Pakistan Journal of Health Sciences

Ensuring Support and Inclusion for Individuals with Autism Spectrum Disorder in Pakistan

2025-12-31T18:12:41+00:00

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by differences in social communication, restricted or repetitive behaviors, and atypical sensory processing. The term “spectrum” reflects the wide variation in strengths, challenges, and levels of support required by individuals with autism, ranging from those who live independently to those needing substantial assistance. As understanding of ASD has expanded globally, it has increasingly been recognized not only as a clinical condition but also as a broader social and public health concern, particularly in countries where awareness, diagnosis, and support systems remain limited [1,2].

Autism Spectrum Disorder (ASD) is among the most urgent and yet least understood social health issues in Pakistan. It influences social communication, behavior, as well as sensory processing, and children and adults display a broad spectrum of skills and disabilities. Worldwide, ASD is found in approximately 1 per 160 children and research in Pakistan shows that prevalence is similar with 1.3% of children in Karachi (2017) and 1.45% of school going children in Lahore (2019) being diagnosed with ASD. In spite of the increased awareness around the world, Pakistan still has a lot of gaps in awareness, diagnosis and care of ASD individuals [1,2].

In Pakistan, the family of children with ASD have enormous challenges in accessing the qualified professionals and evidence-based interventions. Consequently, they are left to deal with complicated behavioral, sensory and co-occurring problems in many cases without much support. This is often postponed through inconsistent screening and lack of professional capacity as a result of early diagnosis, which may greatly improve the outcome. There are also misconceptions and a dependency on untested home remedies or expensive private care and low educational inclusion of children denies them special learning settings. All of these gaps demonstrate that ASD is not merely a medical problem, but a social and even a bigger social and public health problem that requires immediate intervention [1].

The Punjab Autism Act was passed and it has given official support and recognition to the specialized schools, resource centers, research, professional training, and public awareness campaigns. Recent researches emphasize psychosocial needs of families, sensory and behavioral characteristics of children, and the significance of structured and evidence-based interventions. The focus on the early detection of ASD in regular pediatric care and the development of telehealth, as well as on building community-based support networks, such as online parent communities, offering peer support and emotional assistance is growing. These advances are significant progress in the direction of inclusive education and holistic care, and the problems of awareness, early diagnosis, and professional training still exist [3].

Although these positive steps are made, there is still much to be done. To address the problem of stigma, Pakistan needs to invest in ongoing professional training of healthcare workers, implement screening of ASD at the primary pediatric stage, and initiate mass-scale public education programs. There is an urgent need to have robust support systems to families, better access to quality diagnosis and evidence-based therapy. Studies should emphasize on culturally appropriate interventions and experiences of Pakistani families to inform effective policies. Pakistan has the potential to shift the awareness into action by connecting healthcare, education, and social services and promoting community inclusion [3,4].

The developments anticipated in 2025 may represent a critical turning point for autism care and policy in Pakistan. However, sustained, coordinated efforts across healthcare, education, and social sectors will be essential to ensure that individuals with ASD are empowered to thrive and that their families receive the long-term support, inclusion, and dignity they deserve.

Radiologic Evaluation of Paranasal Sinus Anatomical Variations: A Systematic Review of CT and CBCT Studies and Their Surgical Implications

2025-12-04T04:40:03+00:00

Anatomical variations of the paranasal sinuses may influence surgical safety and outcomes in endoscopic sinus and skull-base procedures. This review compiles radiologic evidence to quantify variant prevalence and delineate surgical significance. Objectives: To evaluate computed tomography (CT) and cone-beam computed tomography (CBCT) studies for the prevalence, morphology, and clinical relevance of paranasal sinus anatomical variations, emphasizing their implications for endoscopic sinus and skull-base surgery. Methods: A systematic search of PubMed, Scopus, and Cochrane databases (January 2010–March 2025) was conducted following PRISMA 2020 guidelines. A total of 612 articles were screened, and 17 studies fulfilled the inclusion criteria. Eligible studies included original human CT or CBCT analyses reporting prevalence or morphology of variants (Onodi, Haller, Keros, accessory maxillary ostium [AMO], and roof asymmetry) with relevant surgical commentary. Weighted means were derived from pooled prevalence data across comparable imaging modalities using frequency-based aggregation. Study quality was evaluated using QUADAS-2 and modified Newcastle–Ottawa scales. Results: Seventeen studies were included. Weighted mean prevalence values were Onodi 34%, Haller 45%, and AMO 42%, with deep Keros type III fossae present in 5–9%. Ranges reflect inter-study heterogeneity in imaging protocol and cohort size. Radiology-guided findings highlighted optic-nerve proximity in Onodi, cribriform vulnerability in Keros III, orbital risk with Haller cells, mucus recirculation with AMO, and corridor distortion from concha bullosa or ethmoid-roof asymmetry. Conclusions: Anatomical variants of surgical relevance are frequent and population-dependent. Structured radiologic reporting using CT or CBCT improves pre-operative planning, mitigates optic-nerve and skull-base risks, and enhances procedural safety.

Anatomical and Dermatologic Manifestations of Estrogen Deficiency in Postmenopausal Women: A Systematic Review

2025-12-16T07:26:22+00:00

Estrogen deficiency after menopause contributes to structural and symptomatic changes in genital, cutaneous, and adnexal tissues, yet available evidence remains scattered across clinical and imaging disciplines. Objectives: To summarize contemporary evidence on anatomical and dermatologic manifestations of estrogen deficiency in postmenopausal women and to evaluate the effects of local hormonal and device-based treatments. Methods: A systematic review following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for English-language studies from 1 January 2017 to 31 December 2024. Eligible designs included randomized controlled trials, observational and cross-sectional studies, imaging investigations, and pilot interventions involving naturally or surgically postmenopausal women. Outcomes included clinical signs, symptom scores, imaging parameters, and dermatologic manifestations. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and the Newcastle–Ottawa Scale for observational and imaging studies. Results: Eighteen studies met the inclusion criteria. Randomized trials of low-dose vaginal estradiol and selective estrogen receptor modulators improved vaginal pH, Vaginal Health Index, Vaginal Maturation Index, dryness, and dyspareunia with minimal systemic absorption. Dermatology-focused cohorts commonly reported xerosis, pruritus, dermatoses, nail fragility, and female-pattern hair loss. Imaging studies demonstrated reduced dermal and vaginal wall thickness and altered echogenicity. Evidence for fractional CO₂ laser and radiofrequency remained limited to small pilot studies with short follow-up. Conclusions: Estrogen deficiency is consistently associated with measurable structural and symptomatic changes in genital and cutaneous tissues. Local estrogen therapy offers reliable short-term benefits, whereas device-based interventions remain investigational and require larger controlled trials.

