Pakistan Journal of Health Sciences

Freezing Threats: The Health Implications of Extreme Cold Weather in Pakistan

Ayesha Humayun — 2026-01-31

Pakistan is a diverse country in terms of climate; however, some of the most extreme cold in Pakistan can be witnessed in the northern areas, such as Hunza, Skardu, Ashkomen Valley, and a section of Baltistan. During January and February, the climate in these regions can be as low as -100 °C, and glaciers like Siachin, Passu, Batura, and Baltoro make sure that the environment is as cold as it can be throughout the entire year. Cold weather is also a natural characteristic of such areas, but it presents significant health issues to the population, both physical and mental [1-3].

Extreme cold has the most direct effect on the health of human beings, especially those who are the most vulnerable. Low temperatures may cause hypothermia, which is a life-threatening condition in which the body is unable to generate heat at a rate faster than it loses it. In northern Pakistan, frostbite is also typical of hands, feet, ears, and the nose, causing tissue damage and amputation in severe cases. Specifically, children, the elderly, and individuals with chronic illnesses are more prone to it because their bodies cannot better control temperature. Unfortunately, not all houses in remote northern parts have proper heating, insulation, and proper clothes that would help people to prevent cold-related diseases [1-4].

There is also a surge of respiratory problems during winter. The cold air irritates the respiratory system, weakens immunity, and thus, makes individuals more susceptible to diseases like influenza, bronchitis, and pneumonia. The frequency of chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), also deteriorates during colder seasons as a result of indoor air pollution caused by the burning of wood, coal, or kerosene to heat the home. These indoor fuels emit toxic smoke, further complicating respiratory distress and leading to more and more hospital admissions [3, 4].

Cardiovascular health is also influenced by cold weather. Low temperatures make blood vessels narrow, resulting in a rise in blood pressure and heart rate. This increases the chances of heart attacks and strokes, especially among the aged. Research has revealed that there is a seasonal trend in mortality whereby more mortality is registered in winter months owing to cardiac-related complications. Unanticipated cold waves in cities where individuals might be exposed to cold air following the indoor heating also led to cardiovascular crises [5].

The other critical health issue is the increase in winter injuries. Falls and fractures are more likely in the northern areas where roads are slippery and icy. Only inaccessible emergency services in the mountains can postpone the treatment, which deteriorates results. Moreover, cold weather in most cases compels individuals to be at home in a congested area, thus contributing to the transmission of communicable diseases, including tuberculosis, influenza, and even COVID-19 [6].

Mental health is another area impacted by prolonged cold. Reduced daylight hours and extended indoor time may cause seasonal affective disorder (SAD) and depression and anxiety, especially in susceptible groups. Social isolation in remote areas during the winter season increases these mental health issues, and it is highly important to offer community support and mental health services [7].

Cold health impacts in Pakistan should be prevented. Heating homes and other public shelters, supplying warm clothes and blankets, and educating people on how to take care of themselves on winter days can save lives. Influenza and pneumonia vaccines are to be given priority, particularly to the high-risk groups. Avoidable deaths can be prevented through better access to healthcare in remote northern regions, as well as the emergency response system in severe cold waves. Health risks caused during winter seasons can be further mitigated by fortifying nutrition and educating people regarding healthy indoor heating habits.

Cold weather in Pakistan is not merely a state of the environment, but it is a major issue of public health. Hypothermia and frostbite are not the only consequences of winter on human health, since respiratory and cardiovascular issues can also be significant, especially in the highlands of the north. The solution to these problems is a complex intervention of health, community awareness, and governmental assistance to make sure that the cold is not a threat to death. Focusing on winter health strategies, Pakistan will be able to secure the most vulnerable groups and minimize the impact of cold-related diseases.

Best Practices in Leadership Training in Undergraduate Medical Education: A Systematic Review of Studies Published Between 2017–2024

Marina Khan — 2026-01-31

Leadership is increasingly recognized as a core professional competency in undergraduate medical education, yet existing training remains inconsistent in structure and depth. Recent studies show considerable variation in how leadership is taught and evaluated, making it difficult for medical schools to define effective educational strategies. Objectives: To synthesize contemporary evidence on teaching methods, curricular structures, and reported outcomes of leadership training for undergraduate medical students (2017–2024). Methods: A systematic search of PubMed, Scopus, and the Cochrane Library (2017–2024) identified original research involving undergraduate medical students. Eligible studies reported a leadership-related intervention, perceptions, or readiness. Data extraction focused on teaching approaches, duration, assessment tools, and reported learning outcomes. Study quality was appraised using MMAT and JBI checklists. Results: Fifteen studies met the inclusion criteria. Most interventions were short workshops, brief courses, or needs-assessment surveys, with only a few longitudinal or integrated curricula. Common pedagogical methods included interactive workshops, reflective activities, team-based tasks, and student-led sessions. Outcomes largely reflected self-reported improvements in communication, teamwork, and confidence, while evidence of behavioural change or objective performance was limited. Considerable inconsistency existed in outcome measures and leadership competencies assessed. Conclusion: Current evidence indicates growing attention to leadership training but highlights significant gaps in curricular structure, assessment tools, and long-term evaluation. Programs using blended, experiential, and repeated learning opportunities show promise, but more rigorous, longitudinal, and competency-based approaches are needed to establish effective leadership development in undergraduate medical education.

Anatomical Variations of the Hepatic Artery: A Systematic Review with Relevance to Hepatobiliary and Transplant Surgery

Naz Akhtar — 2026-01-31

Hepatic arterial anatomy shows substantial variation, and recognizing these patterns is important during hepatobiliary, pancreatic, and transplant procedures. Objectives: To systematically summarize current evidence on hepatic artery variations reported in recent imaging and cadaveric studies and to compare the frequency of major anatomical patterns with contemporary literature. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Searches of PubMed, Scopus, and the Cochrane Library were conducted for studies published between January 1, 2017, and December 31, 2024, and additional full-text articles were sought through reference lists and targeted searches in Web of Science and Google Scholar. Inclusion criteria covered observational imaging studies and cadaveric dissections reporting hepatic arterial anatomy using Michel, Hiatt, or modified classifications. After screening, eleven studies met the criteria for inclusion in the final synthesis. Data were extracted on study design, population, imaging modality, and reported arterial patterns. Results: Across the included studies, classic Michel Type I anatomy was the most frequent configuration, whereas Types II and III were the most common variants. Minor differences were observed between adult, pediatric, and cadaveric cohorts, likely reflecting population heterogeneity and variations in imaging resolution. The findings were descriptive, as none of the studies evaluated surgical outcomes. Conclusions: Contemporary evidence confirms that non-classic hepatic artery patterns are common across diverse populations. While modern CT angiography and multidetector imaging facilitate consistent identification of these variants, current literature remains descriptive. Further prospective studies are required to determine their clinical impact.

