The Professional Medical Journal

A comparative study of ultrasound-guided versus fluoroscopy-guided transforaminal epidural steroid injection in lumbar radiculopathy: Efficacy, safety, and radiation exposure.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: Transforaminal epidural steroid injection is the most used intervention as minimally invasive non-surgical management of lumbar radiculopathy. While fluoroscopy guidance remains the traditional gold standard, ultrasound guidance has also gained popularity. This study compares the efficacy, safety, and radiation exposure of ultrasound-guided versus fluoroscopy-guided TFESI. Study Design: Prospective, Single Blind, Randomized Controlled Trial. Setting: Department of Anesthesia and Pain Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: August 2025 to January 2026. Methods: 88 patients (44 per group) diagnosed with unilateral lumbar radiculopathy. Group A received fluoroscopy-guided TFESI (FG), and Group B received ultrasound-guided TFESI (USG) with fluoroscopic confirmation. Outcome were assessed at baseline, 1 week, 4 weeks, and 12 weeks; radiation dose (mGy); fluoroscopy time (seconds); and procedure duration (minutes). Results: Significant improvements in VAS and ODI were observed in both groups from baseline, with no significant differences between groups at 12 weeks (p < 0.001) (VAS: USG 2.4 ± 1.1 vs. FG 2.3 ± 1.2, p = 0.68). Radiation exposure and Mean fluoroscopy time were significantly lower in the USG group (0.27 ± 0.10 mGy vs 3.45 ± 0.65 mGy, p < 0.001, and 0.17 ± 0.07 s vs. 52.91 ± 13.91 s, p < 0.001, respectively). No major complications occurred in either group. Conclusion: Ultrasound-guided TFESI is an effective and radiation-free alternative to fluoroscopy-guided TFESI in the treatment of lumbar radiculopathy.

Correlation of national early warning score 2 with outcomes of acute exacerbation of chronic obstructive pulmonary disease.

Warda Ajmal, Muhammad Ashraf, Shanzay Haider — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the correlation of the National Early Warning Score 2 (NEWS2) at admission with the clinical outcomes in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Study Design: Prospective Longitudinal Observational study. Setting: Department of Medicine, Shifa International Hospital, Islamabad. Period: Sep-2025 to Feb-2026. Methods: A total of 207 patients aged ≥18 years with a confirmed diagnosis of chronic obstructive pulmonary disease and presenting with acute exacerbation requiring hospital admission, were enrolled. The NEWS2 was calculated at the time of presentation and patients were categorized into low (0–4), medium (5–6), and high (≥7) risk categories accordingly. In-hospital mortality was recorded during the hospital stay, while 3-month mortality and recurrence of exacerbation were assessed using hospital records and/or telephonic follow-up. Spearman correlation was used for statistical analysis considering p<0.05 as significant. Results: When assessed using the NEWS2, the majority of patients fell in the high-risk category (52.66%) followed by medium-risk (30%) and low risk (17.39%). A statistically significant but weak correlation was observed between NEWS2 risk category and in-hospital mortality (r = 0.183, p = 0.008), which indicates that higher NEWS2 risk category was associated with increased in-hospital mortality. A clinically meaningful progressive gradient across risk categories was also shown for 3-month mortality and exacerbation frequency; however, these did not reach statistical significance. Conclusion: NEWS2 demonstrates directional utility as an early bedside risk stratification tool in patients presenting with AECOPD, supporting its integration into the routine decision-making at emergency departments.

The impact of obesity in patients undergoing laparoscopic cholecystectomy.

Saad Yaqub, Tanvir Ahmad, Syeda Samina Ashfaq, Muhammad Ans — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the effect of obesity on operative duration and the rate of conversion to open surgery among patients undergoing laparoscopic cholecystectomy. Study Design: Analytical Cross-sectional study. Setting: Department of Surgery. Period: 25 November 2025 to 24 May 2026. Methods: Recruitment was concluded after the required sample size of 194 patients had been achieved. A total of 194 patients scheduled for laparoscopic cholecystectomy were included and categorized into two equal groups: obese (n=97) and non-obese (n=97). The sample size was determined using the WHO sample size calculator with a confidence level of 95% and study power of 90%. Patients aged between 18 and 60 years, of either gender, were selected through simple random sampling. Baseline demographic and clinical characteristics including age, sex, body mass index (BMI), ASA classification, associated comorbidities, and history of prior abdominal surgery were documented. All procedures were performed by consultant surgeons having a minimum of three years’ post-fellowship experience. The primary outcomes assessed were operative time and frequency of conversion to open cholecystectomy. Statistical analysis was carried out using SPSS version 25. Independent sample t-test and Chi-square test were used for comparison, with p≤0.05 taken as statistically significant. Results: Obese patients demonstrated a longer mean operative time compared to non-obese patients (97.43 ± 35.04 minutes vs. 87.45 ± 35.75 minutes); however, this difference did not reach statistical significance (p=0.051). The rate of conversion to open cholecystectomy was significantly greater in the obese group than in the non-obese group (14.4% vs. 3.1%; p=0.005). Subgroup analysis further revealed increased conversion rates among obese individuals in several categories, particularly females, younger patients, those with higher ASA grades, and patients with diabetes mellitus or hypertension. Conclusion: Obesity appears to increase the likelihood of conversion from laparoscopic to open cholecystectomy and may also contribute to prolonged operative duration. Thorough preoperative evaluation, appropriate patient counseling, and experienced surgical management are important factors in achieving favorable outcomes in obese patients undergoing laparoscopic cholecystectomy.

Surgical Site Infection (SSI) with and without suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the incidence of surgical site infections (SSI) with and without the use of suprafascial intrawound vancomycin powder in instrumented posterior spinal fusion. Study Design: Randomized Controlled Trial. Setting: Department of Neurosurgery, Allied Hospital-I, Faisalabad. Period: 01-01-2026 to 30-06-2026. Methods: We randomly assigned 74 patients from each group to undergo posterior spinal instrumentation; the patients' ages ranged from 18 to 65. In addition to the usual prophylactic intravenous antibiotics, Group A also got intrawound vancomycin powder. In contrast, Group B only received intravenous antibiotics. Over the course of three months, patients were monitored for the occurrence of SSI, as defined by the CDC. A chi-square test was used to compare the SSI rates between the groups, and the data were analyzed using SPSS version 25.0. Results: The overall frequency of SSI was 13.5% (20/148). Group A showed a significantly lower rate of SSI (6.8%) compared to Group B (20.3%) (p = 0.016). Among infections, 8.8% were superficial and 4.7% were deep. Stratified analysis demonstrated a consistent reduction in SSI in the vancomycin group across most subgroups. Conclusion: Suprafascial intrawound application of vancomycin powder significantly reduces postoperative SSI in instrumented posterior spinal fusion and may be considered an effective, safe, and cost-efficient adjunct to standard antibiotic prophylaxis.

Outcome of mechanical thrombectomy for acute ischemic stroke and risk factors associated with mortality: A single center experience from Pakistan.

