inflammatory+mechanisms&sca_esv=af69388857e2a179&rlz=1C1CHBF_enPK1146PK1146&sxsrf=AE3TifOWi4bjixoO0xGHnoUmQGpdH-_Jsw%3A1757328643670&ei=A7W-aP_VKJCLi-gPqPqByAs&ved=2ahUKEwjd_57F_8iPAxV73AIHHdwiHgkQgK4QegQIARAE&uact=5&oq=serum+uric+acid+%28SUA%29+in+left+ventricular+diastolic+dysfunction+%28LVDD%29+&gs_lp=Egxnd3Mtd2l6LXNlcnAiR3NlcnVtIHVyaWMgYWNpZCAoU1VBKSBpbiBsZWZ0IHZlbnRyaWN1bGFyIGRpYXN0b2xpYyBkeXNmdW5jdGlvbiAoTFZERCkgMgQQIxgnSIMGUPkCWPkCcAF4AJABAJgBvwKgAb8CqgEDMy0xuAEDyAEA-AEBmAIBoALHApgDAIgGAZIHAzMtMaAHjwOyBwMzLTG4B8cCwgcDMi0xyAcG&sclient=gws-wiz-serp&mstk=AUtExfDP7kyg0xybtfhptMX9qC8MpXLAnoJKLbtBsC4MWeFCUSCzx1p7w1xFDNoHY9moai6UPbkwRBY9y1Sre0knzBOE1KWLJI8vV_HDLbOvDIu9M7dFD7q6uoisyG2TYthHEUTSdHnXVrm8suIan-B2868Ga5cVomy00LrdMplGtA1wwDHTeTfVcpG3NoRDemJ6yF8DnFgGzWJSLHXravGKc9Ynrip-qQ3DW0BPZ2Wr_MHieJKStVMVzHymIanJqy_-E3HyAhATwd513pHx3juuZSmkdGEHxNPgWvY1Gyn2xw6TLA&csui=3">pro-inflammatory mechanisms and by impacting metabolic pathways. The role of serum uric acid (SUA) in left ventricular diastolic dysfunction (LVDD), however, remains unclear in patients with end-stage renal disease (ESRD) undergoing hemodialysis. This study is aimed to determine the association of hyperuricemia with left ventricular diastolic dysfunction in end stage renal disease patient on maintenance hemodialysis. Methods: A prospective study was carried on 129 patients with end stage renal disease of either gender of aged between 18 to 70 years who initiated maintenance hemodialysis at our hospital. Before and after hemodialysis, SUA levels were measured via standard enzymatic assay, and LVDD through echocardiographic evaluation followed ASE guidelines. Results: The mean age of the eligible participants was 42.80 ±10.86 years. 65 (50.3%) of the patients were male and 64 (49.6%) were female. Most of the patients had dialysis twice a week 91 (70.5%). The pre-dialysis, uric acid was 6.89 + 1.23 and post-dialysis it reduced to 4.78 + 1.13, significant difference was as p-value was <0.05. Similarly, frequency of hyperuricemia was also compared which shows also a significant difference. Further, a moderately strong positive correlation was found between post-dialysis uric acid levels and LVDD grading (Spearman’s r = 0.518), suggesting a direct association between residual hyperuricemia and cardiac dysfunction severity. Conclusion: Haemodialysis alone has a moderate effect on uric acid clearance, even though it is the primary option for renal replacement therapy in low-income countries for patients with ESRD. These findings underscore the potential role of serum uric acid as a modifiable cardiovascular risk factor in dialysis-dependent patients.
Copyright (c) 2025 khadija tuz zohrah Abdul aziz, Pooran Mal, Sunil Ishwer Lal, Aqsa Fatima, Salam Ali, Asfa Memon, Mukesh Kumar
Role of Level-IV Post-graduation in Basic Sciences in Research Development and Quality Improvement of Graduate Medical Education in Pakistan
Medical education has undergone evolutionary and dynamic changes. More emphasis is on curricula to be spirally integrated, learner centered, community oriented and competency-based. The goal remains to provide best evidence-based and patient-centered personalized care. Integration of preclinical and clinical disciplines remains the key to achieve this goal. Thus the role of basic medical science teachers has also evolved to accomplish the required outcome.1 A detailed knowledge of clinically oriented basic medical sciences is a prerequisite to inculcate the lifelong critical thinking and problem-solving skills in healthcare professionals, acquisition of clinical competence, diagnostic accuracy and selection of most appropriate evidence-based management according to patients’ needs.2 To face the dynamic curricular needs, there are growing challenges to the quality of basic medical education in the country. These include lack of motivated and trained basic science faculty, acquisition of teaching skills according to modern day requirements, stepwise clinical integration, barriers in pursuing undergraduate and postgraduate research, limited access to well-maintained data registries and research software in basic sciences.3,4 As per global consensus, competency-based learning in basic medical sciences is essential in present century’s clinical practice and the ability to apply basic medical science concepts to clinical practice is an essential and relevant indicator of educational outcomes in medical institutions.5
Prevalence of Primary Post-partum Haemorrhage and Factors Related to it among Women Delivered in a Tertiary Care Hospital of Lahore
Background: Primary Post-partum haemorrhage (PPPH) is the multi-factorial and the leading cause of maternal mortality. The following study is set to identify prevalence and factors related to it among women delivering in a tertiary care hospital in Lahore. Patient and methods: A cross-sectional study was conducted in the Departments of Obstetrics and Gynaecology, Services Hospital Lahore from January to June 2021. Data was collected on a structured questionnaire from three hundred and forty-eight women and their medical records using a non-probability purposive sampling technique. The variables included socio-demographics, antepartum, and intrapartum characteristics. Assessment of PPPH was carried out by primary obstetrician, by visual estimation and data was entered on SPSS version 23.0. The chi-square test was used as a test of significance, and binary regression was applied. A p-value <0.05 and Odds’ Ratio >2 was taken as significant. Results: Ninety-nine out of the total (28.4%) had PPPH. Illiteracy and low socio-economic status (income value less than the median) had significant associations with PPPH (AOR 4.26 p-value=0.015, CI 1.322-13.684) (OR 0.146, p-value=0.005, CI 0.259-0.789), respectively. A statistically significant association was found between PPPH and uterine atony (p-value=0.000, AOR=39.88, CI=60.84-2628.12), placental complications (p-value 0.035, AOR=3.321, CI=1.091-10.11), fatal demise (p-value 0.000, AOR=31.89, CI=7.99-128.243) and PIH (p-value 0.028, AOR=0.341, CI=0.130-0.892). Conclusion: This study showed a high prevalence of PPPH. Illiteracy, socioeconomics, uterine atony, placental complications, and fetal demise were significant contributors. These findings highlight the importance of socio-demographics and good management of the third stage of labour. Further research with a larger sample size can refine these insights for the development of targeted preventive strategies.
Copyright (c) 2024 Alaita Fatima Bakhtiari, Taskeen Zahra, Aaima Kamal, Afshan Shahid , Faisal Mushtaq, Sunniya Rasool
Career Intentions and their Influencing Factors among Medical Students: A Study on Brain Drain
Background: “Brain drain” is defined as the migration of educated and highly skilled professionals to developed countries, especially in pursuit of better opportunities. The objective of this study was to determine the career intentions of medical undergraduates and their influencing factors. Subjects and methods: A descriptive cross-sectional study was conducted after approval from the Institutional Research Committee from May to September 2023 with no IEC/244-23. By using non-probability convenience sampling, all 3rd, 4th, and final years MBBS were included in the study as a whole sample of 350. Data was collected with the help of a closed-ended questionnaire. Additionally, the Quality-of-Life Scale (WHOQOL-Bref), designed by the World Health Organization, and the Perceived Stress Scale-14 (PSS-14) were used. Data was analyzed in IBM SPSS version 25. Descriptive statistics, Chi-square, T test, and Pearson correlation were used for analysis, and a p-value of ≤ 0.05 was considered significant. Results: In this study, 53.8% of the participants were female (n=188) while 46.2% (n=162) were male, with the mean age of 23.05 ±1.45 years. Most of the students were unsatisfied after choosing the medical field (55.8%, n=195). The PSS-14 score mean was 1.88±0.48, and it was found that those participants who thought of practicing abroad were not statistically different from those who wanted to work in this country. After applying the Pearson correlation test between the WHOQOL-Bref and PSS-14 scores, it was found it be significant and negative (r=-0.520, p<0.05). Conclusion: The study's results indicate that the majority of medical students intend to pursue their careers abroad. Key factors contributing to this decision include long working hours, physical/verbal violence, and mobbing in their workplace
Copyright (c) 2025 Uzma Sagheer, Muhammad Talal Tayyab, Fatima Jafar, Umair Masood, Rafia Tahir, Humayun Suqrat Hasan Imam
Comparison of Effectiveness of Apremilast versus Methotrexate and Apremilast in Patients with Chronic Plaque Psoriasis
Background: Chronic plaque psoriasis is a prevalent, immune-mediated skin disorder characterized by erythematous plaques with silvery scales. The condition significantly impacts patients’ quality of life, necessitating effective treatment strategies. Objective: To compare the efficacy of apremilast versus methotrexate plus apremilast in patients with chronic plaque psoriasis. Methods: This prospective observational study was conducted at the Outpatient Department of Dermatology Services Hospital, Lahore. After getting approval from Ethical Review Committee, sixty patients of plaque psoriasis were observed in two groups of thirty patients each, depending on which treatment they were taking. Group A patients received apremilast, while Group B received oral methotrexate combined with apremilast. The primary outcome was the achievement of PASI 75 (75% reduction in Psoriasis Area and Severity Index) after three months of treatment. Patients were followed up after 3 months for calculation of PASI. Results: The study included 34 males (56.7%) and 26 females (43.3%), with a mean age of 42.80 ± 10.68 years. The baseline PASI score significantly reduced from 28.25 ± 5.86 to 7.09 ± 2.18 after three months. The mean percentage reduction in PASI score was 69.89 ± 11.22% in Group A and 76.76 ± 9.80% in Group B. Efficacy was observed in 42.9% of patients in Group A and 57.1% in Group B, which was statistically significant (p value =0.014). Conclusion: The combination of methotrexate and apremilast was more effective than apremilast alone in treating chronic plaque psoriasis.
Copyright (c) 2025 Masooma Zafar, Hira Tariq, Uzma Amin, Alina Abbass, Saelah Batool, Faria Asad
Incidence of Sacralization of 5th Lumbar and First Coccygeal Vertebrae: An Osteological Study on Dried Sacra of Pakistani Population
Background: Sacralization can occur when the fifth lumbar or the first coccygeal vertebra fuses with the sacrum. Given the increasing incidence of lower back pain and its impact on human health and wellbeing, understanding the etiology of sacralization is important. The study aimed to estimate the incidence of sacralization of the fifth lumbar and first coccygeal vertebrae in the sacrum and to define the types of sacralization observed in the cadaveric sacra. Methods: A descriptive study was done on 285 adult human dry sacra from bone bank of Fatima Jinnah Medical University and Rashid Latif Medical College in Lahore, Pakistan. The study involved examining the number of vertebral segments and sacral foramina and classifying the sacra into different types. We also calculated the sacral index and measured the length and width of these sacra. Result: Out of the sample, 68% of sacra were typical, while sacralization was observed in 32% of cases. Among the sacralized sacra, 70 % were fused with the fifth lumbar vertebra (L5) and 30% were fused with the first coccygeal vertebra. The incidence of sacralization was similar in both genders. Conclusion: Sacralization is common and can be asymptomatic or associated with low back pain, disc degeneration/ herniation, scoliosis, and spondylolisthesis. Surgeons, anesthetists, obstetricians, and physicians can benefit from this knowledge to treat a wide range of patients.
Copyright (c) 2025 Saira Munawar, Aliya Zahid , Tahira Athar , G.P William, Qurat Ul Ain
The Role of Multidisciplinary Teams in Managing Severe Trauma in Emergency Settings: Optimizing Coordination and Care
Background: Trauma is a leading cause of morbidity and mortality, especially in resource-limited settings with limited infrastructure and personnel. Multidisciplinary trauma teams (MDTs) are crucial for effective management, yet their implementation in such environments faces challenges. This study evaluates the impact of MDTs on patient outcomes and identifies strategies to enhance trauma care in resource-constrained settings. Patients and Methods: This retrospective study included 90 adults with severe trauma admitted to the A&E. Patients were categorized based on the quality of multidisciplinary team care: MDT-Optimized (coordinated, timely interventions) and Non-Optimized (delayed or incomplete interventions). Data were collected on demographics, injury details, and outcomes from electronic medical records, focusing on in-hospital mortality, morbidity, hospital stay, and time to treatment. Results: Of the 90 patients studied, 74.4% had blunt trauma, primarily from road traffic accidents and falls. The mean Injury Severity Score (ISS) was 23.5. Sixty-four percent received MDT-Optimized Care, while 36% experienced delayed or incomplete care. The MDT-Optimized group had faster times to surgical intervention (2.4 vs. 4.1 hours) and initial stabilization (12.5 vs. 24.8 minutes). Mortality was lower in the MDT-Optimized group (5.2% vs. 28.1%) and morbidity was reduced (15.5% vs. 59.4%). Hospital stays were shorter (9.6 vs. 14.3 days), and recovery outcomes were better, with 82.8% of MDT-Optimized patients discharged with full recovery or mild disability compared to 50% in the Non-Optimized group. Multivariate analysis highlighted ISS >25, delayed surgery, and lack of MDT coordination as factors increasing mortality and morbidity. Conclusion: In conclusion, this study demonstrates that the involvement of multidisciplinary teams in managing severe trauma in emergency settings significantly improves patient outcomes, including reduced mortality, lower complication rates, shorter hospital stays, and better recovery. The findings are in line with previous studies and underscore the necessity of implementing well-coordinated, team-based approaches to trauma care, particularly in resource-limited environments.
Trauma Outcomes in Patients with Pre-existing Conditions: How Effective are ATLS Protocols?
