The Professional Medical Journal

One counter, many risks: The public health challenge of unregulated pharmacies in districts of Punjab, Pakistan.

Asma Ali, Shamaila Hassnain — Tue, 30 Jun 2026 00:00:00 -0700

Pattern-driven neuroimaging of intracranial hemorrhage: CT/MRI findings and their clinical implications - A comprehensive review article.

Muhammad Nawaz, Bella Virk, Ihsan Ullah Khan — Tue, 30 Jun 2026 00:00:00 -0700

Intracranial hemorrhage (ICH) represents a significant and growing healthcare burden in Pakistan, with an increasing number of patients presenting to tertiary care hospitals. This rise is attributed largely to contemporary lifestyle factors and prevailing traffic conditions. The etiologies of ICH are diverse, encompassing trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic transformation of ischemic infarction, cerebral aneurysms, arteriovenous malformations and fistulas, vasculitis, tumor-related hemorrhage, and venous sinus thrombosis. Accurate interpretation of neuroimaging is critical for early diagnosis and effective management; however, trainee doctors frequently encounter challenges in recognizing the imaging features associated with different types of ICH, which may lead to diagnostic delays or inappropriate treatment decisions. This review aims to give a thorough insight of the characteristic imaging patterns of intracranial hemorrhage across modalities, with a focus on practical, pattern-based interpretation. By consolidating key diagnostic features and correlating them with underlying pathology, this article seeks to support trainee physicians in improving diagnostic accuracy, enhancing patient outcomes, and contributing to the standardization of care in clinical settings.

A cross-sectional study to evaluate different dermoscopic patterns in the diagnosis of pityriasis versicolor.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate dermoscopic patterns in the diagnosis of pityriasis versicolor. Study Design: Cross-sectional study. Setting: Dermatology Department of Ghurki Trust Teaching Hospital, Lahore. Period: October, 2023 to May, 2024. Methods: Included 60 consecutive patients diagnosed clinically with pityriasis versicolor. Skin scrapings from the lesions were examined using potassium hydroxide (KOH). Woods lamp examination was done and the fluorescence was documented. Dermoscopy was performed using HEINDELTA 30 and images were recorded for analysis. Results: Non-uniform pigmentation was observed in all the representative lesions. Clearly defined borders were observed in 93.3% of cases, predominantly in the hypopigmented variant (41.7%). Inconspicuous ridges and furrows were identified in 68.3%. The halo sign was observed in 36.7% patients, predominantly in the hypopigmented variant (28.3%), while the contrast halo sign was noted in 8.3% chiefly in the hyperpigmented variant (33.3%). Folliculocentric pattern was present in 40% cases. Invasion of hair follicles was seen in 31.7% patients. Gender-based analysis of data showed a statistically significant higher frequency of non-uniform pigmentation, clearly demarcated borders, perilesional hyperpigmentation, invasion of hair follicles, and scaling in males compared to females. Vascular patterns i.e. linear branching and dotted pattern were significantly more common in older patients. Conclusion: Dermoscopy is a valuable, non-invasive tool for identifying characteristic patterns of pityriasis versicolor, thereby improving diagnostic accuracy. Key dermoscopic features, along with observed age and gender variations, can aid in early diagnosis and better clinical assessment.

Comparison of phototherapy with ursodeoxycholic acid versus phototherapy alone in neonates with hyperbilirubinemia alone.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the mean duration of phototherapy in neonates with indirect hyperbilirubinemia undergoing phototherapy with ursodeoxycholic acid versus phototherapy alone. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Medicine, Allied Hospital Faisalabad. Period: 20^th September 2023 to 19^th March 2024. Methods: A total of 60 neonates of both genders, presenting within 3-7 days of life with Jaundice were included. Infants with ABO and Rh incompatibility, Glucose-6-phosphate dehydrogenase (G6PD) deficiency, Crigler-Najjar syndrome, Gilbert syndrome, hypothyroidism and the infants with diabetic mothers were excluded. The treatment was assigned according to the following plan – Intervention group: In addition to phototherapy, the patients in this group were administered oral ursodeoxycholic acid suspension in a dose of 30 mg/kg/day every 12 hourly. Comparison group: Patient in this group received phototherapy only. The distance between the phototherapy units and baby was kept 30 centimeters. Bilirubin estimation was done spectrophotometrically using diazo reagent by Malloy and Evelyn method until bilirubin levels fall < 10 mg/dl. Duration of phototherapy to achieve this level was noted. Results: The mean age of neonates was 3.89 ± 1.13 days; 58.3% were male. The mean duration of phototherapy in the UDCA group was 1.57 ± 0.68 days, significantly shorter compared with 4.40 ± 1.07 days in the phototherapy-only group. Conclusion: This study has shown that duration of phototherapy for bringing bilirubin < 10 mg/dl is lower in ursodeoxycholic acid group compared to phototherapy alone in term neonates with hyperbilirubinemia.

Spectrum of bands causing intestinal obstruction in pediatric patients: A three year retrospective study.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To identify the spectrum of banks causing intestinal obstruction in pediatric patients at two tertiary care hospitals of Sindh, Pakistan. Study Design: Retrospective, Descriptive, Cross-sectional study. Setting: Department of Pediatric Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, and Chandka Medical College, Larkana. Period: 1^st April 2020 to 30^th March 2023. Methods: We reviewed the medical records of all patients under the age of 14 years who presented with intestinal obstruction. Data including demographic characteristics, clinical features, diagnostic modalities, etiology, treatment, and outcomes were noted and analyzed. Results: A total of 254 patients were included in our study. Congenital anomalies were the leading cause (63.0%), with malrotation (18.1%), intussusception (15.7%), and Hirschsprung's disease (11.4%) being most frequent. Acquired causes accounted for 27.2% of cases. Surgical intervention was required in 85.4% of patients. The mean hospital stay was 7.5 ± 3.2 days. The overall mortality rate was 4.7%, primarily associated with complex congenital anomalies and delayed presentation. Conclusion: Intestinal obstruction in children is predominantly caused by congenital anomalies. Timely surgical intervention can reduce the morbidity and mortality in most of the cases.

Treatment outcomes and its determinants among the children with tuberculosis in a Tertiary Care Hospital.

Mariam Bibi, Mohsina Noor Ibrahim, Mashal Khan, Wajid Hussain — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine tuberculosis (TB) treatment outcomes and identify its determinants. Study Design: Analytical, Cross-sectional study. Setting: Medical units and TB clinic of National Institute of Child Health (NICH), Karachi, Pakistan. Period: January 2025 to December 2025. Methods: A total of 172 children, aged 6 months to 15 years with clinically or bacteriologically diagnosed TB who received anti-TB therapy were analyzed. Management followed National TB Control Program guidelines with a 2-month intensive phase and continuation phase duration based on TB site. Outcomes were analyze applying chi-square of fisher’s exact test, while multivariable logistic regression analysis was used to determine predictors of successful treatment outcomes, with adjusted odds ration (aOR), and 95% confidence interval (CI). P<0.05 was taken as statistically significant. Results: Among 172 children, 94 (54.7%) were male, and the median age was 4.6 years (IQR 2.0–9.2). Pulmonary TB was diagnosed in 103 (59.9%), and bacteriological confirmation in 64 (37.2%) children. After excluding 23 (13.4%) lost to follow-up, and in remaining 149 children, 131 (87.9%) children achieved treatment success, while 12 (8.1%) died, and 6 (4.0%) failed. Reduced success was associated with previously treated TB aOR 0.31 (95%CI: 0.09–0.98, p=0.047), hypoalbuminemia aOR 0.33 (95%CI: 0.12–0.86, p=0.023), and human immunodeficiency virus (HIV) positivity aOR 0.09 (95%CI: 0.01–0.74, p=0.036). Conclusion: Treatment outcomes in children with TB were largely favourable, although death, treatment failure, and loss to follow-up remained clinically important. Prior TB treatment, HIV infection, and low serum albumin were associated with reduced treatment success.