Mehreen Shamim, Mubashir Hussain, Nisha Modi, Irfan Amjad Lutfi — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To find out the outcomes of mechanical thrombectomy (MT) for acute ischemic stroke and risk factors associated with mortality. Study Design: Retrospective study. Setting: Department of Neurology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: October 2022 till January 2025. Methods: A total of 136 acute stroke patients management unit started functioning to caters patients requiring ntravenous thrombolysis (IVT) and MT. All patients who underwent MT for LVO from October 2022 till January 2025 were included. Inclusion criteria for MT was age >18 years, National Institutes of Health Stroke Scale (NIHSS) >6, ischemic cerebral signs on computed tomography (CT) scan by using Alberta Stroke Program Early CT Score (ASPECT) >6 and time from onset < 8 hours were included. Baseline demographics, risk factors, type of stroke, endovascular procedure and outcome were noted. Primary aim was to evaluate outcome (mortality and functional recovery). Secondary aim was predictors of mortality. Results: There were 136 patients who underwent MT, and baseline modified Rankin scale (MRS) and NIHSS were 4 and 14 respectively. Overall, 77.2% patients did achieve successful recanalization and we observed in hospital mortality of around 30.1%. Factors leading to poor recanalization were older age and high MRS score. Predictors of mortality were higher baseline MRS score, failed to achieve recanalization, procedural complication and reocclusion. Conclusion: This study demonstrates the important role of mechanical thrombectomy in the treatment of acute ischemic stroke. Older age, high MRS and ASPECT score remain factors associated with poor recanalization resulting in higher mortality.

Metronomic capecitabine in metastatic triple negative breast cancer.

Asima Luqman, Sarah Khan — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the efficacy and safety of metronomic capecitabine in patients with metastatic TNBC (mTNBC), with progression free survival (PFS) as primary end point and toxicity profile as secondary endpoint. Study Design: Retrospective study. Setting: Department of Radiotherapy, Quaid e Azam Medical College, Bahawalpur, Pakistan. Period: 1st January 2022 to 30^th October 2025. Methods: The study included patients with mTNBC of any age who were metastatic at presentation. All patients received first-line chemotherapy, or subsequently went on to receive the second-line chemotherapy. Capecitabine at a dose of 500 mg twice daily was administered to patients with stable disease after initial chemotherapy. Patients were asked to follow up every 4 weeks and thorough clinical examination was performed at each follow up. Results: Out of 643 breast cancer patients, 117 (18.2%) had stage IV disease, with 47 (40.1%) having mTNBC. The median age was 44 years. There were 33 (70.2%) patients who achieved stable disease and started metronomic capecitabine following initial chemotherapy. Among these 33 patients, 24 (72.7%) had stable disease while remaining 9 (27.3%) experienced disease progression. The most common toxicities were mild nausea and vomiting, noted in 9 (27.2%), grade 1 diarrhea 4 (12%), grade 1 mucositis 3 (9.1%), and grade 1 myelosuppression 4 (12.4%). Conclusion: Metronomic capecitabine was an effective and well-tolerated treatment option for patients with mTNBC, particularly in the short term.

Comparison of stress response between conventional laryngoscopy versus video laryngoscopy in patients undergoing general anesthesia.

Omair Khawar, Khaleel Ahmad, Waqar Ahmad, Hassan Mujtaba — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To compare the hemodynamic stress response between video laryngoscopy and conventional direct laryngoscopy in patients undergoing general anesthesia. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi. Period: Oct-2025 to Dec-2025. Methods: A total of 192 patients aged 18–50 years, belonging to ASA class I–II and undergoing elective surgery under general anesthesia were randomized into two equal groups. Patients in Group VL underwent video laryngoscopy while patients in Group DL underwent conventional direct laryngoscopy. The primary outcomes were hemodynamic parameters recorded at baseline (T0), during laryngoscopy (T1), at intubation (T2), and at one minute post-intubation (T3). These outcomes were compared between the two groups by applying independent t-test, where a p-value < 0.05 was considered significant. Results: Mean age of patients was 40±7.57 years, ranging from 18 to 50 years with a slightly higher number of male patients (53.13%) compared to the females (46.88%). The results showed an expected increase in HR and BP during laryngoscopy and intubation in both groups; however, analysis of the primary outcomes confirmed that the magnitude of the increase was significantly lower in the VL group compared to the DL group at T1, T2, and T3. Specifically heart rate, systolic blood pressure, diastolic blood pressure and MAP were significantly lower in the video laryngoscopy group at T2 (p< 0.0001). Conclusion: Video laryngoscopy provides a significantly reduced stress response regarding hemodynamic changes compared to conventional laryngoscopy in patients undergoing general anesthesia.

Comparison of postoperative pain with and without rectus sheath block in patients undergoing midline laparotomy.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To compare mean postoperative pain with and without rectus sheath block in patients undergoing midline laparotomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: April’24 to September’24. Methods: We enrolled 84 patients aged 13–60 years undergoing elective or emergency midline laparotomy who were randomly assigned to two groups: Group A (RSB group) and Group B (non-RSB group). RSB was performed using a landmark-based technique with 0.25% bupivacaine. Pain intensity was measured at 1, 4, 12, and 24 hours following surgery using the Visual Analogue Scale (VAS).Rescue analgesic requirements were also recorded. Results: The RSB group showed significantly lower VAS scores at 1 hour (2.46 ± 0.73 vs. 4.56 ± 0.69, p = 0.000) and 24 hours (4.51 ± 0.62 vs. 4.82 ± 0.74, p = 0.041). Mean rescue analgesic doses were also significantly lower in the RSB group (1.12 ± 0.77 vs. 2.74 ± 1.13, p = 0.000). Demographics were comparable across groups, with 63.1% males and 50% ASA I status. Findings align with 12 supporting studies, suggesting consistent benefit of RSB in terms of pain control and opioid-sparing effects. Conclusion: Landmark-guided rectus sheath block significantly reduces postoperative pain and opioid use in midline laparotomy. Its efficacy is comparable to ultrasound-guided methods and may be enhanced through preoperative timing and adjuvant use. RSB is a valuable tool, especially in settings lacking advanced imaging.

Frequency and risk factors of Surgical Site Infections following neurosurgical procedures.

Malik Liaqat Ali Jalal, Syed Muhammad Ahmed, Zermina Tanvir — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency and identify risk factors associated with SSIs following neurosurgical procedures. Study Design: Analytical Cross-sectional Investigation. Setting: Neurosurgery Department of Nishtar Hospital Multan. Period: May 2025 to January 2026. Methods: Following ethical approval, 292 patients undergoing cranial or spinal procedures were enrolled. Data included demographics, comorbidities, procedural details and microbiological profiles. Infections were classified using CDC criteria. SPSS version 23.0 analyzed data. Chi-square and Independent sample t-tests were used to assess the associations and p value <0.05 taken as significant. Results: Among 287 patients overall SSI frequency was 5.2%. Significant risk factors included diabetes mellitus (OR 4.89), obesity (OR 3.42), emergency surgery (OR 3.78), operative duration exceeding 180 minutes (OR 5.08), and delayed antibiotic prophylaxis (OR 3.69). Staphylococcus aureus was the predominant pathogen (40%), with 50% methicillin resistance. Gram-negative organisms included Escherichia coli and Pseudomonas. Infected patients experienced prolonged hospital stays (18 vs 6 days), higher reoperation rates (73.3% vs 4.4%), and increased 90-day mortality (13.3% vs 1.1%), respectively. Conclusion: SSIs constitute a major preventable complication driven by modifiable patient and procedural risk factors. Implementing standardized prevention protocols alongside robust antimicrobial stewardship is essential to reduce morbidity, mortality and healthcare costs in resource constrained settings.