Serum Liver Enzyme Patterns in Pediatric Hepatitis: A Systematic Review

2025-12-23T06:50:36+00:00

Patterns of serum aminotransferases, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) offer essential insights into the etiology and severity of pediatric hepatitis. Recent epidemiologic shifts, including adenovirus- and AAV2-associated cases, have highlighted the need for an updated synthesis of biochemical trajectories in children. Objectives: To systematically review published data (2018–2024) describing serum ALT and AST patterns in pediatric hepatitis across classical and emerging etiologies. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched for English-language original studies reporting ALT/AST levels in children with hepatitis. Reviews, meta-analyses, and non-original reports were excluded. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and the Joanna Briggs Institute (JBI) checklists for cross-sectional and case-series designs. Extracted data included study characteristics, population details, enzyme levels, and clinical outcomes. Due to heterogeneity in design and reporting, findings were synthesized narratively. Results: Fourteen studies comprising approximately 2,300 participants were included. Autoimmune hepatitis demonstrated sustained moderate-to-high ALT/AST elevations (300–2,400 U/L). Acute viral hepatitis A/E showed abrupt spikes typically exceeding 1,000 U/L with rapid normalization. Severe or non-A-E hepatitis and adenovirus/AAV2-associated cases displayed the most extreme enzyme surges, with peaks occasionally surpassing 5,000 U/L. Most studies showed moderate overall quality but consistently low measurement bias. Conclusions: Serum ALT and AST remain robust and sensitive markers of pediatric hepatocellular injury, with distinct kinetic profiles across etiologies. Standardized, multicenter studies are needed to refine biochemical thresholds and enhance diagnostic interpretation.

Pterygium Is a Pre-Malignant Condition: A Systematic Review

2025-12-31T07:30:00+00:00

In a hot and humid climate Pterygium is one of the common ocular surface disorders. The ultraviolet radiations have been implicated in the pathogenesis of this condition. Objectives: To investigate the association between pterygium and ocular surface squamous neoplasia (OSSN) and to determine the prevalence rates of both diseases in varied populations worldwide. Methods: The internet search in the selected databases resulted in 420 articles in the first round. The second round of screening of the titles excluded 26 articles ascribed to be duplicates. The third round of evaluation ended with the exclusion of 341 articles because they lacked an association between the pterygium and OSSN. In the final round, 29 studies were excluded according to the inclusion and exclusion criteria. Results: A total of 12492 pterygia samples were reported in 24 studies. Most of the studies had been conducted in hot and temperate climates. Out of these twenty-four, three studies were from areas of low UV Radiation like Canada, while six were from the USA, three were from South America, four studies were from Australia and New Zealand, three were from Europe, and one each was from South East Asia, the Middle East, and Far East Asia and Africa. Conclusions: There is a paucity of homogeneity in the reported data on the correlation of pterygium and OSSN. Such studies will delineate the relationship between patients with pterygium and suspected OSSN and will provide predictive information to care for public health issues in these countries.

Post Operative Outcomes of Acute Perforated Appendix During Index Admission

2025-12-31T18:14:31+00:00

Acute perforated appendicitis is a serious condition associated with higher morbidity, prolonged hospital stays, and increased risk of complications. Understanding postoperative outcomes is crucial for optimizing patient care, improving clinical decision-making, and reducing healthcare burdens. Objective: To determine the postoperative outcomes of acute perforated appendicitis during index hospital admission. Methods: This descriptive study was conducted at the Department of Surgery, Khyber Teaching Hospital, Peshawar, from October 1, 2024, to July 31, 2025. Male and female patients aged 18 to 60 years diagnosed with acute perforated appendicitis were enrolled. The patients were evaluated for postoperative outcomes, recorded in terms of surgical site infection, wound dehiscence, hospital stay, and intestinal obstruction. Data analysis was carried out using SPSS version 26.0. Results: The Mean age of the participants was 33.91 ± 11.834 years, while the mean hospital stay was 7.12 ± 2.721 days. Most of the patients were male (n=101, 67.8%). Retrocecal position of the appendix was frequently recorded in 98 patients (65.8%). Hospital stay more than seven days was observed in 57 patients (38.3%), followed by surgical site infection (n=47, 31.5%). Wound dehiscence was the least frequently recorded in 21 patients (14.1%). Conclusions: Acute perforated appendicitis was associated with increased occurrence of postoperative complications and morbidities. Male patients with advanced age were more likely to experience prolonged hospital stay and surgical site infection.

Carotid Artery Doppler Study in Patients Presenting with STEMI

2025-12-31T18:13:21+00:00

Carotid Artery Disease (Carotid CAD) is a significant risk factor for cardiovascular events, particularly in patients with ST-Elevation Myocardial Infarction (STEMI). Carotid artery stenosis (CAS) has been related to poor outcomes in STEMI patients, but limited data exist on the prevalence and severity of CAS in this population, especially in Pakistan. Objectives: To evaluate the presence, severity, and characteristics of Carotid CAD through Doppler ultrasonography in STEMI patients, and to assess the relationship between CAS and clinical outcomes such as hospital stay duration. Methods: A cross-sectional observational study was conducted at Hayatabad Medical Complex, Peshawar, from May 2025 to August 2025. A total of 172 patients with STEMI were assessed using a Mindray® DC 70 Colour Doppler Ultrasound Scanner. The severity of CAS was classified as mild, moderate, or severe based on Peak Systolic Velocity (PSV). Results: The study found that 48 (27.9%) patients had mild CAS, 86 (50%) had moderate stenosis, and 38 (22.1%) had severe stenosis. The mean PSV values were 95.3 cm/s (mild), 123.4 cm/s (moderate), and 142.8 cm/s (severe). Patients with severe stenosis had significantly longer hospital stays (mean 9.2 days) compared to mild (6.3 days) and moderate stenosis (7.5 days); the p-values obtained were 0.025 and 0.035, respectively. Hypertension showed a significant association with severe stenosis (p = 0.016). Conclusions: This research work highlights the high prevalence of CAD in STEMI individuals.

