The Professional Medical Journal

Development of Integrated AI-Based Application (App) to Optimize Emergency Department Workflow in Pakistan.

Ali Hassan, Obaid Ullah Ahmad, Ayesha Shahid — Fri, 01 May 2026 00:00:00 -0700

Pakistan healthcare exhibits high burden owing to increase workload, un-optimized resource use and burnt-out professionals.¹ Emergency departments of any hospital remains the most bustling area facing overcrowdings, long wait time, unequal prioritization of patients because of manual triaging. According to Emergency services department Government of the Punjab, Pakistan average medical emergencies per day accounts for 4597 emergencies.² Triage systems and App for instance (Ambulance Dispatch System) in USA, UK³ have shown promising results, quicker assessment and more reliable allocation of patients to respective sub-specialty in a timely fashion. Everyday many patients die while reaching hospital, waiting for the help or ambulance to arrive and hospital gets overburden by manual triaging.

Evaluating the efficacy of negative pressure wound therapy (NPWT) in optimizing chronic lower limb wounds.

Ihtesham Ali Khan, Zahra Tauqeer, Riaz Ahmed Khan Afridi — Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate the efficacy of Negative Pressure Wound Therapy in optimizing chronic lower limb wounds of various etiologies. Study Design: Descriptive, Prospective. Setting: Department of Burns and Plastic Surgery, Lady Reading Hospital Peshawar. Period: December 2024 to November 2025. Methods: A total of 100 patients meeting the inclusion criteria were enrolled through non-probability consecutive sampling. NPWT was applied after proper debridement, using intermittent negative pressure ranging from -90 to -120 mmHg. Wounds were assessed for granulation tissue, infection status, and size reduction. Data were analyzed using SPSS version 29, with a significance level of 0.05. Results: The mean age of patients was 50.27 years, with a male-to-female ratio of 2:1. Trauma (42%) was the most common etiology. NPWT resulted in a significant wound size reduction from 18.2 cm² to 12.0 cm² (p = 0.002), with 100% of patients developing granulation tissue. Healing occurred by secondary intention in 38% and primary closure in 27% of cases. Overall efficacy of negative pressure wound therapy was 81%. The therapy was well-tolerated with minimal complications. Conclusion: negative pressure wound therapy proved effective in promoting granulation tissue formation, reducing wound size, and preparing chronic lower limb wounds for closure, supporting its role as a valuable tool in managing chronic wounds.

Modified bridle versus bridle tendon transfer procedures for the treatment of foot drop.

Humaira Mushtaq, Atta-ul-haq, Muhammad Nasrullah, Muhammad Faisal — Fri, 01 May 2026 00:00:00 -0700

Objective: Foot drop results in considerable disability for the patient. We transferred tibialis posterior tendon in a modification of Bridle procedure in such patients and recorded the pre-operative and post-operative data. Then we compared them with standard Bridle procedure to ascertain the comparative efficacy. Study Design: Quasi-experimental study. Setting: Jinnah Burn and Reconstructive Centre (JBRSC) Lahore. Period: 1^st October 2024 to 30^th April 2025. Methods: On a total of 70 patients after consent, the patients were divided into two groups: Group A had Modified Bridle procedure as tendon of tibialis posterior (TP) was anastomosed to the extensor hallucis longus as well as extensor digitorum longus above the retinaculum and a slip was Pulvertaft to tibialis anterior below the retinaculum. Group B underwent standard Bridle procedure. Patient satisfaction, dorsiflexion and hammer toe deformity were assessed after which analysis was done using Statistical Package of Social Sciences (SPSS) version 25. P-value less than 0.05 was considered statistically significant. Results: Both groups were comparable at baseline (age, sex, side, cause of foot drop, hammer-toe), supporting a fair outcome comparison. The modified Bridle showed a clear shift toward better dorsiflexion grades (Excellent/Good 85.7% vs 60.0%), with the overall test narrowly missing significance (p-value=0.051), suggesting a strong favorable trend. Patient satisfaction was higher with the modified procedure (85.7% vs 57.1%; p-value=0.042). Overall, results indicate that the modified Bridle yields better patient-reported outcomes, with a near-significant advantage in functional dorsiflexion. Conclusion: This modification of Bridle procedure improves the outcome of patients with foot drop helping them in this severely debilitating disease in terms of improved dorsiflexion, better patient satisfaction and very few chances of hammer-toe deformity in comparison to standard Bridle procedure.

Functional outcomes and postoperative complications after ilizarov hip reconstruction for abnormal hip joints.

Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate functional outcomes and postoperative complications following Ilizarov hip reconstruction in patients with abnormal hip joints. Study Design: Prospective Observational study. Setting: Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: December 2024 and May 2025. Methods: Ilizarov hip reconstruction was done on forty-one patients between the ages of 15 and 40 years who had chronic, unstable, or abnormal hip joints. The main outcome of the functional activities was measured with the help of the Modified Harris Hip Score (HHS) preoperative and at final follow-up 6 months. The complications that occurred after an operation were documented and assessed descriptively. Statistical processing was done in SPSS, and the p-value of 0.05 was taken to be significant. Results: The mean age of patients was 26.4 ± 6.1 years, with 61% males. The mean Modified HHS improved significantly from 48.7 ± 9.6 preoperatively to 82.3 ± 7.4 postoperatively (p < 0.001). Postoperatively, 78% of patients achieved good to excellent functional outcomes. Complications occurred in 4 patients (9.8%), including pin-tract infection (4.9%), knee stiffness (2.4%), and delayed union (2.4%), all managed conservatively. No major complications such as deep infection, neurovascular injury, or mechanical failure were observed. Conclusion: Ilizarov hip reconstructs are effective on adolescents and young adults with abnormal hip joints and offer a high statistical improvement in terms of short-term functional results and a low complication rate. It is a safe and effective joint-preserving salvage intervention capable of restoring functionality, improving gait, and postponing the onset of total hip arthroplasty in this difficult patient population.

Diagnostic accuracy of magnetic resonance imaging (MRI) in detecting malignant breast lesions keeping histopathology as gold standard.