Biochemical Characterization of Novel Adipokines and Their Physiological Role in Insulin Sensitivity: A Systematic Review

Abida Jaffar — 2026-01-31

Novel adipokines have garnered attention for their roles in glucose regulation and the early development of metabolic imbalance. Several of these molecules influence insulin signalling, inflammation, and adipose tissue function, but their behavior across different clinical settings remains incompletely understood. Objectives: To synthesize recent human evidence on novel adipokines and insulin sensitivity, evaluate the consistency of their associations across various populations, and assess their potential relevance as early metabolic biomarkers. Methods: A systematic search was conducted across PubMed, Scopus, and Google Scholar for human studies published between 2019 and 2024. Original English-language studies measuring at least one novel adipokine alongside an insulin-related marker were included. Data were organized into structured tables and synthesised narratively. Risk of bias was assessed using the Joanna Briggs Institute (JBI) criteria for observational studies. Results: Eighteen studies met the inclusion criteria. Omentin-1 showed the most consistent inverse association with insulin resistance and was reduced in obesity, metabolic syndrome, PCOS, and NAFLD. Chemerin demonstrated a reproducible positive association with insulin-resistant states and higher inflammatory burden. Nesfatin-1 showed variable behaviour across disease stages and populations. Visfatin, Vaspin, DLK1, and Galanin displayed emerging but less consistent associations. Adiposity, inflammation, and residual confounding influenced the strength and direction of reported relationships. Conclusions: Several novel adipokines may act as early markers of metabolic stress and altered insulin action. Omentin-1 appears protective, whereas Chemerin aligns with insulin resistance across multiple populations. Other adipokines show context-dependent responses. Clinical application remains limited by heterogeneity in study design, population characteristics, and laboratory methods.

Comparison of Outcomes of Transbuccal Approach Versus Transoral Fixation in Open Reduction and Internal Fixation of Mandibular Angle Fracture

Muhammad Khalil — 2026-01-31

Fractures of the mandibular angle pose surgical challenges due to limited access and complex anatomy. The transbuccal approach improves access but requires a small skin incision, while the transoral approach avoids external scars but may limit visualization. Objectives: To compare transbuccal and transoral approaches for open reduction and internal fixation (ORIF) of mandibular angle fractures with respect to surgical time, intraoperative access, and postoperative occlusion. Methods: Eighty patients with isolated unilateral mandibular angle fractures were prospectively assigned to transoral (n=40) or transbuccal (n=40) fixation. Surgical time, intraoperative accessibility (scored 1–3), and postoperative occlusion were recorded. Data normality was assessed using the Shapiro-Wilk test, and comparisons were made using the Mann–Whitney U test (p<0.05). Results: The transoral approach significantly reduced median surgical time compared to transbuccal fixation (41 (15) vs. 69 (4) minutes; U=4.000, p<0.001). Conversely, intraoperative accessibility was superior with the transbuccal approach (1 [1] vs. 2 (0); U=314.000, p<0.001). Postoperative occlusion was comparable between groups (0 (0) vs. 0 (0); U=783.000, p=0.765). Conclusions: Both approaches provide similar postoperative occlusal outcomes. The transbuccal method offers enhanced intraoperative access, whereas the transoral technique reduces operative time and avoids external scars. Surgical technique should be selected based on case complexity, access requirements, and cosmetic considerations.

Factors Associated with Poor Compliance of Antiepileptic Drugs in Children with Epilepsy

Lalit Kumar — 2026-01-31

Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal electrical discharges in the brain. Objectives: To determine the factors associated with poor compliance with antiepileptic drugs in children with epilepsy. Methods: This cross-sectional study was conducted at the Outpatient Department of Neurology of the National Institute of Child Health, Karachi, Pakistan, from January 2025 to June 2025. A total of 185 children aged 1–12 years with epilepsy, diagnosed ≥6 months earlier, were recruited by non-probability consecutive sampling. Compliance with antiepileptic drugs was assessed using the Morisky Medication Adherence Scale (MMAS-8), classifying scores ≥6 as compliant. Factors behind non-compliance were noted. Data were analyzed using SPSS v26 with chi-square and binary logistic regression applied, taking p<0.05 as significant. Results: In a total of 185 children, the mean age was 7.4 ± 3.1 years, and 104 (56.2%) were males. Respondents were 117 (63.2%) mothers and 68 (36.8%) fathers, with a mean parental age of 34.8 ± 6.7 years. Residence was urban in 118 (63.8%), and rural in 67 (36.2%). Low socioeconomic status was noted in 92 (49.7%), and 47 (25.4%) parents were illiterate. Overall, 119 (64.3%) children were compliant and 66 (35.7%) non-compliant. Non-compliance was significantly associated with rural residence (AOR 1.9, 95% CI 1.0–3.6), low socioeconomic status (AOR 2.5, 95% CI 1.1–5.7), and illiteracy (AOR 6.9, 95% CI 2.4–20.5). Conclusions: Non-compliance with AEDs in children with epilepsy in Karachi was strongly influenced by rural residence, low socioeconomic status, and low parental education.