Clinical, radiological, and immunological profile of transverse myelitis in children: Experience from the largest public-sector paediatric Hospital in Sindh.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the clinical, radiological, and immunological profiles of paediatric TM patients at a tertiary care hospital in Karachi, Pakistan, and to identify the prevalence of comorbid Vitamin B12 and folate deficiencies. Study Design: Descriptive Cross-sectional study. Setting: Department of Neurology, National Institute of Child Health (NICH), Karachi, Pakistan. Period: June 2023 to June 2024. Methods: Thirty-one patients aged 3 to 18 years meeting the 2002 Transverse Myelitis Consortium criteria were enrolled using non-probability consecutive sampling. Evaluation included spinal MRI, CSF analysis, serum AQP4 and MOG antibody testing, and nutritional assessments. Results: The mean age was 7 years, with a female predominance of 61.3%. Lower limb weakness and bladder dysfunction were universal (100%). Longitudinally extensive transverse myelitis (LETM), involving ≥3 vertebral segments, was observed in 64.5% of patients. CSF pleocytosis occurred in 74.2% and elevated protein in 80.6% of cases. Nutritional analysis revealed Vitamin B12 deficiency in 22.6% and RBC folate deficiency in 12.9% of the cohort. Conclusion: Paediatric TM in the Pakistani population is characterized by a high frequency of longitudinally extensive lesions and profound autonomic failure. The significant prevalence of B12 and folate deficiencies identifies a regional metabolic-inflammatory interface, suggesting that routine nutritional screening is essential for children presenting with acute myelopathy.

EFFECTS OF RACECADOTRIL ON THE TREATMENT OF ACUTE WATERY DIARRHEA IN CHILDREN

Tue, 30 Jun 2026 00:00:00 -0700

Background: Acute watery diarrhea remains a leading cause of childhood morbidity in Pakistan. Racecadotril, an enkephalinase inhibitor with antisecretory properties, has shown variable efficacy in pediatric populations. This study compared the efficacy of Racecadotril plus oral rehydration solution (ORS) versus ORS alone in children with acute watery diarrhea. Methods: A quasi-experimental study was conducted at the Department of Pediatrics, Combined Military Hospital, Quetta, from July to December 2025. A total of 220 children aged 1 to 12 years with acute watery diarrhea were admitted using non-probability consecutive sampling. Participants were allocated to Group A (Racecadotril 1.5 mg/kg/day thrice daily plus ORS, n=110) and Group B (ORS alone, n=110) based on odd/even medical registration number. The primary outcome was diarrhea resolution at 72 hours, defined as <3 stools per day with Bristol Stool-Scale type 4 or 5. Baseline characteristics and stool pathogens were also analyzed. Chi-square test was used for comparison, with p ≤ 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Median age was 3.2 years (IQR: 1.8-5.5) in Group A and 3.4 years (IQR: 1.9-5.6) in Group B (p = 0.76). Rotavirus A was the predominant pathogen, detected in 107 (48.6%) children. At 72 hours, diarrhea resolution was achieved in 88 (80.0%) children in Group A compared to 70 (63.6%) in Group B (χ² = 7.43, p = 0.008), representing a 16.4 percentage point absolute difference. The treatment effect was most pronounced in children aged 1-3 years (82.1% vs. 57.4%; p = 0.005). No significant differences were observed in older age subgroups. Conclusion: Racecadotril to ORS significantly improves diarrhea resolution at 72 hours in children aged 1 to 12 years with acute watery diarrhea, with greatest benefit in children under four years. Racecadotril is an effective adjunctive therapy to ORS in Pakistani clinical settings.

Pattern of congenital heart defects among neonates admitted to Bahawal Victoria Hospital.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine the prevalence and pattern of CHDs among neonates admitted to a tertiary care hospital in Bahawalpur. Study Design: Analytical Cross-sectional study. Period: September 2025 to March 2026. Setting: Pediatric Medicine Department of Bahawal Victoria Hospital/Quaid-e-Azam Medical College, Bahawalpur. Methods: A total of 357 consecutively enrolled neonates (≥1000 g, ≥5-minute APGAR score≥5, gestational age up to 28 days) underwent standardized echocardiographic assessment by a consultant pediatric cardiologist. Demographic and clinical data were recorded, and CHDs were classified as acyanotic or cyanotic. Data were analyzed using SPSS 27.0. Results: Echocardiography identified congenital heart defects in 38 neonates, yielding 10.6% frequency. Acyanotic lesions predominated (81.6%), with ventricular septal defect being most common (47.4%). Family history showed a strong association with CHD (p<0.001), while lower five-minute APGAR scores demonstrated a modest correlation (p=0.049). Sex and birth weight were not significant predictors. Cardiac murmurs, cyanosis, tachypnea, and feeding difficulties were significantly more prevalent among affected neonates (all p<0.001), highlighting essential clinical screening indicators. Conclusion: This study demonstrates high frequency of congenital heart disease among neonates predominantly acyanotic and strongly associated with family history and clinical indicators such as murmurs and respiratory compromise.

Comparison of the efficacy of morphine and magnesium sulphate versus morphine alone to manage pain after coronary artery bypass grafting.

Muhammad Bilal Nazar, Farrukh Ahmad Sandhu, Arij Sardar — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the efficacy of morphine and magnesium sulphate versus morphine alone to manage pain after coronary artery bypass grafting. Study Design: Prospective Cohort Study. Setting: Department of Anesthesiology, CPEIC Multan. Period: June 2025 to December 2025. Methods: Department of Anesthesiology, CPEIC Multan. Methods: Sample size was calculated through OpenEpi online software using formula for cohort study. Where, Efficacy in magnesium sulphate group = 68%, Power of the study = 80%, Efficacy in morphine only group = 17%, Confidence level = 95%, Sample size =60 (30 in each group). Sampling technique was Non-probability consecutive sampling. Inclusion Criteria, Age 35-65 years, either male or female gender, planned to undergo coronary artery bypass grafting. The data was analysed through SPSS version 23. Efficacy between the two groups was compared using chi-square test and p-value ≤ 0.05 was taken as significant. Post stratification chi-square test was applied and p-value ≤ 0.05 was taken as significant. Results: A total of 60 patients were enrolled into the study in equal proportions. Morphine plus Magnesium Sulphate (MM) group had significantly lower mean Visual Analogue Scale (VAS) pain scores at 6, 12 and 24 hours than the Morphine alone (M) group (p <.05 ). The MM group had a much lower requirement to rescue analgesia, and the efficacy was found to be 68% as compared to 17% in the M group (p=0.001). More so, the ICU stay and intubation time were much shorter in the MM. Conclusion: Morphine in combination with magnesium sulphate is more effective than morphine in treatment of postoperative pain following coronary artery bypass grafting. Magnesium sulphate is a safe and cost-effective adjunct to cardiac anesthesia, it substantially decreases opioid use, decreases pain scores, and length of stay in the ICU, indicating magnesium sulphate as a useful option.

