Journal of Bahria University Medical and Dental College
Click here for Old Users. The Journal of Bahria University Medical and Dental College (JBUMDC) is a peer-reviewed, multidisciplinary biomedical Journal of Basic and Clinical Health Sciences (Print ISSN: 2220-7562 and Online ISSN:2617-9482 CODEN: JBUMB7). It was established in 2011 with the main aim to promote and disseminate high-quality research papers among the healthcare research community. It is published quarterly in January, April, July, and October. It is recognized by Pakistan Medical and Dental Council (PM&DC) IP/0072 It is recognized by Higher Education Commission of Pakistan (HEC) for Year 2021-22 (Sr. No 27859) for Year 2022-23 (Sr. No 29081) for Year 2023-24 (Sr. No 29036) for Year 2024-25 There are no processing and publication charges for article processing and publication.
Bahria University Medical and Dental College
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
Effect of Maternal Anemia on Birth Weight among Newborns
Objectives: To evaluate the association between maternal anemia and low birth weight in newborn at SITH, Lodhran. Study design & settings: Prospective cohort study at Department of Pediatrics nursery and gynae and obs department at Shahida Islam Teaching Hospital, Lodhran. Materials & Methods: Pregnant women of child bearing age between 18 and 40 years with singleton pregnancies confirmed via ultrasound were included. Those who were pregnant with hemoglobinopathies, multiple pregnancies (twins, triplets, etc.), preterm pregnancy, pregnant and had such conditions as GDM, PIH, preeclampsia were excluded. Two groups of women will be divided as having been exposed and not being so. Exposed group (Anemic mothers): Hemoglobin level of less than 11 g/dL in pregnant women, as tested during their third trimester. Unexposed group (non-anemic mothers): Hemoglobin level of =11 g/dL in pregnant women, as assessed during their third trimester. The weight of babies at the time of birth was determined within 30 minutes of birth using a standard calibrated digital weighing scale, and noted in grams. Results: Low weight of babies at birth was observed in 24(48.0%) women and was anaemic as compared to 08 (16.0%) women who were non-anaemic thus the p-value of 0.002 and relative risk of 3.00 which is noticeable and represents positive relationship of maternal anemia and low weight of babies in our study. Conclusion: Following findings carried in the study, the likelihood of anemic women bearing low birth weight babies is greater than non-anemic women.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc/4.0
Comparison of Self-efficacy of Dental house officers regarding content and Extent of Education in Rehabilitative Endodontics in Public and Private dental institutes
Objective: To compare whether the self-efficacy score of dental house officers was associated with the extent of education content received in public & private dental institutes. Study design and Setting: It was a comparative analytical study, conducted at various public and private dental colleges of Karachi from March 2022 to December 2022. Method: The validated endodontic general self-efficacy scale (ESES) related to the content of endodontic education was used. Data was analyzed on SPSS version 23. The mean rank of ESES items and performance of Root Canal Treatment (RCT) was assessed through Mann-Whitney U test. P value < 0.05 was taken as statistically significant.
Dental interns, Education, Endodontic, House Officers, Self-Efficacy.