Background: This study aimed to assess the impact of trauma protocol adherence on patient outcomes in a resource-limited setting, comparing those with and without pre-existing conditions. Chronic illnesses were hypothesized to worsen trauma outcomes, with key variables including mortality, morbidity, length of hospital stay, and ICU admission. By evaluating the influence of comorbidities on trauma management, the study provides insights into optimizing care for vulnerable populations in constrained environments. Patients and Methods: A retrospective observational study was conducted on 120 trauma patients admitted to Sharourah General Hospital over a 12-month period. Patients were divided into two groups: those with pre-existing conditions (Group 1, n=60) and those without (Group 2, n=60). Data collected included age, gender, Injury Severity Score (ISS), mortality, length of hospital stay, time to treatment, ICU admission, and post-trauma complications. Results: Patients in Group 1 (with pre-existing conditions) were older, with a mean age of 62.5 years, compared to 38.2 years in Group 2 (without pre-existing conditions). Mortality was higher in Group 2 (26.7%) than in Group 1 (18.3%), though the difference was not statistically significant. ICU admissions and morbidity, including infections and respiratory failure, were more frequent in Group 1. The length of hospital stay and time to definitive treatment were similar between the two groups, though patients with pre-existing conditions experienced more variability in hospital stay and treatment delays. Conclusion: In conclusion, while patients with pre-existing conditions had higher morbidity and ICU admission rates, injury severity remained the primary determinant of mortality. Adherence to trauma protocols can help standardize care, but tailored approaches are necessary for managing the complexities of patients with chronic conditions.
Impact of Trauma Protocol Adherence on Patient Outcomes in Resource-Limited Settings: A Study from Sharourah General Hospital, Saudi Arabia
Background: In resource-limited settings, the management of trauma patients poses significant challenges due to limited medical resources, personnel, and infrastructure. Adherence to standardized trauma protocols is crucial for optimizing patient outcomes, yet the impact of protocol adherence in such settings remains underexplored. Patients and Methods: A retrospective observational study was conducted, reviewing trauma cases admitted to the ED. A total of 200 trauma patients were included and divided into two groups: 120 patients with strict protocol adherence and 80 patients with documented protocol deviations. Inclusion criteria were adult trauma patients with complete medical records, while exclusion criteria included patients dead on arrival, transferred out, or pediatric cases. The primary outcome was mortality, with secondary outcomes including morbidity, length of hospital stay, time to definitive treatment, and recovery status at discharge. Results: Patients whose care adhered to trauma protocols had significantly lower mortality rates (8.3% vs. 18.7%, p = 0.02), fewer complications (15% vs. 25%, p = 0.04), and shorter hospital stays (5.2 ± 2.1 days vs. 7.8 ± 3.5 days, p < 0.001) compared to those with protocol deviations. Additionally, the time to definitive treatment was faster in the adherence group (3.2 ± 1.1 hours vs. 5.6 ± 2.8 hours, p = 0.03). Protocol adherence was identified as an independent predictor of lower mortality and shorter hospital stays in multivariate analysis. Conclusion: In conclusion, the study findings clearly demonstrate that adherence to trauma protocols is associated with significantly better patient outcomes, even in resource-limited settings. By implementing structured and standardized care pathways, healthcare providers can overcome many of the challenges posed by limited resources, leading to improved survival rates, reduced complications, and faster recovery. These results highlight the critical importance of reinforcing trauma protocols and ensuring that they are strictly followed in emergency care settings.
Early Prediction of Preeclampsia: The Role of Doppler Ultrasound in Improving Maternal and Fetal Outcomes
Background: Early identification of Doppler abnormalities allows for closer monitoring, early intervention, and tailored management strategies to mitigate the severity of preeclampsia and its complications particularly in high-risk pregnancies, those with a history of preeclampsia or other risk factors. This study aimed to evaluate the efficacy of uterine artery Doppler ultrasound in predicting preeclampsia during the first trimester and its impact on maternal and fetal outcomes. Patients and Methods: A prospective cohort study was conducted with 150 pregnant women between 11-14 weeks of gestation. Uterine artery Doppler ultrasound was performed to measure pulsatility index (PI), resistance index (RI), and the presence of an early diastolic notch. Patients were followed throughout pregnancy to assess the development of preeclampsia. Maternal and fetal outcomes were recorded, including preterm birth, low birth weight, NICU admissions, and maternal complications. Results: Of the 150 participants, 25 (16.6%) developed preeclampsia. Abnormal Doppler findings were significantly associated with the development of preeclampsia, with a sensitivity of 80% and specificity of 84%. The negative predictive value was 96%, indicating effective early risk stratification. Patients with early detection had fewer cases of severe preeclampsia (40% vs. 60%, p < 0.05), fewer preterm births (12% vs. 28%, p = 0.04), and reduced NICU admissions (10% vs. 25%, p < 0.05) compared to those without early detection. Maternal ICU admission was also lower in the Doppler abnormality group (2% vs. 10%, p < 0.05). Conclusion: Early prediction of preeclampsia using uterine artery Doppler ultrasound allows for timely interventions, significantly improving maternal and fetal outcomes by reducing the severity of preeclampsia and associated complications. Incorporating this non-invasive screening tool into routine antenatal care can enhance pregnancy management and lower the risks of adverse events.
Navigating Complexities: Morbidity and Outcomes in Women Undergoing Five or More Recurrent Cesarean Sections
Background: Cesarean sections (CS) are increasingly common, especially in high-risk pregnancies. While generally safe, each additional CS increases the risk of complications such as uterine rupture, placenta accreta, and post-operative morbidity. Women undergoing five or more CS face elevated risks, necessitating tailored management strategies to mitigate both immediate and long-term health impacts. This study explores the morbidity and outcomes associated with multiple cesarean deliveries to improve patient care. Patients and Methods: This retrospective cohort study was conducted at Gurrayat General Hospital and MCH Center Arar, a tertiary care facility specializing in obstetrics and gynecology. The study included 75 women with a history of five or more cesarean deliveries. Data were collected from medical records, including patient demographics, cesarean section details, and post-operative outcomes. Statistical analyses were performed using chi-square tests and t-tests, with significance set at p < 0.05. Results: The average age of participants was 35.2 years, with a mean BMI of 31.5 kg/m². Major surgical complications occurred in 34% of cases, including uterine rupture (8%) and placenta accreta spectrum disorders (6.7%). Post-operative hemorrhage occurred in 16% of patients, and infections were documented in 12%. Long-term complications included chronic pain (20%), infertility (10.7%), and psychological effects (16%). A significant association was found between higher BMI and post-operative morbidity (p < 0.01). Conclusion: This study highlights the increased risks and complications associated with undergoing five or more cesarean sections, including major surgical issues, post-operative morbidity, and long-term health effects. These findings emphasize the need for improved management strategies and support for women with multiple cesarean histories.
Copyright (c) 2023 Tarifi AO, Akhtar N, Atito A, Othman RA
Conservative Management of Ectopic Pregnancy: A Population Based Study in Saudi Arabia
Background: Ectopic pregnancy occurs in 1-2% of all pregnancies and remains a significant cause of first-trimester pregnancy-related mortality, accounting for 10-15% of such deaths worldwide. Traditionally managed through surgical interventions, recent advancements in diagnostic technologies, including transvaginal ultrasonography and serial serum β-hCG measurements, have facilitated the development of conservative management strategies. These approaches, particularly medical management with methotrexate, offer a promising alternative to surgery by preserving fertility and providing effective treatment in carefully selected patients. Patients and Methods: This prospective observational study was conducted at Gurrayat General Hospital over 2 years to evaluate the outcomes of conservative medical management for ectopic pregnancy using methotrexate. Patients received either a single-dose or multi-dose methotrexate regimen, and outcomes were assessed based on β-hCG levels, resolution time, and the need for surgical intervention. Results: Out of 50 patients with ectopic pregnancy, 90% achieved successful resolution with methotrexate therapy. 64% received a single-dose regimen, with 81.25% achieving success, while 36% were treated with a multi-dose protocol, with 83.3% responding effectively. The mean time to resolution was 28 days, with the single-dose group showing a shorter resolution time compared to the multi-dose group. Minor side effects were reported in 6% of patients, and no severe methotrexate toxicity occurred. Five patients required surgical intervention due to treatment failure or clinical deterioration. Conclusion: This study confirms that conservative management with methotrexate is a highly effective and safe treatment for ectopic pregnancy in appropriately selected patients, achieving a 90% success rate and minimizing the need for surgical intervention. Further research is needed to refine patient selection criteria and standardize treatment protocols.
A Drug Synergism: Mosapride and Ondansetron Combination a Promising Drug Treatment for Gastroparesis
Methods: This experimental study was done in Combined Military Hospital Lahore and Fatima Jinnah Medical University over 18 months. Isolated tissues obtained from adult healthy rabbits and rats were used in the study. Sample size was calculated by OpenEPI formula. Animals were divided into 5 groups comprising 20 animals in each group. Strips of rabbit ileum and rat gastric fundus tissues were allowed to stand in an organ bath with an isotonic force transducer attached to powerlab (AD instruments). Increasing concentrations of serotonin, mosapride, and ondansetron were applied to tissues and their responses were recorded by the change in the mean force of contraction (grams). Increasing concentrations of serotonin and mosapride were administered in the presence of ondansetron and their responses were recorded. T-test was and ANOVA followed by Post Hoc Tukey’s test were used for statistical analysis. Results: There was a dose-dependent increase in the mean force of contraction with Serotonin, mosparide and ondansetron on rabbit ileum and rat gastric fundus tissue. Increasing concentration of mosparide in the presence of ondansetron also showed a dose-dependent increase in response as depicted by the change in the mean force of contraction in grams. Conclusion: Mosapride has less stimulatory effect on gastrointestinal tissue as compared to when used in combination with ondansetron.
Copyright (c) 2025 Nazia Rashid , Wardah Siddique, Irum Nazeer Malik, Ayela Eman Zia, Muniza Qayyum, Binish Anwar
Comparison of the Effect of Dipeptidyl Peptidase-4 Inhibitors Sitagliptin and Vildagliptin on Intestinal Motility of Rabbit Ileum and Rat Gastric Fundus Tissue
ABSTRACT Background: Diabetes mellitus is a pervasive metabolic disorder. Its prevalence is very high all over the world. Long-standing disease may result in many complications including diabetic gastroparesis. Research to evaluate the impact of antidiabetic drugs on intestinal motility is an important field of research Materials and methods: This study was performed in CMH Lahore Medical College and FJMU, Lahore, on isolated tissues obtained from adult healthy rabbits and rats over 18 months. Animals were divided into four groups of each species; each group comprised twenty animals. Strips of rabbit ileum and rat gastric fundus tissues were allowed to stand in physiological salt solution in an organ bath with transducers attached to the Powerlab. Increasing concentrations of Sitagliptin and Vildagliptin were administered and a change in intestinal motility was recorded by powerlab (AD instruments) as a change in the force of contraction(g). Then increasing concentrations of sitagliptin and vildagliptin,were administered in the presence of ondansetron. Unpaired t-test was used to compare the difference between the two groups of drugs A p-value of less than 0.05 was considered significant. Results: There was a dose-dependent inhibitory effect of sitagliptin and vildagliptin on intestinal motility.Sitagliptin has an inhibitory effect when administered alone and change the force of contraction from 19.86±1.71 to 14.00±1.5 on rabbit ileum and from 9.008±1.3 to 6.4±1.18 on rat gastric fundus tissue. Sitagliptin in the presence of ondansetron has dual effect at low concentrations it has inhibitory effect and at high concentration it has stimulatory effect. Sitagliptin has more significant inhibitory effects on the force of contraction as compared to vildagliptin (p-value < 0.001). Conclusion: The Present study confirms the inhibitory effect of sitagliptin and vildagliptin on the gastrointestinal motility.
Copyright (c) 2024 Nazia Rashid , Muniza Qayyum, Gulpash Saghir, Javaira Fatima, Waqar Ahmed Siddiqui, Sehrish Zaffar
Sanitary Practices of Street Food Vendors: A Cross-sectional Comparative Study, Lahore, 2023
Background: Street food is an important source of nourishment for many in urban areas. However, any compromise in hygienic practices can render it unsafe for human consumption. The objective of this study was to assess the sanitary practices of street food vendors and their relation to the sociodemographic profile, in Lahore Subjects and methods: This was a cross-sectional comparative study conducted in Lahore, Punjab for 6 months after ethical clearance. Street vendors from areas around Ameer ud Din Medical College, which are densely populated with a multitude of offices and hostels, were included in the study after informed consent. Convenience sampling and a predesigned questionnaire were used by the researchers to collect data from 288 vendors. Demographic variables and vending practices were studied and compared using chi-square test. For data entry and analysis SPSS version 23 was used. Results: The average age of the vendors was 34.6 years. 286 (99.3 %) were males,195 (67.7%) were married and 138 (47.9%) had vending experience of less than 5 years. 60 (21%) had education of graduate and above level. 209 (76%) had a monthly income below 50,000 rupees. 61 (21.2%) had a good vending practices score, i.e. a score of 75% and above based on water usage, usage of sanitary toilet facilities, hand washing and nearby environment of the vending site. There was no significant association between sanitary practices and sociodemographic variables. Conclusion: Most vendors did not have a good vending practices score. Sanitary practices of the vendors had no relation with gender, marital status, education, work experience or monthly income of the vendors.
Copyright (c) 2025 Rozina Shahadat Khan , Asma Ali , Zobia, Muhammad Abubakar Khan, Hanzala Munir
Breathing Movements of Fetus, Length of Cervix and Vaginal Secretion Positive Fibronectin, As Tools to Predict Chances of Preterm Labour
Background: The leading cause of newborn health problems and death results from preterm labour. Early predictions about developing preterm labour need to be exact to enable prompt medical assistance. This study evaluates fetal breathing movements together with cervical length measurements and vaginal fibronectin tests to determine their accuracy in predicting preterm labour whether used separately or in combination. Methods: This was cross sectional study took place within a Lady Willingdon Hospital with n=110 pregnant women participating who were at gestational weeks 24 to 34. Three tests were utilized to evaluate fetal breathing movements and cervical length measurements using transvaginal ultrasound while fibronectin levels required vaginal secretion analysis. The study measured either preterm labour or term delivery as its primary outcome. The analysis used Sensitivity, Specificity, Predictive Values and Logistic Regression techniques. Results: The occurrence of preterm labour developed in 50% (55/110) of all participants. Fetal breathing movements measured at 5.3 ± 1.1 movements were lower than the 7.2 ± 0.9 movements seen in control subjects with a statistically significant difference (p<0.05). Preterm women exhibited cervical lengths measuring 2.1 ± 0.6 cm that were significantly shorter than the term-group values of 3.4 ± 0.5 cm (p<0.01). The group of preterm subjects showed higher fibronectin concentrations than term subjects along with measurements of 50.2 ± 20.5 ng/mL versus 10.1 ± 8.4 ng/mL (p<0.01). Multi-parameter assessment generated the most accurate results through a combined logistic model providing an odds ratio of 0.38 (95% CI 0.22–0.64, p<0.001). Conclusion: The assessment of fetal breathing movements plus cervical length along with fibronectin levels works effectively as preterm labour risk predictors. Prediction accuracy increases when different clinical parameters are combined into a single assessment approach for potential clinical implementation.
