Pakistan Journal of Health Sciences

Comparative Efficacy of Low-Dose Alteplase versus Standard Dose among Acute Ischemic Stroke Patients: A Single-Centre Experience in Pakistan

Tariq Khan — 2026-04-30

Intravenous (IV) alteplase(tPA) at a dose of 0.9 mg /kg is the standard treatment of acute ischemic stroke (AIS), but it carries the risk of intracranial hemorrhage. Objectives: To assess the efficacy and safety of tPA low dose (LD; 0.6 mg/kg) as compared to standard-dose (SD; 0.9 mg/kg) in AIS patients in normal clinical practice. Methods: In this retrospective comparative cohort study, 320 AIS patients administered IV-tPA within 4.5 hours of stroke symptoms were selected in 2 groups (160 patients receiving LD; 0.6mg/kg), and 160 patients (SD; 0.9mg/kg) were developed in the Department of Neurology, Pak Emirates Military Hospital, Rawalpindi, between January 2023 and December 2024. The measured outcomes were functional independence (mRS=02) at 90-day, incidence of symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Few individuals (32.5%) in the (LD; 0.6 mg/kg) group had positive functional outcomes compared to those in the (SD; 0.9 mg/kg) group (40.0%), but the difference was not significant (p=0.152). The (LD; 0.6mg/kg) (1.9% vs. 5.6%) (p=0.038) significantly reduced the risk of sICH. There were no differences in the 90-day mortality rates between the groups (11.3% vs. 13.8%, p=0.299). Adjusted (LD; 0.6 mg/kg) was, however, associated with reduced risk of sICH (aOR 0.30; 95% CI 0.08-0.98; p=0.040) but not functional outcome (aOR 0.82; 95% CI 0.54-1.25; p=0.361). Functional outcomes were strongly predicted by age, baseline NIHSS, and treatment length. Conclusions: In routine clinical practice, (LD; 0.6 mg/kg) was selectively used in higher-risk patients and showed a promising safety profile with functional outcomes broadly comparable to (SD; 0.9 mg/kg) therapy.

Incidence of Urethrocutaneous Fistula Formation in Patients Undergoing Urethroplasty with and without Stent for Hypospadias

Saira Shafee — 2026-04-30

Hypospadias is a common congenital anomaly in boys, and urethrocutaneous fistula (UCF) remains a frequent complication after urethroplasty. The routine use of urethral stents is still debated, especially in low-resource settings such as Pakistan. Objectives: To compare UCF incidence between stented and stentless urethroplasty and to identify factors associated with fistula formation. Methods: A randomized controlled trial was carried out in the Department of Pediatric Surgery, Children’s Hospital Multan, from 10 May to 10 November 2025. A total of 110 boys aged 1–12 years with distal or mid-penile hypospadias were randomized to stent urethroplasty (Group A, n=55) or stentless urethroplasty (Group B, n=55). Data were analyzed using t-test, Mann–Whitney U test, chi-square test, and binary logistic regression with p<0.05 as significant. Results: Mean age was 6.1±2.6 years in Group A and 5.7±2.9 years in Group B. Overall UCF incidence was 10% (11/110), higher in Group A than Group B (14.5% vs 5.5%; p=0.046). At 12 weeks, UCF occurred in 14.5% of stented repairs and 5.5% of stentless repairs (p=0.046). Postoperative infection and longer operative duration were independently associated with UCF. Hospital stays, a secondary outcome, were longer in the stented group. Conclusions: In this cohort, stentless urethroplasty demonstrated a lower 12-week UCF incidence compared with stented repair.

Frequency of Fibroadenoma in Patients Presenting with Palpable Breast Lumps: A Cross-sectional Study

Saira Aijaz Soomro — 2026-04-30

Palpable breast lumps are a common presentation in surgical practice, particularly among young women, and encompass a wide range of benign and malignant conditions. Fibroadenoma is the most frequently encountered benign breast tumor in this age group; however, local hospital-based data on its frequency with statistical precision remain limited. Objectives: To estimate the proportion of fibroadenoma among female patients presenting with palpable breast lumps at a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted at the Department of General Surgery, Bilawal Medical College, Liaquat University of Medical and Health Sciences (LUMHS), Hyderabad, from January 2025 to June 2025. A total of 60 female patients aged 15–35 years with clinically palpable breast lumps were enrolled using non-probability consecutive sampling. All patients underwent triple assessment, including clinical evaluation, imaging (ultrasound ± mammography), and Tru-Cut biopsy with histopathological examination. Data were analyzed using SPSS version 23.0. Frequencies were reported with 95% confidence intervals (CIs). Results: The mean age was 24.6 ± 4.8 years. Fibroadenoma was diagnosed in 22 patients, yielding a frequency of 36.7% (95% CI: 25.0–49.3%). The superolateral quadrant was the most commonly involved site. The proportion of fibroadenoma was consistent across age groups, BMI categories, marital status, breast laterality, and lump duration. Conclusions: Fibroadenoma constitutes over one-third of palpable breast lumps in young women presenting to a tertiary care hospital. These findings highlight the importance of structured diagnostic evaluation to guide appropriate management and avoid unnecessary surgical intervention.