Comparative role of serratus anterior plane block and thoracic erector spinae plane block in post-operative analgesia for breast surgery.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the analgesic efficacy of the serratus anterior plane block and thoracic erector spinae plane block in terms of duration of analgesia, pain score at 12 hours, and total opioid consumption in women undergoing breast surgery. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesiology, Fauji Foundation Hospital, Islamabad. Period: Sep-2025 to Dec- 2025. Methods: Sixty female patients planned for unilateral breast surgery were included and equally randomized to receive either erector spinae plane block (Group ES) or serratus anterior plane block (Group SA). Severity of pain in the postoperative period was assessed using the Numerical Rating Scale. Primary outcome was the duration of analgesia (time to need for first rescue analgesia), while secondary outcomes included pain score at 12 hours and total opioid consumption in first 24 hours. Results: The duration of analgesia was significantly longer in Group ES compared to Group SA (394.3 ± 34.1 min vs. 324.3 ± 29.9 min, p < 0.0001). A lower but statistically non-significant pain score was observed at 12 hours in Group ES (4.43 ± 1.14 vs. 4.96 ± 1.03, p = 0.06). Similarly, total 24-hour opioid consumption was also lower in Group ES compared to Group SA, however it did not reach statistical significance (60.13 ± 11.86 mg vs. 64.23 ± 9.51 mg, p = 0.16). Conclusion: Erector spinae plane block provided a significantly longer duration of analgesia as compared to serratus anterior plane block in women undergoing breast surgery.

Analgesic efficacy of diclofenac and paracetamol versus pethidine for post operative pain after cesarean section.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the analgesic efficacy of diclofenac sodium and paracetamol versus pethidine after cesarean section. Study Design: Quasi-experimental study. Study Design: Department of Anesthesia, CMH Skardu. Period: 1^st Feb 2022 to 31 July 2022. Methods: Female patients with age from 18-40 years, ASA I or ASA II, singleton pregnancy on ultrasonography at term pregnancy planned for Lower segment cesarean section (LSCS) were included in the study. Sampling was done using a non-probability consecutive allocation of 152 patients with 76 participants in each group. Patients from Group A received intravenous pethidine while patients from Group B received per rectal diclofenac sodium and paracetamol intravenously. Recorded variables were Age, BMI, ASA grade and post operative pain on a VAS at 0 hours, 06 hours and 12 hours. Results: Mean age of 28.21 ± 5.79 years in Group A and 29.40 ± 5.84 years in Group B. Body mass index among the groups revealed mean values of 22.72 ± 1.64 kg/m²and 22.65 ± 1.65 kg/m²in Group A and Group B respectively. Post LSCS pain at 06 hours among the groups was reported by 27(35.5%) patients in Group A as compared to 10 (13.2%) patients in Group B (P=0.01). At 12 hours 30(39.5%) patients experienced pain in Group A as compared to 11(14.5%) patients in Group B with a p-value of 0.01. Conclusion: Analgesic efficacy of diclofenac and paracetamol was superior to pethidine for post operative pain after cesarean section.

Geographic and socio-economic determinants of advanced stage presentation for radiotherapy in cervical cancer: Analytical cross sectional study.

Asima Luqman, Qudsia Anwer, Wajahat Hussain, Maria Hassan — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To identify independent geographic and socio-economic predictors of advanced FIGO stage at the time of radiotherapy initiation among cervical cancer patients. Study Design: Analytical Cross-sectional study. Period: January 2024 to December 2025. Setting: Department of Oncology, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur. Methods: Ethical approval was obtained from Institutional Review Board. 120 adult females with histologically confirmed carcinoma cervix prescribed definitive or palliative radiotherapy were enrolled using non-probability consecutive sampling. Excluded were patients with recurrent disease following prior curative treatment or incomplete records lacking essential staging. Data collection integrated clinical staging, estimated geographic distances, and socio-economic questionnaires capturing insurance and assets. Statistical analysis utilized Chi-square tests and multivariate logistic regression to calculate Adjusted Odds Ratios with 95% confidence intervals using SPSS version 23.0. Results: Mean participant age was 51.8±10.9 years, with 68.3% residing rurally. Overall, 70.0% presented with advanced-stage disease (FIGO IIB–IVB). Multivariate logistic regression identified travel distance exceeding 50km (AOR=2.76, p=0.004), low socio-economic status (AOR=3.08, p=0.002), and primary-level education or less (AOR=2.19, p=0.030) as significant independent predictors. Rural residence significance attenuated after adjustment for distance. Subgroup analysis showed 88.2% advanced stage in low SES/distant patients versus 38.5% in high SES/nearby patients. Conclusion: Rural residence and low socio-economic status are primary determinants of advanced-stage cervical cancer presentation. Decentralized screening services and financial support mechanisms are urgently required to improve early detection and survival outcomes in this region, mitigating regional health disparities.

Outcome of ankle joint function after anterior cruciate ligament reconstruction using peroneus longus graft.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the outcome of ankle joint function after anterior cruciate ligament (ACL) reconstruction using the peroneus longus tendon (PLT) autograft. Study Design: Prospective Longitudinal study. Setting: Department of Orthopedic Surgery, Madinah Teaching Hospital, Faisalabad. Period: 19^th July 2025 to 1^st Feb 2026. Methods: Arthroscopic repair utilizing ipsilateral PLT autograft was performed on 96 patients, ranging in age from 18 to 50 years, who had a verified ACL rupture. The American Orthopedic Foot and Ankle Society (AOFAS) score was used to evaluate ankle function before and after surgery at 3,6, and 12 weeks. Statistical analysis was carried out using repeated measures ANOVA to analyze changes over time, based on demographic and clinical data. To account for any confounding factors such as age, gender, BMI, involved side, comorbidities, and injury mechanism, stratification was used. Results: The mean AOFAS scores increased progressively from 64.35 ± 4.14 at 3 weeks to 73.35 ± 3.13 at 6 weeks and 81.75 ± 3.71 at 12 weeks, indicating significant improvement in ankle function (p < 0.001). Excellent and good functional outcomes were achieved in 92.7% of patients, with fair outcomes in 7.3%. Donor-site complications were minimal, with preserved eversion and plantarflexion strength in the majority of patients. No patient reported ankle instability, gait disturbance, or limitations in daily or sports activities. Functional outcomes were significantly associated with age, BMI, gender, and mode of injury, while side of knee involvement had no effect. Conclusion: ACL reconstruction using the peroneus longus tendon autograft provides excellent knee stability while preserving ankle joint function. The procedure is safe, effective, and associated with minimal donor-site morbidity, making PLT a reliable graft option for ACL reconstruction.