Copyright (c) 2025 Qindeel Zahra , Noamia Ashraf, Sadaf Zahra Syed, Bushra Khan, Afroze Ashraf, Mahham Janjua, Quraa Mehmud
Frequency of Anxiety and Depression in Patients with Acne Vulgaris
Background: The mental health and overall well-being of individuals can be profoundly affected by acne. The objective of this study was to determine the prevalence of anxiety and depression among individuals suffering from acne vulgaris. Methods: A cross-sectional survey was conducted at Unit 1 of the Department of Dermatology, Mayo Hospital Lahore, spanning from March 9th, 2022, to February 3rd, 2023. The study included 115 patients, all diagnosed with acne vulgaris. Patients were selected using non-probability consecutive sampling. . Anxiety and depression levels in patients with acne vulgaris were assessed using the 14-item Hospital Anxiety and Depression Scale (HADS) with scores ranging from 0 to 21 to indicate normal, borderline, or anxiety/depression levels. Results: The age range of the patients varied from 14 to 35 years, with an average age of 22.4 ± 5.5 years. Among patients diagnosed with acne vulgaris, depression was noted in 52 (45.2%) individuals, while anxiety was present in 66 (57.4%) patients. Upon comparison, there were no statistically significant differences in the occurrence of depression and anxiety among various subgroups of patients classified by age, gender, educational background, employment status, and marital status. Conclusion: Our study found that a significant proportion of patients with acne vulgaris experienced anxiety and depression. These mental health challenges were observed across all demographic factors, including age, gender, education level, employment status, and marital status.
Copyright (c) 2025 Sana Rafiq, Amna Saeed, Ayesha Hameed, Iqra Fatima , Wajieha Saeed , Ghazala Butt
The Need for Implementation of Interprofessional Education in Undergraduate Health Professions Colleges in Pakistan
ABSTRACT Background: The purpose of this study is to look into the necessity of integrating Interprofessional Education (IPE) into Pakistani undergraduate health professions colleges. The main goal is to evaluate staff and student awareness, attitudes, and perceived barriers regarding IPE. Methods: A mixed-methods approach, combining surveys (n=128) and focused group discussion (n=17), was utilized to obtain comprehensive insights into the perspectives of both students and faculty members over a period of 10 months from medical, dental and nursing colleges. Surveys were distributed to a stratified sample of students and faculty members, evaluating their awareness, perceptions, and challenges related to IPE. Additionally, semi-structured FGD was conducted with a subset of participants to delve deeper into their viewpoints. Descriptive statistics and thematic analysis were employed to analyze the quantitative and qualitative data, respectively. Results: The survey responses and FGD narratives revealed scanty awareness regarding IPE concepts among both students and faculty members. While participants expressed positive attitudes toward IPE, significant challenges such as curriculum constraints, limited resources, and organizational resistance were identified as barriers to effective implementation. The qualitative analysis highlighted the potential benefits of IPE, including improved teamwork, communication skills, and patient-centered care. Conclusion: Despite the acknowledged benefits of IPE, challenges persist that hinder its successful integration. This study advocates for a comprehensive strategy to overcome challenges and promote the effective implementation of IPE, ultimately contributing to more proficient and patient-centric healthcare delivery in Pakistan.
Copyright (c) 2025 Attia Sheikh, Aeeza Malik
Role of Office of Research Innovation and Commercialization in Promotion of Research and Development in Degree Awarding Institutes of Pakistan
A country's sustainable growth relies heavily on indigenous, authentic, and continuous research activities. The research process is a creative endeavor with objectives to expand existing theories, discover new knowledge through various organized research methods, and resolve everyday problems.1 As technology advances, universities have become increasingly pivotal in the processes of invention, innovation, and commercialization. Traditionally, Degree Awarding Institutes (DAIs), remained concentrated on scientific knowledge and research, seeking to expand fundamental phenomena without an immediate commercial focus. However, with the increasing use of fifth generations digitalization and artificial intelligence, DAIs have become the nucleus of research productivity instrumental in the socio-economic uplift of the communities and country.1-3 The role of the Office of Research, Innovation and Commercialization (ORIC) in DAIs has become important, bridging the gap between innovations and the market. Universities have the potential to cater to the interests of inventors and investors significantly, playing a crucial role in benefiting society by translating valuable scientific advancements translate into practical and positive impacts.4,5 Pakistan's independence and partition from India in 1947 had a significant impact on the scientific and higher education landscape of the newly born country. At the time of independence, Pakistan inherited only a small fraction of the scientific and technological infrastructure that existed in pre-partition India. This limited inheritance posed challenges to the development of science, higher education, and research. Coming seventy years after its inception, the trajectory of innovation took a low rise. Pakistan is the fourth most populous country in Asia homing 231 million people. As per 2021-22 statistics, $374.7 Billion was its Gross Domestic Product (GDP), and the GDP per capita recorded was $1,501 having the 9th largest labor force estimated at 63.89 million, spending 2% of its GDP on education. Till 2020-21, a total of 2,245,998 students were enrolled in 222 Higher Education Institutes (HEIs) (Public and Private) across the county.6 Research and Development (R&D) in Pakistan is mainly conducted by public universities and research institutes, with most of the funding provided by the government. The private sector's contribution to the Gross Expenditure on Research and Development (GERD) is not substantial. The government has shown unprecedented support for science and technology, particularly in higher education, even with limited resources. R&D expenditure in higher education has seen a significant increase, rising nearly fourfold from about 530 million Rupees to 2,000 million Rupees over the last few years.5 The primary focus areas for R&D in Pakistan include agriculture, engineering, defense, health and industrial research. Despite these substantial improvements in support for R&D and higher education over the past five years, Pakistan continues to face challenges. The country has one of the lowest ratios of scientists and engineers per million population, highlighting the need for ongoing investment and development in this sector.3,5,6 Since their establishment in 2011 by HEC, it is impressive how the Offices of Research Innovation and Commercialization (ORICs) have effectively cultivated research culture and boosted industry involvement in applied research programs within universities. This was made possible through collaborations with businesses and industries.3,5 The concept of a formal office of ORIC in universities is comparatively recent in Pakistan. Previously, the universities kept on promoting their research without commercialization in isolation. In 2011, only six universities across the country had ORIC office in their campus.5 Currently, a total of 89 ORIC offices in medical and non-medical DAIs, resulting in a steady increase in R&D-related activities.5 However, the United Nations Educational, Scientific and Cultural Organization’s Institute of Statistics has revealed that just 0.16% of Pakistan's GDP is invested in domestic R&D.7 Even this minimal allocation underscores the nation's commitment to promoting innovation and driving industrial advancement. A recent survey by the Pakistan Institute of Development Economics (PIDE) reveals that in Pakistan's Golden Triangle, nine out of ten firms did not allocate any funds to research in the past year. Among firms that have embraced enhanced processes, 34% emphasize the substantial improvements in their operations. The remaining stagnant discovery emphasizes the crucial relationship between R&D, skilled manpower, and operational efficiency.7 This further highlights the development of links between research and development (R&D), innovation, and operational efficiency, and ORIC in strategic planning. ORIC can prove effective in creating this relationship by encouraging productive and relevant research and its commercialization utilizing Business Incubation Centers (BICs), development of industrial linkages, collaborating and networking among themselves in subject matters, and strategically placing research and innovation in the center.5,7 Embracing R&D should not be just a choice but a necessity. It serves as the cornerstone for navigating through a swiftly evolving business environment, unlocking undiscovered potential, and gaining a competitive advantage. Although ORIC's role in collaboration of R&D in industry and academia, may pose challenges, the benefits seem to outweigh monetary numbers, impacting researchers, academics, industries, and the overall economic prosperity of the nation. Medical DAIs are special in this context. Besides the call for aligning research to national health policy, lack of infrastructure, appropriate funding, human resource, and regulatory mechanisms are identified as barriers towards evidence-based healthcare.8 The augmented burden of disease for resource-limited countries like Pakistan highlights the urgent need for quality and relevant clinical research to identify and implement cost-effective and innovative contextual treatment regimens. The ‘triple helix model’ consisting of university-industry-government is also proposed for the medical and life sciences ecosystem.4 Given the growing interdependencies among these traditionally separate entities, it is becoming essential for medical-related DAIs to overcome the above-mentioned key hurdles through collaboration and ommercialization.2,4,8 Establishment of ORICs in medical DAIs are expected to encourage and redirect their focus towards developing research programs, advancing from invention to innovation, and expanding these discoveries through industrial collaboration.2 Facilitating these initiatives within universities, especially medical DAIs and encouraging knowledge exchange among institutions and industries can play a crucial role in reaching these objectives. Establishing incubators would further, aid in the commercialization of research and development (R&D) projects and networking.4,5,7 While the outcomes of these efforts may not be immediately apparent, they will establish crucial foundations for self-sufficiency and long-term sustainability. This will ultimately lead to substantial growth in evidence-based practices within healthcare settings.
Integrated Risk Factors and Self-Reported Non-Communicable Diseases in Lahore: A Cross-Sectional Analysis
Background: Integrated risk factors of non-communicable diseases (NCDs) are those that contribute collectively to the development of a variety of chronic diseases such as cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases. The study aims to determine the prevalence of non-communicable diseases and their integrated risk factors in the adult population of Lahore through a self-reported questionnaire. Methods: This analytical cross-sectional study was conducted in Lahore from April to September 2023. A sample size of 1833 was included in the study. The eligibility criteria were the general population of Lahore aged above 18 years who could understand English. Participants were accessed via online Google Forms shared by 4th year students as per of their project using convenience sampling. The WHO STEP-wise questionnaire was used for data collection. Data was entered and analyzed by SPSS version 23. Chi-square was applied between any non-communicable disease and sociodemographic data and risk factors. A p-value less than 0.05 was considered statistically significant. Results: The study of 1833 participants (51.3% males, 48.7% females) found hypertension (29.4%) as the most common self-reported non-communicable disease. Key risk factors included insufficient fruit and vegetable intake (>95%), smoking, and physical inactivity. Non-communicable diseases were significantly associated with age >40, male gender, and lower socioeconomic status (p < 0.05). Conclusion: Smoking, inadequate fruit and vegetable consumption, high salt intake, and physical inactivity are the most prevalent risk factors of non-communicable diseases in this community. Urgent public health interventions are needed to reduce them, especially in the youth and young adults.
Copyright (c) 2025 Mehreen Nasir, Iram Manzoor, Guzel Umar, Esha Alam, Fatima Anum, Hadiqa Tariq
Avoidance of pre-analytical errors in laboratory testing: a neglected area needing prompt attention
Medical errors have significant impact on patient outcomes; therefore, reducing them is critical for patient safety. Medical errors can be classified as diagnostic, therapeutic, preventive, or rehabilitative. Even as technology advances, these errors remain a significant issue in medical practice.1 In laboratory medicine, three types of diagnostic errors can be identified in the processing of laboratory samples: preanalytical, analytical, and postanalytical errors.2 Before a sample is prepared for analysis, preanalytical activity starts with a clinical request for a laboratory test. Preanalytical errors are the errors that happen prior to the actual analysis of a specimen. All three stages of the entire test procedure must be error-free to qualify for the results to be reported accurately. Pre-analytical errors are a significant source of errors in laboratory testing and thus may compromise patient care. In the analytical and postanalytical phases, automation has greatly decreased errors. However, because the preanalytical stage still relies heavily on human handling, there is still considerable room for improvement. The errors in this stage can range from sample collection to testing preparation, and need to be eliminated because they account for 70% of all errors in the diagnostic process.3 Sample mix-ups, inadequate sample amounts, incorrect labelling, and transportation delays are examples of common preanalytical errors.4 These errors frequently result in sample rejection because of hemolysis, incorrect tubes, and clotted blood.5 Patient safety and best practices may be jeopardized if these errors are not identified and fixed, which could delay the diagnosis and subsequent course of treatment. Minimizing these errors could be accomplished by training personnel who perform blood sampling on daily basis and adhering to standard laboratory procedures.6 The venipuncture and collection of sample in appropriate tubes are important steps and have been identified as the most frequent causes of pre-analytical errors.3-5 Blood samples are susceptible to hemolysis because of using small-bored needles, moving the plunger quickly, and shaking the sample vigorously in DOI: http:/doi.org/10.37018/JFJMU/1578 the collection tube after using incorrect phlebotomy technique. Selecting the incorrect blood collection tubes may result in the insufficient blood needed for analysis, cause clots due to improper additives or blood-anticoagulant mixing, lead to measurement errors of analytes. Furthermore some of the analytes may be falsely elevated due to phenomenon of hemoconcentration due to prolonged or inappropriate torniquet application. Samples that are rejected due to incorrect labeling lead to misidentification, and delay patients’ diagnosis and management while putting additional burden on wastes resources. Sample integrity is compromised by poor storage conditions, delayed transportation, and sample processing, which leads to erroneous lab results. Moreover, laboratory results are influenced by drug-test interactions that may lead to inappropriate results. It is imperative to obtain information regarding the medications being taken by the patient.
Frequency and Indications of Cesarean Section in Females Undergoing Induction of Labor: A Cross-sectional Study at a Tertiary Care Hospital
Background: Induction of labour is a method to increase the vaginal delivery rate in women in whom the spontaneous onset of labor does not occur or they need to be delivered before the estimated date of delivery. However, in literature, the frequency of cesarean section is reported to be high after induction and not much work has been done especially in local settings. So we conducted this study to attain the current extent of cesarean section after induction and its most common indications. This study determined the frequency of cesarean sections and identified their indications in females undergoing induction of labor. Patients and methods: This descriptive cross-sectional study was done in the Department of Obstetrics and Gynecology, Central Park Teaching Hospital, Lahore from March to September 2021. After IRB approval 100 females were included in the study who were induced with Prostaglandin E2. Informed consent was taken and mode of delivery was observed. In cases of cesarean section, indications were noted in proforma. Results: In this study, 40% of women had cesarean section and 60% underwent normal delivery. The most frequent indication was fetal distress (32.50%) followed by refusal for further dose (25%), failed induction (22.50%) and prolonged or obstructed labor (20%). The frequency of cesarean section was higher in younger primiparous (55%) and obese women (42.5%). Conclusion: This study concluded that the frequency of cesarean section is higher in women undergoing induction of labour. The most frequent indication was fetal distress followed by refusal for further dose and failed induction.