Fri, 01 May 2026 00:00:00 -0700

Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting malignant breast lesions, using histopathology as the gold standard. Study Design: Cross-sectional study. Setting: A Tertiary Care Hospital in Sargodha, Pakistan. Period: February 2024, to December, 2024. Methods: With a sample size of 256 patients MRI, using dynamic contrast-enhanced MRI (DCE-MRI), was performed to evaluate the morphological and kinetic features of breast lesions. Histopathology results, obtained via fine needle aspiration cytology (FNAC) or biopsy, were used as the gold standard for comparison. Results: MRI showed a sensitivity of 93.9%, specificity of 73.5%, and an overall diagnostic accuracy of 89.3%. Conclusion: MRI is highly sensitive and accurate for detecting malignant breast lesions but has limitations in specificity, resulting in false positives. It is most effective when used as an adjunct to other imaging techniques and histopathology.

Appropriate versus Inappropriate urinary catheterization: A cross-sectional study in a Tertiary Care setup.

Jamal Ara, Aneela Altaf Kdwai, Saleemullah Paracha — Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the frequency and appropriateness of urinary catheterization among adult patients admitted to the medical and surgical wards of a tertiary care hospital and the most common indication for each. Study Design: Cross-sectional Descriptive study. Setting: Abbasi Shaheed Hospital, Karachi. Period: April 1, 2021, to April 30, 2021. Methods: All adult patients of both genders admitted to the medical and surgical wards, including their respective sub-specialties, were included in the study, while the pediatric patients were excluded. Data was collected from all catheterized patients, including demographic characteristics and the indications for catheterization, regardless of the duration of catheter use. The appropriateness of catheterization was recorded based on established clinical indications. Results: Among 712 admitted patients, 348 (48.8%) were catheterized with an indwelling urinary catheter. Of the 348 catheterized patients, 210 (60.3%) were appropriately catheterized, whereas 138/348 (39.6%) patients were inappropriately catheterized. Altered state of sensorium was found to be the most common reason for catheterization whereas catheterization secondary to urinary incontinence without sufficient skin breakdown was found to be the most common reason for inappropriate catheterization. Conclusion: The frequency of inappropriate urinary catheterization at our tertiary care setup was found to be 39.6%, which is alarmingly high. These numbers highlight that a significant number of admitted patients are catheterized without a valid indication. These inappropriate catheterizations can be avoided, thereby preventing the complications related to urinary catheterization. The study results highlight the need for strict implementation of guidelines which will not only reduce the complication but will also cause financial benefit to the patients.

Safety and outcome of same day discharge after elective PCI (Percutaneous Coronary Intervention) in patients with stable coronary artery disease.

Muhammad Yasir, Faisal Abbas, Muhammad Akram Asi, Munir Ahmad — Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the outcome in patients on same day discharge after elective PCI in patients with stable CAD. Study Design: Descriptive, Case Series study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology. Period: 10^th April 2021 to 9^th October 2021. Methods: A total of 241 patients with stable coronary artery disease as per operational definition undergoing PCI of age 40-80 years and both genders were included. In each patient procedure was done by a consultant cardiologist (at least 3 years’ post-fellowship experience). All patients were discharged from ward if remain stable for 6 hours. Patients were followed by researcher for 2 weeks and complications i.e. hematoma formation, allergic reaction and re-hospitalization (yes/no) were noted. Results: The age of the participants in this research was between 40 and 80 years with an average age of 61.15 years and SD of 8.27. Majority of the patients 125 (51.87%) were between 40 to 60 years of age. Out of 241 patients, 130 (53.94%) were female and 111 (46.06%) were males with female to male ratio 1.2:1. In my study, outcome in patients on same day discharge after elective PCI in patients with stable CAD was found to be hematoma in 13.28%, allergic reaction in 10.79% and re-hospitalization in 9.13% patients. Conclusion: This study concluded that same day discharge after elective PCI in patients with stable CAD is a safe practice.

Early outcome of mitral valve repair in rheumatic mitral regurgitation.

Shahbaz Ahmad Khilji, Waqas Khalid, Shuja Tahir — Fri, 01 May 2026 00:00:00 -0700

Objectives: To evaluate and record the early outcomes of mitral valve repair in patients with rheumatic mitral valve regurgitation in advanced functional classes (NYHA III/IV). Study Design: Prospective Observational study. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: March, 2023 to March, 2025. Methods: One hundred and thirty patients having rheumatic mitral valve regurgitation in functional class (NYHA) III/IV were studied. Baseline demographical informations, perioperative, and initial postoperative outcomes were documented. Early (less than 30 days) mortality was taken as primary outcome measures, and secondary outcome measures were postoperative complications, ICU and hospital stay, and early echocardiographic valve function. Results: A successful repair was done on the patients having rheumatic mitral valve regurgitation having satisfactory post-operative morbidity and mortality rates. Majority of the patients exhibited satisfactory initial valve competency and none or mild residual mitral regurgitation on pre-discharge echocardiography. The initial results were similar to those of modern repair-based cohort and pool reports, indicating the safety of repair in the selected rheumatic patients. Conclusion: In rheumatic mitral regurgitation, mitral valve repair is linked to good short-term results in case of an appropriate patient selection.

Comparison of postoperative pain, bleeding and septal hematoma formation after septoplasty with and without nasal packing.

Fri, 01 May 2026 00:00:00 -0700

Objective: To compare postoperative pain, bleeding and septal hematoma formation after septoplasty with and without nasal packing. Study Design: Randomized Control Trial (RCT). Setting: Department of ENT, Sir Ganga Ram Hospital, Lahore. Period: June 1^st, 2025 to November 30^th 2025. Methods: In this randomized controlled trial, 100 patients who met the selection criteria were enrolled and were split into two equal groups of 50 patients each at random. Group A had nasal packing following septoplasty and Group B patients did not have nasal packing Patients were assessed over 1, 3, 6, 12 and 24 hours postoperatively and outcomes were assessed. Results: The patients in Group A had an average age of 32±4.71 years while those in Group B was 33±9.31 years. The Group A mean VAS pain score at 24 hours compared to Group B was 4±0.61 versus 2±0.51 (p=0.000), respectively. At 24 hours, in Group A versus B, septal hematoma was present in 1 (2%) versus 1 (2%) patient respectively and at the time of discharge, it was present in 2 (4%) versus 2 (4%) patients (p=1.000), respectively. Bleeding at 24 hours occurred in 4 (8%) versus 8 (16%) patients in Group A versus B respectively (p=0.218). Conclusion: There was no difference in bleeding or septal hematoma between patients with and without nasal packing and septoplasty without nasal packing was substantially related with decreased pain.