Correlation Between Brain MRI Findings and Serum Ammonia Levels in Hepatic Encephalopathy

Muhammad Fahad Atta — 2026-01-31

Diagnosis or seeing prognosis of hepatic encephalopathy (HE) from a diagnostic laboratory testing or imaging modality point of view lacks a gold standard. Objectives: To correlate the brain MRI findings and serum ammonia level in HE patients for better diagnosis and prognosis. Methods: Retrospective cross-sectional analytical research was conducted at Shahida Islam Medical College and Hospital for six months, from August 2024 to January 2025. After ethical approval, using non-probability consecutive sampling, all patients with documented increased levels of ammonia and HE with MRI Brain were included. SPSS version 23.0 was used for data analysis. For correlating the ammonia levels with MRI brain findings, point-biserial Pearson correlation was applied, keeping p<0.05 as statistically significant. Results: The study of 207 hepatic encephalopathy patients found a mean serum ammonia level of 111.55 ± 41.8 µmol/L, with higher levels in severe cases (134.8 ± 37.45 µmol/L). MRI abnormalities included white matter changes (54.11%), basal ganglia changes (46.86%), and cortical atrophy (31.4%). A strong positive correlation (r=0.62, p<0.001) was observed between serum ammonia levels and MRI severity scores. Conclusions: Serum ammonia levels showed a significant positive correlation with the severity of brain MRI findings in hepatic encephalopathy, indicating that higher ammonia levels are associated with more pronounced neuroimaging abnormalities.

Wound Closure Techniques: Subcuticular Vs Interrupted Transdermal Sutures in Paediatric Patients Undergoing Open Appendectomy for Complicated Appendicitis: A Randomized Controlled Trial

Muhammad Rehman Waheed — 2026-01-31

Paediatric patients who undergo open appendectomy for complicated appendicitis face risks of surgical site infections (SSIs) and poor wound healing. Objectives: To compare continuous subcuticular versus interrupted transdermal sutures to determine their effects on SSI rates, scar cosmesis, and overall wound healing. Methods: A randomized controlled trial (TCTR20250527004) was conducted from September 2024 to March 2025, enrolling patients aged ≤12 with complicated appendicitis. Patients of both genders aged up to 12 years presenting to the paediatric surgery emergency with acute appendicitis grade 2 and above. Patients were randomized equally into two groups: Group A (continuous subcuticular closure) and Group B (interrupted transdermal closure). Primary outcomes were SSI, wound dehiscence, and Manchester Scar Scores up to 30 days post-op. Statistical analysis was done using SPSS version 23.0, with t-tests and logistic regression. Results: A total of 112 patients were included in the study, with 56 in each group. The mean number of patients with surgical site infection (SSI) in group A was 1.30 ± 0.46, and in group B mean SSI was 1.37 ± 0.49, with a p value of 0.43. However, the grade of appendicitis was a significant predictor of infection, with higher grades correlating with increased odds of infection (OR=1.83, p<0.001). The Manchester scar score showed that Group A had a mean of around 15.5+3.24 versus Group B mean of about 17.8 ± 2.92, p-value <0.005. Conclusions: The current study concludes that while both continuous subcuticular and interrupted transdermal suturing led to similar SSI rates.

Acute Kidney Injury and Its Short-Term Outcomes among Children with Malaria Admitted to the National Institute of Child Health

Abdul Qadeer Shaikh — 2026-01-31

In Pakistan, the overall reported contribution of malaria to acute kidney injury (AKI) is not well studied. Objectives: To determine the frequency and short-term outcomes of AKI in children presenting with malaria. Methods: This analytical, cross-sectional study was conducted at the National Institute of Child Health, Karachi, Pakistan, during 13^th January 2025 to 13^th July 2025. Children aged 1-16 years with confirmed malaria were analyzed. Detailed demographic, clinical, and laboratory data were collected. AKI was staged using KDIGO criteria. Outcomes included need for dialysis, hospital stay, and mortality. Data were analyzed using IBM-SPSS Statistics, version 26.0. Statistical significance was set at p<0.05. Results: Among 237 children, 135(57.0%) were male, while the mean age was 7.9 ± 3.6 years. AKI was identified in 28 (11.8%; 95% CI: 7.9-16.5%) children. Fever was universally present in all children. Oliguria was significantly more frequent in children with AKI (64.3% vs. 7.2%, p<0.001). Oliguria (64.3% vs. 7.2%, p<0.001), dehydration (57.1% vs. 22.0%, p<0.001), and hypotension (25.0% vs. 4.3%, p<0.001) were significantly more common among children with AKI. Dialysis or renal replacement therapy was required in 21.4% children with AKI (p<0.001). Mortality occurred 10.7% children with AKI vs. 0% without AKI (p<0.001). Conclusions: AKI affects a notable proportion of children hospitalized with malaria. AKI in malaria is linked to more severe clinical presentation and significantly worse short-term outcomes.

Ultrasonographic Features in Recognition of Malignant Thyroid Nodule with Fine Needle Aspiration Cytology as the Gold Standard

Abdul Samad — 2026-01-31

A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding tissue. The diagnosis of these nodules is a common clinical procedure globally. Objectives: To determine the sensitivity, specificity, and predictive values of ultrasound for identifying malignant thyroid nodules, using fine-needle aspiration cytology (FNAC) as the gold standard. Methods: In this cross-sectional study, 209 consecutive patients with suspected thyroid nodules were enrolled after providing written consent. Each participant underwent a cervical ultrasound performed by an experienced radiologist, which was followed by an FNAC. The Bethesda System was used for the cytological diagnosis. The diagnostic performance of ultrasound was calculated against the FNAC results, and data were analyzed using SPSS version 26.0. Results: The mean age of the 209 patients was 43.58 ± 9.87 years. Using FNAC as the gold standard, ultrasound demonstrated a diagnostic accuracy of 88.04%. The sensitivity was 86.3%, the specificity was 89.7%, the positive predictive value (PPV) was 88.89%, and the negative predictive value (NPV) was 87.27%. Conclusions: The study concludes that ultrasound characteristics are a highly sensitive and accurate method for identifying malignant thyroid nodules, with an overall diagnostic accuracy of 88.04%.