Cone Beam Computerized Tomographic (CBCT) Assessment of Buccal Bone Thickness in Maxillary Aesthetic Region

Safia Rehmat — 2026-04-30

Buccal bone thickness (BBT) in the maxillary aesthetic region is a key determinant of ridge remodeling and the chances of recession of the mucosa following implantation. Objectives: To measure BBT at standardized levels around maxillary central incisors, lateral incisors, and canines on CBCT scans of patients from Peshawar, Pakistan. Methods: This cross-sectional study assessed 96 CBCT scans of patients aged 18–60 years obtained from the Department of Oral and Maxillofacial Radiology, Rehman Medical Institute/Rehman College of Dentistry, Peshawar, over six months from 3 February 2025 to 3 August 2025. BBT was measured on sagittal reconstructions at the crestal level (L0) and at 1 mm (L1), 3 mm (L3), and 5 mm (L5) apical to the crest. Descriptive statistics were reported; gender differences were explored using independent-samples tests and age associations using Spearman correlation (α=0.05). Results: At L0, BBT was <1 mm in 90.6% of central incisors, 90.7% of lateral incisors, and 84.3% of canines. Males showed greater BBT than females at selected levels (central incisors: L1 and L5; lateral incisors: L5). Age showed statistically significant but weak correlations with BBT at L1 for central incisors and at L5 for lateral incisors and canines. Conclusions: In this sample, the buccal plate in the anterior maxilla was predominantly thin (<1 mm), particularly for lateral incisors and at the crest. Preoperative CBCT assessment should guide implant positioning and the anticipated need for augmentation, with consideration of patient sex and age.

Incidental Renal Artery Stenosis amongst a Cohort of Hypertensive Patients Undergoing Coronary Angiography: An Analytical Cross-Sectional Study

Zuhoor Ud Din — 2026-04-30

There has been less research on accidental RAS in patients with hypertension who have received coronary angiography. Objectives: To determine the prevalence rate of incidental renal artery stenosis (IRAS) in patients having coronary angiography. Methods: This analytical cross-sectional study was conducted at Khyber Teaching Hospital for six months between 1st April 2025 and 30th September 2025. Consecutive sampling was used to enroll 139 hypertensive patients under diagnostic coronary angiography as participants. Findings of coronary angiography and incidental evaluation of the renal artery were recorded, with stenosis of ≥50% seen as IRAS. The analysis of data was done with SPSS version 25.0. Odds ratios were estimated at 95% confidence intervals using univariate analysis. Results: Incidental renal artery stenosis was observed in 18.0% of patients, and in 13.7% and 4.3%, respectively, bilateral and unilateral renal artery stenosis. IRAS was significantly correlated with longer hypertension period and high serum creatinine (p<0.05). Conclusions: Nearly one-fifth of hypertension patients who had coronary angiography had incidental renal artery stenosis, most of which were unilateral. Chronic hypertension and high creatinine were identified as some of the most important associated factors, and it is important to evaluate renal arteries when the coronary arteries should be evaluated to be able to assess the cardiovascular and renal risks.

Comparison of Post-Operative Port Site Pain after Gall Bladder Retrieval through Umbilical versus Epigastric Port in Patients Undergoing Laparoscopic Cholecystectomy

Kausar Noor — 2026-04-30

Port-site pain is a typical issue that occurs after laparoscopic cholecystectomy. When the gall bladder is to be retrieved, the site used could be umbilical or epigastric and could have an effect on the extent of pain, which would impact patient comfort and recovery. Objectives: To determine the difference in post-operative port-site pain between umbilical and epigastric ports during laparoscopic cholecystectomy in patients. Methods: It was a descriptive study done for six months at Khyber Teaching Hospital. Non-probability consecutive sampling was used to enroll 36 patients undergoing elective laparoscopic cholecystectomy and randomized them into umbilical and epigastric port groups. The Visual Analogue Scale (VAS) was used to measure post-operative pain at 6, 12, and 24 hours. The analyzed data were processed in SPSS v. 25. The chi-square test, independent samples t-tests, and multivariate linear regression were employed to measure the predictors of pain. The p-value≤0.050 was considered significant. Results: The umbilical port also recorded lower VAS scores at each time point (p≤0.050). Multivariable regression established port site as the significant predictor of pain with the only significant adjusted variable (p=0.003). Conclusions: The recovery of the gall bladder through the umbilical port would lead to much lower early post-surgery pain than through the epigastric port, regardless of patient demographics or comorbidities, and is an argument in favor of the umbilical port as the site of extraction.

Comparison of Ultrasound-Guided Ilioinguinal and Iliohypogastric Nerve Block with and without Tramadol for Postoperative Pain in Patients Undergoing Caesarean Delivery

Saad Salman Safir — 2026-04-30

Maternal relief, early mobilization, and breastfeeding are dependent on the effective postoperative pain management following caesarean section. Objectives: To compare the analgesic effect of ultrasound-guided ilioinguinal-iliohypogastric nerve block with ropivacaine only versus ropivacaine with tramadol in patients who underwent elective cesarean delivery. Methods: A retrospective study was performed on a sample of 100 individuals, and the study was performed in two groups. Group A was given ropivacaine, and Group B was given ropivacaine and tramadol to relieve postoperative pain. Median [IQR] and mean ± SD were estimated, and comparisons between them were done by Fisher's Exact test, Mann-Whitney U-test, and independent t-test, with p≤0.05 taken as significant. Results: The combination of Ropivacaine and Tramadol gave better analgesia in patients who had a caesarean than when Ropivacaine was used. The combination group had a much longer pain-free period (20 vs. 14 hours, p=0.002), and the overall pain scores were lower (1.0 ± 0.7 vs. 1.8 ± 1.0, p=0.001). The patients needed fewer rescue analgesics, and there was no difference in opioid side effects. Conclusions: The combination of Tramadol and Ropivacaine has a significant positive effect on postoperative analgesia in patients undergoing a caesarean section, extending pain-free periods and decreasing the intensity of pain, with minimal adverse effects, which makes it an effective and safe approach to enhancing patient comfort and satisfaction.