Effective role of diode laser in the management of acquired subglottic and tracheal stenoses.

Fri, 01 May 2026 00:00:00 -0700

Objective: To assess the efficacy of Diode Laser-assisted Transoral Laser Microsurgery (TLM) in the management of acquired subglottic and tracheal stenoses. Study Design: Descriptive Case Series. Setting: Department of ENT Surgery, KRL Hospital Islamabad. Period: 01.07.2021 to 30.01.2023. Methods: Subglottic and tracheal stenosis represent a major therapeutic challenge. Minimally invasive endoscopic treatment strategies including trans-oral laser surgery and pneumatic dilatation, with or without temporary stenting, yield good results. In this unique study, 62 patients were included via non-probability consecutive sampling. They underwent transoral endoscopic laser surgery. Clinical findings in outpatient tracheoscopy were recorded and all data was analyzed using SPSS. Results: Half of the patients were <25 years, with significant male predominance. Percentage frequency of stenosis was 8.1%, 38.7%, 33.8% and 19.4% for Myer Cotton grade I, II, III and IV respectively. The glottis to lesion distance ranged from 1.5 to 11 cm with a mean of 2.7±1.71 cm while the length of the stenotic segment ranged from 1 to 6 cm with a mean of 1.28±0.95 cm. Successful decannulation of the tracheostomy tube was achieved in 85.48% patients. Time between first surgery and decannulation ranged from 0 to 18 months with a mean of 9.78±5.52 months as many patients, particularly Myer and Cotton grade I and II stenosis were extubated at the time of primary surgery. Conclusion: We conclude that trans-oral endoscopic treatment with diode laser has highly successful outcomes in expert hands. This minimally invasive technique has advantages of no skin incisions, expedited recovery and improved quality of life for tracheostomy dependent patients.

Uterus-preserving reconstruction for müllerian duct anomalies: Five-year experience and outcomes of a novel low-cost cervico-vaginoplasty technique in a resource-limited setting.

Shakila Yasmin, Khiaynat S Hashmi, Sadaf Un Nisa — Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate the feasibility and outcomes of three tailored surgical approaches for restoring menstrual outflow and fertility. Study Design: Prospective Cross-sectional. Setting: Bahawal Victoria Hospital, Bahawalpur, Pakistan. Period: January 2020 to December 2024. Methods: Thirty patients with congenital cervical and/or vaginal outflow tract obstruction (cervical agenesis, cervico-vaginal agenesis, and OHVIRA syndrome) were included. Three surgical strategies were used according to anatomy: (1) an abdominoperineal cervico-vaginoplasty with McIndoe neovagina and finger-guided uterovaginal anastomosis, (2) ultrasound-guided transvaginal creation of a neo-cervical canal, and (3) a purely vaginal septal excision approach for OHVIRA syndrome. A silicone intrauterine catheter and a low-cost syringe-based vaginal mould were used to maintain patency. Primary outcomes included restoration of menstruation, canal patency, complications, and fertility outcomes. Results: Complete cervical agenesis was identified in 40%, partial cervical agenesis in 20%, and combined partial cervical and partial vaginal agenesis in 23.3%. Twenty-three patients underwent abdominoperineal cervico-vaginoplasty, three underwent ultrasound-guided canal creation, and four underwent vaginal septal resection for OHVIRA. Of the 20 patients undergoing primary reconstruction, two (10%) developed restenosis, which was corrected successfully in both cases. Among the ten patients with prior failed surgeries, two required a hysterectomy. Menstrual restoration occurred in 27 patients (90%). Four patients had OHVIRA syndrome; three conceived spontaneously, including one remarkable case of twin gestation with one fetus in each uterus delivered by elective cesarean after dual cerclage. Four patients achieved spontaneous conception, with healthy live births. Conclusion: Tailored uterus-preserving reconstructive surgery using abdominoperineal, ultrasound-guided, and vaginal approaches, supported by a low-cost stenting (silicone catheter) and mould system, is safe and effective for complex Müllerian anomalies, even in resource-limited settings.

Diagnostic accuracy of the O-Rads and Adnex models in identifying malignant adnexal lesions taking histopathology as gold standard.

Shamoona Rashid, Hassan Bukhari, Sadia Zafar, Ramsha Javed — Fri, 01 May 2026 00:00:00 -0700

Objective: To use histopathology as the gold standard to assess the diagnostic accuracy of the O-RADS and ADNEX models in identifying malignant adnexal lesions. Study Design: Cross Sectional (validation) Study. Setting: Aziz Fatima Medical and Dental College Faisalabad, Faisalabad Medical University, Faisalabad. Period: 01-01-2025 to 30-06-2025. Methods: Included were 170 patients aged 20–60 who were admitted for elective surgical ovarian mass exploration and excision. An oophorectomy history, a history of adnexal malignancy, a history of adnexal mass surgery, pregnancy or ectopic pregnancy, and failure to have surgery within 120 days of the ultrasound screening were all disqualified. Five milliliters of venous blood were sent to the pathology lab for the measurement of serum CA-125 levels. Senior radiologist performed the ultrasound, noting O-RADS and ADNEX model properties. The advanced gynecologist performed the surgery. On O-RADS, ADNEX model, and histology, a malignant adnexal lesion was observed. Results: In terms of identifying malignant adnexal lesions using histopathology as the gold standard, O-RADS's overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 90.53%, 85.33%, 88.66%, 87.67%, and 88.24%, respectively. When employing histopathology as the gold standard to identify malignant adnexal lesions, the ADNEX model's overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 86.17%, 81.57%, 85.26%, 82.67%, and 84.12%, respectively. Conclusion: This study found that the diagnostic accuracy of the O-RADS and ADNEX models for identifying malignant adnexal lesions is nearly equal.

Comparison of absorbable and non-absorbable sutures used for skin closure in lower segment cesarean section.