Between biochemical pathways and physiological dysfunction in major depressive disorder: A systematic review.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To explore the relationship between key biochemical pathways and their associated physiological dysfunctions in major depressive disorder. Study Design: Systematic Review. Setting: PubMed, Scopus, Web of Science, and Google Scholar. Period: 2000-2025. Methods: Comprehensive literature search was conducted using major databases, including PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025. Studies were included if they involved human subjects diagnosed with MDD and examined biochemical pathways such as neurotransmitter systems, hypothalamic–pituitary–adrenal (HPA) axis dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and neuroplasticity in relation to physiological outcomes. A total of 62 studies met the inclusion criteria and were included in the qualitative synthesis. Results: The review revealed that multiple biochemical abnormalities are consistently associated with physiological dysfunction in MDD. Neurotransmitter imbalances, particularly involving serotonin and dopamine, were commonly reported. Dysregulation of the HPA axis with elevated cortisol levels was frequently observed. Increased inflammatory markers, including pro-inflammatory cytokines, were also widely documented. Additionally, oxidative stress and mitochondrial dysfunction were linked to impaired cellular function and reduced energy metabolism, while decreased levels of neurotrophic factors such as brain-derived neurotrophic factor (BDNF) were associated with reduced neuroplasticity. These pathways were found to interact and contribute collectively to both central and systemic manifestations of the disorder. Conclusion: This systematic review concludes that major depressive disorder is associated with multiple interacting biochemical pathways, including neurotransmitter imbalance, HPA axis dysregulation, inflammation, and oxidative stress. These alterations are closely linked with physiological dysfunctions affecting both brain and systemic functions. Understanding these integrated mechanisms may help in developing targeted and personalized treatment strategies for MDD.

Efficacy of stone cone in ureteroscopic pneumatic lithoclast for lower ureteric stone.

Muhammad Salman Arshad, Shabbir Hussain Chaudhry, Fahad Mehmood Khokar — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the efficacy and safety of stone cone during ureteroscopic pneumatic lithoclast for lower ureteric stone. Study Design: Comparative Cross-sectional study. Setting: Department of Urology Jinnah Hospital, Lahore. Period: July 2025 to December 2025. Methods: Comparative Cross-sectional study. Methods: Included 125 patients with lower ureteric stones. Patients were randomly divided into two groups: Group A (Stone Cone, n=63) and Group B (Control, n=62). All patients underwent ureteroscopic fragmentation using a pneumatic lithoclast. Outcomes measured included stone-free rate, incidence of retropulsion, operative time, auxiliary procedures, postoperative complications as well as hospital stay. Statistical analysis was performed using SPSS, with p ≤ 0.05 considered significant. Results: Stone retropulsion was significantly lower in the Stone Cone group (3.2% vs 17.7%, p=0.009). The stone-free rate was higher in Group A (96.8% vs 82.3%, p=0.008). Mean operative time (31.8 ± 6.4 vs 38.9 ± 7.6 min, p<0.001) and hospital stay (1.4 ± 0.6 vs 2.1 ± 0.8 days, p<0.001) were significantly shorter in the Stone Cone group. The need for auxiliary procedures was also reduced (3.2% vs 16.1%, p=0.015). Conclusion: The use of Stone Cone during ureteroscopic pneumatic lithoclast for lower ureteric stones significantly improves stone-free rates, reduces retropulsion, shortens operative time and decreases the need for secondary procedures. Stone Cone is a safe, effective and cost-efficient, particularly valuable in resource-limited settings.

Comparison of efficacy of Rifaximin and Lactulose plus Zinc versus Rifaximin and lactulose alone in patients with hepatic encephalopathy at a tertiary care hospital.

Tauqeer Hussain, Javed Iqbal, Nauman Sarwar, Muhammad Saad, Khatija — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To compare the clinical efficacy of adjunctive zinc supplementation combined with standard lactulose and rifaximin therapy against lactulose and rifaximin alone in patients presenting with hepatic encephalopathy. Study Design: Analytical Cross-sectional Investigation. Setting: Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. Period: June to December 2025. Methods: One hundred eight adult patients diagnosed with hepatic encephalopathy (West Haven grades I–IV) were enrolled via consecutive sampling and allocated into two therapeutic arms. The intervention cohort received oral lactulose, rifaximin, and a zinc-carnosine formulation, whereas the control arm received standard dual therapy. Clinical efficacy was defined as a ≥1-grade improvement on the West Haven scale following seven days of continuous treatment. Data were analyzed using SPSS version 23.0, with Chi-square tests determining statistical significance. Results: Baseline demographic and clinical profiles were comparable between groups. Following the intervention period, 53.7% (n=29) of patients receiving zinc achieved substantial clinical improvement compared to 25.9% (n=14) in the standard therapy group (χ²=8.94, p=0.003). The calculated number needed to treat was 3.6. Both regimens exhibited comparable tolerability, reporting only mild gastrointestinal disturbances without serious adverse events. Conclusion: Supplementing conventional pharmacological management with zinc significantly accelerates short-term neurological recovery in hepatic encephalopathy. Integrating this affordable micronutrient adjunct into acute care protocols represents a highly effective strategy for optimizing clinical outcomes in cirrhotic populations.

Efficacy of melatonin as an adjunct to first-line therapy in epileptic patients.

Safiullah, Sadia Riaz — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the efficacy of melatonin as an adjunct to first-line antiepileptic therapy in reducing seizure severity, seizure frequency, and electroencephalographic (EEG) abnormalities in pediatric patients with generalized epilepsy. Study Design: Quasi-experimental Comparative study. Setting: Department of Pediatrics, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Period: July 2025 to Dec 2025. Methods: A total of 60 children aged 2–12 years with generalized epilepsy and suboptimal seizure control despite first-line antiepileptic therapy were enrolled using consecutive sampling. Patients were allocated into two groups: the treatment group (n=30) received melatonin as an adjunct to first-line therapy, while the control group (n=30) received placebo with first-line therapy. Melatonin was administered at bedtime for 12 weeks (1 mg for children <5 years and 2 mg for ≥5 years). Seizure severity was assessed using the Chalfont-National Hospital Seizure Severity Scale (NHS-3), while seizure frequency over a three-month period and EEG findings were recorded at baseline and follow-up. Data were analyzed using SPSS version 25.0, and a p-value of less than 0.05 was considered statistically significant. Results: The two groups showed no significant differences in baseline demographic and clinical characteristics. At 12 weeks, seizure severity scores were significantly reduced in the melatonin group compared to the placebo group (10.7 ± 2.4 vs. 17.9 ± 4.3; p < 0.001), with a mean reduction of 7.9 ± 3.1 versus 1.5 ± 1.6, respectively. Seizure frequency also showed a significant reduction in the melatonin group compared to placebo (mean reduction: 3.1 ± 1.1 vs. 0.4 ± 0.9; p < 0.001). 50% of patients in the melatonin group showed significant EEG normalizationin contrast to 26% in the placebo group (p = .03). Conclusion: Adjunctive use of melatonin with first-line antiepileptic therapy results in significant improvement in seizure severity, seizure frequency, and EEG findings in pediatric patients with generalized epilepsy, supporting its safety and effectiveness as an additional treatment option in children with inadequate seizure control.

