Pakistan Journal of Health Sciences

Frequency of Intradialytic Complications among Patients of Maintenance Hemodialysis on Thrice Weekly

2025-10-02T07:15:41+00:00

Renal replacement therapy for ESRD includes hemodialysis, peritoneal dialysis, and transplantation, with hemodialysis being the most common. Over two million patients receive it annually. ESRD patients often have comorbidities like heart disease, vascular disease, and COPD, increasing their health risks. Objectives: To determine the frequency of intra-dialytic complications occurring in patients on maintenance hemodialysis. Methods: This cross-sectional study was conducted at the Nephrology Department of Sir Ganga Ram Hospital, Lahore. A total of 83 ESRD patients aged 15–70 years, undergoing thrice-weekly hemodialysis, were selected using non-probability consecutive sampling. Patients with acute renal failure, dementia, or unconsciousness were excluded. Dialysis was performed using Fresenius, Surdial, Toray, and Nipro machines, with complications monitored over two months. Data were recorded using a structured proforma and analyzed with SPSS version 25.0, with qualitative variables presented as frequencies and percentages and continuous variables as mean ± SD. Chi-square tests were applied, with statistical significance set at p≤0.05. Results: Among 83 patients (63.9% male, 63.9% >40 years), 60.2% had CKD for <5 years. Diabetes (65) and hypertension (29) were the leading causes. The most common complications were hypotension (28), nausea/vomiting (17), and cramping (11). There was no significant association among complications of CKD with age, gender, duration of disease and type of hemodialysis (p-value>0.05). Conclusions: Dialysis complications are common, with hypotension being the most frequent, followed by nausea, vomiting, hypertension, and muscle cramps. Diabetic patients are more vulnerable, emphasizing the need for better monitoring and preventive strategies to improve outcomes.

Celiac Disease Among Patients with Type 1 Diabetes Mellitus

2025-10-02T07:15:50+00:00

The prevalence of celiac disease (CD) in type-1 diabetes mellitus (T1DM) may vary depending on the region, genetic background, and screening practices. Objectives: To determine the frequency of CD in patients with T1DM. Methods: This cross-sectional study was conducted at the Outpatient Department and Pediatric Ward of Children’s Hospital and Institute of Child Health, Multan, Pakistan, from February 2024 to July 2024. The inclusion criteria were children aged 2-18 years with type 1 diabetes mellitus (T1DM). Anti-transglutaminase assessment for the diagnosis of CD was performed, and it was deemed positive if the serum anti-tissue transglutaminase IgA antibody level was ≥100 IU/mL or the histopathology of the intestinal biopsy specimen was consistent with Marsh category 3 or higher. Data analysis was performed using IBM-SPSS Statistics, version 26.0. Results: The mean age was 9.03±3.6 years. There were 57 (58.2%) children who were male. Fifty-two (53.1%) children belonged to middle-class families. A positive family history of T1DM, autoimmune thyroiditis, and CD was noted in 46 (46.9%), 10 (10.2%), and 6 (6.1%) cases, respectively. The diagnosis of CD was confirmed in 20 (20.4%) children with T1DM. There were 4 (20.0%) and 2 (10.0%) patients with positive CD who had a positive family history of autoimmune thyroiditis and CD, respectively. Conclusions: The frequency of celiac disease was high among children with type 1 diabetes mellitus. The utility of anti-tTG evaluation is a non-invasive diagnostic tool for the screening of CD and can be utilized for the early diagnosis of CD in children with T1DM.

Polycystic Ovary Syndrome and Insulin Resistance: Comparative Analysis of Obese and Non-Obese Women in a Tertiary Care Setting Pakistan