Outcome of kyphoplasty for the management of osteoporotic vertebral compression fractures.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the clinical and radiological outcomes of percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures. Study Design: Prospective Cohort study. Setting: Department of Orthopedics, GTTH, Lahore, Pakistan. Period: 18^th December 2025 to 30^th Mar 2026. Methods: Patients who had undergone percutaneous kyphoplasty were selected. The clinical assessment at 12 weeks was made with respect to pain using the Visual Analog Scale (VAS), while the radiological assessment was done with respect to vertebral body height on lateral radiograph images. Data were analyzed using SPSS 27. Results: The mean age of patients was 65.8 ± 8.2 years (age range 46–83), with females being more common (73.3%). The highest number of cases involved L1 vertebrae (38.7%), and there was predominance of cases involving a single vertebra (60.0%). The mean VAS pain score was significantly reduced from 9.2 ± 0.7 to 1.8 ± 1.9 at 12 weeks (p < 0.001), resulting in a mean decrease of 7.4 points in pain intensity. Mean vertebral body height was improved from 2.78 ± 0.35 cm to 3.05 ± 0.32 cm (p < 0.001), which corresponds to an average increase of about 9.7% in height. Conclusion: There was an observed improvement in the degree of pain reduction and in the amount of increase in height of the affected vertebrae at 12 weeks in patients suffering from osteoporotic vertebral compression fractures, making it a reliable and safe form of treatment for OVCFs.

Intratympanic depomedrol or oral prednisone. A comparative analysis in idiopathic sudden sensorineural hearing loss (SSNHL).

Muhammad Saqib, Muhammad Azeem Aslam, Rehab Fatima, Hadia Wali, Tahir Muhammad — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the efficacy of systemic steroids and intratympanic steroid therapy in terms of hearing outcomes in patients diagnosed with sudden sensorineural hearing loss. Study Design: Prospective Non-randomized Clinical study. Setting: Department of Otorhinolaryngology, Shifa International Hospital, Islamabad. Period: November 2024 to November 2025. Methods: All patients diagnosed with SSNHL were enrolled consecutively and categorized into two groups based on treatment received: oral or intratympanic steroids. All patients were followed. Pre-treatment hearing threshold and post-treatment hearing threshold after completion of treatment and repeat audiogram within 2 months after treatment were assessed. Results: Twenty-nine patients were included (12 oral, 17 intratympanic). There was no significant difference in hearing threshold improvement between oral and intratympanic steroid therapy (Mann–Whitney U = 78.0, p = 0.303), and post-treatment hearing recovery according to Siegel’s criteria was comparable between groups. Multivariable analysis identified longer symptom duration, history of mumps, associated vertigo, and asthma as significant negative predictors of hearing improvement, independent of treatment modality. Conclusion: Oral and intratympanic steroid therapy demonstrated comparable effectiveness in the treatment of idiopathic sudden sensorineural hearing loss. Prognostic factors, particularly delayed presentation and associated vertigo, history of mumps and history of asthma, appear to play a more decisive role in hearing recovery than the route of steroid administration.

To determine the efficacy of underlay technique for myringoplasty in terms of hearing improvement.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine the efficacy of underlay technique for myringoplasty in terms of hearing improvement. Study Design: Descriptive Case Series. Setting: E.N.T Department, Sir Ganga Ram Hospital, Lahore. Period: 11/8/2025 to 10/2/ 2026. Methods: Consecutive non probability sampling. A total 132 patients were observed in this study. An extensive ear, nose, and throat examination was performed along with a full history. Pure tone audiometry and tuning fork tests were used for preoperative evaluation. General anesthesia was used for every procedure. The underlay technique was carried out using the endaural approach. A large tympanomeatal flap was elevated based on the superior vascular pedicle together with the annulus. The middle ear was filled with tiny pieces of spongeston. Results: Mean age of patients was 30 years with standard deviation ± 12.46. Male patients were 44 percent while 78% patients were female. Additionally, 84% of patients found success with the underlay approach, whereas 21% did not. Conclusion: According to our research, the underlay method was 84% successful in improving hearing following myringoplasty.

Comparison of interrupted and semi-continuous suture techniques in rheumatic valvular disease by analysis of paravalvular regurgitation following mitral valve replacement: A retrospective cohort study.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare o fboth interrupted and continuous technique following mitral valve replacement in terms of paravalvular regurgitation in patients with rheumatic heart diseases. Study Design: Retrospective Cohort study. Setting: Peshawar Institute of Cardiology, Peshawar. Period: 01/01/2022 to 31/12/2024. Methods: Analyzed 110 patients (46 males, 41.8%; 64 females, 58.2%) with a mean age of 39.8 ± 11.5 years and mean BMI of 23.3 ± 4.2, all of whom underwent isolated MVR for rheumatic pathology. Patients were grouped based on the suture technique used: semi-continuous or interrupted. Outcomes assessed included operative mortality, New York Heart Association (NYHA) functional class, PVR severity, and cross-clamp time. Results: Operative mortality was identical in both groups, with 1 patient each (0.9%), accounting for a total mortality of 1.8% (p = 1.0). Most patients were categorized as NYHA Class I or II postoperatively, representing 44.0% and 50.5% of the overall cohort, respectively. NYHA Class III occurred in 1.8% of the semi-continuous group and 3.7% of the interrupted group. PVR rates were comparable between techniques, with any-degree PVR observed in 44.5% of the semi-continuous group and 41.8% of the interrupted group. Moderate-to-severe PVR was slightly more prevalent in the semi-continuous group (1.8%) compared with the interrupted group (0.9%); however, this difference was not statistically significant (p = 0.5). Mean aortic cross-clamp time was significantly shorter for the semi-continuous technique (68.75 ± 22.2 minutes) than the interrupted technique (91.7 ± 27.3 minutes). Conclusion: Semi-continuous and interrupted suture techniques demonstrate comparable efficacy in preventing paravalvular regurgitation following rheumatic MVR, with no significant differences in operative mortality or postoperative functional class. The semi-continuous technique, however, offers the advantage of reduced cross-clamp time. Further prospective studies are warranted to validate these findings and explore long-term outcomes.

Management and characteristics of significant Post-CABG pleural effusions requiring intervention and their clinical outcomes.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the characteristics, management approaches, and clinical outcomes of significant post-CABG pleural effusions, with emphasis on effusion type and predictors of intervention. Study Design: Retrospective Observational study. Setting: Peshawar Institute of Cardiology, Peshawar. Period: January 2024 to December 2025. Methods: A total of 100 post-cardiac surgery patients with clinically significant pleural effusions were included. Data on demographics, surgical details, pleural fluid characteristics, interventions, complications, and outcomes were extracted from electronic medical records and analyzed using descriptive statistics in SPSS version 23. Results: The cohort was predominantly male (75%) with a mean age of 58.30 ± 9.06 years. Most patients had moderate (64%) or large (32%) effusions. Transudative effusions predominated (74%), while 26% were exudative. Chest tube drainage was the most common intervention (74%). Procedure-related complications were uncommon (3%) but were significantly associated with exudative effusions (p = 0.047). Radiological lung expansion was achieved in 93% of patients. Conclusion: Post-CABG pleural effusions are predominantly transudative and can be managed safely with pleural drainage. Chest tube drainage remains the preferred approach, while exudative effusions warrant closer monitoring due to a higher complication risk.

Antibody screening in the general population: A single center experience in Karachi.