Copyright (c) 2025 Sanya Muqaddas, Rubina Muqaddas, Tehmina Zafar, Rubeena Badar , Rozina Naurin, Tayyaba Majeed
Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) Knee in detecting Anterior Cruciate Ligament (ACL) Tears assuming Arthroscopy as Gold Standard
Background: Anterior cruciate ligament is a core ligament of the knee joint and is vulnerable to injuries in sports and athletics. Timely diagnosis of ACL injuries can result in better management and fast repair. This study explores the diagnostic accuracy of Magnetic resonance imaging (MRI) of knee joint in ACL complete tear. Patients and methods: To decide the diagnostic efficiency awareness, particularity, positive predictive values (PPV), negative predictive values (NPV) worth and demonstrative precision of X-ray in contrast with arthroscopy for identification of upper leg tendon tears of the knee. A total 78 patients were considered in this study with suspicion of ACL rupture. Patients underwent both MRI and arthroscopy for the detection of ACL tears. The outcomes of the MRI were compared with the accepted gold standard, arthroscopy. Results: The mean age of the patients enrolled in the study turned out as 45.1 ± 12.8 (p<0.001). ACL tears were presented in 52.6% of the patients according to both arthroscopy and MRI. According to MRI, there were 39 true positives (TP), 2 false positives (FP), 2 false negatives (FN), and 35 true negatives (TN). It was found out that PPV was 90.3%, NPV was 97.2%, sensitivity was 95.12%, specificity was 94.59%, while accuracy was observed as 94.87%. Conclusion: MRI can serve the patients in diagnosis such that it is non-invasive, cheap and can avoid unwanted arthroscopies in case of ACL tears diagnosis. These results also support the fact that MRI can be used as an alternative to arthroscopy in the Pakistani population. These findings can serve to better plan medical facilities in Pakistan.
Copyright (c) 2025 Mian Waheed AHMAD, Amsal Saeed , Nawaz Rashid
Diagnostic Potential of Haematological Indices (Mentzer Index and RDWI) to Distinguish Iron Deficiency Anemia and βTT
ABSTRACT Background: Iron Deficiency Anemia (IDA) and β-thalassemia trait (βTT) are the most frequently encountered entities presenting with microcytic hypochromic anemia. It is essential to distinguish between IDA and βTT to avoid incorrect diagnosis of βTT and unnecessary iron therapy. The high cost and inaccessibility of specific confirmatory tests has led to the utilization of different red blood cell (RBC) indices to differentiate them. The objective of this study was to assess the diagnostic accuracy of RDWI and Mentzer Index for screening and differentiation of IDA and βTT in terms of cost-effectiveness, availability to be used as a valid screening tool in resource constraint settings. Patients and methods: This analytical study was conducted at Hematology, Department, Service Institute of Medical Sciences/Services Hospital,Lahore. Total 322 patients with microcytic hypochromic anemia were enrolled . IDA was diagnosed on the basis of low serum ferritin (<15ng/ml) and βTT by HPLC, showing HbA2 >3.5%. Mentzer index and RDWI were calculated from parameters obtained by automated CBC analyzer. MI <13 and RDWI <220 favors βTT. MI >13 and RDWI >220 favors IDA. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and positive likelihood ratio of Mentzer and RDWI were calculated for IDA and βTT. Results: MI has a PPV of 88.6%, NPV of 64.6%, an accuracy of 79.9%, and a positive likelihood ratio of 3.47. RDWI has positive predictive value of 93.8%, a negative predictive value of 74.8%, an accuracy of 87.2%, and a positive likelihood ratio of 6.44 for IDA. Positive likelihood ratio of MI and RDWI for BTT is 4.11 and 6.96 respectively. Conclusion: MI and RDWI are valid screening tools with high diagnostic accuracy for initial screening and differentiation of IDA and βTT.
Copyright (c) 2024 Asma Munir, Arrosa Rahim , Faryal Zafar , Hafiz Muhammad Haseeb , Rabia Zahid
Prevalence and Distribution of Talon Cusp in Permanent Dentition among Non-Syndromic Pakistani Population
Background: Talon cusp is a rare accessory cusp developing from cementoenamel junction (CEJ) of the anterior teeth as a vertical ridge. The purpose of this study was to determine the prevalence and distribution of Talon cusp in Non-Syndromic Pakistani population. Methods: This cross sectional study was conducted at Margalla Dental Hospital from April 2022 to September 2022. Non-probability, convenience sampling technique was used. A mouth mirror and Community Periodontal Index of Treatment Needs (CPITN) probe were used for intra-oral examination after drying teeth with the help of cotton gauze. Once identified, Talon cusp was classified and patient’s demographics and tooth characteristics were recorded. SPSS 21 was used for data analysis. Descriptive statistics were used for demographic and tooth related variables such as age, gender. An association of demographic variables and characteristics of anomaly was made using Chi-square test. The level of significance was kept at α at < 0.05. Results: Of 1298 participants, 653 (50.3 %) were males and 645 (49.7%) were females. The mean age of the participants was 37.57 ± 16.2 years. Most of the participants were Punjabi (1128, 86.8%). The person prevalence of Talon Cusp was 0.45% (6 patients out of 1298 had Talon cusp) with Type 3 Talon cusp most frequently found. No significant difference between genders or ethnicity and presence of Talon’s cusp was observed among study participants. Conclusion: Within limitation of this study we concluded that the prevalence of Talon cusp among Pakistani Population is 0.45%. There is an almost equal distribution among maxillary central and lateral incisors with Type 3 Talon cusp most frequently found.
Copyright (c) 2025 Ayesha Yasir, Nauman Bari Khan, Huma Farid, Muhammad Azhar, Anum Afshan, Wasif Hassan Awan
Maternal Environmental Factors Associated with Congenital Hydrocephalus
Background: Congenital hydrocephalus is characterized by dysregulated cerebrospinal fluid circulation and is associated with serious morbidity. The objective of this study was to identify the various maternal factors related to the occurrence of congenital hydrocephalus. Patients and methods: This was a retrospective study conducted at the University of Health Sciences, Lahore (UHS) and Children’s Hospital and Institute of Child Health. A total of 96 patients of congenital hydrocephalus along with their mothers were enrolled in this study. Data was collected by using proforma for history taking from mothers regarding antenatal period and family history details. Collected data was entered, processed, and analyzed in SPSS version 21.0. Results: The mean maternal age of the participants was 27.88 ± 5.36 years. The results of maternal parity showed a mean of 2.85 ± 1.86 children. A history of self-medications including analgesics, over-the-counter antibiotics and herbal medicines used in the first trimester was found in 53 (55.2%) mothers. Eighty (83.3%) mothers did not take folic acid supplementation during pregnancy compared to only 16 (16.7 %) mothers who regularly took folic acid. No mother was reported to be a smoker or alcoholic. A family history of congenital HCP was reported by 10 (10.4%) mothers. Consanguinity history showed that 40 (40.7%) patients had consanguineous marriages while 56 (58.3%) had non-consanguineous marriage histories. Conclusion: The common maternal factor associated with the occurrence of congenital hydrocephalus was the lack of regular folic acid supplementation during antenatal care.
Copyright (c) 2024 Rahat Bano Siddiqui, Uzma Erum , Rabia Rauf , Shumaila Shakoor, Sabahat Zulfiqar, Mehwish Razzaq
Knowledge, Attitude and Practices of Hepatitis B among Family Members of Hepatitis B Cases in District Dera Ghazi Khan of Punjab, Pakistan: A Community-Based Study
Background: Hepatitis B virus (HBV) is a major global health concern, potentially leading to complications like cirrhosis and liver cancer. This study evaluated knowledge, attitudes, and practices regarding HBV among family members of HBV-positive patients in a rural area. Methods: A descriptive cross-sectional study was conducted from January to August 2021 in Union Council Choti Zareen, District Dera Ghazi Khan, Punjab, Pakistan. The study targeted 200 immediate family members of Hepatitis B-positive cases, excluding those residing outside the study area, non-family caregivers, and critically ill individuals. Data was collected through face-to-face interviews. Categorical variables were presented as percentages, while continuous variables were reported as means and standard deviations. Associations were analyzed using the Chi-square test, with significance set at p ≤ 0.05. Results: Knowledge of HBV was universal (100%), with 190 (95%) acquiring information from health personnel. Regarding transmission modes, 172 (86%) had knowledge, with unsafe injections (73, 36.5%) being the most recognized route. Preventive measures were known by 172 (86%). Preventive practices were limited with only 38 (19%) requesting sterilized instruments and 6 (3%) observing safe sexual practices. Knowledge of HBV transmission and prevention was significantly associated with age (p = 0.02, p = 0.015), gender (p = 0.0395), education (p = 0.00), and LHW visits (p = 0.00, p = 0.03). Conclusion: Strengthening health education and enhancing LHW outreach in rural areas is essential to improve HBV knowledge and preventive practices, reducing morbidity and mortality
Copyright (c) 2025 Aneequa Sajjad, Syeda Batool, Mahnoor Fatima, Muhammad Qasim Raza, Syeda Zaira Sajjad, Syed Sajjad Sarwar
Comparison of the Effectiveness of Rifaximin plus Lactulose versus Lactulose Alone in Overt Hepatic Encephalopathy in Terms of Complete Reversal
Background: Hepatic encephalopathy is a serious complication of liver disease, marked by cognitive impairment and potentially life-threatening consequences. Lactulose has long been a standard treatment, but its effectiveness may be limited. Adding rifaximin to lactulose has shown promising results in managing overt hepatic encephalopathy (OHE). This study compared the frequency of complete reversal of encephalopathy by rifaximin plus lactulose versus lactulose alone in patients with OHE. Patients and methods: A randomized controlled trial was carried out at Gastroenterology, DHQ, Gujranwala. The patients diagnosed with hepatic encephalopathy (age range = 18-60 years) were included. On the contrary, patients with serum creatinine of >1.5 mg/dl at admission, diagnosed with hepatocellular carcinoma, active alcohol intake (<4 weeks) and patients with significant comorbidities like CVA, epilepsy, and dementia were excluded from the study were not included in the study. Ninety patients into two equal groups; Group A-B. A patients received a combination therapy of Rifaximin (550mg tablet twice daily) and lactulose (30-60 ml thrice a day). Group B patients received lactulose (30-60 ml thrice times daily) placebo capsule (sugar) thrice daily. Both groups were monitored for achievement of optimal bowel function (two to three semisoft stools per day). Results: The patients was 44.9 years. Overall there were 66 (73.3%) males 24 (26.7%) females. The mean MELD scores in group A-B were 33.76 ± 16.76 and 34.36 ± 15.85. The mean duration of liver cirrhosis in group A and group B was 6.49 ± 2.25 and 6.67 ± 2.40, respectively. In group A, a complete reversal of HE was seen in 38 (84.4%) cases while in group B the complete reversal of HE was observed in 24 (53.3%) cases (p-value <0.05). Conclusion: The combination of Rifaximin with lactulose is more effective in treating overt hepatic encephalopathy compared to lactulose alone in terms of complete reversal.
Copyright (c) 2024 Faizan Pervaiz, Ali Hyder , Najam-Us-Sehar Saeed, Jawad Naeem, Zain Haide, Daud Ghilzai
Effect of Psychoeducation on Caregivers’ Burden of Patients Suffering from Obsessive Compulsive Disorder
Background: In chronic mental disorders a considerable burden is placed on persons involved in care. Therapeutically, an evidence-based intervention for patients and their families is psychoeducation that provides information and support to help such individuals having a better understanding of the illness to cope well with it. The objective of study was to determine the effect of psychoeducation on caregivers’ burden of patients suffering from obsessive-compulsive disorder. Subjects and methods: A randomized double-blinded controlled trial was conducted at the psychiatry department of Sir Ganga Ram Hospital on 80 caregivers having scores above 23 on the family burden interview schedule and did not have any psychoeducation session in the previous 6 months. They were divided into two equal groups (40 each). The intervention group received four psychoeducation sessions for one month and the control group was not provided psychoeducation sessions. At the end of four weeks, the family burden interview schedule scores were noted down on proforma and SPSS version 23.0 was used to enter and analyze the data. Results: The mean age of participants in the intervention versus control group was 28 + 4.84 vs. 29 4.62 years. With respect to gender, in the interventional group, there were 18 (24%) males and 20 (26.7%) females and in the control group there were 14 (18.7%) males and 23 (30.7%) females There was a significant difference in mean FBIS score at 4 weeks was 21 4.29 and 33 5.87 respectively (p-value<0.05). Conclusion: Psychoeducation was effective in reducing the caregivers’ burden of patients suffering from obsessive-compulsive disorder.
Copyright (c) 2024 Mariam Naz, Arooj Fatima , Ammara Butt, Ayesha Rashid
Frequency of Fungal Infection in Histopathological Sections of Patients Undergoing Functional Endoscopic Sinus Surgery for Sinonasal Disease
ABSTRACT Background: Fungal rhinosinusitis can occur in different sinonasal conditions. It seemed to be present in 1-18% of these patients. Due to the warm and humid environment of the sinonasal cavity, combined with underlying nasal conditions such as chronic sinusitis and nasal polyposis, these patients are at risk of developing fungal infections. The objective of this study was to find out the frequency of fungal infection in histopathological sections of patients who had underwent functional endoscopic sinus surgery for sinonasal diseases. Methods: A retrospective clinical record review study conducted at the Department of Ear, Nose, and Throat (ENT) of Shifa Foundation Clinic and Shifa International Hospital from August 2018 to January 2024. Total 304 patients who underwent functional endoscopic sinus surgery (FESS) over a period of 6 years, with diagnosis of sinonasal disease established through clinical evaluation and imaging studies prior to surgery, and histopathology reports generated from surgical specimens obtained during the surgery. The surgical specimen was prepared as per the recommendation of the microbiology department of the institutions. The data was analyzed in SPSS to find the frequency of fungal infections. Results: Out of 304 subjects, 62.5% were male and 37.5% female. The study analyzed histopathology reports of patients diagnosed with various nasal and sinus conditions. The most common diagnosis was inflammatory nasal polyps 222 cases (73%), followed by fungal infection with 21 cases (6.9%) and acute on chronic inflammation 20 cases (6.6%). The results indicate a high incidence of inflammatory conditions in the nasal and sinus regions. Conclusion: This study provides fungal infiltration is detected in moderate samples obtained during functional endoscopic sinus surgery.