Copyright (c) 2026 Kiran Fatima Mehboob Ali Bana, Farnaz Ilyas, Shama Asghar (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparison of Maternal and Neonatal Outcomes of Spontaneous versus Directed Pushing Techniques in the Second Stage of Labour
Objective: To compare the maternal and neonatal outcomes of spontaneous and directed methods of pushing during the second stage of the labour. Study Design and Setting: This Prospective comparative study was conducted at the Department of Obstetrics and Gynecology, PAF Hospital Islamabad, over three months. Methodology: After approval from the Ethical Review Committee (ERC Ref No: ERC/FPGMI/OBG/11/2026). A total of 60 singleton term pregnancies were included and equally divided into two groups (n = 30 each). Group A performed spontaneous pushing, whereas Group B performed directed pushing using the Valsalva. Maternal outcomes were length of second stage of labour, episiotomy, perineal trauma and maternal fatigue. Neonatal outcomes consisted of one minute Apgar score and NICU admission. Independent sample t-test was used for continuous variables. Chi-square test or Fisher’s exact test was used for categorical variables where appropriate, P-value =0.05 was considered statistically significant. Results: The duration of second stage was significantly shorter in spontaneous group (38 ± 10 min) vs directed group (45 ± 12 min) (p = 0.002). Episiotomy (26.7% vs 43.3%, p = 0.041), perineal trauma (13.3% vs 26.7%, p = 0.048), and maternal fatigue (16.7% vs 36.7%, p = 0.031) were significantly lower in spontaneous group. No significant difference was observed in Apgar score 7: 6.7% vs 13.3%, p = 0.337; NICU admission: 3.3% vs 10.0%, p = 0.296. Conclusion: Associated with better maternal outcomes and without jeopardizing the safety of the neonate, Spontaneous pushing was associated with shorter second stage of labour, lower episiotomy rate, reduced perineal trauma, and decreased maternal fatigue, without significant differences in neonatal outcomes
Directed pushing, Maternal outcomes, Neonatal outcomes, Perineal trauma, Spontaneous pushing
Diagnostic Accuracy of MRCP for Detecting Choledocholithaiasis in Patients with Obstructive Jaundice keep ERCP as Gold Assistant
Objective: To determine the diagnostic accuracy of MRCP for detecting choledocholithiasis in patients with obstructive jaundice keeping ERCP as gold standard. Study Design and settings: Cross-sectional validation study, Department of Radiology, Madinah Teaching, Faisalabad. Methods: Non-probability consecutive sampling was used to sample 230 patients of both genders, aged 26-70 years, and experiencing obstructive jaundice. Patients who had been diagnosed with choledocholithiasis earlier, with chronic liver disease or have a contraindication to MRI were not included. MRCP was performed on all enrolled patients that underwent ERCP in 48 hours. Findings on MRCP were compared to ERCP findings. The SPSS version 20 was used to analyze data. A 2 x 2 contingency table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Findings: The average age of the patients was 48.72 + 11.43 years. Out of 230 patients, 132 (57.4%) were male and 98 (42.6%) were female. In 168 (73.0) patients, MRCP observed choledocholithiasis whereas in 174 (75.7) patients, ERCP agreement was choledocholithiasis. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value for MRCP were 91.95%, 85.71%, 95.24%, 77.42%, 90.43% respectively. Conclusions: MRCP was found very accurate in diagnosing choledocholithiasis among patients presenting with obstructive jaundice. Keywords: MRCP, ERCP, choledocholithiasis, obstructive jaundice, diagnostic accuracy
MRCP, ERCP, choledocholithiasis, obstructive jaundice, diagnostic accuracy
Comparison of Holmium Laser versus Cold Knife Treatment in Patients with Urethral Strictures
Objective: The goal of this study is to assess the efficacy of optical internal urethrotomy, which uses a holmium laser in comparison to a cold knife, in treating short-segment urethral strictures in our local setting. Study design & Settings: Randomized controlled trial (ClinicalTrials.gov Identifier: NCT07505316) at the Department of Urology, Kidney Center- Bahawal Victoria Hospital, Bahawalpur. Methods: Males aged 18 to 70 years with short segment urethral strictures (length <2 cm), planned to undergo internal urethrotomy were included. Patients with multiple or recurrent strictures, active urinary tract infections, complete urethral obliteration on urethroscopy, with pan-anterior strictures, posterior stenosis, failed prior interventions, were not included. Patients were randomly divided into group A (cold-knife) and group B (holmium laser) through lottery method using sealed opaque envelopes. Post procedure uroflowmetry was performed after 30 days and assessor was not aware of procedures performed Findings: The mean Qmax of the holmium laser group was 18.9 +/- 3.5 ml/sec 30 days after surgery, as compared to the cold-knife group (14.8 +/- 3.2 ml/sec). This was found to be very statistically significant (p < 0.001), which indicated that the cold-knife method did not significantly enhance the urine flow rate compared to holmium laser urethrotomy. Conclusion: In individuals with short-segment urethral strictures, cold-knife and holmium laser urethrotomy both significantly increase urine flow, but the traditional method of holmium laser urethrotomy has a significantly higher post-operative Qmax.