Kanwal Shafiq, Syeda Kanwal Zehra Zaidi, Munazza Rashid, Ghazal Irfan — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the prevalence and spectrum of red cell antibodies in the general population of Karachi. Study Design: Cross-sectional Descriptive study. Setting: Department of Blood Bank Chughtai Lab, Karachi. Methods: April 2024 to April 2025. Methods: A total of 999 samples were recruited for antibody screening. Individuals of all age groups and both genders were included. From each participant, approximately 7 mL of venous blood was drawn using a vacutainer and collected into two separate tubes. Descriptive statistics were used to summarize the findings (using SPSS v24.0). Results: 999 samples were screened for red cell antibodies, of which 77 (7.7%) tested positive. The majority of positive cases were females (93.5%), with a median age of 28.5 years compared to 26 years in males. Anti-D was the most common alloantibody (32.5%), followed by weak positive reactions (16.9%), auto antibody-positive cases (14.3%), and combinations such as anti-D with anti-C (9.1%) and anti-E (9.1%). Less frequent antibodies included anti-c, anti-K, anti-M, anti-C, anti-Jka, and anti-Fya. A significant association was observed between gender and the type of antibody detected (p = 0.016). Conclusion: The prevalence of red cell alloantibodies in the subset population of Karachi was 7.7 %, with a marked predominance among females. Anti-D emerged as the most common antibody, followed by other Rh and non-Rh specificities.

Correlation of spot urinary protein creatinine ratio and quantitative proteinuria in patients with nephrotic syndrome.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the correlation between spot urinary protein-creatinine ratio (PCR) and 24-hour quantitative proteinuria in patients with nephrotic syndrome. Study Design: Descriptive Cross-sectional study. Setting: Department of Nephrology, Khyber Teaching Hospital, Peshawar. Period: 11^th October 2025 to 10^th January 2026. Methods: A total of 144 adult patients (aged 18–70 years) with confirmed nephrotic syndrome were included. Demographic, clinical, and laboratory parameters were recorded. Total 24-hour urinary protein excretion was measured, and a simultaneous random spot urine sample was collected to calculate the protein-creatinine ratio (PCR). Data were analyzed using SPSS v26. Continuous variables were expressed as mean ± standard deviation, categorical variables as frequencies and percentages. Pearson’s correlation coefficient assessed the relationship between spot PCR and 24-hour proteinuria, with p≤0.05 considered significant. Results: The mean age of participants was 50.1 ± 13.0 years, with 57.6% males. The mean spot urinary PCR was 2.90 ± 1.28 mg/mg, and mean 24-hour proteinuria was 3.95 ± 1.48 g/day. Spot PCR showed a strong positive correlation with 24-hour proteinuria (r = 0.87, p<0.001). Subgroup analysis indicated that this correlation was consistent across gender, presence of hypertension, and diabetes mellitus. Conclusion: Spot urinary protein-creatinine ratio strongly correlates with 24-hour proteinuria in patients with nephrotic syndrome, supporting its use as a convenient and reliable alternative to timed urine collection in routine clinical practice.

Outcome of Ibrutinib in chronic lymphocytic leukemia-Real world experience from a developing country.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the efficacy and safety of ibrutinib, a bruton tyrosine kinase inhibitor, in previously untreated or relapsed/refractory CLL patients from Pakistan. Study Design: Cross-sectional study. Setting: National Institute of Blood Diseases and Bone Marrow Transplantation. Period: January 2023 to December 2024. Methods: A total of 35 CLL patients were included in the study. Patients were administered 420 mg of oral ibrutinib daily until disease progression or emergence of intolerable side effects. Descriptive analysis was calculated as means and percentages using the statistical package for the social sciences version 23.0. Survival analysis was performed using the Kaplan-Meier method. Results: The median age of the patient was 56 years. Del17p was detected in eight patients (22.9%). The median follow-up period in patients receiving ibrutinib as first line therapy was 29 months while it was 41 months in relapsed/refractory group. Results showed an overall response rate of 50% for first-line ibrutinib therapy and 45.5% for second-line treatment. Median overall survival could not be established. Hematologic recovery was observed in patients with pre-existing cytopenia(s). Grade 3–4 hematological toxicities were neutropenia, thrombocytopenia, and anemia. Conclusion: The study demonstrated the safety and efficacy of ibrutinib in Pakistani CLL patients, both as first-line and subsequent therapy.

Role of Co-Enzyme Q10 in the improvement of diet-induced hypercholesterolemia in an animal model: Laboratory-based experimental study.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To create a model by inducing hypercholesterolemia in rabbits by feeding them with a high-cholesterol diet in order to perform the lipid profile for alterations in the serum levels of LDL and total cholesterol in the blood and to observe the role of coenzyme Q10 in these Animals. Study Design: Experimental study. Setting: Animal House of National Institute of Health Islamabad, Pakistan. Period: Jan 2023 - Nov 2023. Methods: This study was conducted on thirty-six adult healthy rabbits. Increased blood cholesterol level was developed in experimental animals by giving them high-cholesterol diet for 120 days, the very next day Coenzyme Q10 was given to rabbits for 30 days. Base line levels of serum cholesterol, triglycerides, very low density lipoprotein, Low density lipoprotein, and High density lipoprotein were measured. After 24 hours of the last test dose Lipid markers were tested. One-way ANOVA followed by post hoc Tukey test were applied for calculating mean and standard deviations. Results: High cholesterol diet-fed rabbits showed a significant increase in cholesterol level after 120 days with respect to day zero, the serum total cholesterol level decreased after giving CoQ10 for the next 30 days. Similarly, serum low-density lipoprotein levels showed a significant increase following 120 days of intake of a high-cholesterol diet. However, this increase is followed by a decrease in levels when treated with CoQ10 for 30 days. Conclusion: A High cholesterol diet produces hyperlipidemia in animal models. CoQ10 can be effectively used for lowering the serum levels of cholesterol and low-density lipoprotein, which may be beneficial in correcting dyslipidemia in patients with cardiovascular diseases.

Short term treatment outcomes of primary focal segmental glomerulosclerosis: A single center experience from a tertiary care hospital of South Punjab, Pakistan.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine the short-term treatment outcomes of biopsy-proven focal segmental glomerulosclerosis (FSGS). Study Design: Retrospective, Cohort study. Setting: Department of Nephrology, Kidney Center, Bahawal Victoria Hospital, Bahawalpur, Pakistan. Period: January 2019 to June 2025. Methods: A total of 66 patients with biopsy-proven FSGS, aged 12–60 years, with a minimum follow-up duration of 6 months were analyzed. Information was extracted from registry and hospital records. Baseline demographic, clinical, laboratory and treatment related information were recorded. At six months, outcomes were measured by proteinuria and serum creatinine changes. Statistical analysis was done using SPSS v26, with chi-square, or Fisher's exact test and statistical significance at p<0.05. Results: In a total of 66 patients, the median age was 22.0 years (IQR 16.0–33.5), and 34 (51.5%) were male. Steroid monotherapy was used in 46 (69.7%), and steroids with cyclosporine in 10 (15.2%) patients. At six months, 44 (66.7%) achieved complete proteinuria remission, 12 (18.2%) partial, 8 (12.1%) had persistent, and 2 (3.0%) had massive proteinuria. Renal function remained normal in 58 (87.9%), improved in 4 (6.1%), and worsened in 4 (6.1%) patients. Proteinuria remission correlated with gender (p=0.006) and baseline renal dysfunction (p=0.019). Treatment modality was significantly associated with post-treatment renal dysfunction (p<0.001). No mortality was reported during the study period. Conclusion: Short-term analysis of biopsy-proven FSGS demonstrated that two-thirds of patients achieved complete remission of proteinuria and the majority maintained stable renal function after six months of therapy.