Copyright (c) 2025 Mumtaz Ahmad Umar, Ayesha Jawad, Mohibullah Mushwani, Saira Iftikhar, Farhan Ahmed
Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Patients Admitted with Sepsis: A Retrospective Cohort Study
Background: Sepsis has a high mortality rate and an effective and inexpensive clinical indicator is important to determine prognosis in these patients. The objective of the study was to study serum blood urea nitrogen to albumin ratio as a prognostic factor for in-hospital mortality in patients admitted with sepsis. Subjects and methods: A retrospective cohort study was conducted at Mayo Hospital Lahore. One-hundred and sixty-eight adult patients admitted between March 2022 to March 2023 were included. Data was obtained from medical records. Blood urea nitrogen to albumin ratio was noted along with other co-morbidities and probable infection source. Outcome was noted in the form of discharge or expiry. Univariable and receiver operating characteristics curve analysis was carried out. The results were further verified by multivariate logistic regression analysis to evaluate the independent predictive value of the ratio. Results: Among 168 participants, majority were males with a mean age of 55 years. One-hundred and seven patients were discharged and 61 expired. All-cause mortality was seen higher in patients with higher blood urea nitrogen to albumin ratio (p-value<0.028). The area under the receiver operative (ROC) curve (AUC) was 0.682 [95% CI=0.600-0.765]. A cut-off value of the BUN to albumin ratio was >9.524 calculated from the ROC curve was found to have a sensitivity of 77.0% and specificity of 44.1%. This AUC for BUN-to-albumin ration was more than BUN or albumin alone. Conclusion: Blood urea nitrogen to albumin ratio at admission is significantly associated with in-hospital mortality in patients with sepsis.
Copyright (c) 2025 Amna Suhail, Anam Fatima Bangash, Muzna Suhail, Shadab Masood, Iqra Tahir, Rabia Rathore
Pregnancy-Induced Hypertension and Gestational Diabetes Impact on Fetomaternal Outcomes in COVID-19-Positive Women Hospitalized for Delivery
Background: Studies evaluating the impact of pregnancy-related disorders among COVID-19-positive women on fetomaternal outcomes remained scarce. Therefore, we assessed the impact of pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) on fetomaternal outcomes in COVID-19-positive women hospitalized for delivery. Patients and methods: A review of medical records of 37 COVID-19-positive pregnant women hospitalized at Sir Ganga Ram Hospital Lahore from April to June 2020 was performed. Data retrieved included demographics, comorbid illnesses, and maternal and fetal outcomes. Using SPSS v.26, a Chi-square test was done to assess the impact of comorbid illnesses on fetomaternal outcomes. Results: The mean age of the cases was 25.8 ± 4.6 years, the gestational age was 37.5 ± 1.2 weeks, and the frequency of primigravida was 24.3%. PIH (n = 08, 21.6%) was the most frequent comorbid illness followed by GDM (n = 05, 13.5%). Women with comorbid illness showed statistically significant differences for cesarean delivery (64.3% vs. 35.7%, p-value = 0.022), duration of hospital stay (8.2±3.8 vs. 5.6±1.6 days, p-value = 0.009), low birth weight (85.7% vs. 14.3%, p-value = 0.007), NNU admission (60.0% vs. 40.0%, p-value = 0.009), and marked differences for both maternal and neonatal mortality (100% vs. 0.0%, p-value = 0.078) as compared to women without any comorbid illness, respectively. Conclusions: Comorbidities including PIH and GDM among COVID-19-positive women hospitalized for delivery, had a higher incidence of adverse fetomaternal outcomes and longer hospital stay. These findings suggest that women with comorbid illness require personalized treatment to prevent or decrease poor pregnancy outcomes.
Copyright (c) 2024 Alia Nasir-ud-din, Humaira Akram, Farzana Latif, Shamila Ijaz Munir
Enhancing Short Essay Question Quality in MBBS Course: A Comparative Study of ChatGPT and Human Collaboration
Background: The short essay questions quality plays an important role in assessing students' knowledge and understanding in educational settings. This study aims to enhance the quality of short essay questions by using ChatGPT and teacher collaboration. Objective of the study is to evaluate the short essay questions for a college-level MBBS course made by ChatGPT and human source. Materials and methods: This qualitative exploratory study aimed to develop and evaluate essay questions for a college-level MBBS course at Fatima Memorial Hospital. The study involved selecting course learning objectives and developing questions with ChatGPT 3.5 and specialists. Both groups created 20 questions, which were reviewed by independent experts using a checklist with five components: clarity, problem inclusion, structure, English composition, and appropriate length. Questions were rated on a Likert scale from 1 to 5. SPSS version 25 was used for statistical analysis, including t-tests to compare ratings. The study found differences in quality and effectiveness between AI and human-generated questions. Results: Data analysis was done which showed the mean scores given by human evaluators and AI. Human superseded AI in clarity with the mean score given by human evaluators was 3.51, while AI systems had 3.41. AI accomplished better in structuring the short essay question with the imply rating of 3.63. (p=0.557). AI was advanced in demonstrating the problem inclusion then the human with the score of 3.13 (p=0.774). SEQS made with the aid of the human had good English composition compared to AI (p=0.466). Appropriate length of question became the best factor in which the human and AI each completed same (p=0.917). Conclusion: This study provides a comprehensive analysis by comparing human and ChatGPT in the quality of short essay questions. The results indicate that AI has the capability to replicate human judgment in certain aspects of question.
Copyright (c) 2024 Andleeb Kanwal, Tayyaba Azhar , Anum Zahra, Zahid Anwar , Hajra Talat
Heart Rate Variability in Patients with Coronary Artery Disease and Effect of Percutaneous Coronary Angioplasty
Background: In coronary artery disease (CAD), the balance between the sympathetic and parasympathetic nervous systems is disturbed with sympathetic predominanace. Sympathetic over-activity is eliminated through percutaneous coronary angioplasty (PCA). Heart rate variability is a novel method for evaluating cardiac autonomic dysfunction. The study investigated the impact of percutaneous coronary angioplasty (PCA) on cardiac autonomic dysfunction by comparing heart rate variability patterns in stable and unstable angina patients before and after the procedure. Subjects and methods: An experimental study involving 34 males with stable angina (Group 2), 34 males with unstable angina (Group 3), and 34 healthy males (Group 1) was carried out at Punjab Institute of Cardiology, Lahore, between July 2018 and August 2019. While patients with angina underwent PCA, the healthy group did not. The Holter DMS 300-3A was utilised to record the ECG for five minutes. For Groups 2 and 3, ECG was recorded before PCA, as well as 24 hours and two weeks following angioplasty. Cardioscan Premier12 by DM Software was used to analyse the Holter ECG recordings in both the time (SDNN, RMSSD, NN50, PNN50, and SDNN: RMSSD) and frequency domain indices (HF, LF, and LF: HF). The data was statistically analyzed using the computer programme IBM SPSS statistics version 20. Results: HRV metrics SDNN, RMSSD, NN50, pNN50, LF, HF each (p-value <0.001) were increased and LF: HF (p-value <0.001) was lower in Group 1 than in angina groups. Group 2 and Group 3 showed statistically significant improvements (p-value<0.05) in HRV metrics SDNN, HF, and LF: HF 24 hours after PCA. Conclusion: Patients with stable and unstable angina have reduced heart rate (HRV) compared to normal individuals. However, after PCA, HRV parameters increase, indicating that illness diminishes HRV, but revascularization through PCA improves it.
Copyright (c) 2024 Farkhanda Niamat, Muneeza Saeed, Rahat Mudasar, Amber Naureen, Sidra Latif, Muhammad Bin Saeed
Investigating Third-Year MBBS Students’ Preferences for Various Learning Approaches in Forensic Medicine: A Cross-sectional Study
Background: Medical education forms the foundation for competent and compassionate healthcare professionals. Learning Forensic Medicine and Toxicology plays a crucial role in understanding the medico-legal aspects. Teaching comprises all basic, pre-clinical and practical aspects of the subject and provides scientific expertise in investigating deaths, injuries, and poisoning cases. Thus teaching the subject with core concepts understandable to the intended audience is of paramount importance yet has not been explored in this particular subject. Problem-based learning (PBL) is a widely used educational approach in medical education, given the fact the study aims to investigate preferences about different approaches of PBL learning. Subjects and methods: The study was a descriptive cross-sectional out at the Department of Forensic Medicine and Toxicology, Sahara Medical College, Narowal from January to December 2023. The sample size of 100 students was determined using standard educational research practices, considering the course enrollment, expected response rate, and statistical power. This was based on a 95% confidence level, a 5% margin of error, and a population of 513, ensuring precise findings. Results: The students highly valued student-centred learning (93%) and reflection and evaluation (100%). Preferences were mixed for aspects like authentic problems (73% positive, 27% concern), collaborative learning (59% positive, 41% concern), and integration of knowledge and skills (71% positive, 29% concern). Most students (89%) appreciated self-directed learning, with some concerns (11%). Conclusion: The study revealed that students highly valued student-centred learning and reflection in PBL while expressing concerns about authentic problems, collaborative learning and integration of knowledge and skills. Addressing concerns through curriculum refinement can enhance student engagement and skill development in Forensic Medicine. Further research with diverse populations is needed to understand the broader impact of PBL on learning outcomes. The study revealed interventional significance in terms of improvement in academic grades of PBL on learning outcomes.
Copyright (c) 2024 Hina Akhtar Khan, Sheeba Shabbir, Zulfiqar Ali Buzdar, Tanveer Hussain, Fakhar uz Zaman, Mahnoor Shahzad
Factors Affecting Tuberculosis Treatment Adherence among Newly Diagnosed Patients Attending TB Clinic at Tertiary Care Hospital, Lahore
Background: Pakistan ranks fifth among high tuberculosis (TB) burden countries. Despite Directly Observed Treatment Short Course Strategy (DOTS) implementation, adherence is still poor and Pakistan stood fourth in multi-drug resistant (MDR-TB) cases. This study was conducted to assess tuberculosis treatment adherence among newly diagnosed pulmonary TB patients at TB clinic of tertiary care hospital, Lahore, and to study factors affecting it. Patients and methods: Between May 2021 and February 2022, cross-sectional study was conducted at outdoor based TB Clinic, Services Hospital, Lahore, interviewing 732 active pulmonary TB patients aged 18 to 65 receiving Anti Tuberculosis Treatment (ATT) for at least two months. Adherence was studied incorporating Morisky Medication Assessment Scale (MMAS) and World Health Organization multi-dimensional adherence model (WHO-MAM) in close-ended questionnaire, considering socio-demographic, patient, health system, and therapy-related factors. Those scoring < 6 on MMAS were categorized low adherents. SPSS Version 25 analysed data. Chi-square test and binary logistic regression explored adherence associations, with p<0.05 considered significant. Results: Out of 732 patients,350 (47.8%) males and 382 (52.2%) had mean age of 37.41±13.3 and 38.80±14.08 years respectively, with family income of 22062.86±19915.34 vs 23900.52±22153.02 rupees, knowledge score of 4.62±1.56 vs 4.68±1.55 and MMAS score was 6.57±1.21 vs 6.59±1.22 respectively. Low Adherence was in 64.2%.After adjusting, significant factors were age (AOR=12.378, 6.679-22.94), being unemployed (AOR=2.18, 0.253-0.815), low income (AR=2.678, 1.29-5.56), doctor’s availability (AOR=0.161, 0.067-0.383), non-co-operative staff (AR=6.902,3.197-14.889), distance travelled (AOR=12.056, 5.875-24.74), and adequate knowledge (AOR=3.583,1.699-7.557) Conclusion: Two-thirds (64.2%) of TB Clinic attendees had low adherence. Unemployment, older age, low income, and inadequate knowledge had higher odds of low adherence. Similarly non-cooperative staff and distance from facility significant affected adherence.
Copyright (c) 2024 Ahmad Zain , Taskeen Zahra, Amina Riaz, Faisal Mushtaq , Muhammad Ahsan Naeem, Afshan Shahid
Effect of Turmeric (Curcumin) Supplementation to Prevent Weight Loss in Type I Diabetic Rats
Background: Curcuminoids in turmeric plants reduce the oxidative stress of diabetes and improve glucose utilization, so are helpful to prevent weight loss in diabetics. This study determined the weight loss-preventing effect of turmeric in type I diabetic rats and compared the groups. Subjects and methods: In this randomized controlled trial, alloxan was administered intraperitoneally to produce type-I diabetes. Forty-five albino rats were divided into control group A, diabetic group B and diabetic-treated group C with fifteen animals in each. Turmeric powder was given in a dosage of 300mg/kg body weight through oral gavage method to group C rats after induction of diabetes. Body weights of all rats were recorded by digital scale at baseline, end of 8th week and end of 12th week. Analysis of quantitative data (body weight) was done by using SPSS version 24, applying paired t-test and one-way ANOVA. Results: The average weight of the control group remained stable (mean weight 181 ± 16 g in the 12th week) and the weight change was not statistically significant (p-value = 0.393). The diabetic group showed a gradual decrease in body weight (mean weight 178 ± 18 g in the 12th week) which was statistically significant (p-value <0.001). The diabetic group treated with turmeric powder showed weight stability (mean weight 198 ± 24 g at 12th week) and the decline of body weight was statistically not significant (p-value = 0.063). Conclusion: Type I diabetes causes a significant reduction in body weight. Turmeric powder could be used as a weight-stabilizing agent in diabetics.