Evaluating the Diagnostic Accuracy of Heart Diseases with Chest Pain

Aqeel Ahmed — 2026-01-31

Cardiac diseases refer to sudden, severe cardiac events with life-threatening consequences, often linked to underlying cardiovascular issues, requiring immediate medical intervention. Objectives: To determine the predictive accuracy of the HEART score versus electrocardiogram (ECG) changes for predicting Cardiac events in patients with chest pain. Methods: The study was carried out at the Punjab Institute of Cardiology (PIC), Lahore, and the Mekran Medical College, Turbat, from September 2020 to March 2021. The cross-sectional study included 385 patients. The samples of blood were collected and measured. Patients' HEART scores were calculated. The data were stratified by gender, age, duration of symptoms, smoking, and diabetes. The positive and negative predictive value, sensitivity, specificity, and diagnostic accuracy of the HEART score for each stratum were calculated. Results: There were 269 (69.9%) male and 116 (30.1%) female. The average age was 62.34 ± 8.48, and the age ranged from 35 to 75 years old. The mean duration of the symptom was 4.71 ± 2.24 hours. In predicting adverse events on the HEART score, results showed that 327 (84.9%) were positive, while 373 (96.9%) were positive for ECG changes. The sensitivity, specificity, positive and negative predictive value for predicting adverse events on the HEART score versus ECG changes were 86.7%, 66.7%, 98.7%, and 13.7% respectively. Conclusions: The HEART score effectively predicts major adverse events in chest pain patients, suggesting its continued validation as a clinical tool for risk stratification in emergency departments.

Comparison of Common Bile Duct Dilatation at the Porta Hepatis in Patients with Obstructive Jaundice on Ultrasonography and Magnetic Resonance Pancreatography

Shabana Mehr — 2026-01-31

Obstructive jaundice is a frequent clinical issue that, in most cases, is related to choledocholithiasis, strictures, or malignant lesions. Objective: To compare the level of diagnostic accuracy of USG to that of MRCP in identifying CBD dilatation. Methods: There were 165 patients with clinical suspicion of obstructive jaundice, who were enrolled in six months between 1st July 2024 and 31st December 2024. MRCP was used as the reference standard to assess the diagnostic performance of USG. Calculations were made on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and likelihood ratios. The Receiver Operating Characteristic (ROC) analysis was conducted, and age, gender, BMI, and symptom duration were determined post-stratification to assess diagnostic accuracy. Results: The average age of the participants was 52 years, and 57.6% were men. MRCP was positive in 60.6% of patients with CBD, and USG was positive in 54.5% of patients. USG proved to have a sensitivity of 85.0, specificity of 92.3, and PPV of 94.4 and NPV of 80.0, and a general diagnostic accuracy of 87.9 compared with MRCP. Conclusions: USG offers high specificity and accuracy of diagnosis of CBD dilatation and should be used as a primary imaging tool. MRCP is to be used in cases of inconclusive or negative USG when there is high clinical suspicion.

Prevalence of Tuberculosis Trends in District Abbottabad, Pakistan: A Cross-Sectional Survey

Yasir Ishaq — 2026-01-31

Tuberculosis (TB) remains a major public health concern in Pakistan, with the country ranked sixth among high-burden developing nations. Significant regional disparities in TB incidence emphasize the importance of localized surveillance and targeted interventions. Objectives: To assess the prevalence of TB in District Abbottabad, explore variations by age and gender, and evaluate trends in TB cases reported by healthcare facilities between January 2022 and December 2023. Methods: A retrospective cross-sectional study was conducted from April to October 2024, utilizing secondary data from the TB Control Programme, Khyber Pakhtunkhwa. Purposive sampling included all registered pulmonary tuberculosis patients with positive sputum smear results (PTBSS). Data were entered into Microsoft Excel and analyzed using frequency distributions, histograms, and bar charts to highlight case patterns and temporal trends. Results: In 2022, 810 new bacteriologically confirmed TB cases were reported in Abbottabad, increasing to 843 in 2023, representing a 4% rise. Male patients were more frequently affected, with male-to-female ratios of 1.07 and 1.17 in 2022 and 2023, respectively. The PPM ACD center reported the largest share of cases. Moreover, relapsed pulmonary TB cases rose from 78 to 96 between the two years, showing a 23% increase. The overall relapse rate (23%) was higher than the 11.2% previously reported from Pakistan. Conclusion: District Abbottabad demonstrates a persistent TB burden with a notable 23% rise in relapse cases, indicating gaps in treatment outcomes. Strengthening follow-up, improving adherence, and enhancing case detection in high-risk groups remain crucial for effective TB control.

Procalcitonin Level Evaluation for Prediction of Sepsis-Associated Mortality Rate in a Subset of Karachi Population

Iffat Ara Aziz — 2026-01-31

Procalcitonin (PCT) has been recognized as a crucial biomarker in the diagnosis and prognosis of sepsis, as it reflects the body's response to infection. Objective: To identify the association of procalcitonin level for the prediction of sepsis-associated mortality rate in a subset of the Karachi population. Methods: It was an analytical cross-sectional study conducted at Ziauddin Medical College with approval of the ERC. The sample size was n=130. The set inclusion criteria were patients in whom sepsis was suspected, who given consent to participate in the study, and were within the range of 18-60 years. The exclusion criteria were patients from other hospitals, patients with malignancies and known ischemic heart diseases, patients with thyroid disorders, patients who had leukopenia, and patients who did not give consent to participate in the study. The data were collected through a pre-developed questionnaire, which included questions regarding demographics, presenting complaint, PCT levels at the time of admission, and outcome as positive (recovered) or negative (died). The minimum PCT levels considered as negative were 0.1 – 0.25ng/mL, if the outcome seemed to be positive. Results: Most of the patients with sepsis had 4-6 ng/mL of PCT levels. The increased mortality was found to be significantly associated with high levels of PCT, specifically in patients having PCT 6-8 ng/mL and greater than 8 ng/mL. Conclusions: High PCT levels can predict the outcome of sepsis; PCT levels more than 6 were associated with a high mortality rate in a subset of the Karachi population.

Seasonal Trends, Clinical Profiles, and Outcomes of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes

Bushra Rehman — 2026-01-31

Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children, and diabetic ketoacidosis (DKA) remains its most serious acute complication. While seasonal variation in DKA incidence has been reported globally, such data are lacking from Pakistan, where the pattern is unknown. Objectives: To describe the seasonal trends, clinical profiles, and outcomes of DKA in children and adolescents. Methods: This descriptive, cross-sectional, retrospective study was conducted at the Department of Pediatrics, The Aga Khan University Hospital, Karachi. Data were collected from 1st November 2024 to 1st April 2025. Medical records were reviewed retrospectively from January 2019 to December 2022. Children of both genders aged 1–18 years, diagnosed with DKA either as newly diagnosed or known cases of T1Dm, were included. Demographic data, season at the time of presentation, laboratory parameters, clinical course, outcomes, and complications were recorded. The data were analyzed using R software. Results: A total of 78 cases were included, with a mean age of 9.6 ± 4.8 years. The mean hospital stay was 3 days. Most patients presented with severe DKA (55.1%). The highest frequency of cases occurred in winter (38.5%), followed by spring (24.4%), summer (23.1%), and autumn (14.1%). Autumn had the highest proportion of severe DKA (82%). Hyponatremia was the most common laboratory abnormality (47.43%). Conclusions: Seasonal variation showed slightly higher occurrence of DKA in winter, with most newly diagnosed children presenting with severe DKA. The majority of children (96.2%) had recovered.