Fri, 01 May 2026 00:00:00 -0700

Objective: To compare postoperative wound infection, operative time, and blood loss in women undergoing cesarean section using absorbable (Monocryl) versus non-absorbable (Prolene) sutures for skin closure. Study Design: Non-Randomized Controlled Trail. Setting: Department of Obstetrics and Gynecology, Akhtar Saeed Trust Hospital, Lahore. Period: April 2025 to August 2025. Methods: This study was conducted on 280 women aged 18–40 years, selected via non-probability purposive sampling. Participants undergoing elective or emergency cesarean section were divided into two groups: Group A received absorbable Monocryl sutures; Group B received non-absorbable Prolene sutures. Standardized protocols were followed for preoperative preparation, wound closure, and postoperative care. Outcomes were assessed on postoperative days 2 and 7–10. Results: The mean operative time was 59.78 ± 16.63 minutes in Group A vs. 60.79 ± 17.99 minutes in Group B (p = 0.625). Mean blood loss was 505.37 ± 178.56 ml vs. 492.79 ± 172.53 ml, respectively (p = 0.549). Wound infection occurred in 18.6% of participants. Operative time was significantly longer in the non-absorbable group among patients with wound infection (p = 0.046) and pus discharge (p = 0.040). Blood loss was significantly higher in unbooked patients of Group A (p = 0.025). Conclusion: Both absorbable and non-absorbable sutures were comparable in terms of operative time and intraoperative blood loss. However, the presence of wound infection and pus discharge contributed to longer operative time in the non-absorbable group. Clinical context and surgeon judgment should guide suture selection.

Evaluating the postoperative pain after laparoscopic-assisted bilateral dual Transversus Abdominis Plane (TAP) block in laparoscopic cholecystectomy.

Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate the mean post-operative pain scores of patients undergoing laparoscopic-assisted bilateral dual transversus abdominis plane (TAP) block in laparoscopic cholecystectomy. Study Design: Observational study. Setting: Department of Surgery, Unit 1, Services Hospital Lahore, Pakistan. Period: February 2022 to August 2023. Methods: Non-probability consecutive sampling was used to recruit participants. The study included 60 patients aged 18 to 80 years undergoing elective laparoscopic cholecystectomy for symptomatic gallstones. Selection was restricted to those classified as ASA I and II, regardless of gender. Patients who required conversion to open cholecystectomy, had a known allergy to bupivacaine, were diagnosed with "chronic pain syndrome," or were known alcohol or substance abusers within the past six months were excluded from the study. After obtaining informed consent, the patients were randomly assigned to two groups, Group A and Group B, using a random number table. Patients in Group A received a laparoscopic dual TAP block, while those in Group B did not receive any TAP block. Post-operatively all patients received injection paracetamol 1gram intravenously thrice a day as baseline analgesia. Each patient was followed till 24 hours post-operatively at which postoperative VAS score was noted. The data were entered and analyzed using SPSS version 23.0. Results: Mean age was 46.45 ± 14.06 years with 13 (21.67%) male and 47 (78.33%) female. The mean BMI of the participants was 29.02 ± 3.12 kg/m². The mean duration of surgery was 31.53 ± 5.43 minutes for Group A and 32.63 ± 5.95 minutes for Group B. The mean post-operative VAS score in Group A (laparoscopic dual TAP block) was 1.63 ± 0.85, compared to 4.47 ± 1.07 in Group B (control), with a p-value of 0.001, indicating statistical significance. Conclusions: Postoperative pain score was less after laparoscopic-assisted bilateral dual TAP block in laparoscopic cholecystectomy as compared to controls.

Efficacy of 3 ML local anesthetic versus 5 ML in terms of pain relief for closed manipulation of distal radius fracture.

Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the efficacy of 3 ml vs. 5 ml local anaesthetic Xylocaine in terms of pain relief for closed manipulation of a distal radius fracture. Study Design: Quasi-experimental Research. Setting: Carried out on patients visiting the Emergency Department (ED) of Ziauddin University Hospital, Karachi with DRFs,. Period: February 2024 to July 2024. Methods: A total of 68 patients diagnosed with DRF were consecutively selected and randomly placed in two groups. Group A patients were managed with 3 ml and group B patients with 5 ml of local anaesthetic Xylocaine before the procedure. The orthopaedic surgeon pursued the standard procedure of closed reduction for DRFs. Before and after surgery, each patient was evaluated for pain using the visual analogue scale (VAS). Statistical interpretation was done with SPSS version 26 by taking a significant p-value of ≤ 0.05. Results: Of the 68 DRF patients, gender was similar in both groups; male patients were 5 (14.7%), and female patients were 29 (85.3%) in each group. The mean pain score on VAS was 9.26 ± 0.51 and 9.12 ± 0.54 before surgery (p-value = 0.252) and 5.91 ± 1.64 and 4.59 ± 1.99 after surgery (p-value = 0.004) in group A (3 ml local anaesthetic) and group B (5 ml local anaesthetic), respectively. The efficacy of local anaesthesia Xylocaine in the management of DRF was significantly higher in group B (5 ml local anaesthetic) as compared to group A (3 ml local anaesthetic) [13 (38.2%) vs. 5 (14.7%); p-value=0.028]. Conclusion: It was concluded that adequate analgesia is provided by 5 ml of local anaesthetic xylocaine applied as a haematoma block for closed manipulation of a distal radius fracture.

CT KUB scans for renal colic: Optimization of scan range to reduce patient radiation burden.

Fri, 01 May 2026 00:00:00 -0700

Objective: To optimize the scan range of CT KUB scans for renal colic to reduce patient radiation while maintaining diagnostic accuracy. Study Design: Cross-sectional study. Setting: Department of Radiology, Tertiary Care Hospital, Sargodha. Period: January 2024 to June 2024. Methods: A total of 95 adult patients (age ≥ 18 years) who received CT KUB due to the suspicion of renal colic with complete imaging data were included. Data collection encompasses demographic information (age, gender) and CT scan parameters (scan range, slice thickness, and radiation dose). Scan range optimization involved reviewing CT images to determine the optimal range covering kidneys, ureters, and bladder. Radiation dose metrics, including the dose-length product (DLP) and effective dose were measured for each CT KUB scan following standard protocols and utilizing dose estimation software. The collected data were subsequently processed and analysis was done via the use of IBM SPSS version 27.0. Results: Among the 95 scans analyzed, 51 (53.7%) were female and 44 (46.3%) were male, with a mean patient age of 43.8 ± 14.6 years. Only 27 scans (28.4%) had less than 10% overscan above the highest kidney target, while 68 scans (71.6%) exceeded this threshold. The mean total scan length was 454 mm (SD = 53.6 mm). The mean overscan above the kidney measured 64.5 mm (SD = 22.2 mm), accounting for 14.3% of the total scan length. Over-scanning ranged from 16 mm (3.9%) to 123 mm (33.2%). Conclusion: This study validates initiating the CT KUB scan at the upper border of the T11 vertebra and concluding at the symphysis pubis to minimize unnecessary radiation exposure while preserving diagnostic accuracy. This optimized scan range effectively reduces over-scanning and enhances patient safety.