urethral stricture, holmium laser, urethrotomy
Diagnostic Accuracy of Magnetic Resonance Spectroscopy in Diagnosing Glioblastoma, taking Histopathology as Gold Standard
Objective: To determine the diagnostic accuracy of magnetic resonance spectroscopy (MRS) in diagnosing glioblastoma in patients with focal brain lesions, taking histopathology as the gold standard. Study Design and Setting: Cross-sectional validation study conducted at the Department of Radiology, Madinah Teaching Hospital, Faisalabad. Methodology: A total of 148 patients aged 20-60 years with focal brain lesions larger than 5 mm and lesion duration of more than one month were enrolled through non-probability consecutive sampling. All patients underwent proton MRS using a 1.5 Tesla MRI system with a single-voxel point-resolved spectroscopy technique. MRS diagnosis of glioblastoma was based on raised choline peak, reduced NAA/Cr ratio, raised Cho/NAA ratio, and raised Cho/Cr ratio. Post-biopsy or post-excision histopathology was used as the gold standard. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, likelihood ratios, and receiver operating characteristic curve analysis were calculated using SPSS version 25.0. Results: The mean age was 42.76 +/- 10.84 years, and 92 (62.2%) patients were male. Histopathology confirmed glioblastoma in 116 (78.4%) patients. MRS showed sensitivity of 93.1%, specificity of 68.8%, positive predictive value of 91.5%, negative predictive value of 73.3%, and overall diagnostic accuracy of 87.8%. Conclusion: MRS is a highly sensitive non-invasive adjunct to conventional MRI for preoperative assessment of suspected glioblastoma; however, histopathological confirmation remains essential because specificity and negative predictive value were moderate.
Glioblastoma; Magnetic Resonance Spectroscopy; Histopathology; Diagnostic Accuracy; Brain Neoplasms
Clinical Significance of Serum C-Reactive Protein Levels in Oral Premalignancies and Oral Squamous Cell Carcinoma
Objective: Assessing serum C-reactive protein (CRP) levels in healthy controls, individuals with oral premalignant disorders, and patients with oral squamous cell carcinoma (OSCC) in order to determine its potential as a screening and diagnostic biomarker. Study Design and Setting: A cross-sectional study was carried out at PNS Shifa Hospital, Karachi over one-year period using consecutive sampling. Methodology: Seventy-eight participants were equally divided into three groups: healthy controls (n=26), patients with oral premalignant disorders (n=26) and OSCC patients (n=26). Serum CRP levels were measured using immunoturbidimetry. Statistical analysis was carried out using one-way ANOVA, chi-square test, receiver operating characteristic (ROC) analysis, and multiple regression. Results: The mean serum CRP level showed significantly higher levels in OSCC patients compared with premalignant and healthy groups (p<0.001). There was a progressively increasing trend in CRP levels from healthy controls to premalignant lesions and OSCC. ROC analysis showed acceptable discriminative ability of serum CRP in distinguishing OSCC and premalignant conditions from healthy individuals. Conclusion: Serum CRP levels show promising ability as a diagnostic and screening tool for oral premalignant and malignant conditions with increasing levels correlating with disease progression. However larger longitudinal studies are recommended to validate these findings. Keywords: Biomarker; C-reactive protein; CRP; Oral premalignant disorders; OPMD; Oral squamous cell carcinoma
Biomarker; C-reactive protein; CRP; Oral premalignant disorders; OPMD; Oral squamous cell carcinoma
Comparison of the Neurological Outcome of Early Vs Late Surgery for Cervical Spinal Cord Injury
Objective: To evaluate the differences in the neurological outcome of early and late surgical intervention in cervical spinal cord injury (CSCI) patients. Study Design & Settings: Prospective cohort study at Department of Neurosurgery, Bahawal Victoria Hospital, Bahawalpur. Methodology: Eighty-eight patients aged between 20-60 years of age and presenting with the acute cervical spinal cord injury within the 12 hours of injury were taken. Patients were categorized into two groups according to the timing of the surgery; early surgery (less than 24 hours) and late surgery (greater than 24 hours). The assessment of neurological status was done on the basis of the American Spinal Injury Association (ASIA) preoperative and one-month postoperative. Neurological recovery was defined as the improvement of one or more by one or two ASIA grades. The analysis of the data was done using SPSS version 25.0, and the chi-square test was used to compare the results. Findings: A statistically significant difference between the early and late surgery groups was found with 56.8% and 31.8% patients recovering neurologically respectively (p = 0.02). Incomplete injuries (B-D) patients showed a superior recovery in comparison to the complete injuries (ASIA grade A). Conclusion: Timely surgery is within the first 24 hours which is linked to a significantly better neurological outcome in patients with a cervical spinal cord injury. Surgical decompression to improve functional outcomes should be given priority to improve long-term disability reduction.