Comparison of Outcome with Ultrasonic Dissector Versus Electrocautery in Modified Radical Mastectomy

Maryum Naveed — 2026-01-31

Breast cancer is the most diagnosed cancer globally. Breast-conservative surgeries are done in several ways to treat non-metastatic breast cancer. Objectives: To compare the duration of surgery, duration of drains, and incidence of seroma formation between bipolar electrocautery and ultrasonic dissector in patients undergoing modified radical mastectomy (MRM) for breast cancer. Methods: This randomized controlled trial was conducted at the Department of Surgery in Bahawal Victoria Hospital, Bahawalpur, from June to December 2024. A total of 138 women aged 35 to 65 years with operable breast cancer planned for MRM were enrolled and randomized into two groups: bipolar electrocautery and ultrasonic dissector. The primary outcome was the incidence of seroma formation, and the secondary outcomes were duration of surgery and drain placement. Data were analyzed using SPSS version 23.0 with an independent sample t-test and chi-square test / Fisher’s exact test applied where appropriate. A p-value<0.05 was considered statistically significant. Results: Patients had a mean age of 50.5±7.8 years; 52.2% of the patients were obese. Both groups were comparable at baseline. The mean operative time and drain duration were significantly lower in the ultrasonic dissector group (41.5 ± 4.4 min and 4.0 ± 0.8 days) compared to the electrocautery group (52.9 ± 4.2 min and 7.1 ± 1.2 days) (p<0.001). Seroma formation occurred in 10.1% cases and was significantly less frequent in the ultrasonic group (14.3% vs. 85.7%, p=0.009). Conclusions: Ultrasonic dissector significantly reduced operative time, drain duration, and seroma formation compared to electrocautery in patients undergoing MRM.

Clinical Practice of Treating Benzodiazepine Poisoning with Kahwa (Black Tea) in Acute Cases of Overdose

Javeria Khan — 2026-01-31

Recently, an increasing trend of using black tea (Kahwa) in many diseases has been noticed due to its numerous health benefits with less to no side effects and easy availability. Objectives: To describe the clinical characteristics, management practices, and short-term outcomes of patients with acute benzodiazepine overdose who received Kahwa as part of supportive care. Methods: This retrospective descriptive study was conducted at the National Poison Control Center, Jinnah Postgraduate Medical Center, Karachi. Patients aged 13–70 years with confirmed acute benzodiazepine overdose were included using a non-probability consecutive sampling technique. All patients received standard supportive care plus enteral feeding of Kahwa via nasogastric tube (NG). Data were analyzed using IBM-SPSS version 26.0, and significance was set at p<0.05. Results: A total of 200 patients with acute benzodiazepine overdose were analyzed. There were 50.5% patients who were male, with an overall median age of 24 years (IQR: 20–38). In most cases, 75.5% presented within two hours of ingestion, and 81.5% had taken ten or fewer tablets. Hypertension and diabetes were present in 4.5% and 4.0% of patients, respectively. The most common presenting features were altered consciousness (25.0%) and non-reactive pupils (27.5%). Intubation was required in 2 patients (1.0%), and flumazenil was given to 3 (1.5%). Conclusions: This study documents current clinical practice in managing benzodiazepine overdose, including adjunctive Kahwa administration. The results are descriptive and do not indicate the therapeutic effect of Kahwa specifically, as no causal interpretation is possible.

Exploring Cochlear and Vestibular Abnormalities in Children with Hearing Impairment; a Tertiary Care Experience

Madeeha Akram Javed — 2026-01-31

Inner ear malformations have a great impact on hearing. Diagnosing them accurately through advanced imaging modalities can help plan management strategies. Objectives: To determine anatomical defects of inner ear malformations in children requiring hearing aids and cochlear implants coming to the tertiary care hospital. Methods: A cross-sectional research design was used with a sample of 104 hearing-impaired children, aged 1 to 14 years, who had moderate to profound hearing loss, collected through a purposive sampling technique. Demographic information was collected through a specially designed questionnaire, which included age, gender, developmental delay, etc. were also assessed. Results: 7 (6.7%; 95% CI (0.019, 0.115)) cases had anatomical defects of the inner ear, including the temporal bone. Among 7 cases, all had bilateral cochlear hypoplasia CH-III, semicircular canal malformations, 3 (42.9%) bilateral hypoplasia, 3 (42.9%) bilateral dysplasia, 1 (14.4%) had bilateral aplasia of anterior and lateral semicircular canals, 3 (42.9%) bilateral dilated vestibule, and 1 (14.3%) narrowing of the internal auditory canal left side. In these 7 cases, 5 (71.4%) with profound degree hearing loss were candidates for cochlear implant and 2 (28.6%) with severe degree hearing loss were using hearing aids. Results of chi-square showed that age at the time of diagnosis (p<0.05), family history of hearing impairment (p<0.001), and severity of hearing loss (p<0.001) had a significant association with the type of hearing impairment. Conclusions: The frequency of inner ear malformations in hearing-impaired children using hearing aids or candidates for cochlear implant was 6.7%. The most common malformations were CH-III and semicircular canal malformations.