Frequency of Antenatal Depression in Obstetric Patients Attending Antenatal Clinic

Abida Sabeena — 2026-04-30

Antenatal depression is a prevalent but poorly understood mental health disorder with adverse maternal and fetal outcomes. It is common in different populations, with its risk factors being different, especially among the low- and mid-income countries. Timely intervention requires early diagnosis. Objectives: To identify the prevalence of antenatal depression and the related sociodemographic and obstetric variables in women visiting the antenatal clinic. Methods: The study was cross-sectional and conducted between January 1, 2025, and July 30, 2025, among 278 pregnant women through consecutive sampling. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure antenatal depression, and a cutoff score of ≥13 was considered to be depressed. The analysis was performed with SPSS version 25.0, and descriptive statistics, a bivariate analysis, and binary logistic regression were applied to determine independent predictors (p ≤ 0.05 was taken to be significant). Results: Antenatal depression was found to be prevalent (27.3, 95% CI: 21.9-32.7%). Major independent predictors were low socioeconomic status (AOR = 2.41; p=0.002), unplanned pregnancy (AOR = 1.94; p = 0.023) and past adverse obstetric outcomes (AOR=1.72; p=0.048). Conclusions: Depression occurred in more than a quarter of antenatal women in this tertiary care facility. The key risk factors are socioeconomic disadvantage, unintended pregnancy, and poor obstetric history. It is advised to conduct regular mental health screening and targeted interventions throughout the antenatal care to enhance maternal and fetal outcomes.

Frequency of Factors Leading to Elective Surgery Cases Postponement at Tertiary Care Hospital, Karachi

. Superna — 2026-04-30

Delay of elective surgery is one of the ongoing issues in hospital systems that disrupts the operating room schedule, creates extra healthcare expenses, patient dissatisfaction, and wasteful use of resources. It is necessary to understand the root causes of these delays to make perioperative planning more effective, multidisciplinary coordination more robust, and patient safety more efficient. Objective: To identify the number of factors that cause the delay of the elective cases of surgeries in a Tertiary Care Hospital in Karachi. Methods: The study was a cross-sectional study carried out in Jinnah Postgraduate Medical Centre, Karachi. The data were gathered in the form of a structured proforma, which included demographic data that was divided into patient-related, surgeon-related, and anesthesia-related. Sampling involved consecutive sampling. Data analysis was done by use of SPSS version 20. Categorical variables were calculated by frequencies and percentages. The Fisher's exact test was used to determine relationships between postponement factors and demographic factors, where p≤0.05 was regarded as significant. Results: The postponement of elective surgery occurred in 12.1% of patients, and patient-related issues (medication unavailability, refusal, not fasting) were the most common reasons. The causes associated with surgery and anesthesia were less prevalent. The delay was not significantly related to the age, sex, home, or ASA status. Conclusions: Patient-related factors were more effective in influencing elective surgery delays than surgeon or anesthesia-related issues. It can be strengthened by having preoperative assessment, enhancing scheduling coordination, and increasing communication within surgical teams to reduce the rate of postponement.

Hypokalemia and Hyponatremia in Hepatic Encephalopathy and Its Distribution Across Age, Gender, and Grade of Hepatic Encephalopathy

Tamoor Iqbal — 2026-04-30

Hepatic encephalopathy is a complication of cirrhotic liver disease precipitated by a variety of factors. One such factor is disturbance in the levels of sodium and potassium. Objectives: To determine the prevalence of hypokalemia and hyponatremia in patients of hepatic encephalopathy at a secondary care setting and its distribution in different age groups, gender, and grades of hepatic encephalopathy. Methods: This cross-sectional descriptive study with stratified analysis was held at the Department of Medicine, Tehsil Headquarter Hospital, Sarai Alamgir, Pakistan, from January 2024 to February 2025. In this study, a total of 127 patients who presented with hepatic encephalopathy were included. All these patients were assessed for the presence of hypokalemia and hyponatremia. Results: Mean age of hepatic encephalopathy sufferers was 50.64 ± 10.29 years. There were 87 (68.50%) male and 40 (31.50%) female patients. The most common cause of cirrhotic liver disease was the hepatitis C virus found in 62 (48.80%) patients. Prevalence of hypokalemia and hyponatremia in HE patients was 24 (18.90%) and 49 (38.60%), respectively. There was no significant difference in the prevalence of hypokalemia in age groups (p=0.609), gender (p=0.482), or grades of hepatic encephalopathy (p=0.902). Hyponatremia was significantly higher in older people (p=0.005) while there was no significant difference in its prevalence based on gender (p=0.824) or hepatic encephalopathy grade (p=0.621). Conclusions: Hypokalemia and hyponatremia are highly common in patients with hepatic encephalopathy presenting at a secondary care hospital.