Interplay between vitamin D, Thyroid function tests and Thyroid Peroxidase antibodies in female patients with sub-clinical hypothyroidism reporting to a Tertiary Care Hospital in Rawalpindi, Pakistan.

Wafa Omer, Omer Jamshed Khan, Riaz Shahbaz Janjua, Muhammad Umar, Saira Karimi — Fri, 01 May 2026 00:00:00 -0700

Objective: To assess the correlation between Serum Vitamin D levels, thyroid function tests and Thyroxine Peroxidase Antibosies (TPOAb) levels in the female patients of sub-clinical hypothyroidism. Study Design: Case Control study. Setting: HBS General Hospital and Department of Chemical Pathology, HBS Medical and Dental College, Islamabad. Period: Jun 2023 to Dec 2023. Methods: Total of 790 female subjects aged 18 to 45 years reporting to the female Endocrine Clinic were consecutively recruited, out of which 450 participated in the study. Those with serum TSH >4.3 to 10 mU/l and normal levels of fT4 and fT3 and TPOAb positive were recruited as cases (n=200). Those who had normal TSH between 0.4 to 4.0 mIU/L and TPOAb negative were recruited as controls (n=250). Results: BMI and smoking was higher amongst controls. In biochemical parameters, there was a highly significant negative correlation between the serum TSH levels and TPO antibodies with the serum 25 (OH) Vit-D level (p<0.0001).fT4 showed a moderately significant positive correlation with serum 25 (OH) Vit-D level (p<0.001) while fT3 did not show any significant correlation with the serum 25 (OH) Vit-D levels. Conclusion: The identified correlations emphasize the importance of comprehensive thyroid assessments, including vitamin D levels, in the clinical management of sub-clinical hypothyroidism.

Effect of FeSO4 therapy on children presenting with migraine at a Tertiary Care Hospital, Karachi, Pakistan.

Zahira Khalid, Shazia Kulsoom, Shazia Soomro, Shazia Bhutto — Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the effect of FeSO₄ therapy on children presenting with migraine at a tertiary care hospital. Study Design: Quasi-experimental study. Setting: Pediatrics Department of National Institute of Child Health, Karachi, Pakistan. Period: January 2025 to September 2025. Methods: A total of 170 children, aged 5–15 years and diagnosed with migraine were included. Iron deficiency anemia (IDA) was labeled using age and gender specific hematologic and biochemical thresholds. Children having IDA received oral FeSO₄ 3–6 mg/kg/day for 3 months, while non-IDA children were given standard care. Data were analyzed using IBM-SPSS v26 applying appropriate statistical tests taking p<0.05 as statistically significant. Results: Among 170 children, 93 (54.7%) were males, and the median age was 10.0 years (IQR 8.0–13.0). IDA was diagnosed in 46 (27.1%) children. After three months of FeSO₄ therapy, median hemoglobin increased from 10.4 (9.9–10.9) to 12.2 g/dL (11.8–12.6), ferritin from 15.3 (12.4–17.8) to 30.8 ng/mL (27.6–33.2), and serum iron from 48.4 (43.0–52.9) to 87.1 µg/dL (80.2–94.6), while TIBC declined from 396.0 (380.7–410.9) to 328.3 µg/dL (312.4–340.8) (all p<0.001). Migraine frequency reduced from 9.0 (7.4–11.5) to 4.0 (3.0–6.5) episodes/month, duration from 6.2 (5.0–7.5) to 3.1 (2.0–4.4) hours, VAS score from 7.2 (6.0–8.5) to 4.3 (3.0–5.5), and school absenteeism from 4.1 (3.0–5.3) to 1.6 (1.0–2.5) (all p<0.001). Conclusion: Among children with migraine, correction of IDA with oral FeSO₄ resulted in significant improvement in hematologic parameters and meaningful reductions in attack frequency, duration, and intensity.

Pattern and outcome of traumatic brain injury among patients admitted in neurosurgery ICU.

Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate the pattern and outcomes of traumatic brain injury among patients admitted to the neurosurgery ICU. Study Design: Cross Sectional Analytical study. Setting: Neurosurgery ICU of Allama Iqbal Teaching Hospital. Period: January to December 2024. Methods: Total 323 patients with confirmed TBI were enrolled using non-probability consecutive sampling. Data on demographics, injury mechanism, clinical presentation, radiological findings, management, complications and outcomes were collected. Outcomes included in-hospital mortality and functional status assessed via the Glasgow Outcome Scale (GOS). Multivariable logistic regression was used to identify predictors of mortality. Data were analyzed using SPSS version 23.0. Results: The mean age was 38.6 ± 16.4 years with 78.0% male predominance. Road traffic accidents (61.3%) were the leading cause. Severe TBI (GCS ≤8) was present in 44.0% of patients. Subdural hematoma (41.8%) was the most common radiological finding. Surgical intervention was performed in 54.5% of cases. Overall in-hospital mortality rate was 28.8%. Poor functional outcome (GOS 1–3) was observed in 49.8% of patients. Independent predictors of mortality included severe TBI (aOR 12.4, p<0.001), bilateral non-reactive pupils (aOR 8.9, p<0.001) and midline shift ≥5 mm on CT (aOR 3.2, p<0.001). Conclusion: TBI predominantly affects young males with high mortality and poor functional outcomes. Early clinical and radiological indicators are strong predictors of death highlighting need for timely interventions and strengthened neurocritical care infrastructure.

Cytomorphological evaluation and diagnostic patterns in FNAC specimens: Insights from 251 case evaluations.