Risk Factors Leading to Extubation Failure in a Pediatric Intensive Care Unit: A Descriptive Study from a Tertiary Care Hospital in Pakistan

Iqra Rehman — 2026-01-31

Extubation failure (EF), defined as the need for reintubation within 72 hours of planned removal of mechanical ventilation, is a serious complication in pediatric intensive care units, yet local data from low- and middle-income countries are limited. Objectives: To describe clinical risk factors for EF among ventilated children in a tertiary Pediatric Intensive Care Unit (PICU) in Pakistan. Methods: This research conducted a six-month descriptive cross-sectional study in the PICU of Civil Hospital Karachi, enrolling all children under 12 years who received invasive mechanical ventilation for >12 hours and subsequently required reintubation within 72 hours of planned extubation. Demographic variables and predefined risk factors (hemodynamic instability, gas-exchange failure, airway obstruction, acute respiratory disease, chronic neurologic disease, malnutrition, poor cough reflex, and exposure to sedatives, inotropes, and steroids) were recorded on a standardized, validated proforma and analyzed using SPSS-23 with chi-square tests (p≤0.05). Results: Among 133 EF episodes, the most frequent risk factors were hemodynamic instability (24.8%), inotrope and steroid use (24.8% each), upper airway obstruction and hypoxemic respiratory failure (15% each), and poor cough reflex (15%), with several patients exhibiting multiple overlapping risk factors. Upper airway obstruction and poor cough reflex were more common in males, whereas cyanotic congenital heart disease and chronic neurologic conditions occurred exclusively in children >5 years of age. Conclusions: EF in this setting is multifactorial, dominated by hemodynamic instability, gas-exchange impairment, and airway-protective deficits; structured, age- and sex-aware extubation-readiness assessment focused on these risks may help reduce reintubation in resource-limited PICUs.

Speech and Language Delay in Early Childhood: Insights from A Clinical Study in Islamabad, Pakistan

Kainat Ali — 2026-01-31

Speech and language delay (SLD) in early childhood is a prevalent neurodevelopmental concern, often resulting in long-term academic, behavioral, and emotional difficulties if unaddressed. While risk factors have been well studied in high-income countries, data from low-resource settings like Pakistan remain limited. Objective: This study aimed to identify and quantify medical, familial, and environmental risk factors among children with isolated SLD in Islamabad. Methods: A cross-sectional study was conducted from August 2023 to February 2024 at the Pediatric Outpatient Department, KRL Hospital, Islamabad. A total of 145 children aged 2–5 years with isolated SLD were enrolled after clinical assessment and audiological screening. Data were collected via structured parent interviews on perinatal history, medical comorbidities, familial predispositions, and environmental exposures. Descriptive statistics were used to report frequencies. Results: Medical risk factors were present in 55.2% of children, with chronic ear infections (45%) and hearing loss (28.6%) being the most common. Birth asphyxia (19.3%) and seizure disorders (16.6%) were also noted. Familial factors were observed in 78.6% of cases, including consanguinity (67.5%) and family history of SLD (21.1%). Environmental exposures were highly prevalent (87.6%), particularly excessive screen time (>2 hours/day in 49.6%), pacifier use (40.9%), and thumb-sucking (27.6%). Conclusions: Children with SLD frequently present with modifiable risk factors across medical, familial, and environmental domains. Early identification of these risks, especially in settings with high consanguinity and limited screening infrastructure, can inform timely interventions and improve developmental outcomes.

Barriers to the Utilization and Acceptance of Low Vision Devices among Patients at Al-Shifa Trust Eye Hospital, Rawalpindi

Maimoona Khalid — 2026-01-31

Low vision significantly impairs daily functioning and quality of life, yet the acceptance and sustained use of low vision devices remain limited. Understanding barriers to utilization is crucial for developing effective rehabilitation strategies, particularly in low- and middle-income settings where access to vision care is constrained. Objectives: To determine the frequency of acceptance and to identify barriers influencing the utilization of low vision devices among patients with visual impairment. Methods: A cross-sectional study was conducted at the Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi. A total of 150 patients aged 15–70 years with low vision were enrolled using non-probability consecutive sampling. Demographic, occupational, and clinical characteristics were recorded, and patients were asked about their acceptance of LVDs. Those who declined were further interviewed regarding barriers. Data were analyzed using SPSS v26, applying Chi-square and t-tests, with p<0.05 considered statistically significant. Results: Overall acceptance was 37%, while 63% declined the use. Acceptance was highest among patients aged 31–45 years (39.3%) and lecturers (69.2%). Diagnosis was significantly associated with acceptance (p=0.010), with higher uptake in maculopathy (35.7%) and pathological myopia (55.6%) compared to retinitis pigmentosa (14.3%) and optic atrophy (8.3%). Affordability emerged as the most critical barrier (41.6% among non-acceptors), while stigma, awareness, and usage difficulty were reported but not statistically significant. Conclusions: Acceptance of LVDs remains suboptimal, with affordability as the dominant barrier. Tailored counseling, structured training, and financial support mechanisms are essential to improve device uptake and enhance quality of life for individuals with low vision.

Fetal Outcomes of Pregnancy with Preterm Premature Rupture of Membrane

Maryam Shahid — 2026-01-31

Preterm premature rupture of membranes (PPROM) is a major contributor to preterm birth and is strongly associated with increased neonatal morbidity and mortality. Objectives: To evaluate fetal outcomes among pregnancies complicated by PPROM and to compare neonatal morbidity and mortality between infants delivered at ≤34 weeks and those delivered after 34 weeks of gestation. Methods: A prospective observational study was carried out at Fatima Jinnah Medical University/Sir Ganga Ram Hospital. A total of 125 pregnant women who had preterm premature rupture of membranes (PPROM) during the period of 28-37 gestational weeks. The diagnosis was made by the examination through the sterile speculum with positive pooling, nitrazine, or ferning. Mothers and babies were observed until discharge. SPSS version 25.0 was used to analyze the data, and p<0.05 was the significant value. Results: The mean gestational age at rupture was 31.2 ± 1.1 weeks in the ≤ 34-week group and 35.3 ± 0.9 weeks in the >34-week group. Early gestation was associated with significantly lower birth weight (1.78 ± 0.34 kg vs. 2.36 ± 0.41 kg; p<0.001), higher NICU admissions (82.3% vs. 35.1%; p<0.001), and increased neonatal complications including respiratory distress syndrome (58.8% vs. 14.0%; p<0.001) and sepsis (32.3% vs. 15.8%; p=0.03). Perinatal mortality was markedly higher among infants ≤ 34 weeks (20.6%) compared to those >34 weeks (3.5%; p=0.002). Conclusions: PPROM is associated with substantial fetal morbidity and mortality, especially when occurring before 34 weeks of gestation. Prematurity, low birth weight, and infection remain the major determinants of poor neonatal outcomes.