2025-10-02T07:15:43+00:00

Polycystic ovarian syndrome is a widespread endocrine disease that is linked to insulin resistance, regardless of obesity. This correlation is especially pertinent to South-Asian groups, where culture and lifestyles could mediate the manifestation of diseases. Objectives: To evaluate the effect of obesity on insulin resistance in women with polycystic ovarian syndrome in a tertiary care setting in Lahore, Pakistan. Methods: An analytical cross-sectional study performed at Avicenna Hospital from May to December 2023. The sample size included 220 women with PCOS, with an equal number of obese and non-obese women. BMI, waist circumference, fasting glucose, and insulin level were measured as clinical and metabolic parameters. IR was assessed on the HOMA-IR with a cut-off of 2.5. Data were analyzed with logistic regression and associated statistical t-tests. All subjects gave written consent before the data collection. Results: Obese women had a much greater BMI, waist circumference, glucose, insulin, and HOMAIR scores (p=0.001). The prevalence of IR was 78% compared to 43% among the obese female versus the non-obese female. BMI was found to predict IR (OR over 3.4 with 95% interval in 2.1-5.5) and fasting glucose (OR over 1.5 with 95% interval in 1.1-2.3). The women were also obese and had an unfavorable lipid profile. Conclusions: Insulin resistance is common in both obese and non-obese women with polycystic ovarian syndrome, but it is higher in the obese group.

Comparison of Immediate Versus Delayed Percutaneous Coronary Intervention on Recovery and Complications in Diabetic Patients with Acute ST Segment Elevation Myocardial Infarction: A Cross-Sectional Study

2025-10-02T07:15:49+00:00

Acute STEMI in diabetic patients leads to worse outcomes, making timely PCI crucial. However, the optimal timing (immediate vs. delayed) of percutaneous coronary intervention (PCI) for long-term recovery and complications in diabetic individuals is still being investigated. Objectives: To compare recovery and complication rates in diabetic acute STEMI patients undergoing immediate versus delayed PCI. Methods: This analytical cross-sectional study was conducted at a tertiary care hospital in Peshawar, Pakistan (October 2024 to March 2025), and enrolled 296 adult diabetic STEMI patients (aged ≥18 years) requiring PCI. After informed consent, data on demographics, medical history, procedural details, and post-PCI outcomes were collected via a structured questionnaire. Participants were categorized into immediate and delayed PCI groups, with statistical analysis using descriptive statistics and Chi-square tests to compare outcomes. Results: A total of 296 diabetic STEMI patients were enrolled, with 32.1% undergoing immediate PCI and 67.9% delayed PCI. The mean age was 55.89 ± 11.57 years, and 77% had type 2 diabetes. The delayed PCI group included a higher percentage of male; however, this variation was not significant. Baseline LVEF did not differ significantly (immediate: 40.54 ± 6.49 vs. delayed: 41.33 ± 7.23, p>0.05). Both groups showed significant post-PCI LVEF improvement (immediate: 49.12 ± 7.10, delayed: 50.85 ± 6.80), but the intergroup difference remained non-significant. No statistically significant differences were observed in intra- or post-procedural complications between the groups. Conclusions: In diabetic STEMI patients, a slight clinical delay in PCI did not significantly impact functional recovery (LVEF improvement) or increase intra- and post-procedural complications when compared to immediate intervention.

The Relationship Between Caffeine Consumption and Sleep Quality among Teenagers in Lahore, Pakistan

2025-10-02T07:15:44+00:00

Caffeine, a widely consumed stimulant, is prevalent among teenagers, particularly through beverages like tea, coffee, energy drinks, and soft drinks. As sleep is vital for physical and mental development in teenagers, increased caffeine intake may adversely affect their sleep quality. However, limited research exists on this association within the Pakistani context, particularly in urban centers. Objectives: To evaluate the relationship between caffeine consumption and sleep quality among teenagers in Lahore. Methods: An analytical cross-sectional study was conducted among 400 teenagers aged 13–19 years from selected schools and colleges in Lahore. Data were collected using a structured questionnaire that incorporated the Caffeine Consumption Questionnaire (CCQ) and the Pittsburgh Sleep Quality Index (PSQI). The CCQ assessed the frequency and quantity of caffeine intake, while the PSQI evaluated the participants’ sleep quality. Participants were grouped based on caffeine consumption levels (low, moderate, high). Statistical analysis, including chi-square tests and logistic regression, was performed using SPSS to determine associations. Results: Many teens regularly consumed caffeine through tea or coffee, as revealed in our findings, which showed that 45.5% of teens consumed it daily and 31% consumed it frequently. The research showed that 68% of participants get poor sleep according to PSQI results, which indicates serious public health risks. Conclusions: The analysis revealed caffeine consumption led to poor sleep quality for teenagers according to research data.

