Pakistan Journal of Health Sciences

Assessing the Etiology and Pathogenesis of Pyogenic Granuloma in Gingival Tissues

2025-04-03T10:09:20+00:00

Pyogenic granuloma is a benign, rapidly growing vascular lesion commonly found on mucous membranes. Although its demographic distribution is well documented, the specific etiology and pathogenesis of pyogenic granuloma in gingival tissues remain poorly understood. Objectives: To evaluate the etiology and pathogenesis of pyogenic granuloma in gingival tissues. Methods: Databases including PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched from January 2009 to February 2024. Prisma guidelines were followed and 20 studies meeting the criteria were included in the systematic review. Results: These results indicate the significant role of etiological factors such as poor oral hygiene, trauma, local irritation, and hormonal factors in the development of pyogenic granuloma. Patients with pyogenic granuloma showed gingival inflammation, thick bundles of collagen fibers, proliferating endothelial cells, overexpression of vascular molecules and CD4+ cells, and a plethora of neutrophils. Conclusions: It was concluded that pyogenic granuloma in gingival tissues is predominantly associated with local irritants, poor oral hygiene, chronic trauma, and hormonal imbalances. These factors trigger inflammatory responses and vascular proliferation, suggesting that targeted interventions such as enhanced oral care and management of hormonal levels could improve prevention and treatment outcomes for gingival pyogenic granuloma.

The Rise of E-Cigarettes and Vaping: Health Risks and Policy Implications

2025-04-03T10:08:34+00:00

The use of e-cigarettes and vaping devices has increased exponentially in recent years, primarily affecting teenagers and young adults. These products have been widely accepted as safer alternatives to traditional smoking, often marketed as aids for smokers looking to avoid the tar and toxins associated with regular cigarettes. However, despite their popularity, e-cigarettes pose serious health risks, necessitating stronger public policies to mitigate their dangers. The recent surge in vaping, particularly among young people, has raised significant health concerns. According to the 2024 National Youth Tobacco Survey (NYTS) conducted by the CDC, e-cigarette use among youth remains a severe public health threat. The survey found that 5.9% of middle and high school students—equivalent to 1.63 million individuals—reported current use of e-cigarettes in 2024. Alarmingly, 38.4% of these users reported frequent use, while 26.3% reported daily use, indicating signs of nicotine addiction.

Although e-cigarettes are perceived as less harmful than conventional cigarettes, they are not entirely safe. Users are exposed to dangerous substances such as nicotine, heavy metals, and volatile organic compounds. Most e-cigarette products contain nicotine, the primary addictive component, which can lead to dependence. The health risks associated with e-cigarette use include worsening asthma symptoms, increased frequency of bronchitis, and a higher risk of lung infections. Additionally, nicotine raises heart rate, increases blood pressure, and may irritate blood vessels. A particularly concerning issue is E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), which emerged as a serious health condition in 2019. Symptoms of EVALI include cough, difficulty breathing, chest pain, nausea, and fatigue. The rising prevalence of adolescent e-cigarette use underscores the urgency of addressing this public health crisis.

Governments worldwide are taking action to combat the e-cigarette epidemic. For instance, the UK government has introduced legislation to ban the sale of single-use vapes starting June 1, 2025. This initiative aims to reduce environmental impact and curb the growing youth vaping trend. Policymakers must take stronger measures to mitigate the associated health risks. Strict regulations on the marketing and sale of e-cigarettes are essential, as these products often target underage individuals through misleading advertisements. Flavored e-cigarettes, which appeal to younger users, should be banned entirely. Additionally, only adult smokers seeking to quit should have access to e-cigarettes, with stricter age verification measures ensuring compliance. Public health campaigns play a crucial role in educating both young people and adults about the risks of vaping. These initiatives should focus on dispelling the myth that e-cigarettes are risk-free and emphasize the potential for nicotine addiction and long-term health consequences. Raising awareness about the dangers of vaping is vital to preventing the next generation from developing nicotine dependency.

While e-cigarettes may have a place in harm reduction strategies for adult smokers, their widespread use—especially among youth—poses significant public health challenges. A comprehensive approach involving stricter regulations, targeted education, and ongoing research is necessary to mitigate the risks associated with e-cigarette use and prevent a new generation from becoming addicted to nicotine.

Comparison of Lignocaine with Ondansetron for Attenuation of Propofol-Induced Pain in Adult Patients Undergoing Laparoscopic Cholecystectomy