Fri, 01 May 2026 00:00:00 -0700

Objective: Background Fine needle aspiration cytology (FNAC) is a relatively inexpensive and minimally invasive diagnostic tool that is highly used in the assessment of palpable lesions in a wide range of anatomical locations. This paper will divide and examine the cytologic appearances, diagnostic distribution, and clinical aspects of the FNAC reports of a tertiary care pathology unit. Study Design: Retrospective Observational study. Setting: Department of Pathology, Indus Medical College and Hospital, The University of Modern Sciences, Tando Muhammad Khan. Period: April 2019 to April 2025. Methods: A total of 251 FNAC reports were retrospectively analysed. Cases were classified according to cytology diagnosis and type of lesion; site of the anatomy; demographics of the patient and guidelines to treatment. The descriptive statistics and cross-tabulation were conducted to determine patterns and associations of diagnoses. The research was approved by our institutional ethical review board. Inclusion Criteria: FNAC reports with complete clinical information and adequate cytological material. Patients of all ages and both genders. Exclusion Criteria: FNAC reports with inadequate or non-diagnostic samples. Cases lacking essential demographic or clinical information. Repeated FNACs from the same lesion during the study period (only the first adequate sample was included). Results: The sample had 168 females (66.9%) and 83 males (33.07%) with an average age of 36.60 +- 18.41 years. The most frequent types of the diagnosis included benign lesion (28.8%), malignant lesion (18.4%), and inflammatory conditions (14.0%). The tuberculous lymphadenitis was identified to be 12.0%. The most sampled anatomic sites were cervical lymph nodes (22.3%) and breast (18.7%). The malignancy rate of definite diagnoses was 18.4% with the mean age of malignancy at 46.8 years as compared to 36.9 years in benign lesions. Conclusion: FNAC shows high levels of usefulness in the classification of various pathological lesions with different cytomorphological features. The epidemiological concerns of the area are underscored in the high rate of tuberculous lymphadenitis in this series. Histopathological correlation and standardized reporting systems are necessary to achieve the best possible diagnostic accuracy and patient management.

Molecular subtyping of medulloblastoma on the basis of immunohistochemistry at Chughtai Institute of Pathology, a single-center experience.

Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the frequency of medulloblastoma subtypes using IHC markers (β-catenin, YAP1, TP53). Study Design: Cross-sectional study. Setting: The Chughtai Institute of Pathology. Period: June 2024 to June 2025. Methods: Twenty-one new diagnoses of medulloblastoma were included and H&E staining for histological variants was processed. Then immune staining using β-catenin, YAP1, and TP53 was performed. The staining results were used to classify medulloblastoma into its subtypes. Chi-square testing and descriptive statistics were used to conduct the statistical analysis. Results: Classic variant was found to be the most common histological type of medulloblastoma. The most frequently detected subtype of medulloblastoma was the Group 3/4 (76.2%), followed by the SHH subtype (23.8%). No WNT subtype was detected. The identification of WNT tumors by nuclear β-catenin negativity and the identification of desmoplastic/nodular histology by the expression of YAP1 were significantly associated (p=0.021). Conclusion: IHC-based molecular subtyping is a cost-effective and reliable method for classifying medulloblastomas in resource limited situations. This can help to individualize therapies for medulloblastomas patients.

Community- and hospital-acquired bacteremia and pattern of antibiotic resistance in children hospitalized with severe acute malnutrition.

Amrita, Mohsina Noor Ibrahim, Misbah Anjum, Wajid Hussain — Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the frequency of community- and hospital-acquired bacteremia and to evaluate the pattern of antibiotic resistance in children hospitalized with severe acute malnutrition (SAM). Study Design: Analytical, Cross-sectional study. Setting: Department of Pediatric Medicine, The National Institute of Child Health, Karachi, Pakistan. Period: February 2025 to July 2025. Methods: A total of 128 children aged 6 months to 5 years with SAM were enrolled using non-probability, consecutive sampling. Demographic details, clinical features, and anthropometric measurements were recorded. Necessary laboratory investigations and blood culture evaluations were performed. Data were analyzed in SPSS 26 using chi-square/Fisher’s exact test and Mann-Whitney U test, with p<0.05 as significant. Results: In 128 children, 71 (55.5%) were males, and the median age was 14.5 months (IQR 10.0–22.6). Bacteremia was identified in 19 (14.8%), of which 15 (78.9%) were community-acquired. Gram-negative organisms accounted for 57.9% of isolates, with E. coli (31.6%) and S. aureus (26.3%) most frequent. Gram-negative isolates accounted for 57.9%, with E. coli (31.6%), and Klebsiella pneumoniae (21.1%) showing high resistance to ampicillin and ceftriaxone. S. aureus isolates were universally susceptible to vancomycin and linezolid. Duration of fever>3 days was associated with bacteremia (OR 2.7; 95% CI 1.0–7.5; p=0.045). Mortality in children with SAM was 12.5% and strongly associated with bacteremia (OR 5.5; p=0.007). Conclusion: There is significant burden of bacteremia and the high prevalence of antimicrobial resistance among children with SAM.

Comparison of silver alloy coated latex catheters versus standard non-coated latex urinary catheters in terms of development of early catheter associated urinary tract infections.

Fri, 01 May 2026 00:00:00 -0700

Objective: To compare the use of silver-alloy coated latex catheters and uncoated latex catheters in the prevention of early CAUTI in patients with a short-term catheterization. Study Design: Randomized Controlled Trial. Setting: Department of Urology, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 24 April 2025 to 24 Oct 2025. Methods: A randomized assignment was done on 66 adult patients who needed catheterization of at least three days, with 33 patients receiving silver-alloy coated and 33 non-coated catheters. Urine microscopy and culture were performed at baseline and on Day 5. Outcomes included significant pyuria (>10 WBC/HPF), positive urine culture (≥10⁵ CFU/mL), and symptomatic CAUTI. Data were analyzed using SPSS 25, with p ≤ 0.05. Results: By Day 5, the non-coated catheter group showed higher mean pus cell counts (17.8 ± 9.4 vs. 9.6 ± 6.5), more significant pyuria (57.6% vs. 27.3%), and more positive cultures (60.6% vs. 21.2%). Silver-coated catheters were associated with significantly fewer overall CAUTIs (21.2% vs. 60.6%, p=0.001) and lower rates of symptomatic UTI, fever, and dysuria. Age- and gender-based stratification showed consistently lower UTI rates in the silver-coated group. Conclusion: Silver-alloy coated urinary catheters effectively reduced early bacteriuria and CAUTI compared with non-coated catheters in short-term use. Their adoption may strengthen infection prevention strategies in hospitalized patients.