Cervical spinal, cord injury, Early surgery, Late surgery, ASIA score
Effectiveness of Post-Burn Finger Contracture Release with 5-Flap Z-Plasty without Graft
Objective: To determine the functional outcome of the 5-flap Z-plasty technique without skin graft in terms of mean improvement in extension lag angle in the surgical management of post-burn finger contractures. Study Design and Setting: A prospective interventional study was conducted at Allied Burn and Reconstructive Surgery Centre Faisalabad, Pakistan, from August 2025 to February 2026. Methodology: A total of 65 patients were enrolled. Patients of both genders with age ranging from 4 to 40 years were included that were having moderate degree of post burn finger contractures with pliable surrounding skin and supple interphalangeal joints. All patients underwent release of contracture using a 5-flap Z-plasty without a skin graft. Extension lag angle was measured pre-operatively and post-operatively using a standard goniometer. Results: Of 65 patients, 37 (56.9%) were male and 28 (43.1%) were female, with a mean age of 15.75 ± 8.91 years. The mean pre-operative extension lag angle was 62.46 ± 12.25°, which decreased significantly to 1.08 ± 2.57° post-operatively (p = 0.001), yielding a mean improvement of 61.38 ± 10.84°. The mean improvement in extension lag angle was stable across subgroups, with no statistically significant differences by gender (p = 0.159) or age group (p = 0.113). Conclusion: The 5-flap Z-plasty technique without skin graft achieves significant functional improvement in moderate degree post-burn finger contractures with good flap viability rates, no donor site morbidity, good colour match, start of early rehabilitation and no need for prolonged immobilization.
Burns; Cicatrix; Finger Injuries; Surgical Procedure
Copyright (c) 2026 Zahida Younas, Shumaila Yousaf, Bushra Akram Mughal, Urwa Tanveer Ahmad, M Behram Abbas, Saqib Shakoor (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparison of Intravenous Ciprofloxacin and Intravenous Ceftriaxone in the Management of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver
Objective: To compare the effectiveness of intravenous ciprofloxacin versus intravenous ceftriaxone in spontaneous bacterial peritonitis (SBP) treatment of patients with liver cirrhosis. Study Design and settings: Randomized controlled trial at Nishtar Hospital Multan/department of medicine. Methodology: 310 patients aged 25-70 years old who are liver cirrhosed, diagnosed with SBP were enrolled using nonprobability consecutive sampling. Patients were randomly allocated to two groups using lottery approach. Group A (n=155) received the intravenous ciprofloxacin (200 mg twice a day) and Group B (n=155) the intravenous ceftriaxone (1 g twice a day). Efficacy was noted after 48 hours of treatment on the basis of: fever, abdominal pains, and decrease of the neutrophil count in the ascitic fluid; and data was analyzed using SPSS version 26 and chi-square test was applied and considered significant p<0.05. Findings: Both groups showed an average age of 42.8 +- 9.6 years in Group A and 43.5 +-10.1 years in Group B and an overall efficacy of 71.0% for ciprofloxacin and ceftriaxone of 79.4% respectively and the difference was statistically significant (p=0.048). Ceftriaxone demonstrated superiority in clinical and lab outcome particularly among patients with advanced liver disease. Conclusion: In comparison to intravenous ciprofloxacin, intravenous ceftriaxone is more effective in treatment of spontaneous bacterial peritonitis in cirrhosis.
Peritonitis; Liver Cirrhosis; Ciprofloxacin; Ceftriaxone; Ascites.