2025-04-03T10:08:40+00:00

Intravenous administration of propofol causes pain that impacts anesthesia procedures. Objective: To compare the efficacy of intravenous Lignocaine and Ondansetron in reducing propofol-induced pain, hemodynamic stability and assess the occurrence of associated adverse effects during induction using a pain scale. Methods: It was a Quasi-Experimental study and conducted for six months from Sep 2024 to Jan 2025 at the Anesthesia department at Islam Medical College, Sialkot. To measure pain effects at laparoscopic cholecystectomy among adult patients. The patients were received 0.5mg/kg Lignocaine through the vein or 8mg Ondansetron before they received propofol treatment. Medical staff evaluated patients' pain levels on a standard scale while recording their vital signs. Data were analysed by SPSS 21.0. The categorical data was analysed through chi-square and evaluated continuous values with an independent t-test at a significance level of 0.05. Results: Lignocaine brought better pain relief from propofol than Ondansetron at a statistical significance of p < 0.001. People in the Lignocaine group reported 15% of bad pain while 32% of patients in the Ondansetron group felt the same pain level. Ondansetron caused short-lived drops in blood pressure and heart rate but the application of Lignocaine generated mild skin issues. Conclusions: The study proved Lignocaine worked better than Ondansetron at stopping propofol pain effects. Despite its merits Ondansetron still serves as a good treatment option and medical staff should monitor heart-related side effects. Additional medical trials must test the effectiveness of using both drugs together as a pain treatment option.

Biochemical Profiles and Clinical Correlates of Hyperkalemia and Metabolic Acidosis in Acute Kidney Injury Patients: A Cross-Sectional Analysis

2025-04-03T10:09:03+00:00

Acute Kidney Injury (AKI) is often complicated by biochemical disturbances, including hyperkalemia and metabolic acidosis. Objective: To examine the biochemical profiles and clinical consequences of hyperkalemia and metabolic acidosis in patients with AKI, with the goal of identifying correlations and prognostic markers to improve management strategies. Methods: The study analyzed 130 geriatric AKI patients with hyperkalemia and metabolic acidosis, assessing clinical outcomes through multivariable regression. Results: In 130 AKI patients with hyperkalemia and metabolic acidosis (mean age: 68.5 ± 10.2 years, 60% males), hypertension (45%) was the most common comorbidity. ICU admission was required in 25%, with an average hospital stay of 8.4 ± 4.5 days. Biochemical markers showed elevated serum potassium (6.2 ± 0.8 mEq/L), creatinine (3.5 ± 1.2 mg/dL), and reduced bicarbonate (18.5 ± 3.5 mEq/L). Serum creatinine (r = 0.80) and potassium (r = 0.67) correlated strongly with dialysis need, while lower blood pH (r = -0.50) was linked to ICU admission. Multivariable analysis identified serum creatinine (OR = 3.00, p < 0.001) as the strongest predictor of severe hyperkalemia and acidosis, with hypertension (OR = 2.15, p = 0.015) and advancing age (OR = 1.05, p = 0.003) also increasing risk. Conclusions: Hyperkalemia, metabolic acidosis, and elevated serum creatinine in acute kidney injury patients are strongly linked to worse outcomes, highlighting the need for early intervention.

Attitude Towards Tele-Medicine Among Caregivers of Pediatric Patients

2025-04-03T10:09:18+00:00

Telemedicine is a vital constituent of digital health-care, particularly stating the deliverance of medical facilities over remote areas by means of Information and Communication Technologies (ICT). The swift progress of mobile applications has improved support for health-care experts, rationalization responsibilities such as time organization, communication, and policymaking. Objective: To assess attitudes of parents having children aged between one to twelve years towards telemedicine. Methods: The cross-sectional study employed an online survey with the sampling strategy as convenience method for recruitment of eligible parents. A self-administered questionnaire was employed to gather sociodemographic data, child-related information, and participants' technological profiles. Attitudes toward telemedicine were measured using a 5-point scale, evaluating the perceived usefulness of various telemedicine services and associated advantages. Data analysis included descriptive statistics to summarize sociodemographic variables and item prevalence, while excluding any missing values. Results: A total of 120 families participated in the study, with caregivers averaging 47.4 years in males, 43.1 in females and children 7.5 years old. The majority of caregivers were female (68.3%), and most children were male (53.3%). Technological profiles indicated high smartphone availability (93.3%) and moderate use of social media accounts. Attitudes toward telemedicine showed significant perceived usefulness, particularly for scheduling medical visits (54.1% rated it as moderate/much) and telemonitoring services (49.1%). Participants recognized advantages of telemedicine, highlighting time efficiency (44.1%) and financial savings (46.6%) as key benefits. Conclusion: Families of pediatric patients demonstrated a strong willingness to engage in telemedicine programs. They showed positive attitude towards usefulness of telemedicine.

The Correlation between Glycemic Control and Microvascular Complications in Type 1 Diabetes Mellitus Patients