Correlation of microbiological cultures with renal profiles in patients suffering from chronic UTI in a tertiary care hospital in Pakistan.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To correlate outcomes of urine culture with renal function tests in patients suffering from chronic UTI with the aim to detect early renal compromise associated with any specific pathogens. Study Design: Cross-sectional, Observational. Setting: Sadaf Yahya Hospital, Daska and Bahria University College of Medicine, Islamabad. Period: 15^th January 2025 to 30^th August 2025. Methods: The sample included adult female patients aged more than 18 years, with a history of chronic or recurrent UTIs. Demographic data, medical history, and past episodes of UTI were noted. Midstream urine specimens were inoculated and cultured. Microorganisms identification was done through gram staining, biochemical assays or automated identification systems. Venous blood samples were collected from each participant to assess renal function. Results: A total of 158 female patients were included in this study. The comparison of renal function parameters between chronic UTI patients was done using independent sample t-test. The serum Creatinine levels were significantly higher in the patients with positive culture [99.28 (18.12) µmol/L] compared to culture-negative patients [83.47 (14.41) µmol/L] with the p value less than 0.001. Comparison of renal function parameters among patients with chronic UTIs according to the type of urinary pathogen identified on culture using one-way ANOVA. Statistical analysis showed a significant difference in serum creatinine across pathogen groups (p < 0.001) whereas differences in serum urea and eGFR were not statistically significant. Conclusion: Patients with chronic UTI were associated with higher serum creatinine.

Association between Vitamin D Deficiency and Disease Activity in Systemic Lupus Erythematosus (SLE).

Umair Arif, Muhammad Hassan, Fahad Qaisar — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the association between SLE patients' disease activity and blood 25-hydroxyvitamin D [25(OH)D] levels. Study Design: Cross-sectional Analytical Investigation. Setting: Bahawal Victoria Hospital, Bahawalpur. Period: January and December 2025. Methods: A total of 85 adult SLE patients who met the 2019 EULAR/ACR criteria participated SLEDAI-2K, BILAG-2004, PGA, and serological markers were used to evaluate disease activity. Vitamin D status was categorized per standard thresholds. Spearman’s correlation and multivariable linear and logistic regression models were used, adjusting for age, gender, BMI, prednisolone dose, hydroxychloroquine use and sun avoidance. Results: Vitamin D deficiency (<20 ng/mL) was present in 63.5% of patients. Significant inverse correlation was observed between 25(OH)D and SLEDAI-2K (ρ = –0.34, p = 0.001). Each 10 mg/mL increase in 25(OH)D was linked with a 1.8-point reduction in SLEDAI-2K (p = 0.002). Deficient patients had 3.7-fold higher odds of high disease activity (adjusted OR = 3.72, p = 0.025). Conclusion: Deficiency of Vitamin D is common and independently linked with higher disease activity in Pakistani SLE patients, supporting routine screening and repletion.

Anatomical changes after suprachoroidal triamcinolone acetonide in patients with diabetic macular edema.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate average change in central macular thickness (CMT) and central subfield thickness (CST) in patients with DME following suprachoroidal triamcinolone acetonide injection. Study Design: Quasi-experimental study. Setting: LRBT, Lahore. Period: June 2025 to December 2025. Methods: Included were 135 patients with DME diagnoses. OCT was used to measure baseline CST and CMT. At four weeks, a follow-up evaluation was conducted. Results: The mean age of patients was 58.9 ± 6.4 years, with the majority being males. 5.5 ± 2.1 years was the average duration of diabetes. The mean baseline CST was 468.90 ± 25.10 µm, which significantly reduced to 293.10 ± 9.20 µm at four weeks (mean reduction 175.80 ± 16.20 µm; p < 0.001). Similarly, the mean baseline CMT decreased from 470.20 ± 24.80 µm to 294.00 ± 10.10 µm (mean reduction 176.20 ± 15.90 µm; p < 0.001). Stratification analysis showed that age and duration of diabetes significantly influenced anatomical response (p < 0.05). Conclusion: The central subfield thickness and central macular thickness were statistically reduced in diabetic macular edema patients four weeks after suprachoroidal triamcinolone acetonide injection. The outcomes suggest that SCTA is an effective method of treatment to achieve short-term morphological change, particularly in elderly patients and those with chronic diabetes.

In-hospital outcomes following primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction and cardiogenic shock: A single-center experience.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate in-hospital outcomes subsequent to primary percutaneous coronary intervention (PCI) among individuals exhibiting ST-elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS). Study Design: Analytical Cross-sectional Analysis. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: April to October 2024. Methods: In total 145 patients within the age range of 30–65 years diagnosed with STEMI complicated by CS undergoing primary PCI were included. Baseline demographics, cardiovascular risk profile, clinical presentation, and angiographic characteristics were recorded. In-hospital outcomes, including mortality, arrhythmias, and contrast-induced nephropathy (CIN), were assessed. Statistical evaluation was performed using SPSS version 26, applying chi-square and binary logistic regression tests. Results: The mean age was 53.6±7 years, with 62.8% males. Hypertension, diabetes, smoking, and dyslipidemia were present in 60.7%, 42.8%, 49%, and 47.6% of patients, respectively. The most common culprit artery was proximal LAD (39.3%). Multivessel disease was observed in 66.2% of patients. In-hospital complications included arrhythmias in 12.3%, CIN in 22.8%, reinfarction in 6.2%, stroke in 2.8%, and major bleeding in 7.6% of patients. In-hospital mortality was observed at 8.3%. CIN showed a significant association with the number of diseased vessels (p=0.027) and culprit artery (p=0.039). On multivariable analysis, CIN (AOR=3.4, p=0.021) and triple vessel disease (AOR=2.8, p=0.034) emerged as independent determinants of mortality. Conclusion: Primary PCI in STEMI patients experiencing CS is characterized by notable in-hospital complications and mortality. Angiographic complexity and renal complications significantly influence outcomes, emphasizing the need for early risk stratification and optimized management strategies.

Efficacy of bed side lung ultrasound for detection of lung pathologies in PICU.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the diagnostic accuracy of bedside lung ultrasound (LUS) compared with chest X-ray for detecting common lung pathologies among critically ill children. Study Design: Cross-sectional, Analytical, Diagnostic Accuracy study. Setting: Pediatric Intesive Care Unit (PICU) of the National Institute of Child Health, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 52 children aged 1 month to 15 years, with respiratory distress, or developing new respiratory signs during PICU stay were analyzed. Bedside LUS was performed using a standardized protocol, with operators blinded to chest X-ray findings. Chest X-ray interpreted by radiology served as the reference standard. Diagnostic performance was assessed using McNemar test, taking p<0.05 as significant. Results: In a total of 52 children, 34 (65.4%) were males. The median age was 3.0 (IQR 1.4-6.0) years. Bedside LUS identified pneumonia or consolidation in 32 (61.5%) children, while chest X-ray reported in 38 (73.1%). Pleural effusion was detected on LUS in 24 (46.2%) children, and on chest X-ray in 21 (40.4%). Pneumothorax was documented in 6 (11.5%) children on both modalities. Pulmonary edema or interstitial syndrome was observed in 8 (15.4%) children on ultrasound, and in 8 (15.4%) children on chest X-ray. Using paired comparison, there was no significant difference between bedside LUS and CXR in detection rates of pneumonia/consolidation (p=0.109), pleural effusion (p=0.453), pneumothorax (p=1.000) or pulmonary edema/interstitial syndrome (p=1.000). Conclusion: Bedside LUS demonstrated clinically meaningful diagnostic performance in critically ill children for pneumothorax, pleural effusion, pulmonary edema or interstitial syndrome, and pneumonia or consolidation.