Knowledge, Attitude, and Practice of Parents of Children with Epilepsy

2025-12-31T18:13:11+00:00

Epilepsy is considered to be present when 2 or more unprovoked seizures occur in a time frame of longer than 24 hours. Objectives: To determine the knowledge, attitude, and practice of parents of children with epilepsy. Methods: This descriptive cross-sectional study was conducted at the Outpatient Department of Pediatric Neurology, National Institute of Child Health, Karachi, Pakistan, from January to June 2025. A total of 262 parents of children aged 1–12 years with epilepsy for ≥6 months were enrolled through non-probability consecutive sampling. A structured 15-item KAP questionnaire (7 knowledge, 5 attitudes, 3 practice) was developed, validated by experts, pilot tested on 20 parents, and showed good reliability (Cronbach’s alpha 0.81). Scores ≥12/15 were classified as good KAP. Analysis was performed using SPSS version 26.0, with chi-square applied post-stratification, taking p<0.05 as significant. Results: In 262 parents, the mean age was 34.6 ± 7.8 years; 117 (44.7%) were fathers, and 145 (55.3%) were mothers. Good knowledge was noted in 209 (79.8%), favorable attitude in 142 (54.2%), and good practice in 122 (46.6%). Overall, a good KAP was observed in 138 (52.7%). Good KAP was associated with urban residence (p=0.006), higher education (p<0.001), and healthcare professionals as information source (p=0.002), but not with gender, age, or income. Conclusions: Most parents had adequate knowledge about epilepsy, while attitudes and practices were comparatively less satisfactory. Better knowledge, attitude, and practice were observed among parents with higher education, those living in urban areas, and those who received information from healthcare professionals.

Knowledge of Seizures, Epilepsy, and Seizure First Aid among Teachers and Students at Various Educational Levels

2025-12-31T18:15:42+00:00

Epilepsy remains poorly understood in low-resource settings, with critical gaps in seizure first aid knowledge. This study assessed awareness among Pakistani students and teachers. Objectives: To assess knowledge of epilepsy and seizure first aid among students and teachers of all educational levels in Pakistan. Methods: This cross-sectional survey using a non-validated Google questionnaire in English and Urdu was shared on various social media platforms by convenience sampling (N=330). Data was analyzed using SPSS version 26.0. Results: A total of 330 responses were included for final analysis. Of which, students were the most numerous (178, 53.9%). Higher proportion of females (219, 66.4%). The majority of both students (164, 49.7%) and teachers (114, 34.5%) had heard of epilepsy or seizures. 42.7% (141) of students and 32.1% (106) of teachers identified epilepsy as a brain disorder. A small percentage of both students (49, 14.8%) and teachers (28, 8.5%) knew how to respond to a seizure. Conclusions: Although limited by a non-validated tool and descriptive analysis, this study revealed major gaps in seizure first-aid knowledge among students and teachers. The findings support the need for structured seizure first-aid training programs for students and teachers, and emphasize the impact of this training upon students' well-being and mental health.

Clinical Characteristics of HIV Patients Presenting with Weight Loss: A Cross-Sectional Study

2025-12-31T18:10:15+00:00

Recognizing the epidemiology of human immunodeficiency virus (HIV) infection is essential for managing HIV infection. Research on the nutritional health of patients infected with HIV has revealed significant weight loss during the course of the infection, and this occurrence is frequently viewed as a negative indicator of survival prognosis. Over 26 million individuals with HIV are currently undergoing antiretroviral therapy (ART), which has greatly lessened the impact of HIV disease. Objectives: To determine the frequency of human immunodeficiency virus in patients presenting with weight loss at Lady Reading Hospital, Peshawar. Methods: This observational cross-sectional study was conducted at the Department of General Medicine, Lady Reading Hospital, Peshawar, from 1^stJuly 2022 to 1^stJanuary 2023. 117 patients of both genders with weight loss were included in this study. Every patient was tested for HIV through an initial screening test. Patients with positive status on initial screening tests were referred to the special testing clinic for further confirmation. Human immunodeficiency virus was noted. Results: The mean age was 41.5±7.8 years and the age range in this study was from 25 to 60 years. Males were 69.2% and females were 30.8%. Human immunodeficiency virus (HIV) was positive in 7.7% of patients. HIV had a significant association with family socioeconomic status, with a p-value of 0.00. Conclusion: In conclusion this study demonstrates that HIV is associated with weight loss and wasting remains a highly prevalent complication in the modern antiretroviral era.

Comparative Impact of Olanzapine and Aripiprazole on the Development of Metabolic Syndrome in Patients with Psychiatric Disorders

2025-12-31T18:10:04+00:00

To compare the development of metabolic syndrome in patients treated with olanzapine versus aripiprazole. Methods: This prospective observational study was conducted at Shahida Islam Medical College and Hospital over six months (June–November 2024). Patients with psychiatric disorders who had received either olanzapine or aripiprazole for ≥6 months were included. Metabolic syndrome was assessed using the International Diabetes Federation (IDF) criteria. Patients were divided into two treatment groups: olanzapine (n=104) and aripiprazole (n=104). Data were analyzed using SPSS version 23.0. Chi-square, Fisher’s exact, independent t, and Mann-Whitney U tests were applied where appropriate, with p<0.05 considered significant. Results: A total of 208 patients were analyzed (mean age: olanzapine 46.42 ± 9.21 years; aripiprazole 47.44 ± 8.78 years). Metabolic syndrome prevalence was significantly higher in the olanzapine group (45.2%) compared to the aripiprazole group (30.8%) (p<0.05). Patients on olanzapine had higher waist circumference, BMI, and blood pressure. Metabolic abnormalities were also more frequent with olanzapine: diabetes (34.0% vs. 15.6%), hyperlipidemia (25.5% vs. 9.4%), and microalbuminuria (25.5% vs. 6.3%). Conclusions: Aripiprazole demonstrated a significantly lower risk of metabolic syndrome and better metabolic outcomes than olanzapine, highlighting the need for careful monitoring and the consideration of safer alternatives in clinical practice.