2025-04-03T10:09:09+00:00

Type 1 Diabetes Mellitus (T1DM) is a chronic condition that destroys pancreatic beta cells, leading to persistent hyperglycemia. Prolonged high levels resulted in an increased risk of microvascular complications. Glycemic control, indicated by HbA1c, plays a critical role in reducing these risks. Objective: To examine the strength of the relationship between HbA1c levels and the severity of microvascular complications in individuals with T1DM. Methods: A cross-sectional study was conducted on 30 patients with T1DM at Liaquat University Hospital, Hyderabad, from December 2024 to February 2025. HbA1c levels were recorded, and microvascular complications were evaluated using KDIGO criteria for nephropathy, ETDRS for retinopathy, and TCNS for neuropathy. Data were analyzed using descriptive statistics and inferential methods, including Spearman’s correlation and linear regression, through SPSS version 22.0. Results: The average age of participants was 24.23 ± 3.45 years, with a mean HbA1c level of 7.65 ± 1.15%. Retinopathy was the most frequent complication (73.3%), followed by neuropathy (63.3%) and nephropathy (40%). Combined complications were present in 40% of cases. HbA1c levels were significantly correlated with the severity of all microvascular complications, showing positive associations with KDIGO (r=0.839), ETDRS (r=0.864), and TCNS (r=0.870). HbA1c values also progressively increased with complication severity (p<0.001). Conclusions: It was concluded that poor glycemic control was strongly associated with the presence and severity of microvascular complications in T1DM patients. These findings highlight the importance of maintaining optimal HbA1c levels to mitigate complications. Further longitudinal studies are warranted to explore these associations in greater depth.

Assessment of Periodontal Health in Patients with Alzheimer's disease in Karachi, Pakistan

2025-04-03T10:08:57+00:00

Alzheimer's disease (AD), causes permanent loss of neurons and neural connections. Objective: To assess the periodontal health status of Alzheimer's disease (AD) patients by assessing plaque index, gingival condition, probing pocket depth, attachment levels, and bleeding on probing, and to correlate these findings with cognitive impairment levels as determined by Mini-Mental State Examination (MMSE) scores. Methods: A cross-sectional study, was conducted at Medicare Hospital between July and October 2024. Total 60 patients were recruited in the study. Hence plaque index, gingival condition, probing depth, attachment levels, and bleeding on probing were used to assess periodontal health, whereas MMSE scores were used to classify cognitive impairment. For statistical analysis, ANOVA and unpaired t-test analyses are carried out using SPSS version 24.0. All of the findings were deemed statistically significant if P was less than 0.05. Results: The study results revealed that the demographic and neurological parameters such as age, the distribution of genders, and the number of teeth of those patients suffering from Alzheimer’s disease. Hence, MMSE scores were significantly lower, indicating substantial cognitive impairment (P < 0.001). As the severity of AD increases, there is a trend for all recorded variables to get worse (p < 0.01). PPD and CAL reveal more periodontal tissue loss in patients with severe AD, while PI and GI show more plaque accumulation and gingival inflammation. Conclusions: This study highlighted a strong link between worsening periodontal health and Alzheimer's severity, emphasizing the need for proactive dental care to improve patient well-being.

Effects of the COVID-19 Pandemic on Treatment Outcomes of Drug-Resistant Tuberculosis Patients in Twin Cities of Pakistan

2025-04-03T10:09:15+00:00

Pakistan is the world's fifth-highest Drug-Resistant Tuberculosis burden region. However, it is difficult to evaluate the setback of COVID-19 when concurrent tuberculosis is excluded in patients from Pakistan, where the national burden of tuberculosis and drug-resistant tuberculosis is substantial and rising despite management efforts. The COVID-19 pandemic is prevalent in countries where tuberculosis, notably drug-resistant tuberculosis is high. Objectives: To compare the pre and para-pandemic favourable and unfavorable outcomes of drug-resistant tuberculosis treatment in PMDT Units of Islamabad and Rawalpindi. Methods: A retrospective cross-sectional study was conducted. The study included Pre and Para-COVID-era drug-resistant tuberculosis patients (n=670) in three sites of Rawalpindi and Islamabad from 2016-2021. A non-probability consecutive sampling technique was applied. A validated structured questionnaire was administered to compare the treatment outcomes of drug-resistant tuberculosis patients. Results: Results show that pre-COVID n=240 (35.82%) and Para-Covid era drug-resistant tuberculosis patients n=226 (33.73%) had favourable treatment outcomes. Unfavorable outcomes before and during the pandemic were 128 (18.35%) and 82 (12.2%) respectively. COVID-19 has affected drug-resistant tuberculosis treatment outcomes, both favourable and unfavorable, which are far behind the treatment success targets set by WHO End-tuberculosis. Conclusions: It was concluded that this study compared drug-resistant tuberculosis treatment outcomes pre- and post-COVID-19, showing success rates surpassing WHO-End tuberculosis targets. Key factors included residential status, gender, and occupation.

Effect of Maternal Nutrition and Micronutrient Supplementation on Neonatal Birth Weight and Health

2025-04-03T10:08:38+00:00

Maternal nutrition significantly influences fetal growth, birth weight, and neonatal health. Deficiencies in iron, calcium, folic acid, and vitamin D increase the risks of preterm birth, low birth weight, and neonatal complications. Objective: To assess the impact of maternal micronutrient supplementation on neonatal birth weight and health outcomes. Methods: A quasi experimental study was conducted at Health Net Hospital, Peshawar. A total of 110 pregnant women were recruited (59 supplemented, 51 non-supplemented). Data on maternal dietary intake, weight gain, and micronutrient consumption were collected. Neonatal birth weight, gestational age, NICU admissions, and morbidity were recorded. Statistical analysis was performed using SPSS version 25.0, with independent t-tests and chi-square tests (p<0.05 considered significant). Results: Neonates in the supplemented group had significantly higher birth weights (3343.54 ± 407.90 g vs. 2825.63 ± 322.46 g, p<0.001). NICU admissions were lower in the supplemented group (6.8% vs. 43.1%, p<0.001). Neonatal morbidity, including infections, jaundice, and respiratory distress, was significantly lower in the supplemented group (p<0.001). Conclusions: Micronutrient supplementation during pregnancy improves neonatal birth weight and reduces neonatal morbidity. These findings highlight the need for targeted maternal nutrition strategies to improve neonatal outcomes, particularly in resource-limited settings.