Relationship between Vitamin D3 deficiency and sternebrae fusion age in young females: A cross-sectional study.

Fatima Farooq, Rafea Tafweez — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To assess the relationship of vitamin D3 on the timing of sternebrae fusion in females aged 18 to 25. Study Design: Cross-sectional study. Setting: Azra Naheed Medical and Dental College, Lahore. Period: Aug 2023 to Jan 2024. Methods: A total of 400 females, aged 18-25, were categorized into four age groups within this cross-sectional study. Investigative modalities included serum vitamin d3 levels and lateral chest x-rays to determine the fusion status of sternebrae 2^nd-3^rd, 3^rd-4^th, 4^th-5^th. Statistical analysis, such as chi-square tests and regression models, were carried out to determine link between Vitamin D3 levels, age, and fusion status. Results: While vitamin D3 was deficient in 60.2% of the participants, fusion of the sternebrae was nearly complete in all age groups (97.5% to 99.2%). Besides this, statistical analysis revealed no significant association between vitamin D3 status and the fusion of any sternebrae segment (p > 0.05). Furthermore, regression analysis also showed no predictive value of vitamin D3 levels on the age of fusion. Conclusion: Vitamin D3 seems to have no significant influence on the fusion rate of the sternebrae; complete fusion occurred by 18 years of age in the majority of females. While Vitamin D3 itself remains an important nutrient, further research is necessary to determine what other systemic factors have a role in the timeline of sternebrae fusion.

Factors associated with needle-stick injuries among healthcare workers in tertiary care hospital: A cross-sectional analytical study.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the 12-month frequency of self-reported needle-stick injuries (NSIs) among healthcare workers, identify associated demographic and occupational risk factors, and evaluate post-exposure care and management practices. Study Design: Analytical Cross-sectional study. Period: January to June 2025. Setting: Shahida Islam Teaching Hospital. Methods: Using stratified random sampling, 379 eligible clinical staff members were recruited. Data were collected via structured, WHO/CDC-adapted questionnaires assessing demographics, injury circumstances, and safety protocols. Bivariate analyses and multivariable binary logistic regression were performed to isolate independent predictors of NSIs while controlling for confounding variables. Results: The 12-month NSI prevalence was 46.2% (n=175). Hollow-bore needles were the most frequently implicated devices (52.6%), primarily during blood withdrawal. Formal incident reporting was suboptimal at 54.3%, with fear of reprimand and heavy clinical duties cited as primary barriers. Multivariable analysis demonstrated that working night or rotating shifts (aOR=2.14), high perceived workload (aOR=1.89), and lacking safety training within the preceding year (aOR=2.85) significantly elevated injury risk. Conversely, possessing five or more years of clinical experience emerged as a strong protective factor (aOR=0.45). Conclusion: NSIs remain a substantial occupational hazard in tertiary care environments, predominantly driven by inadequate safety training, night-shift fatigue, and heavy workloads. Implementing mandatory, hands-on safety reinforcement alongside non-punitive, simplified reporting mechanisms is urgently required to mitigate risks and improve overall post-exposure management.

Frequency of Atrial fibrillation in patients with stroke presenting to tertiary care hospital.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of atrial fibrillation (AF) and its associated clinical factors among patients presenting with acute ischemic stroke at a tertiary care hospital. Study Design: Cross-sectional Observational study. Setting: Ayub Medical Teaching Institute, Abbottabad, a Tertiary Care Hospital. Period: January 20, 2026, to April 22, 2026. Methods: A total of 167 consecutive adults aged ≥18 years with CT- or MRI-confirmed acute ischemic stroke presenting within 7 days of symptom onset were enrolled. Patients with hemorrhagic stroke, transient ischemic attack, non-vascular causes, incomplete records, or those who declined consent were excluded. AF was identified through documented medical history and admission 12-lead electrocardiography. Demographic and cardiovascular risk factor data were collected via a structured proforma. Statistical analysis was performed using SPSS version 26, with associations assessed by the Chi-square test. Results: +AF was detected in 38 patients (23%). The overall cohort had a mean age of 65.2 ± 12.4 years, and 58.7% were male. Patients with AF were significantly older (70.1 ± 13.2 vs. 63.8 ± 11.9 years; age >65 years: 68.4% vs. 48.1%, p=0.031). Significant associations with AF were found for diabetes mellitus (52.6% vs. 34.9%, p=0.038) and obesity (34.2% vs. 17.1%, p=0.029). Hypertension was more common in AF patients but did not reach statistical significance (78.9% vs. 63.6%, p=0.082). Sex, smoking, dyslipidemia, and prior stroke showed no significant associations. Conclusion: Nearly one in four ischemic stroke patients in this cohort had AF, with older age and metabolic risk factors such as diabetes and obesity showing strong associations. These findings underscore the importance of targeted cardiac screening to guide anticoagulation and improve secondary stroke prevention.

Association of hemoglobin and red cell distribution width ratio with upper gastrointestinal bleeding.

Isha Latif, Hayat Ullah, Rimsha Shakeel — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To investigate the relation of Hb to Red cell distribution width (RDW). Study Design: Cross-sectional study. Setting: Department of Physiology, Sahiwal Medical College, Sahiwal. Period: 20 April 2025 to 20 July 2025. Methods: A total of 62 patients with upper gastro intestinal bleed were included in study. The Hb to RDW ratio was calculated for each participant. Data were entered and analyzed using SPSS version 26. Results: It was shown that a total of 62 participants were included out of which 34 were females, and people living in urban areas participated more in this disease (46.8%). In addition to this, our results showed that the mean value of Hb was 9.62, RDW was 17.2, and of Hb to RDW was calculated as 0.617. Furthermore, the Hb to RDW ratio was found to be significant with area-wise distribution (0.023). At the same time, it was found to be nonsignificant with marital status. Gender and area distribution were also measured by Fischer’s exact test but the statistical significance was not Conclusion: The primary study objective to establish a direct association between the Hb/RDW ratio and the incidence or severity of upper GI bleeding was not supported by a statistically significant link.

Estimation of risk of nephrogenic systemic fibrosis inpatients of stage 3-5 chronic kidney disease undergoing magnetic resonance imaging with injectable gadobutrol.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of nephrogenic systemic fibrosis in patients undergoing contrast enhanced magnetic resonance imaging with gadobutrol. Study Design: Cross-sectional study. Setting: Doctors Hospital and Medical Center. Period: August 2025–January 2026. Methods: Total of 101 patients aged 20–80 years with eGFR <60 mL/min/1.73m² undergoing contrast-enhanced MRI. Non-probability consecutive sampling. Data analyzed via SPSS; qualitative variables as frequencies/percentages, quantitative as mean±SD. Chi-square test; p<0.05 significant. Results: No NSF cases observed in CKD stage 3–5 patients at 1 and 3 month. Mild acute reactions occurred in 3 patients (2.8%), all self-limiting. No significant eGFR differences by gender (p=0.301); adverse events significantly below the expected threshold (p=0.001). Conclusion: Gadobutrol is safe for contrast-enhanced MRI in moderate-to-severe CKD without mandatory pre-imaging renal assessment when administered at standard dose per international guidelines, streamlining workflows and ensuring timely, safe diagnostic access.