Identifying Factors Associated with High-Risk Obstructive Sleep Apnea (OSA) among Hypertensive Patients: A Case-Control Study in A Tertiary Care Hospital in Pakistan

Ihtisham Ul Haq — 2026-04-30

Obstructive sleep apnea (OSA) involves repeated upper-airway collapse and intermittent hypoxia. In hypertensive patients, particularly in developing regions, undetected OSA exist which significantly increases cardiovascular dangers. Objective: To identify factors associated with high-risk OSA in patients with raised blood pressure attending two tertiary hospitals in Peshawar. Methods: This case-control study (June 2025–September 2025) included 156 hypertensive adults (78 cases, 78 controls). Inclusion required a diagnosis of hypertension and a specific STOP-Bang score (cases ≥ 3; controls ≤ 2). Exclusion criteria involved prior OSA treatment, pregnancy, resistant hypertension, or severe mental health conditions. Data were collected via structured questionnaires and analyzed using multivariable logistic regression. Results: Mean age, BMI, and neck circumference were significantly higher in the high-risk group (p<0.001). Gender, BMI category, and ischemic heart disease were significantly associated. In crude regression, age, gender, BMI, neck circumference, and ischemic heart disease were significant predictors; however, after adjustment, only older age, male gender, and larger neck circumference remained independently associated with high-risk OSA. Conclusions: Older age, male gender, and increased neck circumference independently predict high-risk OSA in hypertensive patients. STOP-Bang proved useful as a screening tool, and the high prevalence of anxiety highlights the broader clinical burden. Incorporating neck circumference and age into routine hypertension care may aid earlier OSA recognition.

Various Modes of Delivery After a Trial of Labor among Pregnant Women at Term with a Previous One Cesarean Section

Hafsa Razzaq — 2026-04-30

The most crucial approach to lowering the increasing prevalence of cesarean sections and related maternal morbidity is vaginal birth after cesarean (VBAC). The need for local evidence to direct clinical practice is highlighted by the fact that TOLAC success varies across populations. Objectives: To identify the rates of various delivery modalities: spontaneous VBAC, assisted VBAC, and repeat cesarean section among women who have undergone a trial of labor following one prior cesarean section and relate them to age, BMI, and parity. Methods: This study was conducted in the Department of Gynecology at Mohtarma Benazir Bhutto Shaheed Medical College/DHQ Teaching Hospital, Mirpur, Azad Kashmir. It was a descriptive cross-sectional study conducted over 6 months. The sample size was 160 with full-term pregnant women with one prior c-section. Consecutive sampling was applied for this study. Data were analyzed using SPSS version 25.0 with a chi-square test (p<0.05). Results: Spontaneous VBAC occurred in 57.5% of women, assisted VBAC in 20.6%, and repeat cesarean in 21.9%. Assisted VBAC was significantly associated with age ≥30 years (p=0.030) and parity (p=0.026), while spontaneous VBAC was significantly related to BMI (p = 0.041). Conclusions: The VBAC success rate was 78.1%, indicating that TOLAC is a safe and effective option for most women with one previous cesarean section. Although age, BMI, and parity influenced modes of vaginal delivery, they did not significantly affect repeat cesarean rates, supporting planned TOLAC to reduce unnecessary repeat cesarean sections and improve maternal outcomes.

Frequency of Giardiasis in Children Presenting with Chronic Diarrhea

Muhammad Luqman Khan — 2026-04-30

Giardiasis, caused by Giardia duodenalis, is a common enteric protozoan infection in children, particularly in low-resource settings. It may present with chronic diarrhea, weight loss, and dehydration, though many infections remain asymptomatic. Objectives: To determine the frequency of giardiasis among children aged 1 to 5 years presenting with chronic diarrhea. Methods: This cross-sectional study was conducted in the Department of Paediatrics, Khyber Teaching Hospital, Peshawar, over six months. A total of 203 children with chronic diarrhea were enrolled using non-probability consecutive sampling. Stool samples were examined by direct microscopy with saline and Lugol’s iodine staining, as well as formalin-ethyl acetate concentration. Giardiasis was diagnosed based on the presence of six or more cysts per coverslip at 40× magnification. Written informed consent was obtained from all parents/guardians. The study received ethical approval from the institutional review board (IRB Approval No: 935/DME/KMC). Results: Out of 203 children, 20 (9.9%) tested positive for Giardia duodenalis. No significant associations were found with age, gender, or weight. However, a statistically significant correlation was observed between giardiasis and duration of diarrhea. Children with symptoms lasting more than eight weeks had a higher prevalence (24.1%) compared to those with shorter duration (0.8%) (p=0.001). Conclusions: Prolonged diarrhea may be a clinical indicator of giardiasis in paediatric patients. Early detection and improved diagnostic methods are essential for timely treatment, especially in endemic areas with limited resources.

Comparison of the Effectiveness of Palonosetron and Dexamethasone to Prevent Postoperative Nausea and Vomiting in Patients Undergoing Uncomplicated Laparoscopic Cholecystectomy

Samra Ahmad — 2026-04-30

Postoperative nausea and vomiting (PONV), particularly in patients having laparoscopic cholecystectomy, continues to be a prevalent and distressing consequence after surgical operations. It leads to higher hospital stays and resource utilization, as well as patient dissatisfaction. PONV occurrences have been linked to a range of patient-specific, anesthesia- and surgery-related risk factors. Objectives: To determine the effectiveness of palonosetron compared to dexamethasone in preventing PONV in patients undergoing a laparoscopic cholecystectomy operation (uncomplicated). Methods: It was a quasi-experimental study that was conducted in the Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore. The inclusion and exclusion criteria were met, and after that, 108 candidates were included and categorized into 2 groups. In patients of group A, 54 patients received 0.075mg Palonosetron (diluted in 5cc distilled water) intravenously in a single dose. In patients of group B, another 54 patients received 8mg dexamethasone intravenously. Results: Most of the patients included were female (66.7%), and the mean age of patients was 52.82 ± 8.80 years. When compared, the efficacy of both the drugs for PONV using the chi-square test (significant p-value>0.005) showed that only 20 cases (37.0%) of the group palonosetron suffered from PONV. While 42 patients (77.8%) of the dexamethasone group suffered from PONV (p-value=0.00). This showed that Palonosetron is clearly a superior drug in terms of efficacy as compared to dexamethasone. Conclusions: This study concluded that palonosetron is more effective than dexamethasone in preventing PONV in patients undergoing uncomplicated laparoscopic cholecystectomy.