Assessment of Changes in Corneal Endothelial Characteristics in Primary Open-Angle Glaucoma

2025-04-03T10:08:48+00:00

Patients with glaucoma undergo significant changes in corneal endothelial characteristics due to chronically elevated Intraocular pressure (IOP). Objectives: To compare endothelial cell density between primary open-angle glaucoma (POAG) patients and age-matched non-glaucomatous controls. Also to explore the relationship between endothelial cell density and Intraocular pressure. Methods: This case-control study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. It included 41 eyes of patients with POAG aged between 35-70 years and 41 eyes of age-matched non-glaucomatous subjects were taken as controls. The POAG was diagnosed based on Intraocular pressure, optic disc changes, and visual field defects. All participants went through a comprehensive ocular evaluation, that included slit-lamp examination, gonioscopy and Intraocular pressure assessment. The endothelial cell density was assessed via specular microscopy. SPSS version 26.0 was utilized to perform statistical analysis. Results: The average corneal endothelial cell density in healthy control subjects was 2484.51 ± 286.44 cells/mm², but those with POAG showed a statistically significant decline, measuring 2345 ± 270.29 cells/mm² (p=0.02). A notable decrease in endothelial cell density was seen in patients using dorzolamide 2262.00 ± 287.15 relative to patients not using dorzolamide 2451.28 ± 209.56 (0=0.02). Endothelial cell density and the average Intraocular pressure revealed a weak inverse correlation (r= -0.204, p=0.06). Conclusions: It was concluded that POAG patients show reduced corneal endothelial cell density. It also suggests that endothelial cell density declines with higher Intraocular pressure and increased disease severity, making it a possible biomarker of disease progression in POAG.

Outcome of Low Molecular Weight Heparin Use in Pregnant Women with Oligohydramnios at A Tertiary Care Hospital

2025-04-03T10:08:46+00:00

Oligohydramnios refers to an antenatal condition in which the amniotic fluid volume is abnormally low and has poor fetal consequences. This research strives to elaborate on the convoluted connections between oligohydramnios and the associated maternal and fetal risks. Objectives: To find out the frequency of pregnancy outcomes in pregnant women with oligohydramnios using low molecular weight heparin (LMWH). Methods: The prospective cohort study was conducted at the Obstetrics Department of Nishtar Hospital, Pakistan from November 2024 to January 2025. One hundred and twenty-two women fulfilling the inclusion criteria were included. Patients were given 40 mg LMWH subcutaneously once a day. The patients were followed till delivery to determine outcomes including live birth, preterm delivery, weight at birth, admission to the Neonatal Intensive Care Unit (NICU) and pre-eclampsia. SPSS version 26.0 was employed to analyze the data. Results: Out of 122 participants, 120 (98.4%) resulted in live births while 2 (1.6%) were intra-uterine deaths. Among all births, 21 (17.2%) were delivered preterm while 101 (82.8%) were delivered at term. 108 (88.5) weighed >2.5 kg. Among 120 live births, 23 (19.2%) were admitted to the NICU for observation or treatment. Conclusions: It was concluded that the study results support the use of LMWH in oligohydramnios as a proportion of adverse perinatal outcomes was low in our study. LMWH was found to be efficacious, authentic and safe in oligohydramnios to achieve desired clinical outcomes and decrease the burden of associated morbidities and mortalities in the targeted population.

Competency-Based Medical Education: An Analysis of Implementation Challenges in Resource-Limited Settings

2025-04-03T10:08:44+00:00

Competency-Based Medical Education (CBME) employs a systematic outcome-based strategy to enhance the practical and clinical competencies of the graduates. CBME faces challenges particularly in low-resource areas due to differences in faculty and institutional support, as well as institutional and learning resource availability. Objective: To determine the conditions that affect CBME readiness among academic staff and to determine what may obstruct its effective execution. Methods: A cross-sectional study was completed over 6 years (September 2024 - January 2025) with a total of 110 faculty members. The participants were divided into 2 groups using a validated assessment tool aimed at targeted differences in CBME readiness. Subjects filled out questionnaires which were analyzed through chi-squar and independent t-tests. Results: The factors affecting readiness towards CBME age, faculty experience, and student-patient ratios were not significant. Access to digital resources, government funding, and institutional support were significantly associated with higher levels of readiness. Faculty who participated in the simulation-based training and the competency evaluation showed higher levels of readiness for CBME. The training of faculty members did not impact the level of readiness to any significant degree, which points to the necessity of continuous mentoring and practical work. Conclusions: For the adoption of CBME, institutional support, the presence of digital tools, and access to competency-based evaluations are essential. All three of these factors can enhance faculty’s willingness to participate and subsequently improve the effectiveness of medical education. Investing in structured faculty training and technological resources will help a smoother transition to CBME