Acute Complications in Hemodialysis: Frequency, Patterns, and Clinical Implications

2025-10-02T07:15:42+00:00

Chronic Kidney Disease (CKD) is a progressive and irreversible condition increasingly recognized as a global public health challenge. Hemodialysis, though life-sustaining, is frequently associated with acute complications that compromise patient outcomes and healthcare quality, especially in resource-limited settings. Objectives: To determine the frequency of acute complications during hemodialysis in patients with dialysis-dependent CKD at MTI Mardan Medical Complex, Mardan. Methods: This descriptive cross-sectional study was conducted from January to June 2025, involving 326 patients undergoing maintenance hemodialysis. Data were collected using a structured proforma documenting clinical and demographic characteristics, comorbidities, and intradialytic complications across multiple sessions. Standardized clinical definitions were applied to identify events such as hypotension (systolic BP drop ≥20 mmHg or <90 mmHg), hypoglycemia (RBS <70 mg/dL), and chest pain. The data were analyzed using SPSS version 20.0. Results: The mean age was 37.7 ± 12.1 years, with a male predominance (55.2%). The average duration of dialysis was 9.2 ± 5.1 months. Acute complications were observed in 41.7% of patients, with hypotension being the most frequently reported complication. Conclusions: Intra-dialytic complications are common in maintenance hemodialysis, with hypotension being the most prevalent. Enhanced monitoring, standardized protocols, and multicenter studies are warranted to reduce complication rates and improve patient care.

Epigenetic Regulation of the TLR7 Gene and Its Correlation with Immune Dysregulation in Post-COVID Syndrome

2025-10-02T07:17:03+00:00

Toll-like receptor 7 (TLR7) is crucial for recognizing single-stranded viral RNA and initiating type I interferon signalling, which initiates antiviral immune responses. DNA methylation and other epigenetic controls may affect TLR7 expression and play a role in immune dysregulation in post-COVID syndrome. Objectives: To assess the association between immune dysregulation in people with post-COVID syndrome and epigenetic regulation of the TLR7 gene, specifically DNA methylation patterns. Methods: Patients with post-COVID-19 symptoms (≥12 weeks’ post-infection) and age- and sex-matched recovered controls participated in a case-control study. The purpose of peripheral blood mononuclear cells (PBMCs) was to use bisulfite pyrosequencing to analyze the DNA methylation of TLR7 promoter CpG sites, to use qRT-PCR to quantify TLR7 mRNA, and to use flow cytometry to immunophenotype immune cell subsets and type I interferon (IFN-α) production. Analysis was done on statistical relationships among immune parameters, gene expression, and methylation status. Results: In comparison to controls, post-COVID patients showed notable changes in TLR7 promoter methylation patterns, with site-specific hypo- and hyper-methylation associated with corresponding changes in TLR7 expression. Anomalies in B-cell and plasmacytoid dendritic cell (pDC) profiles and dysregulated IFN-α levels were linked to aberrant expression, suggesting persistent innate immune activation. Conclusions: TLR7 epigenetic changes could be a factor in post-COVID-19 persistent immunological dysregulation. These results emphasize TLR7 methylation as a possible therapeutic target and biomarker. To confirm these correlations, more long-term research is needed.

Diagnostic Accuracy of MRCP for Detecting Choledocholithiasis in Patients with Obstructive Jaundice Keeping ERCP as Gold Standard