Effectiveness and Safety of Carbamazepine versus Gabapentin in the Pharmacological Management of Trigeminal Neuralgia

2025-12-31T18:14:01+00:00

Carbamazepine is considered the first-line pharmacological therapy for trigeminal neuralgia (TN). Gabapentin, another antiepileptic drug, is increasingly used, but its role as a substitute for carbamazepine remains uncertain. Objectives: To compare the effectiveness and safety of gabapentin and carbamazepine in the management of trigeminal neuralgia. Methods: This prospective comparative study included 80 patients presenting to the Department of Oral and Maxillofacial Surgery at Sharif Medical and Dental Hospital from February 2023 to January 2024. Patients were divided into two groups of 40 each: Group A received gabapentin 300 mg twice daily, and Group B received carbamazepine 200 mg twice daily. Pain intensity was assessed using the Visual Analogue Scale (VAS), and frequency of attacks was recorded on the 3rd, 7th, and 15th days of follow-up. Side effects were also documented. Mann-Whitney U and Chi-square tests were used for statistical analysis, with p≤0.05 considered significant. Results: Group A exhibited lower median VAS scores compared to Group B at all follow-up intervals, with statistically significant differences on the 2nd and 3rd follow-ups. Although gabapentin demonstrated fewer adverse effects, carbamazepine showed the highest percentage of good therapeutic response based on reduced frequency of attacks. Conclusions: Both drugs are effective in managing trigeminal neuralgia. Carbamazepine provides superior pain relief and reduction in attack frequency, whereas gabapentin is associated with fewer side effects.

Clinical and Echocardiographic Profile of Pediatric Patients with Ventricular Septal Defect

2025-12-31T18:14:51+00:00

Ventricular septal defect (VSD) is the most common congenital heart disease in children, contributing significantly to pediatric morbidity and mortality globally. In resource-limited settings like Pakistan, delayed diagnosis and limited access to pediatric cardiology services can exacerbate disease outcomes. Objectives: To evaluate the clinical presentation and echocardiographic profile of pediatric patients diagnosed with VSD at a tertiary care center in Pakistan. Methods: This retrospective, cross-sectional descriptive study was conducted at the Department of Pediatric Cardiology of the Peshawar Institute of Cardiology from July 1, 2025, to September 31, 2025. A total of 200 children under 18 years of age with echocardiographically confirmed VSD were included. Data on demographics, clinical symptoms, and physical examination findings were collected. Echocardiographic assessment was used to determine the size, type, and location of VSD, along with associated cardiac anomalies. Results: The median age at diagnosis was 9.4 months, with 78% diagnosed within the first year of life. The most common presenting feature was cardiac murmur (60%), followed by recurrent respiratory infections (49%), feeding problems (42.5%), and failure to thrive (38%). Perimembranous VSD was the most prevalent type (62%), followed by muscular (19%), inlet (10%), and outlet (9%) defects. Associated cardiac lesions included patent ductus arteriosus (18%), atrial septal defect (14%), aortic valve prolapse (11%), and pulmonary hypertension (24%). Conclusions: Early recognition and echocardiographic screening, especially in high-risk groups like children with Down syndrome, are essential to improving outcomes. These findings support the need for enhanced screening and resource allocation in pediatric cardiology services in Pakistan.

Impact of Tobacco Cessation Curriculum on Professional Competency of Dental Students: A Survey

2025-12-31T18:13:51+00:00

Tobacco cessation counseling (TCC) has become a crucial component in comprehensive patient care. Dentists are in a unique position to identify tobacco users due to regular patient contact and are pivotal in delivering TCC as part of comprehensive oral healthcare. Objectives: To assess the impact of the tobacco cessation curriculum on the professional competency and intention of dental students to provide TCC. Methods: An analytical cross-sectional study was conducted from January 2025 to March 2025. It involved students from clinical years, dental interns, and postgraduate students from all Public and Private Dental Colleges in Karachi who had a tobacco cessation curriculum in formal dental teaching. A structured, self-administered questionnaire was used to assess intentions and perceived barriers in TCC using constructs of the Theory of Planned Behaviour. Data were entered and analyzed using SPSS version 22.0. Frequencies and percentages were obtained for variables. The chi-square test was applied to evaluate associations. Results: The majority of participants, 239 (79.7%), demonstrated a high intention to deliver tobacco cessation counseling. No significant difference was observed in the intention of dental students and dentists to provide effective TCC (p-value>0.05). Statistically significant differences were observed between the barriers faced by dental students and dentists in that the students were more concerned that they lacked skills of TCC in comparison to dentists (p-value=0.04). Conclusions: The tobacco cessation curriculum effectively boosts dental students' intention to provide counseling, although skill deficits and concern over patient relationships remain notable barriers.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft

2025-12-31T18:10:26+00:00

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries, particularly in active individuals and athletes. Untreated ACL tears can lead to joint instability, meniscal damage, and early osteoarthritis. Objectives: To assess the efficacy of hamstring tendon autografts in arthroscopic ACL reconstruction. Methods: A longitudinal descriptive study was undertaken from July 2023 to January 2024, including 70 patients with ACL rupture with an arthroscopic ACL reconstruction using hamstring autografts. Patients were assessed through Lysholm knee scoring and International Knee Documentation Committee (IKDC) scores at 6 weeks, 3 months, and 6 months postoperatively. Demographic data, clinical characteristics, and outcomes were analyzed using statistical methods, using a p-value≤0.05 as significant. Results: Participants were predominantly male (80%), with a mean age of 35.6 years (SD 5.76). Causes of ACL injury included road traffic accidents (40%), sports activities (31.4%), and falls (28.6%). Preoperative IKDC scores improved significantly from 52.6 (95% CI: 50.9–54.3) to 89.6 (95% CI: 88.8–90.4) postoperatively (p<0.001, Cohen’s d = 5.2). Lysholm scores indicated excellent outcomes (90–100) in 44.3% (SD 4.1), good (80–89) in 38.6% (SD 3.8), fair (65–79) in 12.9% (SD 2.5), and poor (<65) in 4.3% (SD 1.2). Right-sided injuries showed better outcomes (p<0.001). Sports-related injuries had superior outcomes (p<0.001). Conclusions: The study contributes valuable insights into demographic factors influencing results, emphasizing the importance of graft choice in achieving favorable postoperative knee function.