Copyright (c) 2024 Javaria Latif, Saima Mukhtar, Sobia Niaz, Zoobia Irem, Shaista Hussain, Shahid Saeed
Dengue Fever: Prevalence, Risk Factors and Serological Diagnosis in Hyderabad, Sindh, Pakistan
Introduction: Dengue viral infection (DVI), transmitted by mosquitoes, is a significant global health concern, especially due to climate change in tropical and subtropical areas. It manifests in severe forms like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), affecting vital organs. In Pakistan, dengue is endemic with seasonal outbreaks, particularly after monsoons, affecting younger populations more severely. The study investigates the prevalence, risk factors, and serological diagnosis of DVI in Hyderabad, Sindh, Pakistan. The current study was designed to investigate the serology, prevalence, risk factors, mortality and morbidity of dengue fever in Hyderabad, Sindh, Pakistan. Subjects and methods: A case-control study was carried out from 2010 to 2017 at the Civil Hospital of Liaquat University of Medical and Health Sciences, Hyderabad, Sindh, Pakistan in collaboration with the University of Sindh, Jamshoro. Blood samples from 18,320 cases aged 13-75 years, suspected of dengue were analyzed. A questionnaire assessed risk factors, and serology was evaluated through rapid strip tests detecting dengue antigens and antibodies (IgA, IgM, IgG). Statistical analysis, including logistic regression and odds ratio calculations, was performed using SPSS. Results: A total of 18,320 suspected cases were subjected to the strip test for dengue fever. Among these, 1312 (7.2%) cases were found serologically positive. Dengue fever severely affected the population in during the study duration. A higher percentage of dengue-specific IgM-positive (59.6%) cases indicate the primary infection, while a lower percentage of patients with positive IgM and IgG (24.6%) results specify the secondary infection. Result showed the higher prevalence in males patients compare to females, majorly involving dengue-fever, -hemorrhagic fever and-shock syndrome. Furthermore, significantly (p<0.05) reduced levels of leucocytes, monocytes, neutrophils, and platelets were observed in dengue patients than in control cases. Conclusion: Dengue is a serious endemic infection in Hyderabad, with primary infections being more common. Effective preventive measures, including public awareness and the use of mosquito repellents, screen doors, and covered water containers, are crucial to reducing transmission. Further research is needed to explore climatic factors and enhance preventive strategies.
Copyright (c) 2025 Sadia Qamar Arain, Naseem Aslam Channa, Farah Naz Talpur, Nazakat Hussain Memon, Marvi Sheikh, Abdul Rehman Phull
Student’s perception regarding tutorials in pre-clinical undergraduate medical education
Background: Tutorials are one of oldest teaching methodologies and are effectively being used for teaching in medical education. The objective of this study is to identify student’s perspective regarding conventional tutorial teaching in undergraduate, pre-clinical medical curriculum and recognise appropriate changes needed to improve learning of higher order critical thinking and decision making skills among medical graduates in tutorials. Subject and methods: This is a mixed method study conducted at Fatima Jinnah Medical University. Qualitative data was collected by structured interviews from twelve second year medical students. Interviews were transcribed and thematic analysis done for results. DREEM questionnaire was modified to design a questionnaire and was used to collected quantitative data from second year MBBS class, through an online survey. Results: Twelve female medical students of 2nd year MBBS of FJMU participated in structured interviews. Content analysis of transcribed interviews identified three main themes i. e self-directed learning, collaborative learning and problem-based learning. Majority of students made response that tutorials provide active class room participation (60%), learning motivation (55.7%) and learning stimulation (48%). They also opined learning is learner centered (53%) and objective oriented (70%), it builds competence (50%) and confidence (67%), add value to time (57%) and enhances interpersonal skills (44%) in stress free environment (70%). Students also valued handouts and learning materials provided in tutorials (59.6%). However, they felt teaching in tutorials is monotonous (69.36%), do not support memorization (44%) and lack problem solving skills learning (39%). Conclusion: Overall, tutorial learning can be a powerful tool for enhancing student learning and development when implemented thoughtfully and strategically.
Comparison of Mean Duration of Third Stage of Labor with Oral Misoprostol versus Intramuscular Oxytocin
Background: This study delves into the comparison, recognizing the significance of effective management in preventing complications. Poor management of 3rd stage can lead to retained placenta, excessive bleeding, and increased maternal morbidity. Addressing these concerns, the research aims to contribute valuable insights for enhancing obstetric care and reducing adverse outcomes associated with inadequate management during this critical phase of childbirth. The Study aims to Determine the mean duration of 3rd stage of labor with oral misoprostol versus intramuscular oxytocin. A Prospective Comparative Study. This study was conducted at the Department of Gynecology and Obstetrics, Khair-Un -Nisa Hospital Lahore, Lahore over 12 months period from January 2022 to December 2022. Material and Methods: A total of 100 pregnant women meeting inclusion criteria were included in the study and divided into two equal groups using lottery method. Patients in Group A received oral misoprostol 600µg (3tablets of 200µg) and patients in Group B received 10 units intramuscular oxytocin. Labor process was managed as per standard protocol. All the findings were noted in a predesigned proforma and analyzed using SPSS version 27.0. Results: Mean age of the patients in this study was 25.92±4.55 years. In the study sample 40.0% women were primiparas whereas 60.0% were multiparas. Comparison of both the groups with regard to baseline characteristic produced insignificant difference between the groups (p-value>0.05). Mean duration of 3rd stage of labor was significantly high in group A than group B (4.98±0.82 vs. 3.72±0.80 min; p-value=0.000) and its stratification for age, parity and gestational age. Conclusion: In conclusion, our study reveals a significantly prolonged mean duration of the third stage of labor in the oral misoprostol group compared to the intramuscular oxytocin group. This difference persists across age, parity, and gestational age subgroups, emphasizing the robustness of these findings and contributing insights into intervention efficacy.
Copyright (c) 2024 Rubina Shamsi, Mehreen Yawar, Rida Sohail, Ayeisha Asim
Gender Differences in the Quality of Life of Patients with Liver Cirrhosis
ABSTRACT Chronic liver disease frequently arises as a consequence of hepatitis C virus (HCV) infection, which can have detrimental effects on the quality of life for those affected. Gender may play a significant role in assessing the disease's severity and managing it. Therefore, this study was conducted to see the gender-based difference in HRQoL among patients. Patient and Methods: A cross-sectional study was conducted at the Gastroenterology Department of Jinnah Hospital, Lahore . The study involved a total of 250 patients diagnosed with liver cirrhosis. To assess Health-Related Quality of Life (HRQoL), the researchers utilized the Chronic Liver Disease Questionnaire (CLDQ), which is a liver disease-specific questionnaire containing 29 items categorized into six domains. Each domain is assigned summary ratings ranging from 1 to 7, with higher scores indicating a lesser degree of impairment in HRQoL. The data were analyzed using SPSS version 25.0. Gender-based comparisons of CLDQ domains were made through an independent sample t-test. Results: In this study, total 250 patients were enrolled, 141 (56.4%) being male and 109 (43.6%) being female. The mean age of the patients was 49.52 ± 1.62. The assessment of the patients' liver condition using the Child-Pugh Class revealed that the majority, specifically 118 (47.2%) patients, were categorized as Class B. Within this group, 55 (39.0%) were male, and 63 (57.8%) were female. It was found that females tended to have a less impaired quality of life compared to males (Male=3.26 ± 0.81, Female=5.24 ± 1.02), and this difference was statistically significant. Furthermore, in the domain of fatigue (Male=2.93 ± 1.22, Female=3.05 ± 0.94) and emotional functioning (Male=3.31 ± 0.98, Female=5.04 ± 1.18), there were significant differences in the scores. Notably, males had better scores in the fatigue and emotional functioning as compared to females.. Conclusion: These findings demonstrated that the gender variable's significant impact on HRQoL of CLD patients. It was found that females tended to have a less impaired quality of life compared to males. Males had better scores in the fatigue and emotional functioning as compared to female.
Copyright (c) 2024 Mehreen Zaman, Muhammad Salman Afzal, Yasir Abbas Zaidi
Comparison of Rockall Score and MELD Score for Predicting in Hospital Mortality Patients with Vericeal Bleeding
Background: It has been shown in several studies that Rockall score and MELD score are significantly high in patients who died due to variceal bleeding, hence these scores can be reliably used to predict in-hospital mortality and preventive measures can be taken in earlier phase to prevent mortality. The Objective of this study is determine the in-hospital mortality in patients with variceal bleeding due to cirrhosis and to compare the mean Rockall score and MELD score in patients with or without in-hospital mortality after variceal bleeding. Patients and Methods: The Observational study was conduct at Department of Gastroenterology, DQH Hospital, Gujranwala from June to December 2019. The Cirrhotic patients having age 16-70 years of either gender presenting with variceal bleeding that was diagnosed when there was blood in vomiting due to variceal hemorrhage detected on EGD were enrolled. Demographic details like name, age, gender, BMI, duration of variceal bleeding was obtained. At presentation, Rockall score and MELD score was calculated. The data was analyzed on SPSS version 21.0. Mean Rockall score and MELD score was compared in patients with or without in-hospital mortality by using independent samples t-test. P-value<0.05 was considered as significant. Results: In this study 26% (62/241) patients had in hospital mortality. Among these patients mean Rockall and MELD score was significantly higher as compared to those patients who survived. [Rockall Score: Survivors: 1.82±0.96 & Non-Survivors: 2.46±0.50, p- value<0.001, MELD Score: Survivors: 14.22±3.87 & Non-Survivors: 26.50±5.06] Conclusion: Thus Rockall and MELD score was significantly higher in patients with in hospital mortality. Hence these scores can be reliably used to predict in-hospital mortality and preventive measures can be taken in earlier phase to prevent mortality
Copyright (c) 2024 Jawad Naeem, Faizan Pervaiz, Najam-us-sehar Saeed, Salman Javiad, Muhammad Adil Chouhdary, Hira Shuja
Frequency of Obsessive Compulsive Disorder among Medical Students
Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by persistent and distressing obsessions and compulsions. These repetitive behaviors or thoughts often lead to significant distress and interference in daily life. Among the most common obsessional themes is an intense preoccupation with contamination and illness. The objective of the study is to determine frequency of obsessive compulsive disorder in medical students. Material and Methods: After approval of the study proposal from Ethical review Board of college of physician and surgeon Pakistan a cross sectional study was conducted in the Department of Psychiatry, Allama Iqbal Medical College / Jinnah Hospital, Lahore. over a period of six months from 17-05-2022 to 17-11-2022. Detailed history was taken to assess for exclusion criteria. To assess for presence of obsessive compulsive disorder (OCD) all the medical students included in study was asked a series of questions using Yale-Brown Obsessive This was followed up by a one on one interview of these students with a consultant psychiatrist to make as well as re-affirm the diagnosis. Results: We found that total of 140 students, 51.4 %( n=72) were in age group of 17-22 years and 48.6 %( n=68) were in age group of 23-28 years, mean age was 22.34±1.79 years and BOC scale was 5.40±8.78. There were 40.7 %( n=57) male and 59.3% (n=83) females. According to severity of symptoms, 77.9% (n=109) had subclinical, 2.9% (n=4) mild, 11.4% (n=16) moderate, 5.7% (n=8) severe and 2.1% (n=3) had extreme symptoms. Frequency of OCD was 22.1 % (n=31). There was significant association of age and gender with OCD (P-value<0.05) Conclusion: The results clearly show the impact of being a medical student and the need to increase awareness of obsessive compulsive disorder (OCD) among health workers generally and medical students specifically.
Copyright (c) 2024 Ammara Butt, Fatima Azmat
The Surgical Management of Epilepsy - A Surgeon Perspective
Epilepsy is stereotypical clinical manifestation of recurrent, paroxysmal, excessive, synchronous neuronal activity of cerebral cortex. It affects almost 50 million people world wide1 . The incidence of epilepsy is as high as 50- 60 per 100,000. A range of 4 to 10 per 100,000 person per year makes it one of the most prevalent neurological disorder. Its prevalence in Pakistan touches the upper boundary of world’s prevalence, being 9.99 per 1000 people. It is more prevalent in persons younger then 30 years and it is more prevalent in rural areas2. For a medical personal it may be a clinical scenario but for the affected person it is a big social stigma. Patients suffering from this disease are usually isolated, depressed and deprived of many social rights. Although considered to be disease of high IQ people, every successive fit cause a certain amount of cognitive damage to the affected patient and it can be potentially lethal for the patient and for society if these people have adopted certain professions. For a county like Pakistan where economy is touching its nadir it is highly difficult for patients to comply with adequate antiepileptic drug (AED) therapy. One should clearly differentiate between seizure and epilepsy. A seizure is defined as a “Transient occurrence of signs and symptoms due to abnormaly excessive and synchronous neuronal activity in the brain.” For practical purposes epilepsy can be defined as; At least two un provoked (or reflex) seizures occurring > 24 hours apart. One unprovoked (or reflex) seizure and probability of further seizures Diagnosis of an epilepsy syndrome. Monotherapy is ideal for treatment and control of epilepsy. With increase of number of AEDs the chances of epilepsy control decrease. Surgery is potentially curative for epilepsy or at least it is helpful for reduction of demand of AEDs in carefully selected patients. International League Against Epilepsy (ILAE) gives its recommendations for selection of surgical candidates.
Spectrum of Haemoglobinopathies in Population of Lahore District
Background: Haemoglobinopathies describe a group of genetic disorders in which one or more globin chains are abnormally developed. Thalassemias are a common cause of hypochromic microcytic anemia, which arises from the reduced or absent synthesis of the globin chain of haemoglobin. Studies from various regions of Pakistan have indicated variable prevalence of the disease in Pakistani population with significant ethnic and geographical variations. This study was conducted to find the range of haemoglobinopathies among the population of Lahore District. Patients and Methods: It was a descriptive cross-sectional study conducted at Haematology, Pathology Department, SIMS/Services Hospital, Lahore from 18-3-2021 to 18-9-2021. 364 Patients with both genders and age 1-65 years presenting with anaemia were enrolled in this study. A 5ml sample of intravenous blood was drawn and placed in an EDTA anticoagulant container. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 22. Quantitative variables including age, haemoglobin was described as mean ± Standard Deviation, while qualitative variables including gender, haemoglobinopathies and their spectrum were described using frequencies and percentages. Results: In this study the mean age of the patients was 18.18±13.92 years, 169 (48.84%) patients were male and 177(51.16%) females. The frequency of haemoglobinopathies was found in 76 (21.97%) patients. The most common spectrum of haemoglobinopathies was beta thalassemia trait found in 52 (68.42%) patients followed by Beta thalassemia major 6 (7.89%) and HbD Punjab trait 4(5.26%). Conclusion: This study concluded that the frequency of haemoglobinopathies was 21.97% and the most common spectrum of haemoglobinopathies was Beta thalassemia trait followed by Beta thalassemia major & HbD Punjab Trait in patients referred to Haematology, Pathology Department, Services Hospital Lahore for workup of anaemia.