Comparison of Efficacy of Mesotherapy with Tranexamic Acid versus Ascorbic Acid in the Treatment of Melasma: A Split-Face Comparative Study
Abstract Objectives: To compare the efficacy and safety of intradermal mesotherapy with tranexamic acid (TA) and ascorbic acid (AA) in patients with facial melasma. Study Design and Setting: A quasi-experimental split-face comparative study was conducted at the Department of Dermatology, Tertiary Care Hospital, Malir Cantt, Karachi, over a period of six months after approval of the research protocol by the institutional review authority. Methodology: Sixty patients aged 20–50 years with bilateral facial melasma were enrolled through non-probability consecutive sampling. Intradermal tranexamic acid (100 mg/mL) was administered on the right side of the face, while ascorbic acid (20%) was injected on the left side at two-week intervals for 12 weeks. Treatment response was assessed using the modified Melasma Area and Severity Index (mMASI) score at baseline and follow-up visits. Adverse effects were also recorded. Results: Both treatment modalities showed significant reduction in mMASI scores after 12 weeks. However, the TA-treated side demonstrated a significantly greater mean reduction in mMASI score compared to the AA-treated side (73.9% ± 11.6 vs. 57.5% ± 13.2; p<0.001). Excellent response (=75% improvement) was observed in 56.7% of TA-treated sides compared to 30% of AA-treated sides. Adverse effects including erythema, burning sensation, and pain at injection site were mild and transient in both groups. Conclusions: Intradermal mesotherapy with tranexamic acid was more effective than ascorbic acid in reducing the severity of melasma while maintaining a comparable safety profile. Both treatments were well tolerated; however, tranexamic acid produced faster and greater pigment reduction, particularly in patients with darker skin phototypes
Ascorbic Acid; Melasma; Mesotherapy; Skin Pigmentation; Tranexamic Acid
Frequency of Hyponatremia in Patients with Liver Cirrhosis and Its Association with Hepatic Encephalopathy
Objective: This study aims to determine the frequency of hyponatremia and to investigate its association with hepatic encephalopathy among patients with liver cirrhosis. Study design & Settings: Descriptive cross-sectional study conducted at the Department of Medicine, Gulab Devi Teaching Hospital, Lahore. Methodology: A non-probability consecutive sampling technique was used to enroll 140 patients with liver cirrhosis. Patients with conditions that could affect electrolyte balance or mental status were excluded. Hyponatremia was defined as serum sodium <135 mEq/L and was further categorized into mild, moderate, and severe according to admission serum sodium levels. Hepatic encephalopathy was assessed clinically using the West Haven criteria. Results: Out of 140 patients, 58 (41.4%) had hyponatremia, including 28 (20.0%) mild, 20 (14.3%) moderate, and 10 (7.1%) severe cases. Hepatic encephalopathy was present in 90 patients (64.3%). Hepatic encephalopathy was more frequent among patients with hyponatremia than among those with normal sodium levels (82.8% vs. 51.2%; p=0.001). Conclusion: Hyponatremia is common in patients with liver cirrhosis and has a significant association with hepatic encephalopathy. Serum sodium monitoring may help identify patients who are at increased risk of neurological complications.
Liver cirrhosis; hyponatremia; hepatic encephalopathy
Comparison of Post-Operative Pain and Complications between Onlay and Sublay Mesh Repair of Incisional Hernia in Tertiary Care Hospital in Pakistan
Objective: To assess and compare postoperative pain and complications between onlay and sublay mesh repair for incisional hernias. Study Design and Setting: It is a Prospective Observational Study conducted at Department of Surgery, JPMC Karachi. Duration of study spanned from January to June 2025. Methodology: 50 patients with incisional hernias either underwent onlay (Group A) or sublay (Group B) repair. Age, symptom duration, procedure duration, weight, height, and BMI were characterized using mean ± SD. Gender, ASA grade, and post-operative complication (hematoma, seroma and wound infection) were presented as frequencies and percentages. Pain was gauged using Visual analog score (VAS) at 2nd hour post-op, 24th hour, and discharge. A Chi-square test was utilized, with p = 0.05. A paired t-test was used to compare pre and postoperative pain score between group A and B, with p = 0.05. Results: In Onlay group, incidence of wound infections were 8%, hematoma was 12%, and seroma was 16%. In sublay group, incidence of wound infections were 4%, hematoma was 8%, and seroma was 4%. In Group A, VAS was 8.2 in 2nd hour, 3.9 in 24th hour, and 1.9 at discharge. In Group B, VAS was 6.4 in 2nd hour, 3.2 in 24th hour, and 0.8 at discharge. The results were statistically significant. Conclusion: Group B demonstrated better postoperative outcomes and lower VAS scores. Incidences of wound infection, hematoma, and seroma were lower in group B. This research contributes to valuable evidence favoring the sublay approach as more effective surgical strategy