Comparison of Ureteral Stents-Related Symptoms among Patients with Ureteral Stents of 4.7Fr and 6Fr Diameter

2025-12-31T18:10:48+00:00

Ureteric stents are essential in urology, but factors like diameter, position, and design can significantly impact patients' quality of life. Objectives: To compare the mean IPSS scores among patients with ureteral stents of 4.7Fr and 6Fr diameter. Methods: The quasi-experimental study was conducted at the Department of Urology and Renal Transplant, Mayo Hospital, Lahore, from March to September 2024. 124 patients were selected for this study who required DJ Stenting after open or endourological surgery. Patients were categorized into two groups. Each group contains 62 patients. All patients underwent open or endourological surgery followed by DJ Stenting as indicated. 4.7 Fr DJ Stents were placed in Group A and 6 Fr DJ Stents in Group B. Results: A Total of 124 patients, the mean age of the 4.7 Fr DJ stent group was 47.88 ± 6.56 years, and 49.48 ± 6.57 years in the 6 Fr DJ stent group. The p-value = 0.178, duration of operation 50.85 ± 0.64 minutes in group A and 55.25 ± 0.76 minutes in group B. The p-value = 0.000). There were 43 (55.1%) male and 19 (41.3%) female in group A, and 35 (44.9%) male and 27 (58.7%) female in group B. A (p=0.193) IPSS score was 2.21 ± 0.11 in group A and 6.33 ± 0.19 in group B (p=0.000). Conclusions: It was concluded that ureteral stents with larger diameters result in notably more severe urinary symptoms. It is advisable to use ureteral stents with smaller diameters to alleviate symptoms related to stent use.

An Assessment of Functional Status of Stroke Patients Using the Functional Independence Measure on the Hospitalization, Discharge, and Three Months Post-Stroke: Analytical Cross-Sectional Study

2025-12-15T11:25:30+00:00

Stroke is one of the leading causes of impairment in the world, with effects on the motor functions, cognitive and mental processes, and the general quality of life of the patients. Objectives: To determine the full functional condition of stroke patients through the change in the Functional Independence Measure (FIM) scores at the time of admission, discharge, and three months post-stroke. Methods: This was an analytical cross-sectional study conducted on 108 patients with ischemic stroke in the age group of 18-75 years, at the Department of Neurology, Services Hospital, Lahore. Functional independence was assessed with the FIM scale thrice, on admission, at discharge from the hospital, and three months post-stroke. Repeated ANOVA and paired t-tests were used to compare the changes in FIM scores over time. Results: The average age of the participants was 58.4 years with a standard deviation of 10.2, and men made up 61.1% of the sample. The mean FIM scores did increase significantly between 86.33 +/-14.5 at the time of admission and 102.7 ± 16.5 at discharge, and 118.9 ± 15.8 at three months after stroke (p<0.001). The younger patients (18-50 years) had more functional improvement than the older patients (>=50 years) (p=0.002). A high negative correlation was found between age and functional recovery (r = -0.42, p=0.004). Conclusions: Patients with ischemic stroke recover much of their functional abilities with time, with age at younger years, fewer days in the hospital, and higher baseline FIM scores serving as independent predictors of improved outcomes.

Comparison of Oral versus Intravenous Fluid Therapy on Amniotic Fluid Index in Women with Oligohydramnios

2025-12-31T18:12:51+00:00

Oligohydramnios, characterized by reduced amniotic fluid volume, poses significant risks to fetal growth and pregnancy outcomes. Objectives: To compare the effects of oral versus intravenous fluid therapy on AFI in women with oligohydramnios, and to determine the more effective hydration strategy for clinical use. Methods: Following ethical approval from the Institutional Review Board of Fatima Jinnah Medical University, a quasi-experimental study was conducted. 60 patients diagnosed with oligohydramnios based on operational criteria were enrolled after obtaining written informed consent. Participants were randomly divided into two groups: Group A received IV hydration, while Group B received oral hydration. Both groups remained admitted for one week, during which AFI was measured at baseline and after the intervention. Results: The mean age of participants was 27.67 ± 6.00 years. Baseline AFI was 3.79 ± 0.25 cm, with no significant differences between groups. After one week, Group A (IV hydration) showed a mean AFI of 5.34 ± 0.23 cm, while Group B (oral hydration) achieved a significantly higher mean AFI of 5.69 ± 0.41 cm (p=0.000). Treatment efficacy was reported in 90.0% of Group A and 96.7% of Group B participants (p=0.612). Conclusions: The improvement in AFI with oral hydration was slightly better than with IV hydration, but not statistically significant. The two interventions were safe with no maternal or fetal adverse effects. The first option is oral hydration, which is practical, non-invasive, and cost-effective, especially in resource-restricted settings.

Frequency and Association of Dyslipidemia with Clinical and Biochemical Parameters among Patients with Non-alcoholic Fatty Liver Disease

2025-12-31T18:14:41+00:00

Non-alcoholic fatty liver disease (NAFLD) is increasingly associated with metabolic disorders, particularly dyslipidemia, which contributes to cardiovascular risk and disease progression. Understanding this relationship is essential for early intervention. Objectives: To assess the frequency of dyslipidemia and its association with clinical and biochemical parameters in NAFLD patients. Methods: A cross-sectional study was carried out at the Department of Medicine, Jinnah Hospital, Lahore, from November 2024 to April 2025. A total of 116 ultrasonographically confirmed NAFLD patients aged 18–70 years were registered using non-probability consecutive sampling. Patients with secondary causes of liver disease, lipid-altering medications, or systemic illnesses were excluded. Results: Among the 116 NAFLD participants, the average age was 48.67 ± 11.57 years, and the mean body mass index (BMI) was 28.27 ± 4.60 kg/m². Dyslipidemia was present in 72 (62.1%) of participants. Females comprised 44 (61.1%) of the dyslipidemic group, and 44 (61.1%) were aged 46–70 years. Diabetes mellitus and ischemic heart disease were significantly associated with dyslipidemia (p=0.016 and p=0.004, respectively). Biochemical markers, including BMI (p=0.002), AST (p=0.012), and ALT (p=0.041), were significantly elevated in dyslipidemic patients. Lipid profile abnormalities, such as total cholesterol, triglycerides, and LDL-C, were significantly higher, while HDL-C was lower (all p<0.001). Dyslipidemia prevalence increased with NAFLD severity grade (p<0.001). Conclusion: Dyslipidemia is prevalent in NAFLD and significantly correlates with disease severity and metabolic comorbidities, highlighting the need for integrated lipid and hepatic assessment in clinical management.