Diagnostic Accuracy of Point of Care Ultrasound (POCUS) for Diagnosing Neonatal Pneumothorax Keeping Chest X-ray as Reference Standard

Sara Khan — 2026-04-30

Neonatal pneumothorax needs immediate medical assessment because it poses a danger to life. Neonates face radiation risks from chest X-ray (CXR), which physicians frequently use, but it creates treatment delays. Point-of-care ultrasound (POCUS) offers a rapid, bedside, radiation-free alternative. Objective: To assess how accurately POCUS detects neonatal pneumothorax compared to CXR, which serves as the standard reference. Methods: The descriptive, cross-sectional study took place in the Combined Military Hospital's Neonatal Intensive Care Unit from October to December 2025 after researchers obtained permission through ethical approval (Ref No. 576/2024). The study enrolled one hundred neonates who were 28 days old or younger and showed clinical signs of pneumothorax. A trained radiologist performed bedside POCUS using a high-frequency linear probe. A radiologist who remained blinded to the study read the CXR results. Researchers computed sensitivity, specificity, PPV, NPV, and overall accuracy together with ROC-AUC values. Results: CXR confirmed pneumothorax in 35 neonates. POCUS showed sensitivity 91.6%, specificity 93.75%, PPV 89.18%, NPV 95.2%, and overall diagnostic accuracy 93%. The AUC measurement reached 0.93 while the 95% confidence interval ranged from 0.87 to 0.97. Conclusion: POCUS provides high diagnostic accuracy which makes it an effective NICU screening tool for detecting neonatal pneumothorax.

Multidisciplinary Team Approach for Morbidly Adherent Placenta: Maternal Outcomes Compared with Standard Care

Bushra Iftikhar — 2026-04-30

Morbidly adherent placenta (MAP), part of the placenta accreta spectrum, is a major cause of severe obstetric hemorrhage and may lead to massive transfusion, peripartum hysterectomy, ICU care, and maternal morbidity. Rising cesarean section rates are increasing the burden of MAP in Pakistan. Multidisciplinary team (MDT) management is proposed to improve preparedness, but outcome benefits remain uncertain. Objective: To compare maternal outcomes in patients with MAP managed by an MDT versus standard obstetric care. Methods: A comparative, non-randomized observational study was conducted at the Department of Obstetrics and Gynecology, Pakistan Navy Ship Shifa Hospital, Karachi, from February 2022 to July 2022, vide Ethical Committee PNS Shifa approval. A total of 151 women diagnosed with MAP were included. Outcomes included maternal morbidity, estimated blood loss (EBL), transfusion requirement, time to intervention, hospital stay, and surgical procedures. Results: Overall mean EBL was 512.24 mL, and mean transfusion requirement was 1.91 units. Compared with standard care, MDT management showed no significant differences in EBL (p=0.300), transfusion units (p=0.237), time to intervention (p=0.426), or hospital stay (p=0.926). Maternal morbidity and major surgical interventions were also comparable between groups. Conclusions: MDT-based care showed no significant improvement in blood loss, transfusion needs, or maternal morbidity compared with standard care.

Outcome of Modified Salter Osteotomy in Improving Acetabulum Index of Developmental Dysplasia of the Hip with Age Group of 2-10 Years

Mehtab Ahmed — 2026-04-30

The modified Salter osteotomy is a widely utilized surgical intervention for treating developmental dysplasia of the hip (DDH). Objectives: To assess the outcome of modified Salter osteotomy in improving the acetabular index (AI) in children with DDH aged 2-10 years. Methods: This observational cohort study was conducted at the Department of Orthopedics, JPMC, Karachi, from December 2024 to September 2025. Sixty children aged 2–10 years with DDH undergoing modified Salter osteotomy were included. Baseline demographics, clinical examination, and preoperative radiographs for AI were recorded. Outcomes included change in AI, radiological grading by Severin classification, and clinical results by Modified MacKay criteria at 3 and 6 months. Data were analyzed using SPSS version 26.0 with non-parametric tests, Chi-square/Fisher’s exact test, and Kappa statistic, taking p<0.05 as significant. Results: In a total of 60 children, 12 (20.0%) were boys, and 48 (80.0%) were girls, with a median age of 7 (5.5–9) years, and BMI 25 (23.0–27.0) kg/m². The median AI decreased significantly from 39.0⁰ (35.0⁰–43.0⁰) preoperatively to 21.0⁰ (18.0⁰–25.0⁰) at 6 months (p<0.001). At 6 months, radiological outcomes were excellent in 24 (40.0%), good in 20 (33.3%), fair in 10 (16.7%), and poor in 6 (10.0%). Clinical outcomes were excellent in 22 (36.7%), good in 21 (35.0%), fair in 11 (18.3%), and poor in 6 (10.0%). Agreement between the two systems was substantial (κ=0.71, p<0.001). Conclusions: Modified Salter osteotomy resulted in a significant improvement in AI among children with DDH, accompanied by favorable radiological and clinical outcomes at six months.