Copyright (c) 2024 Arrosa Rahim, Asma Munir, Faiza Bashir, Faryal Zafar, Rabia Zahid, Hafiz Muhammad Haseeb
Frequency and Antibiotic Sensitivity Pattern of Culture Positive Salmonella Typhi in Children Visiting to RHQ Hospital Gilgit
Background: Typhoid fever, caused by Salmonella enterica serovar typhi, is a common infection that affects multiple body systems. Salmonella is a constantly evolving and adaptable bacterium, so overuse of a particular treatment may eventually lead to the development of resistance. To determine the frequency and antibiotic sensitivity pattern of culture positive salmonella typhi in children visiting to RHQ hospital Gilgit. Patient and Methods: An observational cross-sectional study was conducted at RHQ Hospital Gilgit from June to August 2022. Through non-probability, consecutive sampling, a total of 150 patients of either gender with ages ranging from 1 month to 12 years and enteric fever symptoms as well as positive blood culture results for Salmonella species were enrolled in this study. In the microbiology lab, the blood culture bottles were incubated for seven days at 37 °C while daily growth indicators were monitored. On the pre-designed proforma, the basic demographic history and Salmonella species' susceptibility patterns were noted. Data was entered and analyzed by SPSS 25.0. Results: The average age of these patients was 6.63+3.35 years. Among the patients, the majority were male, accounting for 97 individuals (64.6%), while 53 individuals (35.4%) were female. Fever was most common symptoms among patients with highest frequency of 59, followed by body aches (35). Almost 98% of cases were resistant to ciprofloxacin, commonly used as a first-line drug against Salmonella Typhi in Pakistan. Resistance was also very high against ampicillin (92%). The Azithromycin and Imipenem were the only drugs with a sensitivity of more than 90%. Conclusion: The existence of typhoid fever cases and the increasing resistance of Salmonella strains to ceftriaxone and Ampicillin are causes for serious concern. Meropenem and azithromycin, whether used individually or in combination, proved to be the most effective antibiotics for treatment.
Copyright (c) 2024 Muneera Ali, Ziaullah Khan, Abdul Bari
Effect of Anticoagulation on The Hepatic Function of Non-Malignant Portal Vein Thrombosis
Background: In various groups of PVT patients, portal vein thrombosis (PVT) occurs at a rate of 5-26%; the incidence increases with progressive liver disease. Portal vein thrombosis increases portal hypertension, increases the risk of variceal haemorrhage, and decreases hepatic perfusion, eventually leading to hepatic decompensation. Therefore this study is conducted toevaluate the effect of anticoagulation on the hepatic function of non-malignant portal vein thrombosis. Patients and Methods: Total 200 patients were consecutively enrolled in this retrospective study among April 2021 to April 2022. Patients with malignant PVT and those who lacked enough clinical data at the time of PVT diagnosis and during the subsequent clinical course were excluded. Retrospective analysis was used in this study to assess how anticoagulation affected hepatic function. A predesigned proforma were used to collect data. All the data was entered and analyzed by SPSS version 25. All the quantitative variables were presented by Mean+ SD and qualitative with frequency and percentages. An independent sample t test was applied to find out the significant difference of hepatic function among groups. P-value< 0.05 was considered as significant. Results: Total 200 patients were enrolled in current study among which 100 were treated with anticoagulation and 100 without anticoagulation. The mean age among groups were (T= 48.99+1.73 Vs. UT=49.50+1.63). Majority of the patients were male (115/200) and married (161/200). Majority of patients were Males, Married, normal weighted (123/200), moderate ascites (55/200), grade 3 hepatic encephalopathy (105/200) and child PUGH class A (97/200). There was insignificant mean difference of hepatic function among groups. The ALT, AST ALP, Albumin, Bilirubin shows insignificant difference (P-value>0.05). Conclusion: Our research shows that anticoagulation reduces hepatic damage and enhances liver production in people with non-malignant PVT.
Copyright (c) 2024 Muhammad Salman Afzal, Mehreen Zaman, Yasir Abbas Zaidi
Addiction is a complex and multifaceted issue that affects millions of people worldwide. It has the potential to ruin lives, destroy families, and damage communities. Addiction can be defined as a compulsive and uncontrollable urge to engage in a particular behaviour, despite the negative consequences that may result.1 It can take many forms, from alcohol and drugs to gambling, sex, and even food. Addictive behaviours have a profound impact on individuals and society as a whole. The origin of addiction is still a topic of debate among scholars and researchers, with some pointing to genetic predispositions and others highlighting environmental factors such as childhood trauma and stress. Whatever the cause, addiction is a chronic condition that requires support, understanding, and intervention to overcome.2 One of the most significant challenges of addiction is that it is often associated with negative stigmas, shame, and guilt. Many people who struggle with addiction do so in silence, afraid to seek help or admit they have a problem. This stigma can make it difficult for individuals to access the resources and support they need to overcome their addiction.3
Assessment of Knowledge of Pregnant Women Regarding Benefits of Breastfeeding
Background: Breastfeeding is commonly regarded as a cost-effective, readily accessible, and comprehensive source of nourishment for all infants. The positive impacts of breastfeeding on both maternal and infant health are widely acknowledged. Nevertheless, there is data indicating a decline in the prevalence of breastfeeding in numerous developing nations. This study evaluates the extent of mothers' knowledge and understanding of breastfeeding practices, identify gaps in information, and assess how this knowledge influences their breastfeeding decisions and behaviors, ultimately aiming to make interventions to enhance maternal and infant health outcomes. This study aims to assess the proportion of expectant mothers who understand the advantages associated with breastfeeding. Patients and methods: A cross-sectional study was conducted at Central Park Teaching Hospital, from 1st August 2023 to 31st March 2024 in the Gynae OPD. The sample size was calculated of patients who visited Gynea OPD in LG Corporations months. The study's exclusion criteria comprised of women with psychiatric or other related conditions, while married pregnant women with no co-morbidities were included. The Arabic Breastfeeding Knowledge Questionnaire (BFKQ-A) was to assess the participants' knowledge of breastfeeding. Data was analyzed using SPSS version 25. The language of the questionnaire in Urdu for understanding of participants. Results: A total of 205 pregnant women were included. The mean age of mothers was 29.93±5.873 years. The mean BFKQ-A score was 12.51±2.96. Among 205 pregnant women, 68 (33.2%) had excellent breastfeeding knowledge, 62 (30.2%) had good breastfeeding knowledge, 54 (26.3%) had fair breastfeeding knowledge and 21 (10.2%) had poor breastfeeding knowledge. Conclusion: The results of this research revealed a poor understanding of breastfeeding. This underscores the necessity of formulating targeted strategies and regulations to enhance breastfeeding comprehension and establish a supportive atmosphere that assists women during their breastfeeding experience.
Copyright (c) 2024 Muhmmad Zeeshan , Ayesha Rafiq `, Arshad Rafiq, Muhammad Sohail Shahzad, Irfan Younas , Umer Farooq
Relationship between Sedentary Time and physical activity in patients with Non-Alcoholic Fatty Liver Disease
One of the most prevalent chronic liver diseases is nonalcoholic fatty liver disease (NAFLD). Public health is currently threatened by physical inactivity and the resulting health problems. The aim of this study was to investigate the relationship between sedentary behavior and physical activity level in NAFLD patients. Methods: A cross-sectional study was carried at Allama Iqbal Medical College/Jinnah Hospital, Lahore. Purposive sampling was used to enroll 210 participants in the study. NAFLD patients aged between 18 and 80 years attending OPD were recruited after taking their informed consent. Data were entered into SPSS version 25.0 for analysis. Quantitative variables were reported as frequencies and percentages. Spearman rank correlation test was used to determine the relationship between sedentary time and physical activity level. Statistical significance was defined as a P value of 0.05 or less. Results: Total 210 patients were enrolled in current study. Majority 147(70.0) of the patients were 20-50 years old, male 126(60.0%), married 186(88.6%). The most common sign and symptoms of non-alcoholic fatty liver disease were abdominal pain 169(80.5%), followed by change in weight 130(61.9%) and constipation 125(59.5%). Majority of the patients have low and moderate physical activities and have sedentary life style. Their sitting time is almost 6 to 10 hours a day. The current study results showed a negative strong correlation between sedentary time and physical activity of patients [r = -0.650**, P-value <0.05). Conclusion: It was concluded from the current study that sedentary time and physical activity are negatively correlated in NAFLD. The results of current research indicate that reducing inactive time and enhancing physical activity levels are beneficial for reducing the risk of developing NAFLD.
Comparison of Effectiveness of Doxofylline VS Theophylline in Stable Chronic Obstructive Pulmonary Disease Patients
Background: Chronic obstructive pulmonary disease (COPD) is known as an obstructive pulmonary disease it causes particular small airway obstruction. Currently available medications for COPD are not able to reduce the progressive deterioration of lung function. The current study aims to determine the effectiveness of doxofylline and theophylline in improving the pulmonary functions in stable COPD patients. Methods: A Randomized controlled trial was conducted on a total of 80(40 in each group). Stable COPD patients (FEV1/FVC < 0.70) patients visiting the outpatient department of Sir Ganga Ram Hospital for treatment and fulfilling inclusion criteria were enrolled to participate in the study. Both groups were given standard long-acting bronchodilator therapy such as salmeterol inhaler 25mcg twice daily. Group A was given theophylline, while group B was given doxofylline. Independent sample t-test was applied to compare the spirometry findings in both groups by using SPSS 25.0. A p-value of <0.05 was considered statistically significant. Results: In current study it was reported that the 36 (45.0) of patients were 30-40 years old. The majority of patients were male 68(85.0%) and suffered from COPD. There was an increased improvement in spirometric parameters among both groups. The both groups have same effect on spirometric parameters in terms of FEV1, FVC, FEV1/FVC and FEC1% prediction. Both drugs increase the spirometry functionality. (p-value > 0.05). There was significant difference among side effect of both groups. Doxophylline was found to have fewer side effects compared to theophylline. (P value< 0.05) Conclusion: It was concluded that the both drugs theophylline and doxofylline revealed consistent improvement in spirometric outcomes (FEV1, FVC, and the FEV1/FVC ratio) with the passage of time in COPD. The current study demonstrates that both drugs have a equal efficacy and safety profile than theophylline in patients with COPD.
Copyright (c) 2024 Syed Ali Raza, Zohaib Ramzan, Abdul Rehman Khalid, Arif Ur Rehman, Iqra Sultan, Muhammad Naeem Afzal
Unleashing Potential: Fatima Jinnah Medical University's Global Acclaim and Inspiring Academic Journey
Fatima Jinnah Medical University (FJMU), formerly known as Fatima Jinnah Medical College (FJMC), embarked on a transformative journey on July 1st, 2015 when it was awarded the esteemed status of a Medical University by the Government of Punjab from its status as a College for almost 7 decades. This transition from a medical college to a medical university marked a significant milestone in the institute's history. As FJMU continues to build upon its rich legacy, the transition to a medical university empowers the institution to expand its horizons and delve deeper into the realms of medical knowledge and practice. It provides a fertile ground for fostering innovation, nurturing talent, and producing well-rounded healthcare professionals. Fatima Jinnah Medical University (FJMU) has, this year, achieved an extraordinary milestone, cementing its position among the top 800 to 1000 universities globally in the esteemed Times Higher Education Impact Ranking. Times Higher Education (THE) is a renowned global university-ranking organization.1 While they do not specifically rank individual words, THE incorporates the Sustainable Development Goals (SDGs) into their ranking methodology. Their evaluations consider universities' contributions towards the SDGs, encouraging institutions to align their research, teaching, and societal impact with these global sustainability targets. This remarkable recognition not only places FJMU among the world's leading academic institutions but also establishes it as amongst the topmost medical university in Punjab, and the third-ranked medical university in Pakistan.2
Comparison of Saline Infusion Sonography with Hysterosalpingography for its Accuracy in Diagnosing Tubal Status in Subfertile Females
Background: Subfertility is seen in approximately 10-15% of couples of reproductive ages. Tubal factors account for 25-35% of cases of subfertility. Commonly used tests for tubal patency are hysterosalpingography (HSG), laparoscopy and saline infusion sonohysterography (SIS). Saline infusion sonohysterography is a non-invasive test and used in many countries for checking tubal patency with promising results. This study was to compare saline infusion sonohysterography (SIS) with hysterosalpingography (HSG) in terms of diagnostic accuracy in determining tubal patency in subfertile females in a charity hospital. Patients and methods: A prospective cross-sectional study conducted in the Gynaecology Department, Akhter Saeed Trust Hospital, from 15.10.2017 to 14.10.2019. Non-probability consecutive sampling was done and women presented between 18-40 years of age, for evaluation of primary and secondary subfertility and trying to conceive for more than one year were included. Patients with active pelvic infection, active vaginal bleeding or husband having azoospermia were excluded. After informed consent SIS and HSG were done on same day to see the patency of tubes and any complication with both procedures. The data was analyzed SPSS version 23 was used for statistical analysis. Results: Total 166 patients underwent SIS and HSG simultaneously. SIS showed tubal patency in 106 (63.86%) patients and out of these patients, 96 were true positive and 10 were false positive. HSG confirmed tubal patency in 103 (62.05%) cases, out of which 7 patients (false negative) had no patency on SIS. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SIS with HSG in determining tubal patency of subfertile female was 93.20%, 84.13%, 90.57%, 88.33% and 89.76%, respectively. No patient had any serious complications with SIS. Conclusion: This study concluded that saline infusion sonography is a safe and effective tool with high diagnostic accuracy for determining the tubal patency in subfertile females.