2025-10-02T07:15:39+00:00

Choledocholithiasis is a common cause of obstructive jaundice and may lead to serious complications if diagnosis or treatment is delayed. While ERCP is the gold standard for diagnosis and therapy, its invasive nature carries risks. MRCP offers a non-invasive alternative, but its accuracy may be influenced by clinical and technical factors. Objectives: To evaluate the diagnostic accuracy of MRCP in detecting choledocholithiasis using ERCP as the reference standard, and to assess the impact of stone size, location, number, and MRCP–ERCP interval. Methods: This analytical cross-sectional diagnostic accuracy study was conducted in the Department of Radiology, Bahawal Victoria Hospital, Bahawalpur (March 13, 2023, to March 12, 2024). A total of 271 patients with suspected choledocholithiasis underwent both MRCP and ERCP. Sensitivity, specificity, predictive values, overall accuracy, and Cohen’s kappa were calculated with subgroup analyses by stone size, location, number, and MRCP–ERCP interval. Results: MRCP showed a sensitivity of 88.9% (95% CI: 83.5–92.7%), specificity of 67.0% (95% CI: 56.9–75.8%), PPV of 84.2% (95% CI: 78.4–88.7%), NPV of 75.3% (95% CI: 64.9–83.4%) and an overall accuracy of 81.5% (95% CI: 76.5–85.7%). Agreement with ERCP was moderate (Cohen’s kappa = 0.55). Diagnostic performance was highest for stones measuring 5–10 mm, distally located stones, and when ERCP was performed within 3 days of MRCP. Conclusions: MRCP demonstrates good diagnostic accuracy and moderate agreement with ERCP, particularly for medium-sized distal stones and when ERCP is not delayed.

Awareness of Keratoconus Among the Diagnosed Cases of Keratoconus in Patients Visiting Al Shifa Trust Eye Hospital

2025-10-02T07:15:46+00:00

Keratoconus is a chronic, progressive, non-inflammatory, usually bilateral corneal disorder that causes stromal thinning that leads to corneal apical protrusion, irregular astigmatism, and decreased vision. Its etiology is multifactorial, and it is important to determine its awareness and its association with non-genetic, environmental risk factors to prevent it. Objectives: To determine the level of awareness of keratoconus among the diagnosed cases of keratoconus. Methods: This descriptive cross-sectional study was conducted at Al Shifa Trust Eye Hospital in five months using a consecutive sampling technique. SPSS version 22.0 was used for Data Analysis. The Pearson’s Chi-square test was utilized for cross-tabulation. Results: Out of 135 patients, it was seen that participants with a higher level of education (P value 0.0029) and those with positive family history had overall better knowledge about the disease and specific knowledge about eye rubbing as an aggravating factor of the disease (P value 0.00249). In conclusion, overall, 48.1% % had poor knowledge, 34.8% had fair, and only 17% had good knowledge regarding the disease. Conclusions: Despite keratoconus being more common in younger individuals who have internet access, patients still had poor knowledge of the disease. Different strategies can be devised to increase awareness and prevent its progression by eliminating the non-genetic, environmental risk factors, such as eye rubbing and discussing compliance regarding the use of topical anti-allergic medications and regular follow-up visits.

Comparison of The Efficacy of Oral Versus Topical NSAIDs for Pain Relief in Osteoarthritis

2025-10-02T07:15:45+00:00

Osteoarthritis is a leading cause of chronic musculoskeletal pain worldwide, significantly impairing quality of life and increasing healthcare burden. Nonsteroidal anti-inflammatory drugs (NSAIDs), administered orally or topically, remain the mainstay of symptom management, though their relative efficacy and safety profiles require further evaluation. Objectives: To compare the efficacy of oral versus topical NSAIDs for pain relief in osteoarthritis. Methods: This quasi-experimental study was conducted at the Department of Rheumatology, Khyber Teaching Hospital, Peshawar, during the period February 2025 to May 2025. 132 male and female patients aged more than 50 years diagnosed with osteoarthritis were assigned to topical (n=66) and oral NSAID (n=66) groups. Diclofenac gel and tablet diclofenac 50mg BD were administered for 4 weeks, respectively. Patients were evaluated for pain relief using the VAS score. Results: Mean age in topical versus oral NSAIDs was 64.73±8.25 years versus 66.55±9.606 years, respectively. Male participants were 41 (52.6%) and 37(47.4%) in topical and oral groups, respectively. 23(50.0%) had bilateral joint involvement in both groups. Pain relief was recorded in 25 patients (37.9%) with topical NSAIDs compared to 35 (53.1%) with oral NSAIDs (p-value 0.080). Conclusions: Statistically insignificant difference in pain relief was recorded with topical and oral NSAIDs in patients with chronic MSK pain of osteoarthritis. Though the proportion of pain relief was better with oral NSAIDs, the difference was statistically not significant.