The Silent Guardian of Operating Room Patients' Knowledge and Perception About Anesthesia and Anesthetists at a Tertiary Care Hospital

Abdullah Abdul Ghani — 2026-04-30

The role of anesthesiologists in perioperative care is significant, but it is frequently neglected. The knowledge and perception of anesthesia and anesthesiologists can play a major role in influencing the experience and collaboration of patients during the perioperative period. Objective: To evaluate the level of knowledge and perceptions toward anesthesia and the role of anesthesiologists among patients. Methods: It was a cross-sectional study that was conducted from December 2025 to January 2026 at Sindh Institute of Urology and Transplantation (SIUT) in Karachi. Non-probability consecutive sampling was applied to select the sample of 312 patients planned to receive elective surgery. The intrusion was collected by the face-to-face interview using a structured questionnaire that included demographic information and some specific questions that measured knowledge and perception. The analysis of the data was done with SPSS 25. Associations were determined using the chi-square test, and a p-value ≤ 0.05 was regarded as significant. Results: According to the research, 58.3% of the participants showed good knowledge, and 65.4% had a positive perception of anesthesiologists. The residence (p=0.021) and education level (p<0.001) were significantly related to knowledge status. Patients administered general anesthesia had a much better positive perception as compared to those administered with local anesthesia or regional anesthesia (p=0.041). Conclusions: The general knowledge and perception turned out to be satisfactory, but there are still significant misunderstandings, especially in terms of the nature of the work of anesthesiologists.

Diagnostic Performance of Magnetic Resonance Imaging for Vertebral Metastases in Routine Clinical Practice

Laila Khan — 2026-04-30

Vertebral metastasis is a frequent complication of systemic malignancies and may cause pain, pathological fractures, and neurological compromise. MRI is commonly used for suspected spinal metastases; however, the diagnostic performance of routine 1.5-Tesla MRI interpreted using visual criteria in everyday practice remains unclear. Objectives: To determine the diagnostic accuracy of conventional MRI for the detection of vertebral metastases using histopathology and/or multidisciplinary clinic radiologic consensus as reference standards. Methods: This prospective cross-sectional study at MTI Bacha Khan Medical College and Mardan Medical Complex, Pakistan (15 Sept–15 Dec 2025), included 106 adults with suspected vertebral neoplastic lesions who underwent 1.5-Tesla MRI. Two blinded radiologists independently interpreted scans, resolving discrepancies by consensus. Histopathology and/or tumor board consensus served as the reference standard. Sensitivity, specificity, predictive values, accuracy, and ROC-AUC were calculated. Results: Of 106 patients, 64 (60.4%) had vertebral metastases by the reference standard. MRI sensitivity was 42.2% (95% CI: 30.1–54.3), specificity 54.8% (95% CI: 39.7–69.9), PPV 58.7% (95% CI: 44.5–72.9), NPV 38.3% (95% CI: 26.1–50.5), and overall accuracy 47.2% (95% CI: 37.7–56.7). The AUC was 0.515 (95% CI: 0.40–0.63). False positives were commonly due to hemangioma and infection, whereas false negatives were mainly related to poor image quality, small/early lesions, and reader variability. Conclusions: Conventional 1.5-Tesla MRI using routine visual criteria showed low sensitivity, modest specificity, and limited accuracy for vertebral metastases. Clinical correlation and reference-standard confirmation remain essential for equivocal cases.

Postoperative Illeus After Exploratory Laparotomy

Bahr Ud Din — 2026-04-30

Postoperative ileus is a common and significant complication following abdominal surgery, particularly after exploratory laparotomy. It is characterized by a temporary impairment of gastrointestinal motility leading to delayed passage of bowel contents, abdominal distension, nausea, vomiting, and prolonged hospital stay. Identifying the frequency of postoperative ileus after exploratory laparotomy is essential for understanding its clinical burden and for improving perioperative management strategies aimed at reducing postoperative morbidity. Objectives:
To determine the frequency of postoperative complications in patients undergoing emergency exploratory laparotomy for non-traumatic ileal perforation. Methods: This Analytical cross-sectional study was conducted from 15th July 2025 to 16th October 2025 at the Department of Surgery, Lady Reading Hospital, Peshawar. A total of 115 patients, aged 18–65 years, undergoing exploratory laparotomy were included using non-probability consecutive sampling. Results: The mean age was 41.08 ± 14.05 years, and 64.3% were male. Wound infection was the most frequent postoperative complication observed in 33 patients (28.7%), followed by peristomal excoriation in 19 (16.5%), postoperative ileus in 18 (15.7%), wound dehiscence in 13 (11.3%), and fistula formation in 3 patients (2.6%). Conclusions: Postoperative ileus remains a considerable complication after exploratory laparotomy. Diabetes, hypertension, obesity, and older age are important predictors.

Identification of Genetic Variants Associated with Chronic Kidney Disease Using Restriction Fragment Length Polymorphism