Aerobic bacteriological profile and susceptibility antibiogram of isolates from pus in complicated wound infections in a Tertiary Care Hospital in Faisalabad.

Rabia Ali, Shahzad Amjad Khan — Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the aerobic bacteriological profile of pus samples from complicated wound infections and to assess the antimicrobial susceptibility patterns of the isolated organisms in a tertiary care hospital in Faisalabad. Study Design: Retrospective Descriptive study. Setting: Pathology Laboratory, Aziz Fatima Medical and Dental College, Faisalabad. Period: January to December 2024. Methods: A total of 112 pus samples from patients with complicated wound infections were analyzed. Samples were processed using standard aerobic culture techniques. Bacterial isolates were identified by conventional microbiological methods, and antibiotic susceptibility testing was performed using the Kirby–Bauer disc diffusion method in accordance with standard guidelines. Results: Out of 112 pus samples, 35 (31.3%) were culture positive. The isolates included Staphylococcus aureus (MSSA) (3), methicillin-resistant S. aureus (MRSA) (10), coagulase-negative staphylococci (5), Escherichia coli (6), Enterobacter spp. (4), Klebsiella spp. (1), Citrobacter spp. (1), and Yersinia pseudotuberculosis (2). Antibiotic susceptibility testing revealed that clindamycin, vancomycin, and linezolid showed high effectiveness against Gram-positive organisms (>95% sensitivity). Among Gram-negative isolates, carbapenems (meropenem 93%, imipenem 90%) and aminoglycosides (87%) were the most effective. Fluoroquinolones, sulfonamides, and third-generation cephalosporins demonstrated poor efficacy (<30%). Conclusion: Complicated wound infections remain a significant clinical problem, with MRSA contributing substantially to the burden of disease. Carbapenems and aminoglycosides remain valuable therapeutic options for Gram-negative infections. Continuous antimicrobial surveillance and strict stewardship programs are essential to guide effective empiric therapy and curb antimicrobial resistance.

Retinal Breaks In Retinal Detachment; Plugged with AMG & LASER vs Choroidectomy & LASER Vs LASER

Fri, 01 May 2026 00:00:00 -0700

Objective: To compare the effectiveness of Human amniotic membrane grafts with LASER vs choroidectomy with LASER vs LASER only in treating retinal breaks in retinal detachments.

Study Design: We conducted a retrospective cohort study in the department of Ophthalmology Hospital X, spanning over a period of twelve months from 1^st March 2023 to 1^st March 2024. A total of 60 patients, 42 males (70%) and 18 females (30%) with a mean age of 47 years were enrolled in this study and randomly divided into three groups of 20 patients each, in which retinal breaks were treated with AMG and LASER, choroidectomy and LASER and with LASER only respectively. The patients were followed up for six months after surgery.

Results: Complete anatomical closure was used to gauge the success of the surgery. Patients treated with AMG and LASER achieved full anatomical closure in 90% cases whereas patients who underwent choroidectomy and LASER had anatomical closure in 75% cases. In patients where no such intervention except LASER was done, rates of spontaneous closure were 60% of the cases.

Conclusion: The retinal breaks plugged with AMG had better closure rates than those treated by choroidectomy and those without any intervention.

Frequency of posterior segment abnormalities detected by b-scan ultrasonography in patients with dense cataracts.

Fri, 01 May 2026 00:00:00 -0700

Objective: To determine the frequency and types of posterior segment abnormalities detected by B-scan ultrasonography in patients with dense cataracts and to assess their association with demographic and clinical factors. Study Design: Descriptive Cross-sectional study. Setting: Department of Ophthalmology, L.R.B.T Eye Hospital, Multan Road. Period: over six months 22 June 2025 to 22 Dec 2025. Methods: was conducted on 194 patients aged 40–80 years with dense cataracts (LOCS III grade ≥4) B-scan ultrasonography was performed to detect posterior segment abnormalities. Data on age, gender, comorbidities, and cataract grade were collected. Statistical analysis was performed using SPSS version 26.0, with the Chi-square test applied to evaluate associations (p < 0.05 considered significant). Results: Among 194 patients, 35 eyes (18.0%) exhibited posterior segment abnormalities, while 159 eyes (82.0%) were normal. The most common abnormalities included vitreous hemorrhage (5.2%), retinal detachment (3.1%), and vitritis (2.1%). The prevalence of abnormalities significantly increased with age (p = 0.022), diabetes mellitus (p = 0.042), and higher cataract grade (LOCS III grade 5, p = 0.020). Gender (p = 0.963) and hypertension (p = 0.582) were not significantly associated with posterior segment abnormalities. Conclusion: For patients with dense cataracts, B-scan ultrasonography is an essential tool for identifying posterior segment abnormalities. These abnormalities are significantly predicted by older age, diabetes mellitus, and higher cataract grade, highlighting the significance of preoperative evaluation to maximize surgical planning and visual outcomes.

Assessment of anxiety and depression among medical students of Sahiwal Medical College: A cross-sectional study.

Fri, 01 May 2026 00:00:00 -0700

Objective: To estimate anxiety and depression among medical students and its association with demographic factors. Study Design: Cross-sectional study. Setting: Sahiwal Medical College, Sahiwal. Period: October 2024 to July 2025. Methods: Screener instruments like Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used to identify anxiety and depression levels. Data was transferred to Excel and SPSS V-23 for descriptive statistics, variance analysis and Chi-square (χ²) tests to investigate the associations between demographic variables. The significance of the results was compared with p-value (p ≤ 0.05) to explore sociodemographic’s differences. Results: The response of 441(74.6%) students (anxiety; 223, depression; 218) out of 591 enrolled at the time of study was recorded. Results reveal that overall anxiety disorders was 88.8% which includes low anxiety 58.3%, moderate anxiety 16.1%, and severe anxiety 14.3%, and 39.9% of students suffered from depression (any level). There were higher rate of moderate to severe anxiety in female students (38.7% as against 21.1% of males) and depression (40.9% as against 38.9% of males). The MBBS 3^rd year students also showed most mental distress along with demographics like rural locality and hostelite status. Conclusion: The medical students suffer from anxiety and depression at an alarming rate with variation among genders and study years. The findings show that there is a need for routine psychological assessment, counseling services, and stress management programs in the medical institutes of Pakistan.