Association of Liver Enzymes with Thyroid Hormone Levels in Hyperthyroid Patients: A Cross-Sectional Study from a Tertiary Care Hospital

2025-10-07T07:49:58+00:00

Hyperthyroidism, characterized by the overproduction of thyroid hormones, may impact liver function. Understanding this relationship is essential for early identification and management of liver dysfunction in hyperthyroid patients. Objectives: To determine the association between thyroid hormone levels (TSH, T3, T4) and liver function tests (ALT, AST, ALP, bilirubin, and total protein) in patients with hyperthyroidism.

Methods: This cross-sectional study was conducted from 28 July 2023 to 28 January 2024 at the Endocrinology OPD of Gulab Devi Hospital, Lahore. A total of 100 hyperthyroid patients were selected using non-probability sampling. Demographic data, thyroid profiles (T3, T4, TSH), and liver function tests (LFTs) were recorded. Data were analyzed by SPSS version 26.0 using descriptive statistics and Chi-square tests to assess associations. Results: Out of 100 hyperthyroid patients, 59 were female and 41 were male, with a mean age of 38.5 + 10.2 years. Elevated ALT was observed in 27% of patients, AST in 13%, ALP in 23%, bilirubin in 13%, and total protein in 11%. Chi-square analysis showed significant associations between TSH and ALT (p=0.028) and AST (p=0.017), as well as between T3 and ALP (p=0.031). No significant associations were found between T4 and any of the liver enzymes. Conclusions: A significant proportion of hyperthyroid patients showed abnormal LFTs, indicating a relationship between thyroid dysfunction and hepatic involvement. Further large-scale studies are recommended

Alveolar Bone Dimensions in Orthodontic Unilateral Impacted Canine Cases using Cone Beam Computed Tomography

2025-10-07T07:50:06+00:00

Impacted canines are due to missing laterals, crowding, or genetics. The alveolar bone that acts as a shock absorber distributes the masticatory forces to the underlying tissues. Objectives: To study the mean alveolar bone dimensions on the impaction and non-impaction side of Orthodontic unilateral impacted canine cases using CBCT. Methods: This descriptive cross-sectional research was organized at the Department of Orthodontics, CMH Lahore Medical College, where 165 patients were enrolled as per the selection criteria. Bucco-palatal width of the alveolar bone was measured at the level of the alveolar crest, while alveolar bone height was calculated from the alveolar crest to the nasal floor, on the impacted side. These were compared with corresponding alveolar bone dimensions on the non-impaction side, and the values were recorded. An independent samples t-test was used to find out whether any significant difference was present, and post-stratification. A p-value<0.05 was considered significant. Results: The mean age of the patients was 34.99 ± 14.69 years. There were 77 (46.7%) male and 88 (53.3%) female. On the impacted side, the mean width of alveolar bone was 6.58 ± 0.67 mm, and the mean height was 17.28 ± 0.67 mm. On the non-impacted side, the mean width and height of alveolar bone were 8.40 ± 0.96 mm and 19.01 ± 0.96 mm, respectively (p=0.001). Conclusions: The mean width and height of the alveolar bone on the impacted canine side were lower than the respective alveolar bone dimensions on the non-impacted side.

Impact of Diabetes on Short-Term Outcomes in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention (PCI)

2025-10-07T07:49:47+00:00

Diabetes mellitus is a major global health issue, significantly increasing the risk of morbidity and mortality, especially after myocardial infarction. Objectives: To assess the impact of diabetes on short-term outcomes in STEMI patients treated with primary PCI. Methods: This comparative cross-sectional study enrolled 200 patients undergoing elective coronary angiography at Shahida Islam Medical Complex, Lodhran, using non-probability consecutive sampling. Qualitative variables, such as gender and hypertension, were summarized as frequencies, while quantitative variables, including age, BMI, and HbA1c, were expressed as mean ± standard deviation (SD). Outcomes, including stroke, arrhythmia, renal failure, and mortality, were compared using the Chi-square test, whereas changes in serum creatinine were analyzed with independent t-tests. Statistical significance was set at p < 0.05. Data were collected using a structured proforma and analyzed using SPSS version 21.0. The combined effect of categorical variables was calculated and reported as risk ratios with 95% confidence intervals. Results: Diabetic patients were older and had a higher prevalence of hypertension, smoking, and prior ischemic heart disease (IHD). They showed significantly worse short-term outcomes, including higher rates of stroke (5.6%, p=0.04), renal failure (11.1%, p=0.02), and mortality (10.0%, p=0.03) compared to non-diabetics. Conclusions: There are worse short-term outcomes possibly related to diabetes mellitus in STEMI patients undergoing PCI, particularly for stroke, renal failure, and mortality. These findings highlight the need for aggressive management of diabetic patients presenting with STEMI.