Zahid Habib Qureshi — 2026-04-30

Chronic kidney disease (CKD) is one of the most common kidney diseases that poses serious health risks. Objective: To identify the genetic variants associated with CKD. Methods: A cross-sectional study was conducted among 183 participants at Ibn-e-Sina Hospital, Multan, from Nov 2023 to May 2024. Klotho (KL), Catalase (CAT), Cyclophilin (Cyp), tumor protein p53 (p53), and Superoxide dismutase 1 (SOD1) genes were selected for polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Primers were designed via primer3plus and amplified via Snap Gene. In-silico RFLP involved NEB cutter and Snap Gene for the construction of the sequence map and the mutated band. Wet lab RFLP involved DNA cleavage by restriction enzymes. After PCR incubation, samples were visualized via gel electrophoresis. The T-Coffee tool aligns sequences, enabling the identification of variations in amino acids. Results: The target genes were successfully amplified in the CKD patients before proceeding to RFLP analysis. TaqI, EcoRI, AlwI, and AccI restriction enzymes were selected from in-silico Sequence Maps to cut the band of SOD1, Cyp, KL, and p53 genes, respectively. Cleave bands of mutated sequences were obtained. The alignment of wild-type to mutated with T-Coffee tool revealed six amino acid substitutions in CAT (Asp/Asn, Asp/Gly, Tyr/Asp, Lys/Arg, Gln/Ser and Ala/Val) and single amino acid substitutions in KL (Phe/Val), Cyp (Ser/T), SOD1 (Gly/Arg) and p53 (Leu/unknown). Conclusions: The current study identified genetic variants in KL, CAT, Cyp, p53, and SOD1 genes that may influence CKD progression and therapy.

Artificial Intelligence in Internal Medicine: Opportunities and Challenges in Clinical Practice

Sami Ullah Mumtaz — 2026-04-30

Artificial intelligence (AI) is the topic of choice in today’s discussions. It is basically the replica of human intelligence by computers or robots, enabling them to observe, learn, reason, and resolve. Unlike usual software, AI uses data and algorithms to perform better with every passing day by learning from new information and experiences. Its key components are machine learning, deep learning, and cognitive functions. Its key types are artificial narrow intelligence, artificial general intelligence, and super intelligence [1].

Worldwide AI use has been superfast in early 2026, even more than the internet and smartphones. The countries leading the AI usage are India, 59 %, the United Arab Emirates, 58 %, Singapore 53 % and China, 50 % [2]. Pakistan has successfully launched its AI policy in 2025, with the potential to increase GDP growth from 7% to 15% by 2030. However, current usage is only confined to 15% in Pakistan. As far as health sector usage is concerned, it’s at an emerging stage [3]. It can play a pivotal role in day-to-day clinical internal medicine practice and can revolutionize internal medicine physicians’ hospitals and clinics, as well as outpatient and inpatient departments. Then it raises a question: will it replace internal medicine physicians [4]?

In Pakistan, this opportunity is very useful in many ways. Our hospitals' overburdened outdoors are dealt with by limited human resources, and hence these AI-supported systems can diagnose and treat in less time, which will improve patient management and will handle patients’ burden. In remote cities like Narowal, AI will definitely play a vital role in internal medicine physicians’ quick diagnosis, timely management, and referrals where required [5]. It can give clues in history and examination, interpret investigations like computed tomography, magnetic resonance imaging, electrocardiograms, chest radiographs, and even routine ultrasounds. Similarly, state-of-the-art management is possible in emergencies where minute-to-minute management matters and hence increases physicians’ efficiency and can change the patient’s outcome. It can also be the clerical job of patient history notes and even tell us about the possible course of the disease and future admission rate [6].

AI can decrease internal medicine physicians' burnout by decreasing workload and repetitive administrative tasks. It promotes evidence-based medicine by setting standards of care. Hence, quality care can be assured in overburdened resource-limited settings. The WHO has also set a worldwide mechanism for the safe and ethical use of AI in healthcare. It ensures public interest by giving six core principles, including protecting autonomy, human well-being, transparency, responsibility, inclusiveness, and sustainability [7].

However, despite the advantages, there are significant challenges associated with AI usage. The lack of local data giving rise to algorithm bias is a critical limitation. Limited infrastructure and resources also hinder its effective deployment. Lack of regulatory frameworks is also challenging. Lack of internal medicine physicians trained with AI tools can also be a limitation. It may also hamper physicians' critical thinking skills, a risk of over-reliance. It could be difficult to define accountability if an incorrect clinical or medicolegal decision is made by AI, using Western data models [8].

There are possible solutions to best use AI systems in our country. It should be adapted to local data, disease patterns, and population dynamics rather than relying purely on Western data. A systematic and cautious approach is important for integrating AI into internal medicine for accurate results. Physicians must be trained adequately before using AI tools critically rather than passively accepting them. Infrastructure and resources must be enhanced for effective functioning. Regulatory frameworks must be established to address ethical concerns, data protection, and accountability. AI should act as a decision support system, with the physicians being fully responsible for patient care [9].

AI can help evidence synthesis by analyzing large data and assist in applying guidelines at the point of care. It can increase adherence to best evidence-based medicine (EBM) and reduce variability in patient management. However, EBM is not totally about data. It incorporates clinical expertise, patient values, and the best clinical evidence. AI can assist the evidence component, but it cannot replace physicians’ expertise. Therefore, AI should be taken as an extension of EBM rather than a substitute for it [10].

AI is revolutionizing internal medicine, but its role must be clearly defined. It is a good supportive tool that can enhance patient care, but it cannot replace internal medicine physicians. The future of medicine will not be determined by AI alone, but by how effectively physicians integrate it into their practice. Clinicians who embrace and thoughtfully adopt AI will thrive in this new era, while those who disregard it will become obsolete.