Domperidone vs Metoclopramide: Comparative Evaluation of Efficacy in Treating Diabetic Gastroparesis

Asma Saeed — 2026-01-31

Gastroparesis represents a diabetes-related condition that causes diabetic patients to experience nausea, vomiting, and bloating. Objectives: To evaluate the effectiveness of Domperidone and Metoclopramide for gastric emptying improvement and gastrointestinal symptom reduction in patients with diabetic gastroparesis. Methods: A total of participants were n=76. Data collection occurred through a study of diabetes patients with gastroparesis who were given Domperidone (10 mg three times daily) or Metoclopramide (10 mg three times daily) for six weeks. The researchers evaluated gastric emptying half-time (T½) as the main outcome, while considering symptoms of nausea, vomiting, and bloating. The study evaluated both negative side effects and participant medication adherence. Results: The gastric emptying reduction using Domperidone exceeded that of Metoclopramide following administration to patients, as Domperidone decreased T½ from 125.6 ± 18.4 minutes to 98.2 ± 15.6 minutes while Metoclopramide decreased T½ from 124.8 ± 17.9 minutes to 107.5 ± 16.9 minutes (p = 0.04). The patients who received Domperidone reported better decreases in nausea, vomiting, and early satiety symptoms than those who received Metoclopramide (p=0.03, p=0.02, and p=0.04). The occurrence of extrapyramidal symptoms together with QT prolongation proved more common in patients treated with Metoclopramide. Compliance was similar between groups. Conclusions: Diabetic patients with gastroparesis experienced superior gastric motility response and symptom relief after taking domperidone compared to metoclopramide, along with better outcomes regarding extrapyramidal symptom development.

Comparison of Phenylephrine and Ephedrine in Managing Spinal-Induced Hypotension in Lower Segment Caesarean Section (LSCS)

Madiha Shah — 2026-01-31

Spinal-induced hypotension is a frequent complication of spinal anesthesia during lower-segment caesarean section and may adversely affect maternal comfort and uteroplacental perfusion. Phenylephrine and ephedrine are commonly used vasopressors, but they differ in their cardiovascular effects. Objectives: To compare systolic blood pressure stabilization, heart rate changes, vasopressor dose requirements, and maternal outcomes between phenylephrine and ephedrine. Methods: This prospective observational comparative cohort study was conducted at the Department of Anesthesiology, Hazrat Bari Imam Sarkar Medical and Dental College, and Hazrat Bari Imam Sarkar Teaching Hospital, Islamabad. Two hundred parturient who developed spinal-induced hypotension were enrolled (100 received phenylephrine and 100 ephedrine). Hemodynamic parameters were recorded at baseline and at 3 and 6 minutes after vasopressor administration. Data were analyzed using an independent-samples t-test, a Mann–Whitney U test, and a Chi-square test. Results: Phenylephrine maintained significantly higher systolic blood pressure at 3 minutes (p=0.008). Ephedrine was associated with significantly higher pulse and heart rate (p=0.003 and p=0.004). Bradycardia was more frequent with phenylephrine (p=0.001), while tachycardia and higher repeat-dose requirements were more common with ephedrine (p=0.025 and p=0.017). Duration of hypotension was significantly shorter with phenylephrine (p=0.003). Conclusions: Both vasopressors effectively managed spinal-induced hypotension; however, phenylephrine provided more stable systolic control and faster recovery, whereas ephedrine caused greater heart rate variability.

Frequency of Urinary Retention in Guillain-Barré Syndrome Patients

Atta Rasool — 2026-01-31

The Guillain-Barré Syndrome (GBS) is an acute autoimmune polyneuropathy that can also have autonomic dysfunction, which leads to complications like urinary retention. These autonomic disorders should be identified early to reduce morbidity and avoid secondary complications, and improve patient outcomes. Objective: To determine the frequency of urinary retention among GBS patients. Methods: This retrospective cross-sectional study involves 129 patients diagnosed with GBS from 18 July 2025- 18 October 2025 at the Department of Neurology, Pak Emirates Military Hospital. Information on age, gender, body mass index, and disease severity was determined using the Hughes Functional Grading Scale. The presence of urinary retention was determined clinically. Chi-square test and logistic regression were applied to determine significant associations, considering p<0.05 as statistically significant. Results: A total of 129 patients were included with a mean age of 57.2 ± 17.3 years, predominantly females comprising 58.1%. The mean BMI was 30.2 ± 3.5 kg/m². Urinary retention was observed in 13 (10.4%) patients and is significantly more common among older patients (mean age 67.1 ± 8.9 years, p=0.02) and those with severe disease (p=0.01). No significant associations were found with gender (p=0.34), BMI (p=0.21), or area of residence (p=0.42). Conclusions: Urinary retention is a notable autonomic manifestation in GBS, particularly among older and severely affected patients. Early detection and management can help prevent urinary complications and reduce the duration of hospital stays.

Association between Obstructive Sleep Apnea and Ischemic Stroke: A Case-Control Study

Umair Islam — 2026-01-31

Previous evidence has suggested an association between obstructive sleep apnea (OSA) and cardiovascular and cerebrovascular conditions. There is, however, little data examining the prevalence and severity of OSA among individuals with ischemic stroke, specifically within Pakistan. Objectives: To determine if the prevalence and severity of OSA were significantly higher in individuals with ischemic stroke compared to age and gender matched control participants without a stroke. Methods: A case-control study was conducted at Khyber Teaching Hospital. A total of 184 individuals were enrolled in the study. The study consisted of 92 individuals diagnosed with ischemic stroke supported by radiographic evidence and 92 individuals without cerebrovascular disease, all matched for age and sex. Clinical and demographic data were collected using a standard questionnaire. Participants who scored ≥3 on the STOP-BANG questionnaire were referred for Type III daytime portable polysomnography testing. Results: Participants with ischemic stroke had significantly higher rates of OSA (AHI ≥5) than controls (80.4% in stroke vs 50.0% in controls, p<0.0001). The incidence of severe OSA in stroke participants was 26.1% compared to only 6.5% of control participants. Conclusions: Many patients who experience an ischemic stroke also have OSA (Obstructive Sleep Apnea), and OSA increases the risk of having a stroke independent of the actual ischemic stroke. This evidence supports the use of OSA screening and treatment as part of their prevention strategies against future strokes.