Awareness of cardiovascular, renal, and cerebrovascular complications of uncontrolled hypertension among hypertensive patients in a Tertiary Care Hospital of Abbottabad.

Sayyed Anas Shah, Mohammad Javed, Abid Ali, Yasir Khan — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To assess the level of awareness and its predictors in hypertensive patients in a tertiary health-care facility. Study Design: Cross-sectional study. Setting: Outpatient Department of a Tertiary Care Hospital in Abbottabad Medical Complex, Abbottabad. Period: 15 December 2025 to 15 March 2026. Methods: The study was conducted on a sample of 126 hypertensive patients who presented to the outpatient department of a tertiary hospital in Abbottabad, Pakistan. Data was collected through a designed, interviewer-based questionnaire. The operationalization of awareness was the ability to identify all three complications (cardiovascular, renal, and cerebrovascular) of uncontrolled hypertension. Chi-square and descriptive statistics were used for data analysis. Results: The overall awareness of all three major complications was 53.2% (67/126). The highest awareness was regarding cardiovascular complications (61.9%), followed by renal (55.6%) and cerebrovascular (54%) complications. A statistically significant correlation between the level of education and awareness was observed, in which the level of awareness progressed from illiterate patients (28.6%) to patients with higher education (78.0%). There were no significant correlations with age, sex, and years of hypertension (p > 0.05), indicating that these variables were not significant predictors of awareness. Conclusion: Patients in Abbottabad are still not adequately aware of the major complications of uncontrolled hypertension. The only significant predictor of awareness was education level. Specific educational interventions, particularly those aimed at individuals with lower educational levels, are immediately justified in order to improve awareness and prevent long-term complications.Top of FormBottom of Form

Role of Lung Ultrasound (LU) in early diagnosis of Interstitial Lung Disease (ILD) in patients with Rheumatoid Arthritis (RA).

Mahpara Munir, Khalid Parvez, Muhammad Ammar Khan, Salman Azhar — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine role of lung Ultrasound in Early Diagnosis of ILD in Patients with RA. Study Design: Observational Prospective study. Setting: Madina Teaching Hospital (MTH), University Medical and Dental College Faisalabad (UMDC). Period: July 2022 to December 2022. Methods: Adults with a diagnosis of RA and signs and symptoms of ILD in RA who were included. Lung function testing and diagnostic imaging were carried out. Results: The research comprised a total of 141 participants, consisting of 55 (39%) males and 86 (61%) females, with an average age of 51.92±12.15 years. The majority of the participants were positive for Rh factor, namely 112 out of 79% of the individuals examined. Mean duration of rheumatoid arthritis was 15.8 ± 10.4 years. Analysis of the patients' medical records revealed that 51.1% individuals had a documented history of smoking. Of all the patients, 60 people (42.6%) were using glucocorticoids. ILD was detected by HRCT in 108 of the 141 patients in the study group, representing a 76.6% prevalence. The LUS detected symptoms of ILD in 101 out of 141 individuals, representing a percentage of 71.6%. Concordance among LUS and HRCT was 66.7%. The sensitivity for LUS was 75%, while the specificity was 39.39%. Conclusion: The results show that LUS is a valuable method for identifying ILD in RA patients and is capable of accurately predicting the occurrence of ILD in these patients. Larger cohorts, the test's cost-efficiency, and the usefulness of LUS in the follow-up of patients who have already been diagnosed with ILD should all be assessed in future research.

Fetal and maternal outcome following implementation of Labour Care Guide.

Noor Ul Ain Fatima, Abeera Ali, Tehreem Fatima, Shehla Tabassum, Faiza Irshad — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of maternal and neonatal outcomes following implementation of the World Health Organization (WHO) Labour Care Guide in term pregnancies. Study Design: Descriptive Observational study. Setting: Department of Obstetrics and Gynaecology, Allied Hospital, Faisalabad, Pakistan. Period: July 2024 to December 2024. Methods: A total of 73 term pregnant women monitored using the WHO Labour Care Guide were included. Women with singleton, cephalic pregnancies at ≥37 weeks were enrolled, while high-risk and medically complicated pregnancies were excluded. Maternal outcomes and neonatal outcomes were recorded. Data were analysed using SPSS version 26. Results: The mean maternal age was 26.8 ± 4.2 years, and 52.1% of participants were primigravida. The mean duration of the second stage of labour was 64.8 ± 25.4 minutes, with 87.7% experiencing a normal second stage. Spontaneous vaginal delivery occurred in 76.7% of women, while 23.3% required operative delivery. Maternal complications were infrequent, including postpartum haemorrhage 5.5%, perineal trauma 12.3%, and infection 4.1%, with no cases of uterine rupture. Most neonates 94.5% had normal 5-minute APGAR scores ≥7, 8.2% developed respiratory distress, and 9.6% required NICU admission. Maternal age, parity, and gestational age were not significantly associated with most maternal or neonatal outcomes, although younger mothers (18–25 years) had significantly higher NICU admission rates (p = 0.031). Conclusion: Implementation of the WHO Labour Care Guide was associated with favorable maternal and neonatal outcomes in term pregnancies. The guide supported structured intrapartum monitoring while maintaining maternal and neonatal safety.

Frequency of female sexual dysfunction in depression.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of sexual dysfunction among married women with untreated Major Depressive Disorder (MDD). Study Design: Analytical Cross sectional study. Period: June 2025 to December 2025. Setting: Outpatient department of Psychiatry and Behavioral Sciences, DHQ Hospital, Faisalabad Medical University. Methods: Total 193 married women aged 18–45 years, diagnosed with MDD per DSM-5 criteria and not on antidepressants, were enrolled using non-probability consecutive sampling. Sexual function was assessed using Female Sexual Function Index (FSFI), with a total score ≤26 indicating dysfunction. Data were analyzed using SPSS version 23.0; chi-square tests were applied to examine associations, with p ≤ 0.05 considered significant. Results: The mean age of participants was 31.4 ± 6.2 years. Sexual dysfunction was present in 137 women (71.0%), with the lowest FSFI domain scores in desire (2.8 ± 1.1) and arousal (3.1 ± 1.3). Significant associations were found between sexual dysfunction and older age (p = 0.021), longer marriage duration (p = 0.008), higher parity (p = 0.014), and cesarean delivery (p = 0.032). Employment status showed no significant association (p = 0.217). Conclusion: Female sexual dysfunction was frequent in women with untreated depression, particularly affecting desire and arousal, and is significantly influenced by reproductive and demographic factors.