Assessment of Maxillary Premolar Root Position Within the Alveolar Bone Using Cone Beam Computed Tomography

2025-10-07T06:31:42+00:00

The location of maxillary premolars with respect to the alveolar bone and maxillary sinus is critical for treatments like extractions and implantation. CBCT imaging provides extensive information on root placement, sinus proximity, and buccal bone dimensions, enabling proper diagnosis and treatment planning. Objectives: To assess the position of the maxillary premolars’ roots within the alveolar apparatus and their relationship to the maxillary sinus using cone-beam computed tomography. Methods: This is a cross-sectional descriptive study that included CBCT images of 105 patients with 411 maxillary premolars were viewed retrospectively over a period of six months. After obtaining permission from the institutional ethical review committee, each pair of premolars was observed on either side of the mouth. Each exhibited a distinct association between its root tip and the sinus floor, categorized into four different types. The roots were also variable in the alveolar housing and were either buccal, middle, or palatally placed. Results: In our study, the majority of maxillary first premolars had roots positioned away from the sinus floor, with root angulation predominantly directed toward the buccal side. In contrast, most second premolars exhibited roots located close to or extending into the sinus floor, with their roots generally positioned centrally within the alveolar bone. Conclusions: Maxillary first premolars have weaker buccal bone, whereas second premolars are more affected by sinus proximity during implant insertion operations. Given these specific anatomical obstacles, CBCT imaging is recommended for accurate diagnosis and effective implant design.

Empowering Young Girls in Pakistan through HPV Vaccination and Cervical Cancer Awareness

2025-10-02T07:15:37+00:00

Cervical cancer is a major public health challenge in Pakistan, with over 5,000 new cases and nearly 3,000 deaths each year, making it the third most common cancer among women and the second most frequent among those aged 15 to 44.(1, 2) The disease is often diagnosed late, contributing to disproportionately high mortality compared to neighboring countries. Human papillomavirus (HPV) infection is the primary cause, with high-risk genotypes 16 and 18 responsible for nearly 90% of invasive cervical cancers, and recent data from Karachi show a prevalence of 16.7% among tested women.(3, 4)

Despite being largely preventable through vaccination and early detection, cervical cancer in Pakistan remains neglected due to extremely low awareness, harmful misconceptions, lack of organized screening, and deep-rooted cultural stigma surrounding sexual and reproductive health. Many people wrongly believe that cervical cancer only affects women who are sexually active or have multiple partners, creating stigma that discourages open discussion and preventive care.(5) These cultural taboos and widespread opposition to addressing sexual and reproductive health leave countless women without access to life-saving knowledge and early detection. The silence and shame surrounding cervical cancer have allowed it to remain hidden, leaving Pakistani women disproportionately vulnerable to a disease that could otherwise be prevented or treated in time.(6, 7)

In September 2025, Pakistan took a historic step by launching its first nationwide Human Papillomavirus (HPV) vaccination campaign, targeting 13 million girls aged 9 to 14 years. The vaccine is being provided free of charge through schools, health facilities, outreach sites, and mobile teams, with support from WHO, UNICEF, and Gavi. This initiative will not only protect young girls from cervical cancer a disease that claims thousands of lives each year, but also integrate HPV vaccination into routine immunization, ensuring protection for future generations.(8)

This campaign is more than just a health intervention; it is an empowerment movement for women and girls. By protecting them early, we are giving them the right to a healthier future, free from a preventable disease. Families, teachers, and communities must come together to encourage every eligible girl to get vaccinated. With collective effort, Pakistan can break the silence around women’s health, eliminate cervical cancer, and empower women to lead stronger, healthier lives. The way forward is clear to make screening services accessible, spread accurate information to every household, and create safe spaces where women can seek care without fear or stigma.