Clinical Accuracy of Intraoral Scanner Impressions Compared with Conventional Impressions in Fixed Partial Prostheses: A Systematic Review

Sheema Shakir — 2026-04-30

The use of digital impression systems in prosthodontics has gained greater acceptance, but issues surrounding their clinical accuracy compared to traditional elastomeric impressions still exist, particularly for fixed partial prostheses. This comparison is crucial as many practices transition to digital workflows. Objectives: The primary objective of this review was to evaluate the clinical accuracy of intraoral scanner (IOS) impressions versus conventional impressions for fixed partial prostheses. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane Library for comparative clinical studies published between January 2018 and January 2024. Eligible studies included human trials comparing IOS and conventional impressions for tooth- or implant-supported fixed prostheses. Methodological quality was assessed using a modified QUADAS-2 tool. Results: Fifteen clinical studies met the inclusion criteria. Quantitative analysis revealed marginal gaps for digital workflows ranging from 30 to 90 μm, comparable to the 35–100 μm range observed for conventional methods. Digital impressions demonstrated superior time efficiency and patient comfort. For short-span restorations, IOS accuracy was equivalent to conventional methods; however, conventional techniques showed slightly better stability in long-span implant cases. Conclusions: Current clinical evidence suggests that intraoral scanners provide accuracy comparable to conventional impressions for most fixed partial prostheses, with added benefits in efficiency and patient experience. While caution is advised for complex full-arch cases, IOS can be reliably integrated into routine practice.

Platelet-Rich Plasma and Er: YAG Laser Therapy for Female Stress Urinary Incontinence: A Systematic Review

Misbah Ur Rahman — 2026-04-30

Female stress urinary incontinence (SUI) is a prevalent condition that negatively affects quality of life. Although surgery is effective, concerns related to morbidity and patient reluctance have increased interest in minimally invasive treatment options. Objectives: To systematically evaluate clinical evidence on the effectiveness and safety of platelet-rich plasma (PRP) injections and non-ablative Er: YAG vaginal laser therapy in women with stress urinary incontinence. Methods: This systematic review followed PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and the Cochrane Library were searched for studies published between January 2018 and March 2025. Randomized controlled trials and prospective interventional cohort studies involving adult women with SUI were included. Data were extracted on validated symptom scores, objective outcomes, adverse events, and treatment effects. Risk of bias was assessed using Cochrane RoB-2 and NIH tools. Due to heterogeneity, results were synthesized narratively. Results: Ten studies (six randomized trials and four cohort studies) were included. Both PRP and Er: YAG laser therapy demonstrated improvement in symptom severity using validated patient-reported and objective measures. Sham-controlled trials generally favored active treatment, while combined PRP and pelvic floor muscle training showed greater benefit. Most randomized trials had some risk of bias, and cohort studies were of fair quality. Conclusions: PRP injections and Er: YAG vaginal laser therapy are promising minimally invasive options for selected women with mild to moderate SUI, though further high-quality trials are needed to confirm long-term effectiveness.

Impact of Burnout on Academic Performance and Well-Being among Medical Students: A Systematic Review

Hajra Imtiaz — 2026-04-30

Medical student burnout has become a significant issue in the global community, with growing evidence of its negative implications on academic performance and mental health. Although there is an increasing body of research in this field, unified data on the extent and implications of burnout is scarce in the low- and middle-income contexts. Objective: To systematically review the impact of burnout on academic performance and well-being among undergraduate medical students. Methods: The systematic literature search was performed in PubMed, Scopus, Google Scholar, and Cochrane Library to identify research published from 2018 to 2024. Original English-language observational studies assessing burnout with validated measures and reporting academic or well-being outcomes were found. The selection of studies was done in accordance with PRISMA. The quality of methodology was determined with the help of the NIH Quality Assessment Tool. A narrative synthesis approach was used. Results: The qualitative synthesis included 15 studies. The prevalence of burnout was between 34.3% and 63.5. The most affected domain was emotional exhaustion. Increased burnout was always correlated to lower GPA/CGPA, worse examination results, lower learning motivation, worse quality of life, worse anxiety, depression, sleep problems, and stress. Conclusions: Burnout is highly prevalent among medical students and significantly compromises both academic performance and mental well-being. Institutional strategies focusing on workload regulation, mental health support, and improvement of learning environments are urgently needed.

Performance of Graphene-Reinforced Dental Materials in Restorative and Prosthodontic Applications: A Systematic Review

Maria Naeem — 2026-04-30

Mechanical fatigue, marginal degradation, microbial biofilm formation, and low long-term durability are persistent challenges associated with dental restorative and prosthodontic materials. The integration of graphene and its variants is an effective approach to enhance the structural and biological properties of conventional dental biomaterials. Objective: To systematically evaluate the performance of graphene-reinforced dental materials in restorative and prosthodontic applications. Methods: This systematic review was performed in accordance with PRISMA-2020 guidelines and involved searches of PubMed/MEDLINE, Scopus, and Cochrane Library to identify original research published between January 2019 and March 2025. Sixteen original in-vitro studies examining graphene-modified dental materials were included. Case reports, reviews, and animal studies were excluded. Meta-analysis was not performed due to substantial heterogeneity in graphene types, concentrations, base materials, and outcome measures. Narrative synthesis of data was performed on mechanical, physical, antimicrobial, and biocompatibility results. Results: Sixteen original in-vitro studies were included. Graphene derivatives, mainly graphene oxide and graphene nanoplatelets, were incorporated into resin composites, PMMA denture base materials, glass ionomer cements, dental adhesives, and CAD/CAM polymers. The majority of studies exhibited improved flexural strength, hardness, fracture resistance, and antimicrobial properties against Streptococcus mutans and Candida albicans. However, higher concentrations of graphene in certain formulations resulted in increased surface roughness and a lower degree of conversion. Conclusions: Graphene-reinforced dental materials exhibit promising mechanical reinforcement and antimicrobial properties in laboratory settings. However, formulation-dependent trade-offs and the lack of long-term clinical data necessitate further standardized experimental and clinical investigations before routine clinical adoption.