Placenta previa and Placenta Accreta Spectrum (PAS): Obstetric risk factors and fetomaternal outcome at a Tertiary Care Hospital in Sialkot.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the obstetric risk factors associated with placenta previa and placenta accreta spectrum (PAS), and to assess fetomaternal outcomes among pregnant women presenting to a tertiary care hospital. Study Design: Retrospective Analytical Cohort study. Setting: Department of Obstetrics and Gynecology, Khawaja Muhammad Safdar Medical College / Allama Iqbal Memorial Teaching Hospital, Sialkot. Period: January 2024 to December 2024. Methods: All women presenting to the emergency department or outpatient clinic with a pre-operative or per-operative diagnosis of placenta previa or PAS were included. Diagnosis was established through transabdominal ultrasonography performed by a consultant radiologist. Demographic, obstetric, operative, and neonatal data were extracted from hospital records. Maternal outcomes included hemorrhage, transfusion requirements, hysterectomy, ICU admission, and mortality. Neonatal outcomes included birth weight, APGAR scores, NICU admission, and neonatal mortality. Data were analyzed using SPSS version 17. Results: A total of 48 women were included. The mean maternal age was 30 ± 3 years, and mean gestational age was 35.6 ± 3.9 weeks. Emergency cesarean section was performed in 64.6% of cases. Placenta accreta was diagnosed in 21 women (43.8%). Hysterectomy and maternal ICU admission were required in 41.7% of cases each. There were 2 maternal deaths and 7 neonatal deaths. Primary postpartum hemorrhage occurred in 52.1% of patients. Preterm delivery (<37 weeks) was observed in 50% of neonates, while 31.3% required NICU admission. Conclusion: Placenta previa and PAS are associated with significant maternal morbidity and adverse neonatal outcomes. Early diagnosis, vigilant antenatal monitoring, and timely multidisciplinary management are essential for optimizing fetomaternal outcomes.

Frequency of skin disorders associated with pregnancy at a tertiary care hospital of Karachi: A cross sectional study.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of skin disorders associated with pregnancy at a tertiary care hospital of Karachi. Study Design: Cross sectional study. Setting: Emergency Department, Abbasi Shaheed Hospital Karachi. Period: 1^st April 2023 to 31^st March 2025. Methods: The data was collected through filling proforma contains demographic information; any complains related to skin disorder. The skin lesion was diagnosed clinically and confirmed after getting dermatological opinion and relevant laboratory / other investigations. The participants were divided in to two groups. Group 1 was included women with physiological skin changes in pregnancy. Group 2 included skin disorders specifically related to pregnancy and any skin disorders. Results: A total of 335 participants were enrolled. Pruritus was the commonest complain experienced by our participants 94 (28.1%). Fungal infection and scabies accounted for the main reason of pruritus. Group I showed normal physiological changes in pregnancy 196(58.50%). Among the specific skin lesions in pregnancy, 30 (9%) were found with Intrahepatic cholestasis of pregnancy. Other skins lesions results showed scabies cases were 8(2.4%), herpes simplex was seen in 3(0.9%) cases, 7(2.1%) participants had fungal infection and Tinea corporoa was 5(1.5%), Two (0.6%) case had diagnosed Lichen plannus and 2(0.6%) had Psoriasis. Conclusion: The study concluded that Physiologic skin changes were commonly observed during pregnancy and Pruritus was the commonest complain. A significant number of scabies and fungal infection were observed.

Frequency of various factors leading to peripartum hysterectomy.

Maryam Rehman, Huma Ahmed — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of common causes of peripartum hysterectomy and to evaluate their association with demographic and clinical variables among women managed at a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Sialkot Medical College and its Affiliated Hospitals. Period: September 2025 to March 2026. Methods: After approval from the Institutional Review Board of Sialkot Medical College (IRB No. SMC-IRB/03/25 dated 21st January 2025), this descriptive cross-sectional study was conducted on 100 patients undergoing peripartum hysterectomy who were included through non-probability consecutive sampling. Data were collected using a predesigned proforma that included demographic variables such as age, body mass index (BMI), mode of delivery, and socioeconomic status, along with clinical variables including obstructed labour, previous cesarean section, grand multiparity, prolonged labour, placenta previa, and uterine atony. Data analysis was performed using SPSS version 22.0. Quantitative variables were expressed as mean ± standard deviation, while qualitative variables were presented as frequencies and percentages. Stratification and post-stratification Chi-square tests were applied, and a p-value ≤0.05 was considered statistically significant. Results: The mean age of the patients was 29.52 ± 4.40 years, while the mean BMI was 24.91 ± 2.82 kg/m². Cesarean section was the most common mode of delivery (58%), and the majority of patients belonged to the low socioeconomic group (63%). The most frequent risk factor associated with peripartum hysterectomy was previous cesarean section (74%), followed by grand multiparity (46%), uterine atony (45%), obstructed labour (35%), placenta previa (25%), and prolonged labour (18%). Stratified analysis demonstrated no statistically significant association of these risk factors with age, BMI, mode of delivery, or socioeconomic status (p > 0.05). Conclusion: Previous cesarean section, grand multiparity, and uterine atony were the most common factors associated with peripartum hysterectomy. The high prevalence of these potentially preventable risk factors highlights the importance of reducing unnecessary cesarean sections, improving antenatal risk assessment, and ensuring timely obstetric management to decrease maternal morbidity and improve outcomes.

Risk factors of iron deficiency anemia among pregnant women in tertiary care hospital.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To identify socioeconomic and dietary risk factors associated with iron deficiency anemia among pregnant women. Study Design: Descriptive Cross-sectional study. Period: June to December 2025. Setting: Inpatient Obstetrics and Gynecology Ward, Bahawal Victoria Hospital, Bahawalpur. Methods: One hundred ninety-two pregnant women aged 20–35 years with laboratory-confirmed iron deficiency anemia were recruited through consecutive sampling. Iron deficiency was defined per RCOG hemoglobin thresholds across gestational trimesters. A pre-tested structured questionnaire captured demographic profiles, obstetric history, and dietary frequencies. Data analysis utilized SPSS version 23, with categorical associations evaluated via Chi-square or Fisher’s exact tests, establishing statistical significance at p<0.05. Results: Nutritional deficits were prominent; 38.0% consumed fewer than three daily meals, while 62.0%, 71.4%, and 44.8% reported suboptimal weekly consumption of meat, eggs, and vegetables. Overall, 54.2% demonstrated composite dietary insufficiency. Severity stratification highlighted socioeconomic disease gradients. Reduced educational attainment and lower household income were significantly associated with moderate to severe anemia (p=0.018 and p=0.007, respectively). Inter-pregnancy intervals under two years strongly predicted inadequate daily meal frequency (p=0.003) and multiple concurrent dietary deficiencies (p<0.001). Parity and geographic residence demonstrated no significant correlations. Conclusion: Maternal iron deficiency anemia in this cohort is primarily driven by financial limitations, poor dietary diversity, and short birth spacing. Implementing targeted nutritional education and structured family planning interventions remains essential for improving maternal hematological outcomes and reducing perinatal complications.

Ventilator associated pneumonia and its outcome in children admitted at pediatric intensive care unit of a tertiary care hospital.