Exposure of Acute Gastroenteritis in Relation to Season: A Cross-Sectional Study Based on Demographic Representation of Paediatric Patients with Their Outcomes

2025-12-18T09:38:48+00:00

Among children, acute gastroenteritis (viral) is a major concern for public health. In Pakistan, childhood mortality remains fourth largest, with gastrointestinal infections remaining a major cause. Objectives: To compare acute gastroenteritis and seasonal variations based on their demographic representation. Methods: After informed consent and ethical approval, this cross-sectional (prospective) research was carried out in the Paediatric Ward of Al-Tibri Medical College and Hospital, Karachi, from June 2023 to May 2024. Patients diagnosed with acute gastroenteritis were included, while those with any other diagnosis (such as intestinal obstruction, urinary tract infection, etc.) were excluded. SPSS version 23.0 was used for the analysis of data. To test significance, the chi-square test was applied at a p-value≤0.05. Results: Among 377 paediatric cases, 55% were male and 45% female, with 34% infants and 38% between 1-4 years. 63% of patients were admitted in the summer and 37% in winter, with most being admitted in May 2024 (14%) and least in the month of November 2023 (3%). The majority were discharged alive and healthy (99%). A significant association was observed in patients admitted in each month (p-value<0.001). Conclusions: This study showed that acute gastroenteritis in paediatric patients was more common among males and children aged 1–4 years, with a significantly higher number of admissions during the summer months, particularly in May 2024. Despite the seasonal surge, almost all patients recovered well, with 99% discharged alive and healthy.

Assessment of Symptom Severity, Urinary Flow, and Prostate Volume in Men with Benign Prostatic Hyperplasia: A Cross-Sectional Correlation Study

2025-12-31T18:13:01+00:00

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in ageing men, yet patient-reported symptoms, urinary flow parameters, and prostate size often show inconsistent clinical relationships. Clarifying how these measures relate may improve diagnostic interpretation and clinical decision-making. Objectives: To evaluate the correlations among symptom severity (IPSS), peak urinary flow rate (Qmax), and prostate volume in men with BPH. Methods: A cross-sectional analytical study was conducted among 56 men aged ≥50 years with clinically diagnosed BPH. Symptom severity was assessed using the International Prostate Symptom Score (IPSS). Uroflowmetry provided Qmax values, and transabdominal ultrasonography measured prostate volume. Pearson correlation coefficients with 95% confidence intervals were calculated to assess associations among variables. Results: The mean age of participants was 62.79 ± 6.64 years, and most reported moderate to severe symptoms (mean IPSS 21.79 ± 6.22). No significant correlation was found between IPSS and Qmax (r = –0.064, p = 0.639; 95% CI –0.32 to 0.20) or between IPSS and prostate volume (r = 0.216, p = 0.110; 95% CI –0.03 to 0.45). Prostate volume showed a weak, nonsignificant inverse association with Qmax (r = –0.139, p = 0.306; 95% CI –0.37 to 0.13). Conclusion: The absence of significant correlations among IPSS, Qmax, and prostate volume confirms that symptom burden, flow limitation, and gland size represent different dimensions of BPH. Clinical decision-making should therefore integrate these measures collectively rather than interpreting them in isolation

Diagnostic Accuracy of Computed Tomography with Intraoperative Findings in Prediction of Metastatic Cervical Lymph Nodes in Oral Squamous Cell Carcinoma by Taking Histopathology as Gold Standard

2025-12-31T18:14:11+00:00

Oral squamous cell carcinoma is a common cancer with a high risk of cervical lymph node metastasis. Accurate identification of metastatic nodes is vital for staging and treatment planning. Computed tomography (CT) is widely used for pre-surgical assessment, while intraoperative lymph node evaluation offers additional diagnostic value. Objectives: To assess the diagnostic accuracy of CT and intraoperative findings in predicting metastatic cervical lymph nodes in oral squamous cell carcinoma, using histopathology as the gold standard. Methods: A cross-sectional study was conducted at the Department OF Radiology, Dr. Ziauddin University Hospital, Karachi, from November 2023 to November 2024. A total of 323 patients with clinically suspicious oral squamous cell carcinoma underwent CT neck scans and intraoperative lymph node assessment based on size, consistency, shape, and adherence. Histopathology of resected nodes was the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: The mean patient age was 51.5 years, with an average lymph node size of 20.9 mm. CT showed sensitivity 97.2%, specificity 84.6%, PPV 76.3%, NPV 98.4%, and accuracy 88.8%. Intraoperative scoring demonstrated sensitivity 89.3%, specificity 88.8%, PPV 80.3%, NPV 94.5%, and accuracy 89.2%. Conclusions: Both CT and intraoperative scoring demonstrated high diagnostic accuracy for detecting metastatic cervical lymph nodes. Their combined application is recommended to enhance staging, guide surgery, and improve patient outcomes.