Initial experience of fistula laser closure in patients with fistula in ANO in a developing country: A prospective cohort study from Pakistan.

Abdullah Bin Saeed, Shaukat Ali, Rana Israr, Nimra Naeem — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To evaluate the initial experience, efficacy, and outcomes of Fistula Laser Closure (FiLaC) in the treatment of patients with fistula in ano in a Pakistani healthcare setting. Study Design: Prospective Cohort study. Setting: Faisal Hospital, Faisalabad. Period: February 2022 to January 2025. Methods: A total of 243 patients aged 20-60 years with clinically and radiologically confirmed fistula in ano were included using convenience sampling. Patients were classified according to Parks’ classification and followed up at 3, 6, and 12 months post-operatively to assess healing and recurrence rates. Results: Among 243 patients, trans-sphincteric fistulas were most common (41.1%, n=100), followed by extra-sphincteric (24.7%, n=60), intersphincteric (22.6%, n=55), and supra-sphincteric (11.5%, n=28) fistulas. The overall primary healing rate was 69.96% (n=173), with primary failure in 30.04% (n=70) patients. Healing rates varied by fistula type: trans-sphincteric 37% (n=37), extra-sphincteric 16.50% (n=10), intersphincteric 12.3% (n=7), and supra-sphincteric 4.10% (n=2). Among the 70 patients with primary failure, secondary healing after repeat laser treatment was achieved in 23% (n=56), with a secondary failure rate of 7% (n=17). Simple fistulas demonstrated superior outcomes compared to complex fistulas. Conclusion: FiLaC appears to be a promising sphincter-preserving treatment for fistula in ano in a developing country context, with satisfactory overall primary healing rates, particularly in patients with simple fistula types. The secondary healing rate following repeat treatment suggests potential for successful outcomes after initial failure.

Comparison of autologous platelet rich plasma dressing versus normal saline dressing in the management of heel pad injuries due to motorcycle wheel spoke.

Jannat Gulzar, Fatima Nauman — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the outcome of autologous platelet rich plasma dressing with normal saline dressing in the management of heel pad injuries due to motorcycle wheel spoke. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics Surgery, Services Hospital, Lahore. Period: April 2024 to April 2025. Methods: After meeting selection criteria, 60 (30 in each group) patients were enrolled and randomly allocated in two groups using computer generated table. In group A, platelet rich plasma was applied. In group B, normal saline dressing was applied. After 12^th week outcomes in terms of reduction in horizontal and longitudinal wound dimensions, complete healing and duration of healing were noted. Results: In PRP group, the reduction in longitudinal size was 77.11%±23.89 and in normal saline group, was 51.47%±21.70 (p-value=<0.001). In PRP group, the reduction in horizontal size was 74.05%±21.51 and in normal saline group, was 48.39%±21.37 (p-value=<0.001). In PRP group, the mean duration of healing was 15.87±5.42 days and in normal saline group, was 18.83±7.19 days (p-value=0.076). In PRP group, complete healing was found in 13(43.3%) patients and in normal saline group, it was found in 2(6.7%) patients (p-value=0.001). Conclusion: Autologous platelet rich plasma dressing showed better outcome as compared to normal saline dressing in the management of heel pad injuries due to motorcycle wheel spoke in terms of complete healing, duration of healing and reduction in wound size.

Difference in IOP (Intraocular Pressure) with and without eye speculum during examination under general anaesthesia using perkins tonometer.

Hira Awais, Seema Qayyum, Fiza Azhar, Amna Mehmud, Zunaira Mubarik, Ruja Ayyub — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare intraocular pressure measurements obtained with and without an eyelid speculum during examination under general anaesthesia using Perkins tonometry. Study Design: Prospective Observational study. Setting: Department of Ophthalmology, Mughal Eye Hospital, Lahore. Periods: 1^st October 2025 to 1^stMarch 2026. Methods: Included 25 children (40 eyes) aged 1–12 years undergoing EUA. IOP was measured using a Perkins handheld applanation tonometer after induction of standardized general anaesthesia. Three readings were obtained first within 5 minutes of given general anaesthesia and subsequently after insertion of a pediatric eyelid speculum. Mean IOP values were compared using a paired t-test, and correlation analysis was performed to assess associations with demographic variables. Results: The mean age of participants was 3.5 ± 2.1 years. Mean baseline IOP without speculum was 11.2 ± 3.8 mmHg, which increased to 12.8 ± 3.2 mmHg after speculum application. The mean IOP difference was 1.6± 0.6 mmHg, which was statistically significant (p < 0.001). No significant correlation was observed between age and IOP change (r ≈ 0.10, p > 0.05). A weak positive correlation was observed between baseline IOP and IOP change (r ≈ 0.30, p < 0.05). Conclusion: Eyelid speculum use during examination under general anaesthesia results in a statistically significant increase in intraocular pressure measurements using Perkins tonometry. Although the magnitude of change is modest, it may be clinically relevant in pediatric glaucoma management, where treatment decisions are often based on single IOP readings.

Role of sports participation in preventing academic burnout among undergraduate medical students.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To explore the role of sports participation in preventing academic burnout among undergraduate medical students. Study Design: Cross-sectional Analytical study. Setting: Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan. Period: April 2025 to September 2025. Methods: Among undergraduate MBBS students from first to final year. Participants were recruited through convenience sampling, and data collected using a structured questionnaire including demographic variables, the International Physical Activity Questionnaire Short Form, and the Oldenburg Burnout Inventory. Descriptive statistics and linear regression analyses were performed to assess associations between physical activity and burnout outcomes (total burnout, disengagement, and exhaustion). The adjusted model controlled for age, gender, and body mass index. Statistical significance was set at p < 0.05. Results: A total of 246 students were included (mean age 20.91 ± 1.58 years; 58.9% male). In unadjusted analyses, physical activity showed weak inverse associations with all burnout outcomes but was significantly associated only with exhaustion (β = -0.129, p = 0.042). After adjustment for age, gender, and BMI, physical activity was no longer significantly associated with any burnout outcome. However, female gender emerged as a significant predictor of higher total burnout (β = 0.298, p < 0.001), disengagement (β = 0.207, p = 0.003), and exhaustion (β = 0.323, p < 0.001). Conclusion: Academic burnout appears multifactorial, and physical activity alone may be insufficient for burnout prevention. More comprehensive and gender-responsive student well-being strategies are needed.