Mehak Siddiquie, Muhammad Zahid Farooq, Asim Khurshid — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency of VAP and its outcome in children admitted to the pediatric intensive care unit (PICU) of a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Intensive Care, Children Hospital Multan, Pakistan. Period: February 2024 to July 2024. Methods: A total of 139 patients of both genders, ages 6 months to 12 years, admitted to the ICU for MV were included. All of the relevant information was noted, and the patients were followed until the final outcome, which included discharge from ICU or expiry. Results: In a total of 139 children, 87 (62.6%) were male. The mean age was 5.94±2.47 years. The development of VAP was observed in 45 (33.1%) patients. Age between 7 to 12 years (p=0.0158), and weight > 20kg (p=0.0053) were having significant association with the development of VAP. Age between 7-12 years (p<0.0001), female gender (p=0.0491), and weight > 20kg (<0.0001) were having significant association with mortality. Mortality was significantly associated with VAP (67.7% vs. 26.4%, p<0.0001), duration of MV > 7 days (p<0.0001), and duration of PICU stay > 10 days (p<0.0001). Conclusion: This study found a relatively high incidence of VAP in the PICU, with significant associations between VAP and age, weight, and mortality.

Childhood trauma and its impact on borderline personality disorder development and symptom severity: A study at Allama Iqbal Teaching Hospital, Dera Ghazi Khan.

Hafiz Shafique Ahmad, Mujeebullah Khan Doutani, Adeena Rasheed — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To examine the relationship between childhood trauma severity and borderline personality disorder (BPD) symptom severity among adult patients, and to explore the role of dissociation and attachment anxiety in this association. Study Design: Cross-sectional study. Setting: Psychiatric Outpatient Department, Allama Iqbal Teaching Hospital, Dera Ghazi Khan. Period: 11-08-2025 to 10 -02-2026. Methods: A purposive sample of 150 adults (18–45 years) diagnosed with BPD was included. Data were collected using a structured proforma assessing demographic variables, childhood trauma (types and severity), BPD symptom severity (DSM-5 criteria), dissociation, and attachment anxiety. Data were analyzed using SPSS version 26. Descriptive statistics, Pearson correlation, multiple regression, and logistic regression analyses were performed. Results: Most participants reported at least one form of childhood trauma, with emotional neglect and witnessing domestic violence being most common. Trauma severity showed a strong positive correlation with BPD symptom severity (r = 0.58, p < 0.001). Dissociation and attachment anxiety were also significantly correlated with trauma and symptom severity. Regression analysis indicated trauma severity as a significant predictor of BPD symptoms, with partial mediation by dissociation and attachment anxiety. Logistic regression showed trauma severity and sexual abuse significantly predicted self-harm behavior. Conclusion: Childhood trauma significantly contributes to the severity of BPD symptoms. Dissociation and attachment anxiety partially mediate this relationship. Trauma-informed and culturally sensitive interventions are essential for improving clinical outcomes in resource-limited settings.

Comparison of inhaler corticosteroids and oral montelukast in children with reactive airways disease.

Faiqa Shah, Afzal Khan, Fatima Riaz, Maria Khalid, Seema Nawaz — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To compare the efficacy of inhaler corticosteroids and oral montelukast in children with reactive airways disease. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, Lady Reading Hospital, Peshawar. Period: 20 July 2025 to 20 January 2026. Methods: A total of 60 children aged 1 to 5 year with reactive airway disease for more than 3 months were enrolled using a 95% confidence level and 80% power calculation. Participant were randomized into two equal groups of 30 each. Group A received inhaler corticosteroids at 200 microgram per day and Group B received oral montelukast at 4 mg once daily in children below 1 year and 5 mg once daily in children above 1 year. Efficacy was defined as complete absence of symptom after 3 months of treatment. Chi-square test and Fischer exact test were applied to compare efficacy between groups and across stratified variables. Results: Inhaler corticosteroids showed efficacy in 73.3% patients compared to 33.3% with oral montelukast (p=0.002). Age-stratified analysis showed significant efficacy in children aged 3 years or less (77.8% versus 40.0%, p=0.041). Female gender demonstrated superior response to inhaler corticosteroids (84.6% versus 35.3%, p=0.012). Urban residents showed better efficacy with inhaler corticosteroids (76.5% versus 31.3%, p=0.007). Conclusion: Inhaler corticosteroids are significantly more effective than oral montelukast in managing reactive airways disease in children.

Empirical antibiotics therapy used for typhoid fever in pediatrics presenting in a tertiary care hospital.

Zara Shafqat, Abid Rafiq Chaudhry, Rashid Ayub — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To determine the frequency and efficacy of empirical antibiotic therapy used for treatment of pediatric typhoid fever in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Fatima Memorial Hospital Lahore. Period: 12 September 2025 to 12 March 2026. Methods: A total of 140 children aged 1-15 years, diagnosed with typhoid fever confirmed by blood culture, were included. Data on demographics, clinical features, and empirical antibiotic prescriptions were collected. Antibiotic sensitivity was assessed for the prescribed empirical antibiotics. Results: The study included 140 children with a mean age of 8.0 years; 51.4% were male. The most commonly prescribed empirical antibiotic was ceftriaxone (52.9%), followed by cefixime and ciprofloxacin (19.3%). Imipenem and azithromycin were prescribed to 4.3% of patients. Sensitivity rates were 70% for ciprofloxacin, 28% for ceftriaxone, 62% for cefixime, 50% for azithromycin, and 100% for imipenem. Only 43% of patients were sensitive to the empiric antibiotic prescribed. Conclusion: The study highlights dependence on ceftriaxone in the treatment of treating pediatric typhoid fever, despite moderate sensitivity rates. The findings demonstrate that there is a need for antibiotic stewardship program that guide appropriate empirical therapy and can also counter the increase of antibiotic resistance in pediatric populations.

Risk factors of asymptomatic vertebral compression fractures in patients with ankylosing spondylitis presenting for spine evaluation.

Muhammad Rizwan, Syed Zahid Hussain Shah, Muhammad Irshad, Muhammad Aamir — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To identify independent clinical and inflammatory risk factors associated with asymptomatic vertebral compression fractures in ankylosing spondylitis patients undergoing routine spinal evaluation. Study Design: Analytical Cross-sectional. Period: January to December 2025. Setting: Department of Neurosurgery, Nishtar Hospital II, Multan. Methods: A total of 289 adults meeting ASAS criteria who underwent spinal imaging. Patients with acute symptomatic fractures, recent trauma, prior spinal surgery, or metabolic bone disorders were excluded. Asymptomatic vertebral compression fractures were defined radiographically using Genant semiquantitative grading without acute pain or neurological deficits. Demographic, clinical, and laboratory parameters were evaluated using SPSS version 24.0, with statistical significance considered at p<0.05. Results: Asymptomatic fractures were identified in 74 participants (25.6%). Affected individuals were significantly older (46.3±9.8 versus 36.1±10.4 years; p<0.001) and exhibited longer disease duration (14.2±7.1 versus 9.8±6.3 years; p<0.001). Prior falls within twelve months (27.0% versus 14.9%; p=0.018) and elevated C-reactive protein levels >6 mg/L (48.6% versus 35.3%; p=0.041) were independently associated with fracture presence. The thoracolumbar junction harbored 47.3% of lesions, with mild grade one deformities comprising 62.2% of cases. Conclusion: Occult vertebral compression fractures represent a frequent complication in ankylosing spondylitis, driven by disease chronicity, mechanical trauma, and persistent inflammation. Targeted imaging protocols and proactive fall prevention strategies should be prioritized for high-risk patients.