Gender Identification Based on Dental Micro-Esthetics: A Study of Dental Professionals' Perceptions

2025-12-31T18:15:32+00:00

Dental micro-aesthetic traits are linked to gender-specific features in dentistry, but their reliability for gender identification remains controversial. Objectives: To assess the correlation between accurate gender identification and micro-aesthetic dental traits through the evaluation of frontal intraoral photographs by observers, specifically dental undergraduates, graduates, and postgraduates. Methods: A cross-sectional study was conducted at Lahore Medical and Dental College (June 2024 to May 2025) with 376 participants (99% response rate). Participants evaluated 10 anonymous frontal intraoral photographs for gender identification via a questionnaire. Descriptive statistics, chi-square tests, and logistic regression analyzed associations between accuracy and clinical experience (>3 vs. ≤3 years), using SPSS version 25.0. Photographs were selected for variability in micro-aesthetic traits. Result: The mean accuracy score was 5.38 ± 1.72 out of 10, with 58.8% scoring 4–6. Accuracy varied significantly (23.94% for Q8 to 70.21% for Q3, p<0.05). Males had higher accuracy of achieving correct answers (p=0.033), indicating that males were more likely to score above the median score of 5. Experienced clinicians prioritized tooth size (p=0.005) and triangular canines (p=0.017). Logistic regression showed experience-based differences in the correct identification of specific female photographs (OR = 0.564 for Q7, p=0.033; OR = 2.583 for Q9, p<0.001). Conclusions: Dental micro-aesthetic traits provide only moderate accuracy for gender identification due to considerable overlap and observer bias. Targeted education on trait variability is recommended.

Frequency of Congenital Anomalies in Newborns

2025-12-31T18:10:37+00:00

Congenital abnormalities (CA) are anatomical or performance-based anomalies that express themselves during the in-utero growth and may be diagnosed during pre-birth, during delivery, and post-birth. Objective: To review the incidence of birth defects in infants. Methods: The descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Civil Hospital, Karachi, during a period of two years, i.e., March 2017 to March 2019. This study had 213 pregnant women. After birth, there was the identification of congenital anomalies in the newborns by visual examination, and other factors were established by the history of the patient or medical records. All the data were recorded on a pre-determined proforma template. Results: The average age of the participants was 27.381 ± 4.08. The most common congenital anomalies were anencephaly (19.7%), hydrocephalus (15.5%), absence of ear/finger/toe/scrotum/arm/leg/limbs (9.4%), cleft lip and cleft palate (8.9%), meningomyelocele (7%), and talipes (8%). The causal variables were maternal age 30 years and above (20.2%), paternal age 35 years and above (19.7%), maternal diabetes mellitus (20.2%), consanguinity marriage (20.2%), maternal infection during pregnancy (8.9%), and maternal folic acid supplementation (61.5%). These are said to be descriptive and not causal. Conclusions: This study highlights the rate of congenital anomalies and the types of congenital anomalies. Its results touch on the importance of routine antenatal care and prenatal screening to intervene and manage affected pregnancies at an earlier stage.

Diagnostic Accuracy of Colour Doppler Ultrasound in Antenatal Diagnosis of Morbidly Adherent Placenta, Taking Operative Finding as Gold Standard

2025-12-31T18:13:31+00:00

Morbidly adherent placenta (MAP), often linked to prior cesarean delivery, is a serious obstetric condition requiring timely Doppler ultrasound diagnosis despite variable specificity. Objectives: To evaluate the diagnostic accuracy of Color Doppler ultrasound (CDUS) for antenatal detection of MAP, using intraoperative findings as the reference standard. Methods: This was a comparative analytical study with a retrospective review of patient data conducted in the Department of Diagnostic Radiology at Aga Khan University spanning April to August 2025 and included pregnant women via consecutive sampling identified as being at risk for MAP. Each participant underwent an antenatal ultrasound assessment, and the sonographic findings were subsequently compared with operative findings. Diagnostic indices such as sensitivity, specificity, positive and negative predictive values, as well as overall accuracy, were determined. Results: Color Doppler ultrasound exhibited strong diagnostic performance in detecting MAP, achieving a sensitivity of 98.10 % (95% CI: 93.29-99.77) and a specificity of 55.56 % (95% CI: 35.33-74.52). The point receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) of 0.89, indicative of excellent discriminatory capacity. Diagnostic accuracies were observed as 90.48% for accreta (p<0.001), 89.19% for increta (p<0.001), and 79.17% for percreta (p<0.001). Subgroup analysis showed the same accuracy in women aged ≤35 years (98.08%) and those >35 years (98.08%). Conclusions: Doppler ultrasound showed high diagnostic accuracy for MAP with excellent ROC performance and consistent sensitivity across maternal age and gestational subgroups.

Frequency of Postpartum Depression in Patients Undergoing Caesarean Section

2025-12-31T18:15:01+00:00

Postpartum depression (PPD) is a common mental health disorder affecting women after childbirth, but its risk varies across clinical and obstetric contexts. However, evidence regarding the association between CS-related maternal, socioeconomic, surgical, and neonatal factors and the development of PPD remains inconsistent. Objectives: To determine the frequency of PPD among women undergoing Caesarean section and its association with education level, socioeconomic status, type of Caesarean section, complications, history of mental health issues, and neonatal complications. Methods: This descriptive cross-sectional study was conducted at the Combined Military Hospital (CMH) Quetta from February 2025 to June 2025. A total of 91 postpartum women who delivered via Caesarean section were included using non-probability consecutive sampling. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of ≥13 to define PPD. Statistical analysis was performed using SPSS version 26.0, and associations between PPD and categorical variables were assessed using the chi-square test. Results: The mean age of participants was 32.14 ± 8.34 years, and the average parity was 2.52±1.68. Postpartum depression was identified in 22 (24%) women. Stratified analysis showed no statistically significant association between PPD and education level (p=0.864), socioeconomic status (p=0.493), type of Caesarean section (p=0.978), complications (p=0.656), history of mental health issues (p=0.794), or neonatal complications (p=0.895). Conclusions: The prevalence of PPD among women undergoing Caesarean section was 24%. However, no significant associations were found with maternal, socioeconomic, surgical, or neonatal factors (all p>0.05). Routine screening and psychological support are essential to address PPD effectively.