Hematoma, Pain, Postoperative Complications, Surgical Mesh, Seroma, Wound Infection
Copyright (c) 2026 Beenish Khan, Rabel Qureshi, Priya Bai, Mazhar Iqbal (Author) https://creativecommons.org/licenses/by-nc/4.0
Evaluation of Robotic Simple Nephrectomy Outcomes Using the modified ClavienDindo Classification System
Objectives: To determine frequency and severity of post-op complications in patients undergoing robotic simple nephrectomy by using modified Clavien–Dindo classification. Study Design and Setting: This longitudinal descriptive study conducted in the Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Methodology: This study was carried over a six-month (6) period. A total of 68 patients undergoing robot-assisted simple nephrectomy for benign, non-functioning kidneys were included through non-probability consecutive sampling. Sample size was calculated using OpenEpi, based on an expected postoperative complication rate of 16%, using 95% confidence and taking 5% margin of error, applying finite population correction. Postop complications occurring within 30 days or one month were graded according to the modified Clavien–Dindo classification. Data were analyzed using SPSS version 24.0. Associations were assessed using t-tests and chi-square tests, with a p-value less than <0.05 considered statistically significant. Results: Among 68 patients, prolonged operative time was associated with increased intraoperative blood loss, higher overall complication rates, greater Clavien–Dindo grades, and the development of CKD (Chronic kidney disease) at followup. Higher body mass index was significantly related to prolonged hospital stay and delayed postoperative recovery. Surgical indication was also associated with increased bleeding and greater complication severity. Conclusions: Prolonged operative time and higher body mass index were important predictors of postoperative morbidity following robot-assisted simple nephrectomy.
Body Mass Index; Clavien–Dindo Classification; Nephrectomy; Postoperative Complications; Robotic Surgical Procedure
Comparison of Outcomes of Microscopic Versus Conventional Thyroidectomy
Objectives: To compare the outcomes of microscopic versus conventional thyroidectomy. Study design & settings: Randomized controlled trial from 16th December 2025 to 15th March 2026 at ENT Department at Sheikh Zayed Hospital, Lahore. Methodology: This Randomized controlled trial (ClinicalTrials.gov Identifier: NCT07488858) involved 74 patients who underwent thyroidectomies at the age of 18 and 65 years. The patients were split into microscopic thyroidectomy (n = 37) and conventional thyroidectomy group (n = 37). EBSLN palsy, RLN palsy, transient and persistent hypocalcemia were categorical variables whereas operation time, and intraoperative blood loss were continuous. The SPSS version 26 was used to analyze the data. The independent t-test was used to compare the continuous variables and the categorical variables were compared with the chi-square test or the Fisher exact test. A p-value of =0.05 was regarded as significant. Results: The mean time of operation of the MT group was 92.6 ± 15.4 minutes and the CT group was 78.9 ± 14.7 minutes. The intraoperative mean blood loss of the MT group was however significantly less than that of the CT group (52.3 ± 18.6 mL vs., 84.7 ± 25.1 mL). Transient RLN palsy was also seen in 5.4% of patients in the MT group, as compared to 13.5% in the CT group, and only persistent RLN palsy occurred in 2.7% patients in the CT group. Conclusion: Even though technique was slightly slower than conventional thyroidectomy, intraoperative blood loss and postoperative complications were also reduced substantially by microscopic thyroidectomy
Thyroidectomy, microscopic thyroidectomy, laryngeal nerve palsy recurrent
Pattern of Lipid Abnormalities in Newly Diagnosed Primary Hypothyroidism: A Cross-Sectional Study from Nowshera, Pakistan