The predictive value of serum C-reactive protein for spontaneous stone passage in patients with distal ureteric stones – an analytical cross sectional study.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine and compare the frequency of spontaneous stone passage within 4 weeks in patients with 4-8 mm distal ureteric stones with normal baseline serum CRP ≤6 mg/L and raised baseline serum CRP >6 mg/L.” Study Design: Analytical Cross-sectional. Setting: Department of Urology and Renal Transplantation, Faisalabad Medical University, Allied Hospital-I, Faisalabad Pakistan. Period: November 2025 to April 2026. Methods: 110 individuals between the ages of 18 and 50 who had a single distal ureteric stone measuring 4 to 8 mm participated in the analytical cross-sectional study. Consecutive non-probability sampling was the method employed. Based on baseline serum CRP values, two patient groups were created: those with CRP ≤6 mg/L and those with CRP >6 mg/L at presentation. Standardised medical expulsive therapy, which includes tamsulosin 0.4 mg once daily, diclofenac as needed, and sufficient water intake, was prescribed to each patient. Together with a KUB X-ray and ultrasound KUB verified SSP at the four-week follow-up assessment. The frequencies of SSP and non-SSP were compared between the two groups using the chi-square test and the ideal CRP cut-off value was determined using receiver operating characteristic (ROC) curve analysis. Results: The average stone size was 6.06 ± 1.26 mm, and the average patient age was 35.27 ± 8.66 years. In all, 81 patients (73.6%) experienced spontaneous stone expuslion. Patients with a CRP level of ≤6 mg/L had a significantly greater SSP than those with a level of >6 mg/L (95.4% vs. 42.2%, p < 0.001). The ROC analysis’s area under the curve (AUC) of 0.945 (95% CI: 0.904-0.986, p < 0.001) demonstrated a high degree of prediction for the serum level of CRP. The ideal cut-off value for CRP levels for SSP prediction was determined to be ≤ 9.53 mg/L, with an 87.7% sensitivity and an 86.2% specificity. Conclusion: In individuals with 4–8 mm distal ureteric stones, the serum CRP level is a significant predictor of spontaneous stone passage. Lower CRP levels result in a much higher spontaneous passing rate. When incorporated into routine clinical examination, serum CRP levels may be helpful for improving patient stratification and assisting in the choice between conservative and interventional treatment choices.

Frequency of ruptured cerebral aneurysms as a cause of intracerebral bleed.

Amaima Gulzar, Sanam Khan, Aiman Mahmood, Usama Shafiq, Aroosa Kanwal — Tue, 30 Jun 2026 00:00:00 -0700

Objective: To determine the frequency of ruptured aneurysms in patients with intracerebral bleed presenting to Shifa International Hospital Islamabad. Study Design: Cross sectional study. Setting: Department of Radiology, Shifa International Hospital Islamabad. Period: September’25 to February’26. Methods: 140 Patients aged from 18 to 70 years of either gender and presentation with Intracerebral bleeding whereas all cases with history of head trauma and craniotomy were excluded from the study. Every patient undergo a CT scan, and the presence of ruptured aneurysms (CT noncontrast shows hemorrhage prominent at well-defined round, slightly hyper attenuating lesion) were documented. Results: Of 140 patients (61.4%) were aged above 50 years, while 38.6% were 50 years or younger. Females predominated (55.0%) compared to males (45.0%). Overall, 46 patients (32.9%) were found to have ruptured aneurysms, while 94 (67.1%) had unruptured aneurysms. Regarding the location of aneurysms, hemorrhagic stroke (HS) was the most frequent presentation (50.7%), followed by subarachnoid hemorrhage (SAH) in 30.7% and combined SAH + HS in 18.6% of cases. Conclusion: We concluded that aneurysm rupture is a multifactorial process governed by anatomic factors (size, location, multiplicity) and patient-specific vessel vulnerability rather than by single metabolic parameters.

Comparison of effectiveness of combination of lidocaine-ketorolac vs lidocaine alone in biers block of upper limb surgery: Focus on intraoperative and post-op pain relief.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the effectiveness of a combination of Lidocaine and Ketorolac versus Lidocaine alone in Bier’s Block for upper limb surgery, in terms of intraoperative and 12 hours postoperative pain score. Study Design: Randomized Controlled Trial (RCT). Setting: Department of Anesthesia, Aziz Fatima Hospital Faisalabad. Period: Six months (January to June’25). Methods: Following approval from the Institutional Ethical Review Committee and the College of Physicians and Surgeons Pakistan, this randomized controlled trial enrolled 100 patients fulfilling the inclusion criteria. Participants were equally divided into two groups. Group A received intravenous lidocaine 4 mg/kg after confirmation of proper tourniquet inflation and absence of distal pulse. Group B received intravenous lidocaine 4 mg/kg combined with ketorolac 30 mg under the same conditions. Postoperative assessment was initiated immediately after tourniquet release. Results: Most participants were aged 20–45 years (64%), with male predominance (76%) and majority classified as ASA-I. The lidocaine-ketorolac group demonstrated significantly lower intraoperative VAS scores at 5, 10, and 15 minutes compared with lidocaine alone (p<0.001). Postoperative pain scores at 1, 6, 12, and 24 hours were also significantly reduced in the combination group (p<0.001). Time to first analgesic request was significantly prolonged with ketorolac (163.26±32.63 vs. 87.54±24.36 minutes; p<0.001). Rescue analgesia requirement and adverse effects were numerically lower in the combination group. Conclusion: The addition of ketorolac with lidocaine increases the analgesic efficacy for both intraoperative and postoperatively in addition to extending analgesic duration for improving the effectiveness of IVRA.

Assessment of the quality of recovery in patients receiving erector spinae plane block compared to local infiltration in patients undergoing major oncological breast surgery.

Tue, 30 Jun 2026 00:00:00 -0700

Objective: To compare the Quality of Recovery (QoR-15) scores and postoperative opioid consumption in patients undergoing major oncological breast surgery receiving the Erector Spinae Plane (ESP) block versus local infiltration (LI). Study Design: Prospective Randomized Controlled Trial. Setting: Department of Anaesthesia and Pain Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Period: March 1, 2025 to September 30, 2025. Methods: Seventy female patients aged 18–65 years, ASA physical status I or II, undergoing unilateral major oncological breast surgery were randomized into two equal groups (n=35 each). Group A received an ultrasound-guided ESP block at T2–T6 using bupivacaine 0.375% (30 ml), and Group B received local infiltration at the incision site with bupivacaine 0.375% (30 ml) with standard general anaesthesia. The primary outcome was the QoR-15 global score assessed at 48 hours postoperatively. Secondary outcome included postoperative opioid consumption. Data were analysed using the Mann–Whitney U test, with p < 0.05 considered statistically significant. Results: Both groups were comparable in baseline demographic and clinical characteristics. At 48 hours, the ESP group demonstrated significantly higher QoR-15 global scores compared to the LI group (median [IQR]: 145.9 [144.3–149.0] vs. 115.8 [112.9–118.0] (p < 0.0001). Significant improvements in the ESP group were observed across all 15 individual QoR-15 items. 24-hour postoperative morphine consumption was significantly lower in the ESP group compared to the LI group (1.71 ± 0.79 mg vs. 3.26 ± 0.70 mg; p < 0.0001). Conclusion: The ESP block significantly improves quality of recovery at 48 hours and reduces postoperative opioid consumption compared to local infiltration in patients undergoing major oncological breast surgery.