Physiological Joint Stability and Clinical Outcomes of Braided Suture Techniques in Posterior Cruciate Ligament Reconstruction

2025-12-31T18:15:00+00:00

PCL plays a critical role in maintaining the stability of the posterior knee joint, highlighting the importance of accurate diagnosis and effective treatment for such injuries. Objectives: To determine the stability of the knee joint in patients with posterior cruciate ligament rupture after the autologous hamstring and braided suture reconstruction. Methods: A Quasi-experimental study was conducted from June 2024 to June 2025 at Shahida Islam Medical Complex. This study included 120 patients with posterior cruciate ligament rupture and was divided into control (group A) and study group (Group B) (n=60 each). Group A underwent single-bundle autologous hamstring reconstruction, while group B underwent the same procedure with an added braided thread treatment. Evaluations were performed both before and after surgery, including assessments of complications, joint mobility, gait analysis, knee joint stability (tested with the KT2000), and knee function as measured by Rasmussen scoring. Results: Group B showed significantly better treatment rates compared to Group A (p<0.05). One year after the surgical operations, Group B exhibited notable improvements in stride speed, joint function, stride length, and Rasmussen scores (p<0.05). The cases also showed significantly reduced gait asymmetry and favorable outcomes from the KT2000 test p<0.05). Conclusions: The combination of autologous reconstruction of the hamstring tendon single bundle by using braided thread enhances clinical outcomes for individuals with PCL tears. This treatment significantly improves joint stability and knee function over the long term, demonstrating its effectiveness as a promising therapeutic option.

Diagnostic Accuracy of Red Cell Distribution Width in Diagnosing Early-Onset Neonatal Sepsis in Term Newborns

2025-12-31T18:14:21+00:00

Inflammation in neonatal sepsis triggers cytokine-driven disruption of erythropoiesis, producing a mix of immature and damaged red cells. Objectives: To determine the diagnostic accuracy of RDW for early onset neonatal sepsis (EONS) in term newborns, taking culture-proven EONS as the gold standard. Methods: This prospective validation study was conducted at the Department of Neonatology of Children's Hospital, Institute of Child Health, Multan. A total of 147 term neonates with suspected EONS were enrolled consecutively. Neonates with asphyxia, meconium aspiration, major congenital malformations, or hemolytic disease were excluded. Clinical and laboratory data, including RDW, were collected. Blood, urine, and cerebrospinal fluid cultures were performed as per CLSI guidelines. EONS was confirmed by positive blood culture. A cutoff value of RDW ≥17% was used for labelling EONS. Data were analyzed using SPSS version 25.0, and the diagnostic accuracy of RDW was calculated, taking culture-proven neonatal sepsis as the reference standard. Results: The mean postnatal age was 3.7±1.4 days. The mean RDW was 16.9 ± 1.9%. RDW of ≥17% was observed in 54.4% of the neonates. Culture confirmed EONS was diagnosed in 59.9%. RDW showed sensitivity of 84.1% (95% CI: 74.8-91.0%), specificity of 89.8% (95% CI: 79.2-96.2%), positive predictive value of 92.5%, negative predictive value of 79.1%, and diagnostic accuracy of 86.4%. The area under the ROC curve was 0.87 (95% CI: 0.81 – 0.93, p<0.001). Conclusions: RDW ≥17% demonstrated high diagnostic accuracy as an early predictor of culture-confirmed EONS in term neonates.

Frequency of Echocardiographic Changes in Patients with Chronic Liver Disease at a Tertiary Care Hospital in Karachi

2025-12-31T18:13:41+00:00

Chronic liver disease (CLD) is a major health burden in Pakistan, commonly due to viral hepatitis. Cirrhotic cardiomyopathy (CCM) is an underdiagnosed complication that may impact prognosis and management. Objectives: To determine the frequency and spectrum of echocardiographic abnormalities in CLD patients and assess their correlation with disease severity based on the Child-Pugh classification. Methods: A cross-sectional study of 187 adult CLD patients was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, between September 2024 and February 2025. Echocardiographic parameters, including pulmonary artery pressure, ejection fraction, systolic, and diastolic function, were evaluated using a Philips EPIQ 7 (Philips Healthcare, Andover, MA, USA) system. Patients were categorized according to Child-Pugh class (B or C). Associations between echocardiographic findings and Child-Pugh class were analyzed using chi-square and logistic regression tests, with p < 0.05 considered significant. Results: Mean age was 55.6 ± 13.4 years; 51.9 % were men. The leading etiologies were hepatitis C (46 %) and B (26 %). Diastolic dysfunction was the most frequent abnormality (53.5 %), while systolic dysfunction occurred in 23.5 %—significantly more common in women (p < 0.001) and in advanced disease (Child-Pugh C: 67 % vs B: 38 %; OR ≈ 3.4, p=0.0001). Pulmonary hypertension (23.5%) and reduced ejection fraction (10.2%) showed no correlation with Child-Pugh class. Conclusions: Echocardiographic abnormalities are common in CLD, particularly diastolic dysfunction. Systolic dysfunction increases with worsening hepatic severity, emphasizing the need for routine cardiac assessment in cirrhotic patients for better risk stratification and management.

Comparison of Rate of Epiretinal Membrane Formation Following Pars Plana Vitrectomy with and without Internal Limiting Membrane Peeling in Advanced Diabetic Eye Disease

2025-12-31T06:04:41+00:00

Pars plana vitrectomy (PPV) is the standard surgery used to treat the advanced cases of diabetic eye disease, though secondary epiretinal membrane (ERM) formation is a common adverse effect of surgery. Objectives: To compare the ERM formation and visual results after PPV in the ILM peel and non-ILM peel groups. Methods: A quasi-experimental study was done in the Department of Ophthalmology and comprised 70 patients with tractional retinal detachment that was at risk of affecting the macula. They have been well assessed ophthalmologically and divided into PPV treated with ILM peeling (Group A) and those treated with no ILM peeling (Group B). Clinical examination, OCT, and visual acuity were done as follow-ups at 2 months, 6 months, and 1 year, and analyzed in SPSS version 20.0 (p≤0.05). Results: Clinical ERM was found in 3 of the patients (8.6%) at 6 months of age in Group A and none in Group B (p=0.23). ERM was identified in 11% in Group A at 6 months and 14% at 1 year, with no ERM identified in Group B (p=0.114). The visual acuity in the non-ILM peel group was significantly higher than the ILM peel group at all the follow-ups (p<0.05). Conclusions: ILM peeling in PPV can decrease secondary ERM and is linked to a better visual outcome after surgery in diabetic eye disease in advanced diabetic patients.