Frequency of Low Birth Weight Neonates in Mothers with Low Serum Ferritin Levels

2025-04-03T10:09:01+00:00

Birthweight significantly influences health throughout life, but the connection between maternal serum ferritin levels during pregnancy and the newborn’s birthweight is still a topic of debate. Objective: To investigate the prevalence of underweight infants born to the mothers with low blood ferritin concentrations at term delivery. Methods: A descriptive cross-sectional study was conducted for a period of six months from November 2019 to April 2020. A total of 151 participants with reduced serum ferritin concentrations at full-term delivery were included in this study. Demographic details were taken including blood sample for serum hemoglobin and ferritin levels were checked and noted in a questionnaire. Data stratification was performed to eliminate other effect modifiers and to statistically test the significance of low birth weight of neonates in mother with low serum ferritin levels, with the help of chi-square test. Results: The typical age of the patients was 25.50 ± 4.08 years. Incidence of Low Birth Weight newborn in mother with reduced serum ferritin levels at term delivery was observed in 33.11% (50/151). Conclusions: Low birth weight, a prevalent issue in Pakistan, is a significant contributor to perinatal morbidity and mortality. Correction of anemia, consuming a diet with a proper nutrient balance and accessing maternal care during pregnancy are anticipated to decrease the incidence of underweight infants and lower perinatal death rate. This study suggests that mothers should receive counselling on prevention of teenage marriages and pregnancies, maintaining a birth interval of 3 years, iron supplementation during pregnancy and avoiding consanguineous marriages.

Association between Temporomandibular Joint dysfunction and Stress in Undergraduate BDS Students of Rawalpindi/Islamabad

2025-04-03T10:09:11+00:00

Temporomandibular Joint Dysfunction (TMJD) is a condition linked with psychological factors like stress. Dental students experience high academic stress which makes them an ideal candidate to investigate the relationship between TMJD and stress. Objective: To investigate the association between TMJD and stress in undergraduate BDS students in Rawalpindi and Islamabad. Methods: A cross-sectional study was conducted among 346 BDS students using convenience sampling. Participants completed structured questionnaires, including Fonseca's Anamnestic Index for TMJD and the Perceived Stress Scale. Data analysis was performed using SPSS version 21.0, employing chi-square tests for categorical data and correlation analysis for continuous variables. he study was conducted in two dental institutes namely Margalla Institute of Health Sciences and Foundation University College of Dentistry and Hospital. Results: Out of 346 participants, 264 (76.30%) were females and 82 (23.70%) were males, with a mean age of approximately 20.7 years. The result of the chi-square test for the association between gender and TMJD was a statistically significant relationship (p = 0.00033), with females showing higher rates of mild and moderate TMJD compared to males, whereas the chi-square test for the association between the year of study and TMJD also indicated a significant relationship (p = 0.023). Conclusions: This study found a significant association between stress and Temporomandibular Joint Dysfunction (TMJD) among undergraduate BDS students.

Incidence and Causes of Early Hospital Readmissions after Cardiac Surgery. One Year Experience at Tertiary Care Hospital, Multan

2025-04-03T10:09:07+00:00

The increased costs, morbidity, and mortality associated with readmissions after cardiac surgery pose a substantial issue for the healthcare system. Objective: To observe the incidence, causes, and outcome of hospital readmissions within two months of discharge after cardiac surgery. Methods: An observational descriptive cohort study was conducted at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan. From September 2023 to August 2024, 1406 patients undergoing cardiac surgery were observed for readmission in the hospital within two months after discharge. Patients who were operated at other facility and those who admitted after 2month were excluded from the study. Perioperative data, reasons for readmission, and outcomes were recorded and analyzed using SPSS version 25.0. Descriptive statistics were applied to continuous and categorical variables. Results: The incidence rate of readmission was 7.5% (n=106). 85.8% readmissions occurred within 30 days after discharge. Common causes of readmission were anticoagulation-related issues (23.6%), wound infections (21.7%), pleural effusion (15.1%), pericardial effusion (9.4%), and sternal dehiscence (6.6%). Surgical intervention was required in 35.8% of readmitted patients. The mean length of readmission hospital stay was 4 ± 2.80 days. Mortality in readmitted patients was 4.7% (n=5). Conclusions: Nearly every 13^th patient needs hospital readmission. Early hospital readmission is most common in patients who needs anticoagulation after valve replacement surgery. Early readmission after cardiac surgery, adversely impacts patient outcomes. Improved anticoagulation management, infection control, and postoperative diuretics, are critical for reducing incidence of hospital readmission

Breast Lump Patterns Across Different Age Groups Among Female Patients Presenting to Surgical Outpatient Department of a Tertiary Care Hospital in District Malir Karachi