Copyright (c) 2024 Nohseen Salahuddin, Ambreen Mumtaz, Sanam Iftikhar, Uzma Siddique, Mariam Sheikh, Alia Waheed
Effects of Pomegranate (Punica granatum) Fruit Juice Extract on Abamectin Induced Hepatoxicity in Adult Albino Rats
Background: The improper use and handling of abamectin in agriculture have had major negative effects on human health. As the liver is a key metabolic organ, regular consumption of pesticide residues from fruits and vegetables may increase the risk of hepatotoxicity. This study aimed to evaluate the potential protective effects of pomegranate (Punica granatum) fruit juice extract against abamectin-induced hepatotoxicity in adult albino rats. Subjects and methods: This experimental study was conducted at PGMI and LGH, Lahore, included 24 adult albino rats(6 in each group).Twenty-four Wistar albino rats (180–220 g, 6–8 weeks old) were randomly divided into four groups (n=6 each). Group A served as the control, while Groups B, C, and D were experimental. All groups had free access to water and standard rat food. For 30 days, Group B received abamectin (10 mg/kg), Group C received pomegranate extract (1 mg/kg), and Group D received both treatments (10 mg/kg abamectin + 1 mg/kg pomegranate extract) via oral gavage. On day 30, blood samples were collected for liver enzyme analysis (ALT, AST, and ALP). Rats were sacrificed under general anesthesia, and liver samples were preserved in 10% formalin for histological analysis using Masson's trichrome and hematoxylin and eosin staining. Liver histology was assessed for toxicity and protection by measuring Hepatocyte size and central vein diameters, observing liver color changes, and analyzing biochemical markers (ALT, AST, and GPX) to evaluate hepatic damage and antioxidant defense. Results: Group B showed significantly increased serum ALT and AST levels, which normalized in Groups C and D. Serum glutathione peroxidase levels were reduced in Group B but restored in Group D. Histological analysis of Group B livers revealed increased central vein diameter, degenerated hepatocytes, nuclear pyknosis, cellular steatosis, sinusoidal congestion, inflammatory cell infiltration, and mild to moderate hepatic fibrosis. Group D showed reduced central vein diameter and partial reversal of histological changes, while Group C exhibited normal liver architecture. Conclusion: Pomegranate juice extract can be used as a very effective dietary supplement to reduce the harmful effects of pesticides such as abamectin
Copyright (c) 2025 Saima Abdul Waheed , Shazia Gul , Hamna Ansari, Muhammad Yasoob
Incidence and Risk Factors of Acute Kidney Injury in Critically Ill Patients in Intensive Care Units of Tertiary Care Hospitals
Background: Over the last decade, the occurrence of acute kidney injury (AKI) in intensive care units (ICUs) has risen due to heightened severity and improved identification of such cases. The study objectives are to identify the incidence and evaluate the risk factors of acute kidney injury in critically ill patients in tertiary care hospitals. Patients and methods: This cross-sectional study was carried out between July and August 2022 at Pakistan Institute of Medical Sciences and Federal Government Services Hospital, Islamabad Pakistan. The study involved the collection of data from 300 critically ill patients admitted to medical, cardiac, and surgical ICUs. The severity of AKI was evaluated according to Kidney Disease Improving Global Outcomes (KDIGO) staging. Patients’ information regarding history of renal disease in family, comorbidities, kidney functions, measurements of urea and creatinine levels was collected. Subsequently, the analysis was conducted at SPSS v 23. Results: Patients mean age was 60.65 ± 4.87 years. Those who developed AKI post-ICU admission had a mean urea level of 61.64 ± 7.5 mg/dl and creatinine 1.63 ± 0.1mg/dl, which increased to 2.2 ± 0.1mg/dl at the time of diagnosis. Majority cases of AKI were categorized as stage 1 (40%) and stage 2 (60%). Among the patients, 60% (n=180) maintained normal kidney functions, while 40% (n=120) developed AKI during their ICU stay. Notably, 35.7% (n=70) of those who developed AKI were males. A notable association was observed between AKI development and factors such as sepsis, hypovolemia, ischemic heart diseases, age, diabetes mellitus, and hypertension (p-value ≤0.05). Conclusion: The key point of the study highlighted a notable incidence of AKI among ICU-admitted patients. Sepsis and hypovolemia emerged as the primary causative factors leading to the onset of AKI.
Copyright (c) 2024 Jais Kumar Karmani, Arif Mumtaz, Zain Ul Abedin Khan, Amna Areej, Syed Rameez Hassan, Maroof Shaukat
Role of Computed Tomography Pulmonary Angiogram in Patients with History of Shortness of Breath and Deep Vein Thrombosis
Background: Computed tomography pulmonary angiography (CTPA) is vital for detecting pulmonary embolism (PE) arising from deep vein thrombosis (DVT) and presenting with shortness of breath. This study aimed to establish CTPA diagnostic role in patients with breathlessness and DVT risk factors, accurately detecting PE and associated vascular abnormalities, thus improving patient outcomes. Patients and methods: This retrospective study was conducted at Department of Radiology, Ittefaq Hospital Lahore over four months. The patient aged over 16-45 with 28 females and 48 males who had a history of DVT and shortness of breath were part of research. CTPA was including performed with bolus tracking. Data was collected after filling consent form, including the duration from onset of symptoms such as leg pain, swelling, chest pain and shortness of breath. Radiologists categorized CT images to report PE findings. Statistical analysis utilized descriptive statistics to describe basic features and chi-square test was used to compare the dependent groups. The p-value less than 0.05 was considered as statistically significant. Results: , bronchiectasis (40.8%), unilateral PE (39.5%), consolidation (39.5%), and ground glass opacity (35.5%). Conclusion: ConclusivelyCTPA's diagnostic utility was evident, identifying PE in a significant proportion with associated findings like bilateral involvement and vascular abnormalities. It provided crucial information for timely PE diagnosis and management in patients with shortness of breath and predisposing DVT risk factors.
Copyright (c) 2024 Nisma Arooj, Iqra Saeed , Ahmed Ishfaq, Laiba Afzal, Hassan Zohaib, Shanza Arshad, Noor Imran
Investigating the Role of BACE1 and SORL1 as Exosomal Biomarkers in Dementia among Type II Diabetic Individuals
Background: Type II diabetes is the major cause of several microvascular and macrovascular complications found to alter the neurological balance within the brain and involve in cognitive impairment. BACE1 and SORL1 genes are the focus of the study, which may be involved in the cross linkage of Type II diabetes disease and dementia. This study aimed to investigate the expression of these two genes in Type II diabetic patients suffering from dementia and its correlation. Patients and methods: Blood samples from a total of 47 subjects divided into four groups (diabetes, diabetes with dementia, brain tumors patients) and 12 healthy controls were collected from Lahore General Hospital (LGH). An internationally preferred minimal mental state examination (MMSE) scoring was used (English and Urdu validated translation). The data was analysed by GraphPad Prism 9.0 and one way ANOVA was performed to find variance amongst the samples with respected to expression analysis. Results: This study included 12 healthy controls and 47 patients (22 males and 25 females) with the mean age±SD (55.9±6.2) during 8 months. BACE1 expression was significantly elevated in the dementia with diabetes group compared to healthy controls (mean difference: 2.1, 95% CI = 1.0 to 3.2, p<0.05). Similarly, SORL1 expression showed a significant increase in the diabetes group compared to healthy controls (mean difference = 1.8, 95% CI = 0.5 to 3.1, p<0.05). However, no significant differences were observed in either BACE1 or SORL1 expression between the diabetes and brain tumor groups (p>0.05 for both comparisons). Conclusion: BACE1 and SORL1 genes expression levels were significantly higher in diabetic (Type II) patients with dementia and with dementia alone. It can be concluded that BACE1 and SORL1 genes expression detected through exosomal analysis can be used as early diagnostic marker in diabetic individuals with dementia.
Copyright (c) 2024 Amna Tanveer , Hafiz Muhammad Haseeb Khaliq, Zunaira Tanveer , Adnan Arshad
CD4 Count Stratification, its Accuracy and Association with TB Site Involvement in HIV / TB Co-infection
Background: Co-infection of HIV and TB is a significant public health concern, as these two diseases can interact and worsen each other's effects, leading to more severe health outcomes. The objective of this study was to stratify CD4 count according to different presentations of TB and see their association in HIV/TB co-infected patients. Other objective was to establish the predictive value of CD4 count for different sites of involvement. Patients and methods: This cross-sectional observational study was conducted from October 2022 till March 2023. A total of seventy-four outdoor and indoor patients were enrolled. Patients aged more than 18 years having confirmed HIV and TB infections were included in the study. Those having any other opportunistic infection and aged less than 18 any having only presumed TB infection were excluded from the study. Patient's data was collected using a predesigned and pretested questionnaire after taking consent and ensuring confidentiality. Baseline CD4 count were recorded and stratified into <100 and >100 CD4 counts. Results: Mean age of the patients was 38.33 (range = 21-78 years), out of which 67 (90.5%) were male and 7 (9.5%) were female. Most frequent was pulmonary TB 34 (46.0%) followed by disseminated TB 13 (17.5%), TB meningitis 10 (13.5%), and pleural TB 08 (10.8%) and others 09 (12.2%). There was no association found between CD4+ T-lymphocyte count and site of involvement of TB. Spearman co-efficient showed no relationship between CD4 count and site of involvement. Conclusion: The Stratification of CD4 count does not show any specific trend for TB site involvement in TB/HIV co-infected patients. No association was found between CD4+ Lymphocyte count and site of involvement of TB in this study. Cut-off predictive value came out to be 53.3 in our study using receiver operating curve.
Copyright (c) 2024 Hina Sadiq, Nasim Akhtar, Sana Tahir Virk, Kazim Abbas Virk, Muhammad Arslan Tariq, Abeer Zafar, Muhammad Hassan Cheema
Birth interval and birth order relationship with undernutrition among children under-five: A hospital-based cross-sectional study
Background: Birth spacing and birth order are significant factors affecting child health and nutritional status but it is often overlooked when dealing with child undernutrition. There remains a need to consider the modifiable risk factors for undernutrition among children. Therefore, this study aimed to find the relationship of preceding birth interval and birth order with undernutrition among children under five years of age. Subjects and methods: The cross-sectional analytical study included 133 pairs of mothers and children who attended Sir Ganga Ram Hospital, Lahore, Pakistan from July to September 2023. Interviewer administered close-ended questionnaire used to collect data (characteristics of index children and their mothers). Children were categorized into well-nourished and undernourished (wasted, stunted or underweight) using the WHO standards for child growth. Crosstabs and binary logistic regression analysis were done to find the relationship between preceding birth interval, birth order and nutritional status. Results: With 67 (50.4%) boys and 66 (49.6%) girls, the mean age of children was 17.9±12.7 (range 6-59 months). Among 94 (70.7%) undernourished children, 80(85.1%) had all three indicators of undernutrition (wasting, stunting, and underweight). Birth order of the index child, age of child, family income and mother’s BMI showed significant association with childhood undernutrition (all p-values ≤0.05). Whereas preceding birth interval, contraception knowledge and practices were not related to childhood undernutrition (all p-values >0.05). Conclusion: The child’s birth order, age, family income, and maternal BMI showed significant association and greater risk of undernutrition; however preceding birth interval was not related with undernutrition among children under five. Limiting the number of births and improving maternal health and nutrition may reduce child malnutrition.
Copyright (c) 2024 Rameeza Kaleem, Muhammad Adnan, Asma Anwar, Maryam Masood
Prevalence and Risk Factors of Polycystic Ovary Syndrome (PCOS) among Medical Students of a Private Medical College in Lahore
Background: Polycystic ovary syndrome (PCOS) is thought to be among the most frequent causes of infertility within the female population, affecting 4-18% of the women in reproductive age worldwide. The study environment, the challenges that medical students face are different from that of other professional degrees. The primary objective of this study was to determine the prevalence of polycystic ovary syndrome (PCOS) symptoms and secondary objective were to identify risk factors among medical students. Subjects and methods: A cross sectional study was conducted on 289 medical students of CMH Lahore Medical College and Institute of Dentistry. The inclusion criteria were female students willing to participate and the exclusion criteria were female students unwilling to participate. Questionnaire based responses were obtained from 289 female students. Data was entered in SPSS version 27.0 and analyzed. Results: It was observed that 8% females were known to have PCOS. There was a significant relation between PCOS and weight gain (p= 0.024), family history of PCOS (p= 0.039) and family history of hypertension (p= 0.018). A significant relation was noted between PCOS and irregular periods (p= 0.009), acne (p= 0.040) and excessive hair growth on the body (p=0.003). Conclusion: PCOS was found to be prevalent. Weight, family history of PCOS and family history of hypertension were found to be the main risk factors whereas irregular periods, acne and hirsutism were the main clinical features observed.
Copyright (c) 2024 Maham Sultan, Javaria Ahmad, Fatima Izhar Mehdi, Kurrat ul Aaien, Muhammad Ashraf Chaudhry
Analysis of Variant Morphology of Suprascapular Notch in Human Cadaveric Scapulae
Background: Suprascapular notch (SSN) is present along the superior border of scapula. Superior transverse scapular ligament converts the notch into an osteo-fibrous foramen. Suprascapular nerve passes below the superior transverse scapular ligament which may undergo calcification resulting in suprascapular nerve entrapment syndrome. This results in shoulder pain with limitation of movement involving muscles supplied by this nerve. The purpose of this study was to analyze the morphology of suprascapular notch in cadaveric scapulae to establish its clinical relevance. Materials and methods: It was an observational study conducted in the cadaveric bone museum of Anatomy Department at Combined Military Hospital, Lahore Medical College and Institute of Dentistry (CMH LMC&IOD). Results: A total of 75 human cadaveric scapulae were observed. Thirty-six scapulae belonged to the right side and 39 to the left side. Overall type-1(28%), type-II (8%), type-III (35%), type-IV (24%), type-V (2.6%) and type-VI (2.6%) were observed. Out of 75 scapulae only 2 (3%) had completely ossified suprascapular ligament and both were on left side. Independent Samples t-test showed statistically significant difference between superior transverse (p-value=0.001), middle transverse (p-value=0.002) and vertical diameters (p-value=0.048) of type-III and type-IV suprascapular notches. Conclusion: This study showed an overall predominance of types III and IV suprascapular notches. This finding is important for surgeons as ossification of suprascapular ligament may predispose patients to nerve entrapment.
Copyright (c) 2024 Shaista Arshad Jarral, Tayyaba Mahmud, Shazia Tufail, Lovina Safdar
Comparison of Effect of Phenytoin and Levetiracetam in Neonatal Seizures
Background: Neonatal seizures occur in the first 28 days of life and are a major threat to the neonate’s developmental outcome. Phenytoin and levetiracetam are both drugs available as treatment options for neonatal seizures. The objective of this study was to compare the effectiveness of standard recommended doses of phenytoin and levetiracetam in terms of treatment, duration of control, and prevention of recurrence of neonatal seizures at follow-up. Patients and methods: A randomized controlled trial was conducted in the NICU Department of Central Park Teaching Hospital, Lahore, from 15 February 2022 till 14 February 2023. The study included 80 neonates divided into two groups, Group A and B, having 40 neonates in each. The efficacy of both drugs was compared across these groups. T-test was performed on SPSS and a p-value of less than 0.05 was considered as significant. Results: There was a significant difference in neonatal seizure control of both the groups of 40 neonates in each group during the hospital stay as well as on 7 days follow up with Levetiracetam being more effective. Conclusion: Levetiracetam was more effective in comparison with phenytoin in the management of neonatal seizures.
Copyright (c) 2024 Arshia Tabassum, Arshad Rafique `, Wahab Qadir , Muhammad Shoail Shahzad, Muhammad Fakhar Ul Zaman, Azka Sohail