Diagnostic Accuracy of Shear Wave Elastography in the Evaluation of Solid Breast Lesions, Taking Histopathology as the Gold Standard

Fariha Mumtaz — 2026-01-31

Breast cancer is the most common malignancy among women worldwide and a leading cause of cancer-related mortality in Pakistan. Accurate differentiation between benign and malignant solid breast lesions is essential for appropriate management. Conventional B-mode ultrasonography is widely used but is limited by operator dependence. Shear wave elastography (SWE) provides an objective, quantitative assessment of tissue stiffness and may improve diagnostic accuracy. Objectives: To evaluate the diagnostic accuracy of shear wave elastography in differentiating benign and malignant solid breast lesions using histopathology as the reference standard. Methods: This descriptive cross-sectional study was conducted at the Department of Radiology, Bahawal Victoria Hospital, Bahawalpur, from March to September 2023. A total of 232 patients with solid breast lesions detected on ultrasound underwent SWE followed by core needle biopsy or surgical excision. Mean elasticity (Emean), maximum elasticity (Emax), and lesion-to-parenchyma elasticity ratio were recorded. Diagnostic performance was assessed using receiver operating characteristic analysis. Results: Among 232 lesions, 153 (65.9%) were benign and 79 (34.1%) were malignant. Malignant lesions showed significantly higher SWE values (p<0.001). AUCs were 0.974 for Emean, 0.986 for Emax, and 0.980 for the elasticity ratio. Emax demonstrated the highest accuracy, with 96% sensitivity and 92% specificity at a cutoff of 130–135 kPa. Conclusions: Shear wave elastography shows excellent accuracy for differentiating solid breast lesions, with Emax being the most reliable parameter.

Fetomaternal Mortality and the Associated Factors in Pregnant Women with Uterine Rupture

Attiya Gul — 2026-01-31

Disruption of all uterine layers in pregnant women can lead to rupture of the uterus. Although it is a rare complication, fetal as well as maternal outcomes can be disastrous. Delay in the diagnosis and management is the reason for adverse outcomes owing to the rare and unexpected nature of the complication. Objective: To determine fetomaternal mortality and its associated factors in pregnant women with uterine rupture. Methods: Total 89 cases with diagnosed ruptured uterus of pregnant women were selected via nonprobability consecutive sampling. Age, body mass index, and gestational age were documented. Outcome variables were fetal and maternal mortality, wound infection, hemorrhage, and hysterectomy. Baseline factors were compared on the basis of fetal or maternal mortality to determine the responsible factors. Results: Mean age of the patients was 31.15±3.83 years. Mean gestational age was 30.32±3.50 weeks, and median parity was 3. Mean BMI was 26.56±1.49 kg/m². Of all the patients, 34 (38.2%) had a positive history of cesarean section. Wound infection was observed in 38 (42.7%) of the patients. Maternal and fetal mortality occurred in 22 (24.7%) and 59 (66.3%) patients, respectively. Conclusions: Fetal and maternal mortality were high among the patients with a ruptured uterus. Maternal mortality was related to high maternal age and parity, while fetal mortality was related to gestational age and maternal BMI. A previous cesarean section was related to both maternal and fetal demise.

Post Concurrent Chemo-Radiotherapy Hearing Loss in Patients of Oral Cavity Cancers

Ramsha Tariq — 2026-01-31

Treatment of head and neck squamous cell carcinoma (HNSCC) includes wide local surgical excision followed by adjuvant therapy. Objectives: To determine the frequency of hearing loss in patients who underwent concurrent chemo-radiation therapy (CCRT) treatment after surgical removal of tumour of the oral cavity. Methods: This cross-sectional study was conducted at the Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, from March 2025 to August 2025. Using non-probability consecutive sampling, 133 patients aged 18–70 years with histopathologically confirmed grade III or higher oral cavity malignancies planned for post-surgical CCRT were enrolled. Hearing was assessed using pure-tone audiometry pre-surgery, two weeks post-surgery, and three months post-CCRT, and categorised by severity. Data were analysed with SPSS version 26.0, using descriptive statistics and chi-square tests, with p<0.05 considered significant. Results: Among 133 post-surgical CCRT patients, 94 (70.7%) were male, and the median age was 48.0 (39.0–58.0) years. T4 disease was present in 114 (85.7%) patients. Hearing loss occurred in 15 (11.3%), highest in >60 years 5 (33.3%, p=0.016), and most frequent in tongue malignancy 10 (66.7%). By CCRT cycles, loss was seen in 1–2 cycles 3 (20.0%), 3–4 cycles 12 (10.5%), and none in >4. Severity of hearing loss was found to have a significant association with cancer, stating (p=0.031). Conclusions: Hearing loss following CCRT for oral cavity malignancies occurred in around one in ten patients, with most cases being mild and associated with older age, tongue primary site, and advanced T stage.

Effectiveness of 2 Weeks Administration of Potassium Competitive Acid Blocker vs Proton Pump Inhibitor Therapy in Patients with H. pylori Induced Gastritis in Pakistan

Muhammad Areeb Iqbal — 2026-01-31

Helicobacter pylori cause major gastric and associated gastrointestinal complications, including gastritis and gastric malignancy. Latest evidence hints at the decline in the effectiveness of therapies having conventional proton pump inhibitors (PPI). Potassium competitive acid blockers (PCAB) have emerged as a potential option owing to longer and faster duration of action. However, limited data are available locally comparing PPI to PCAB-based therapies. Objectives: To compare and contrast the efficacy of two weeks of PCAB vs. PPI-based bismuth-containing quadruple therapy for H. pylori eradication. Methods: The quasi-experimental study conducted at the Department of Medicine, Jinnah Hospital, Lahore, recruited a total of 120 patients (60 in each group), aged 18-70 years, with confirmed H. pylori gastritis. Group A received Vonoprozan (PCAB) while Group B received Esomeprazole (PPI). Results: 86.67% of the patients achieved effectiveness in group A as compared to only 68.33% in group B, with a duration of symptoms of 8 weeks, almost similar in each group. The difference in effectiveness was statistically significant. (p=0.016). Conclusions: Vonoprazan (PCAB) based quadruple therapy is more effective at treating H. pylori-induced gastritis than Esomeprazole (PPI) containing therapies.