2025-04-03T10:08:53+00:00

The number of patients presenting with different types of breast lumps has been on the rise in the Malir district. Many females are being diagnosed with breast cancer. Objectives: To determine the pattern of breast lumps in different age groups in the outpatient department of Al-Tibri Medical College hospital in District Malir, Karachi. Methods: It was a descriptive cross-sectional study conducted at the Department of General Surgery, Al-Tibri Medical College Hospital, Karachi, from 1st November 2022 to 31^st October 2024. Patients presenting in the Surgical Outpatient Department with breast lumps were included in the study. Age at presentation, symptoms, clinical features, investigations, biopsy reports, and operation notes (if operated) were recorded and submitted for analysis. Results: The commonest lesions were fibro-adenoma (33.6%), inclusion cyst of the breast (19%), and breast abscess (18.5%), followed by Carcinoma breast (17.7%). 51.7 % of cases were associated with pain. Among carcinomas, 43% presented with pain. The highest peak of presenting with malignant lesions was from 39 to 43 years, and 2^nd peak was from 49 to 58 years. Most benign lesions presented between 24 to 28 years. The chi-square test showed a strong association between age range and pain (p-value<0.001), age range and type of lump (p-value <0.001), and marital status and type of lump (p-value<0.001). Conclusions: It was concluded that fibro-adenoma is the most common breast disease. Inflammatory lesions are also present frequently in the reproductive age group. Carcinoma breast presented in middle and later age groups, predominantly in married females in our district.

Diagnostic Accuracy of Optical Coherence Tomography to Detect Cystoid Macular Edema (CME) In Patients with Diabetes Mellitus (DM) Taking Fundus Fluorescein Angiography (FFA) As Gold Standard

2025-04-03T10:09:14+00:00

Macular thickening, known as Cystoid Macular Edema (CME), is brought on by fluid buildup in the inner nuclear and outer plexiform layers of the retina as a result of leaking from peri-foveal retinal capillaries. Objective: To determine the OCT's ability to identify cystoid macular edema in individuals with diabetes mellitus, compared to the gold standard of fundus fluorescein angiography. Methods: The Lahore General Hospital's Ophthalmology Outpatient Clinic served as the study's setting. From the Outpatient Department, 143 patients who met the inclusion criteria were randomly selected. Informed consent was obtained from patients before imaging. An indirect biomicroscope was used to evaluate all of the subjects. After completing fundus fluorescein angiography and optical coherence tomography, was diagnosed with cystoid macular edema according to the standardized criteria. A data collection proforma was developed. IBM SPSS version 25.0 was used to analyze the data. Results: In this study, 76 males (53.1%) and 67 females (46.9%) participated. The average age was 47.7 ± 10.3 years and diabetes duration was 5.4 ± 2.9 years. Optical Coherence Tomography (OCT) showed a sensitivity of 88.3%, specificity of 38.5%, PPV of 93.3%, NPV of 25.0%, and an overall accuracy of 84.6% compared to Fluorescein Angiography (FFA) in detecting cystoid macular edema. Conclusions: Diagnosing DME with OCT and FFA is very successful, it ensures early detection and treatment. For Diabetic Mellitus (DM) patients to avoid eyesight loss, accurate and easily accessible diagnostic strategies are essential.

Serum Bicarbonate Changes Among Patients on Thrice Weekly Maintenance Hemodialysis (HD): A Single-Center Study

2025-04-03T10:08:42+00:00

Metabolic acidosis in hemodialysis significantly affects morbidity and mortality. Understanding bicarbonate fluctuations is key to optimizing supplementation and dialysis protocols. Objectives: To determine the inter-dialytic and intra-dialytic changes in serum bicarbonate level among patients undergoing maintenance hemodialysis. Methods: This quasi-experimental study was conducted at the Nephrology Department, Fatima Jinnah Medical University (FJMU)/Sir Ganga Ram Hospital, Lahore, after taking synopsis approval from the CPSP from August 2024 to January 2025. After taking consent, 60 patients on maintenance haemodialysis thrice weekly who met the selection criteria were enrolled. Inter-dialytic and intra-dialytic changes in serum bicarbonate levels were determined. Data were analyzed using SPSS version 26.0. Numerical values were presented as mean ± SD, and continuous variables were analysed using frequency and percentages. Inter-dialytic and intra-dialytic changes in bicarbonate levels were compared using a paired t-test; p≤0.05 was taken as significant. Results: Pre-hemodialysis mean bicarbonate level was 18.65 ± 1.11 mEq/L, increased to 22.18 ± 0.85 mEq/L post-hemodialysis, and by the next hemodialysis session, the mean pre-HD bicarbonate level reduced to 18.78 ± 1.02 mEq/L. Intra-dialytic change showed a mean increase of 3.53 ± 1.19 mEq/L, p-value<0.001 and inter-dialytic change demonstrated a decrease of 3.40 ± 1.18 mEq/L, p-value<0.001. Conclusions: It was concluded that hemodialysis temporarily raises bicarbonate levels, but they drop before the next session, highlighting the need for optimized supplementation or dialysis adjustments to maintain stability.