Passion vs Parental pressure: Gender based motivations for choosing medicine or dentistry – A cross sectional study in a public sector institute in Karachi, Pakistan.

Hina Shah, Areej Fatima, Aamna Khan, Aiman Nadeem, Areesha Sohail, Aneeba Memon — Fri, 01 May 2026 00:00:00 -0700

Objective: To identify the factors influencing the choice of medicine or dentistry as a career among students of Jinnah Sindh Medical University [Sindh Medical College (SMC) and Sindh Institute of Oral Health Sciences (SIOHS)]. Study Design: Cross-sectional study. Setting: Medical and Dental students of Sindh Medical College (SMC) and Sindh Institute of Oral Health Sciences (SIOHS) respectively, Jinnah Sindh Medical University Karachi. Period: 1^st March 2025 to September 2025. Methods: This study recruited 260 students via non-probability convenience sampling. A structured questionnaire assessed socio-demographics and motivations (passion or parental influence) using a five-point Likert scale. Data were analyzed using SPSS version 26.0, with descriptive statistics used for categorical variables and chi-square tests applied to compare passion and parental pressure across gender. Results: A total of 260 students participated, including 90 (34.6%) males and 170 (65.4%) females. Among them, 167 (64.2%) were enrolled in MBBS and 93 (35.8%) in BDS programs. Personal passion (81.5%), was reported as the leading factor influencing career choice followed by prestige and social status (55.7%) and financial stability (51.9%). External inspiration was noted by 47%, while parental pressure was least reported (23%). No significant gender differences were observed in these factors. Information Technology and Business/Management were the most common alternate career preferences if not medicine or dentistry. Conclusion: Students chose medicine or dentistry not only because of their passion but also because of social status, financial independence and other inspirations. Both genders have more or less the same desires to choose medicine or dentistry.

Evaluation of student’s perception of operation theatre learning.

Sheikh Atiq-ur-Rehman, Usman Mahboob, Muhammad Ishaq Khan — Fri, 01 May 2026 00:00:00 -0700

Objective: To evaluate the perception of final-year medical students of operation theatre learning. Study Design: Quantitative & Cross Sectional. Setting: Quaid-e-Azam Medical College, Bahawalpur. Period: 01-10-2021 to 31-12-2021. Methods: All final year MBBS students of this college were involved in the study. The questionnaire was prepared, the variables were selected and the Likert scale was used. The data was collected from the students and then the data was analyzed on SPSS version 23. Results: Two hundred & seventy medical students of final year MBBS class from Quaid-e-Azam medical college took part in this study. 69.7% of students were female and 30.3% of students were male. 67.68% of students disagreed that the space around the operation table was sufficient. 71.1% of students agreed that operation theatre learning was helpful in the examination. 71.5% of students agreed that I have a better internal motivation in operation theatre learning. Conclusion: The students become motivated with learning in the operation theatre. Operation theatre learning offers the medical students to build clinical cognitive recollection by joining in the perceptible sensation of live pathologies with pictorial images and vocal learning and then listening.

Item analysis with precise information: An item information function approach in IRT.

Fri, 01 May 2026 00:00:00 -0700

Objective: To identify valid and reliable items providing precise information regarding learner ability to be included in the test pool. Study Design: Descriptive Cross-sectional study. Setting: SMBB Medical College Lyari Karachi. Period: December 2024. Methods: Purposive sampling techniques are employed to collect data from 100 MBBS students using physiology SBAs at C1, C2 and C3 level from formative assessment of 2^nd Professional MBBS Gastrointestinal tract module held in a public sector medical institute SMBB Medical College, Karachi. The study employed 2 PL dichotomous IRT model for item analysis using discrimination and difficulty index with subsequent application of item information function (IIF) technique to gauge items that rendered precise information employing statistical software STATA 17. Results: The item analysis using discrimination and difficulty index found only one acceptable and two desirable items at C1 level while rest are redundant. There is only one desirable item at C2 level while rest are discarded, at C3 level two items are found acceptable, one desirable and rest are discarded. However, subsequent analysis with IIF shows that only one desirable item from C1, C2 and C3 level is appropriate for inclusion in the test pool whilst others need to be revised. Conclusion: The study considers item information function (IIF) as a supporting approach to a traditional item analysis for building a quality test pool. It is also established that even acceptable items that are possible candidates for inclusion in test pool by item analysis subsequently disqualified by IIF as are failed to submit precise information regarding learner’s ability where only one desirable item from C1, C2 and C3 level appeared to provide precise information hence could be included in the test pool.

Tofacitinib plus methotrexate versus tofacitinib monotherapy in rheumatoid arthritis: A comprehensive evidence synthesis and critical analysis.

Fri, 01 May 2026 00:00:00 -0700

Objective: To compare the benefits of Tofacitinib with Methotrexate vs Tofacitinib alone with respect to efficacy and safety over a period of 6 months. Study Design: Randomized Controlled Trial. Setting: Outpatient Department of Rheumatology, Madinah Teaching Hospital, Faisalabad. Period: 01^st August,2025 to 31^st Jan,2026. Methods: Consisted of 60 people enrolled as per the inclusion criteria (ACR/EULAR 2010 Criteria), after getting approval from the ethics review committee. Individuals segregated into two groups: Group A received Tofacitinib alone, whereas Group B received Tofacitinib with Methotrexate. DAS28-ESR, along with ESR and CRP, was used as an assessment tool for response, both at baseline and at 6 months. Results: Both the arms showed improvement in disease activity, however there were better results in the combination arm than with monotherapy (−2.3 ± 0.6 vs −1.6 ± 0.5; p < 0.001). Remission and reduction of disease activity was observed in the combination group with the occurrence of more adverse effects in the same group. Conclusion: Tofacitinib with Methotrexate provides better efficacy for disease control as compared to Tofacitinib alone. This consolidates the prior belief that Methotrexate is the anchor drug in the management of RA.