Objective: To evaluate the prevalence and pattern of lipid abnormalities among newly diagnosed primary hypothyroid patients presenting to a tertiary care center in Nowshera, Pakistan. Study Design and Setting: Cross-sectional study conducted from October 2024 to May 2025 at the Department of Medicine, Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan. Methodology: This study was conducted over a period of six months and included 109 newly diagnosed primary hypothyroid patients aged 18–70 years, recruited through non-probability consecutive sampling. Hypothyroidism was confirmed by elevated thyroid-stimulating hormone (TSH >4.5 mIU/L) and decreased free thyroxine (free T4 <0.8 ng/dL). Fasting lipid profiles were measured, and lipid abnormalities were defined according to Adult Treatment Panel III (ATP III) criteria. Results: Among 109 patients (mean age 38.6 ± 11.2 years; 68.8% females; mean BMI 27.8 ± 4.6 kg/m²), 86.2% had at least one lipid abnormality. The most frequent lipid abnormality was hypertriglyceridemia (59.6%), followed by low HDLC (55.0%) and elevated LDL-C (53.2%), while hypercholesterolemia was observed in 34.9% of patients. No statistically significant differences were observed across sex, age, or BMI categories (p > 0.05). BMI showed a positive correlation with total cholesterol (r = 0.30, p = 0.002) and triglycerides (r = 0.48, p < 0.001), and a negative correlation with HDL-C (r = –0.21, p = 0.03). Conclusion: Dyslipidemia is highly prevalent in newly diagnosed hypothyroid patients, with hypertriglyceridemia and low HDL-C being the most common abnormalities. These findings highlight the importance of routine lipid screening and early cardiovascular risk management in patients with hypothyroidism
Dyslipidemia; Hypertriglyceridemia; Hypothyroidism; Lipid profile; Low HDL-C; Pakistan
Impact of Intermittent Fasting on Reproductive Markers in PCOS
Objective: To evaluate the effect of a six-week time-restricted feeding (TRF) regimen on anthropometric, metabolic, and reproductive hormonal parameters in women with polycystic ovary syndrome (PCOS). Study Design and Setting: Retrospective observational study conducted at Medical Teaching Institute Bacha Khan Medical College and Mardan Medical Complex, Mardan Pakistan. Methodology: A total of 63 women diagnosed with PCOS according to Rotterdam criteria who completed a six-week TRF dietary regimen (8-hour feeding window from 1:00 p.m. to 9:00 p.m.) were included. Anthropometric measurements and laboratory parameters were recorded before and after the intervention. Variables assessed included body mass index (BMI), waist-to-hip ratio (WHR), insulin resistance using HOMA-IR, androgen profile (free androgen index, testosterone, SHBG), gonadotropins (LH and FSH), and ovarian reserve markers (estradiol and AMH). Paired t-tests were applied and p < 0.05 was considered statistically significant. Results: Significant reductions were observed in BMI, WHR, HOMA-IR, fasting insulin, and free androgen index. Total and free testosterone levels decreased, while SHBG levels increased significantly. LH levels declined and FSH levels increased, improving the LH/FSH ratio. Estradiol levels increased whereas AMH levels showed a modest decline. Clinical improvement was observed in ovulatory function (60.4%), menstrual regularity (60.9%), and hyperandrogenism (63.6%). TRF showed high adherence (82.5%) with minimal side effects. Conclusion: Time-restricted feeding appears to be a safe and effective lifestyle intervention for improving metabolic and reproductive hormonal parameters in women with PCOS. Further randomized controlled trials with longer follow-up are required.
Hyperandrogenism; Insulin resistance; Intermittent fasting; Polycystic ovary syndrome; Time-restricted feeding
Safety and Efficacy of Racecadotril in Acute Watery Diarrhea: A Randomized Controlled Trial in Children Aged 3 –59 Months
Objective: To evaluate the efficacy and safety of racecadotril (1.5 mg/kg thrice daily) in combination with standard oral rehydration therapy (ORT) and compare with placebo plus ORT in 3 - 59 months old hospitalized children with acute watery diarrhea Study Design and Setting: A randomized controlled trial having registration number NCT07392931 was conducted with 200 children aged 3-59 months hospitalized with AWD at the Punjab Rangers Teaching Hospital in Lahore, as a prospective, double-blinded study. Participant enrolment and follow-up covered six consecutive months (1st June to 30th November 2025). The study protocol was approved by the Institutional Review Board (IRB) of Punjab Rangers Teaching Hospital, Lahore (Ref: PRTH/IRB/2023/63). Methodology: Children either received Racecadotril (1.5mg/kg three times a day) or a placebo, with standard oral rehydration therapy. The key outcomes were the number of stools in 24 hours and the length of stay of the children in the hospital. Results: Day 1 (3.1 vs. 4.8) Racecadotril reduced the stool count. The proportion of children who achieved treatment success (a decrease in stools) on the drug compared to placebo was 82% and 48%, respectively (NNT=3). The children who were administered Racecadotril spent 26.4 hours less in the hospital. The adverse effects were rare (8% vs. 12%) and no drug-related or serious problems were observed. The cost analysis showed a savings of 6,230 PKR per patient. Conclusion: Racecadotril is safe, effective, and cost-effective. It promptly reduces stool output and hospital stay of children with AWD regardless of their age and dehydration condition.