Polycystic Ovary Syndrome (PCOS): A Biochemical and Physiological Perspective on a Common Gynaecological Disorder in a Local Hospital of Peshawar

2025-04-03T10:08:36+00:00

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive and metabolic health. It is characterized by hormonal imbalances, insulin resistance, dyslipidemia, and chronic inflammation, increasing long-term health risks. Objective: To compare biochemical, metabolic, and ultrasound markers in women with and without PCOS. Methods: A comparative cross-sectional study was conducted at Health Net Hospital, Peshawar, over six months. In total, 110 participants were recruited and divided equally into 2 groups, with each group considered as PCOS (n=55) and Non-PCOS (n=55). PCOS was diagnosed using the Rotterdam Criteria. Hormonal, metabolic, and inflammatory markers, including luteinizing hormone, Follicle-Stimulating Hormone, testosterone, Dehydroepiandrosterone Sulphate, Anti-Müllerian Hormone, fasting glucose, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), lipid profile, C-reactive protein, Malondialdehyde, and Total Antioxidant Capacity (TAC), were analyzed. Ultrasound findings assessed ovarian morphology, endometrial thickness, and stromal resistance index. Data were analyzed using SPSS. Results: PCOS patients had significantly higher BMI, insulin resistance, and androgen levels. Luteinizing hormone/Follicle-Stimulating Hormone ratio and Anti-Müllerian Hormone were elevated, while Follicle-Stimulating Hormone was lower. Metabolic markers showed increased fasting glucose, HOMA-IR, and dyslipidaemia, with higher LDL and triglycerides and lower HDL. Inflammatory and oxidative stress markers (C-reactive protein, Malondialdehyde) were significantly elevated, while TAC was reduced. Ultrasound findings showed increased endometrial thickness and ovarian stromal resistance in PCOS. Conclusions: It was concluded that PCOS is associated with significant hormonal, metabolic, and inflammatory disturbances. Elevated androgens, insulin resistance, and oxidative stress highlight the need for early screening and a multidisciplinary approach for Effective Management.

The Role of 8% Branched Amino Acids (BCAA) in Patients with Hepatic Encephalopathy

2025-04-03T10:08:55+00:00

Hepatic Encephalopathy (HE) is a neuropsychiatric disorder caused by liver dysfunction, commonly seen in cirrhosis or acute liver failure. Objective: To address the safety and efficacy of branched-chain amino acids (BCAA) solution in patients with HE. Methods: This retrospective study was performed at the Sheikh Khalifa Bin Zayed Al Nahyan Hospital, CMH Rawalakot, Azad Kashmir, Pakistan. Data from patients fulfilling the eligibility criteria during the study span from February 2022 to August 2024 were analyzed. The inclusion criteria were adults aged 18-70 years, diagnosed cases of cirrhosis of the liver, and admitted with HE. The BCCA group was given 8% BCCA solution administered through intravenous (IV) transfusion. Patients receiving any other treatments were categorized as conventional treatment. Psychometric hepatic encephalopathy score (PHES), serum ammonia levels, duration of hospitalization, treatment-related adverse events, and mortality were documented. Results: 467 patients were analyzed, the median age was 54.00 (48.00-63.00) years, and 280 (60.0%) were male. 315 (67.5%) received IV BCAA, while the remaining 152 (32.5%) received conventional therapy. Patients in the BCAA group showed a significant improvement in PHES scores, (-2.1 ± 1.9 vs. -4.6 ± 2.2, p=<0.001), reduction in serum ammonia levels (45.3 ± 8.1 vs. 56.2 ± 10.8 µmol/L, p<0.001), mean duration of hospitalization (8.9 ± 3.7 vs. 10.1 ± 4.5 days, p=0.002), and mortality (3.8% vs. 9.2%, p<0.001). In the BCAA group, 8 (2.2%) patients experienced mild gastrointestinal discomfort, and 4 (1.3%) patients reported transient dizziness.Conclusions: Intravenous 8% BCAA solution effectively enhances cognitive function, lowers serum ammonia, shortens hospitalization, and reduces mortality in hepatic encephalopathy patients.

Association of Personality Traits and Future Specialty Preference among MBBS Students

2025-04-03T10:08:50+00:00

Different personality traits may have a significant impact on medical students’ choices on future selection of their future specialty selection. Objectives: To determine the most common personality traits among medical students. Also, to establish if there is any association between traits and future specialty preference. Methods: An analytical cross-sectional study was conducted from June 2024 to December 2024. A validated questionnaire was used and distributed through social media platforms, and quota non-purposive sampling was done. The Big Five Inventory (BFI) was used for personality traits assessment. For demographics and specialty choice, frequencies and percentages were calculated. The chi-square test was used to assess the association between gender and choice of specialty. Analysis of variance (ANOVA) was employed to assess the mean comparisons of personality traits with specialty preferences. Post hoc, a Tukey HSD test was done to determine the statistical significance of the association between specialty selection and personality traits. p-value < 0.05 was taken as significant. Results: Between gender and specialty selection, a significant association was seen (p=0.033). The personality profiles of medical students showed a higher Mean + SD in the agreeableness profile (3.77 + 0.52). Significant associations with agreeableness and openness traits (p=0.05) were seen with the specialty chosen. Conclusions: The findings offered important perspectives on the relationship between personality traits and specialty selection among medical students. Future studies should build on these ideas, looking into various dynamic influences that affect specialty choice and the significance of personality traits in this regard