SOX10 immunohistochemical stain in differential diagnosis of posterior fossa tumors, a single centered study.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the diagnostic utility of SOX10 immunohistochemical staining in distinguishing posterior fossa tumors, particularly ependymomas and non-ependymomas. Study Design: Cross-sectional study. Setting: Department of Histopathology, Shaukat Khanam Memorial Cancer Hospital and Research Center, Lahore. Period: March 2025 to August 2025. Methods: This cross sectional study included 65 posterior fossa tumors. 33 ependymomas and 32 non-ependymomas: pilocytic astrocytoma, medulloblastoma, meningioma, diffuse midline glioma,andhemangioblastoma. Immunohistochemistry was performed using SOX10, OLIG2, GFAP, synaptophysin, SSTR2 and inhibin. Ependymomas were molecularly subclassified into PF-EPN-A and PF-EPN-B. Statistical significance was assessed using chi-square and Fisher’s exact tests (p < 0.05). Results: PF-EPN-A was the most common ependymoma subtype (81.8%), with older median age than PF-EPN-B (5.0 vs. 2.5 years; p = 0.031). SOX10 was negative in all ependymomas (0/33) but highly expressed in pilocyticastrocytomas (85%) and the single diffuse midline glioma (100%), with significantly higher positivity in non-ependymomas (56.3%; p < 0.001). Synaptophysin was uniformly positive in medulloblastomas (100%). Conclusion: SOX10 is a sensitive and specific marker for distinguishing pilocytic astrocytoma from ependymoma. Its routine use in diagnostic panels enhances accuracy, reduces interpretive uncertainty and supports improved clinical decision-making in pediatric neuro-oncology.

Benefits and barriers of vertically integrated learning: Exploring medical students’ perspectives—a qualitative study from Larkana, Pakistan.

Preh Ayub Abro, Ayesha Junaid, Junaid Sarfraz Khan — Tue, 01 Sep 2026 00:00:00 -0700

Objective: To explore medical students’ perceptions of VIL, focusing on perceived benefits, barriers, and suggestions for improvement. Study Design: Qualitative study. Setting: Chandka Medical College, a Constituent College of Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan. Period: September 2025 to December 2025. Methods: Fifty MBBS students from all academic years, including both genders, participated. Data were collected using an open-ended questionnaire through printed forms and Google Forms, according to student preference and availability. Participation was voluntary, and responses were confidential. Data were analyzed using NVivo software (version 15), following Braun & Clarke’s thematic analysis framework, including familiarization, coding, theme identification, triangulation, member checking, and iterative refinement to ensure credibility and trustworthiness. Results: Thematic analysis identified six major themes: (1) Overall experience of VIL, (2) Integration of basic and clinical sciences, (3) Improvement in learning style and clinical reasoning, (4) Perceived benefits, (5) Barriers, and (6) Suggestions for improvement. Students reported positive experiences, highlighting enhanced understanding, better subject correlation, early clinical exposure, and improved correlation between subjects. Barriers included heavy workload, limited opportunities for clinical practice, inconsistent integration across departments, and time management difficulties. Suggestions included increasing clinical exposure, structured case-based sessions, and improved coordination between departments. Conclusion: Medical students perceive VIL positively, particularly for linking theory with practice, enhancing clinical reasoning, and fostering early clinical exposure. Effective implementation, however, requires careful curriculum planning, structured integration, and coordinated departmental support. These insights can inform curriculum development and policy decisions in Pakistan and similar educational contexts.

Evaluation of the educational environment for medical interns at Tertiary Care Hospital in Peshawar, Using the Postgraduate Hospital Educational Environment Measure (PHEEM): A cross-sectional study.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To evaluate the educational environment for interns during their internship rotations and identify strengths and weaknesses across three domains: role of autonomy, teaching and social support, using the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire in Peshawar. Study Design: Cross-sectional study. Setting: Northwest General Hospital and Research Center, Peshawar. Period: July 2025 to December 2025. Setting: Among 204 medical interns at a tertiary care teaching hospital using the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire. Data were collected from all major clinical departments. Reliability was assessed using Cronbach’s alpha. Comparisons were made by gender using an independent samples t-test and across departments using one-way ANOVA. Statistical significance was set at p < 0.05. Results: This PHEEM-based study found that the overall educational environment for house officers at Northwest General Hospital & Research Centre, Peshawar, was perceived as more positive than negative (mean total PHEEM score = 103.81 ± 26.73 out of 160). The highest-rated domain was Perception of Teaching (39.77 ± 11.78), followed by Role Autonomy (36.38 ± 8.92), while Perception of Social Support scored the lowest (27.67 ± 7.42). One-way ANOVA revealed statistically significant differences across departments in total PHEEM score (p = 0.021), Role Autonomy (p = 0.029), and Social Support (p = 0.010), with Medicine Allied and Surgery Allied departments consistently showing the highest scores and Obstetrics & Gynecology recording the lowest. Conclusion: The PHEEM-based study at Northwest General Hospital, Peshawar, revealed an excellent educational environment for medical interns. Surgery and Allied Medicine excelled, while Obstetrics and Gynaecology scored lowest, likely due to high workloads. Minor improvements in workload management and support facilities could further enhance the internship experience.

Clinical and laboratory differences between early- and late-onset systemic sclerosis: A comparative analytical study.

Tue, 01 Sep 2026 00:00:00 -0700

Objective: To compare the clinical and laboratory changes between early- and late-onset systemic sclerosis. Study Design: Comparative Analytical Cross-sectional study. Setting: Fauji Foundation Hospital (FFH), Rawalpindi (RWP). Period: 1^st September, 2025 to February, 2026. Methods: A non-probability consecutive sampling was applied to recruit 100 individuals with confirmed ‘systemic sclerosis’ (SSc). Patients were recruited and categorized as Early Onset SSc (EOSSc) (onset ≤ 40 years) and Late Onset SSc (LOSSc) (onset >50 years). Groups were compared using t-test, chi-square, and fisher's exact test with significance set at p ≤0.05. Results: Mean age was 32.4 ± 5.1 years in EOSSc and 52.7 ± 6.3 years in LOSSc (p < 0.001). EOSSc had more diffuse cutaneous involvement than LOSSc (p < 0.001). EOSSc increased inflammatory markers (p = 0.01; p = 0.002). Anti-Scl-70 was more prevalent in EOSSct (p < 0.001), whereas anti-centromere antibodies were more frequent in LOSSc (p < 0.001). Pulmonary arterial hypertension (p = 0.01), interstitial lung disease (p = 0.04), and renal involvement (p = 0.02) were more frequent in LOSSc. Conclusion: There are clinical and serological patterns that are associated with age at the onset of the disease in SSc. Early onset disease is more diffuse in nature, with skin inflammation, but the late onset disease has increased prevalence of vascular and organ complications.

Ewing’s sarcoma of the sinonasal tract: Case Report.

Tue, 01 Sep 2026 00:00:00 -0700

Ewing sarcoma (ES) is a highly malignant, poorly differentiated neuroectodermal neoplasm that predominantly arises within the medullary cavity of long bones in children and adolescents. Extraosseous Ewing sarcoma (EES) affecting the head and neck region is exceedingly rare, accounting for only 1% to 4% of all cases, with primary sinonasal tract localization representing a severe diagnostic and therapeutic challenge.