Evaluating the Incidence of Co-Existing Injuries in Anterior Talofibular Ligament Injuries a Magnetic Resonance Imaging Study

2025-04-03T10:09:05+00:00

Ankle lateral ligament injuries are common in everyday life as well as in athletic activities. Ankle injuries most commonly affect the anterior talofibular ligament (ATFL). Due to ATFL's susceptibility, achieving intelligent localization and injury evaluation is extremely important from a clinical standpoint. Objectives: To evaluate the incidence and patterns of co-existing injuries in ATFL damage using Magnetic Resonance Imaging (MRI). Methods: In this cross-sectional study, fifty-five patients undergoing surgical management for ATFL injuries were included. Preoperative MRIs of affected ankles were analyzed to document ATFL integrity and associated injuries. Descriptive statistics were used to summarize findings, with categorical variables reported as frequencies and percentages and continuous variables as means ± SD. Results: The mean age of the patients was 36.8 ± 12.4 years, with 61.8% male and 38.2% female. Associated injuries were observed in 72.7% of patients. ATFL injuries included 30.9% low-grade incomplete, 21.8% high-grade incomplete, and 14.5% complete tears. calcaneofibular ligament (CFL) injuries were common, with 36.4% showing partial tears, and 3.6% complete tears. The deep deltoid ligament was intact in 56.4%, while 43.6% had injuries. The superficial deltoid ligament was intact in 70.9%. The peroneal tendon was intact in 83.6%, with 5.5% having injuries and 10.9% showing tendinosis. Osteochondral Defects (OCDs) were present in 21.8% of cases. Conclusions: It was concluded that ATFL injuries frequently occur with damage to other structures, particularly the CFL and deltoid ligaments. MRI facilitates accurate diagnosis, emphasizing the need for comprehensive assessment and concurrent management of associated injuries during ATFL repair.

Increased First Trimester Serum Uric Acid as A Predictor of Gestational Diabetes Mellitus

2025-04-04T11:01:23+00:00

The gestational period of diabetes type 2 (GDM) is a serious condition that can harm both mothers and newborns throughout pregnancy. Objective: To determine if elevated first-trimester serum uric acid levels lead to gestational diabetes mellitus onset during pregnancy. Methods: A comparative cross-sectional study was conducted between November 2023 and April 2024 at Niazi Medical and Dental College in Sargodha. The study sample consisted of 139 pregnant women separated into two groups: those exhibiting and those absent diabetes in women. The researchers employed independent t-test and Chi-square statistical methods to evaluate age and BMI data, as well as diabetes familial histories and delivery history. Results: Gestational diabetes mellitus patients had higher serum uric acid levels compared to pregnant women without Gestational diabetes mellitus (p<0.001). This study found that uric acid levels above 4.5 mg/dL increased the likelihood of abnormal fasting glucose values by 74.5% (p<0.001). Women with high uric acid levels had a 40% higher risk of developing Gestational diabetes mellitus (OR: 1.40; 95% CI: 1.10-1.80; p=0.02). Conclusions: It was concluded that women who have gestational diabetes mellitus display increased serum uric acid concentrations during their first trimester. Monitoring serum uric acid levels presents an opportunity to detect susceptible pregnant women with gestational diabetes in the early stages, allowing for quick implementation of preventive measures that promote maternal and fetal health.

Frequency of Urinary Incontinence and Its Risk Factors in Patients Attending Gynae Outpatient Department (OPD) of Lady Reading Hospital (LRH) Peshawar, Pakistan

2025-04-04T11:01:25+00:00

Urinary incontinence (UI) is an important health issue acknowledged by the World Health Organization (WHO) that adversely affects the quality of life. Objectives: To find out the occurrence of UI in female presenting to the Gynaecology Out-Patient Department of Lady Reading Hospital and also to find out the frequencies of its risk features for urinary incontinence in women presenting with UI. Methods: A descriptive cross-sectional design was used to conduct this study. The sample consisted of 163 women who presented to the Gynaecology Out-Patient Department of Lady Reading Hospital for any complaints were included in the study. Results: UI was observed in 15.3% of patients. Moreover, Stress UI was 48%, followed by overflow UI 24%, urge UI 20%, and mixed UI 8%. The leading factors for UI consisted of 3.75% more than three normal vaginal deliveries, 24% chronic cough, 12% history of gynaecological operation, 80% Illiterate, and 56% lower urinary tract infection (LUTI). Conclusions: It was concluded that based on the findings of the current study, UI is 15.3% prevalent in Pakistan which is comparable to that of other Asian nations. Furthermore, normal vaginal delivery more than three times and UTI may develop the key risk issues for the development of UI. The magnitude of UI problems may impact on daily lives and habits of the patients.