Racecadotril; Acute watery diarrhea; Antisecretory; Oral rehydration therapy; Randomized controlled trial
Anxiety and Depression in Rheumatoid Arthritis Patients and its Impact on the Quality of Life
Objective: To determine the frequency of depression and anxiety among patients with rheumatoid arthritis (RA) and to assess its impact on the quality of life. Study Design and Setting: This cross-sectional study was conducted in KRL hospital Islamabad from 1-January-2025 to 31-July-2025. Methodology: 115 patients aged 18 years or older with a confirmed diagnosis of RA were included. To evaluate disease severity, standardized criteria i.e. the Disease Activity Score involving 28 joints (DAS28) was employed. The Hospital Anxiety and Depression Scale (HADS), a validated instrument, was used to measure symptoms related to depression and anxiety. The impact on patients' quality of life was assessed using the Health Assessment Questionnaire Disability Index (HAQ-DI). Results: 15 participants (13.0%) were male, while 100 participants (87.0%) were female. The mean duration of RA was 7.70 (±6.41) years. Among the participants, 30 patients (26.1%) were identified as experiencing depression, whereas 22 patients (19.1%) were found to have anxiety. Mean ESR, tender joint count (TJC), swollen joint count (SJC) and VAS score were significantly high in patients with depression and anxiety. The DAS-28 scores averaged 4.88 (±1.36) for those with anxiety/depression versus 3.85 (±1.26) for those without (P-value <0.0001) showing moderate disease activity in both groups. The HAQ-DI score averaged 1.33 (±0.84) for individuals with anxiety/depression as compared to 0.77 (±0.68) for those without (P-value <0.0001). Conclusion: There is a considerably high prevalence of anxiety and depression among RA patients with a significant impact on the quality of life
Anxiety, DAS-28, depression, HADS, HAQ-DI, rheumatoid arthritis
Copyright (c) 2026 Ishma Arif, Anila Nisar, Anum Rasheed, Aanum Misbah Hasanat, Amber Iltaf (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparison of the Outcome of Coblation Tonsillectomy versus Cold Dissection Tonsillectomy
Objectives: To compare the outcome of coblation tonsillectomy versus cold dissection tonsillectomy. Study design & settings: Randomized controlled trial from 26th September 2025 to 25th December 2025 at ENT Department at Sheikh Zayed Hospital, Lahore. Methodology: All patients with chronic tonsillitis of duration >3 months, age 20 to 60 years of either gender were included. Tonsillar cancer, known bleeding disorders (INR >1.5), and a history of peritonsillar abscess were excluded. Patients in a group Group B's tonsils are removed via cold dissection, while group A's tonsils are removed by coblation. Seven days following the operation, the mean post-operative pain was assessed. There were additional reports of initial bleeding, secondary bleeding, and secondary infection. The postoperative discomfort in both groups was compared using the independent "t" test, and the primary, reactionary, and secondary hemorrhages were compared using the chi square test; a p-value of =0.05 was deemed significant. Results: In this study, mean intra-operative blood loss in Group A (coblation tonsillectomy) was 28.90 ± 7.78 ml while in Group B (cold dissection tonsillectomy) was 42.07 ± 4.77 ml (p-value = 0.0001). Mean post-operative pain in Group A was 2.20 ± 0.89 while in Group B was 4.87 ± 1.14 (p-value = 0.0001). Secondary hemorrhage was found in 3.33% patients in the cold dissection group and 0.0% in the coblation group. Conclusion: Coblation tonsillectomy offers benefits such decreased intraoperative blood loss, shorter surgery time, and quicker return to a normal diet
Coblation, tonsillectomy, post-operative pain, blood loss, hemorrhage
Comparison of Metformin and Insulin in the Management of Non-Obese Gestational Diabetes Mellitus Patients
Objective: This study will aim to determine the effects of metformin and insulin in the management of non-obese GDM. Study Design and setting: This Cohort study was carried out in the department of gynecology, Healthways Hospital Khyber Pakhtunkhwa (KPK) Pakistan. The duration of the study was 6 months started from May 2024 to Dec 2024. Methodology: Total 160 GDM patients were recruited which were divided equally in to two groups. To one group metformin 500mg thrice daily were prescribed while insulin (mixtard 70/30) was prescribed to insulin group. The target fasting blood sugar (FBS) was set <95mg/dl. All the patients were followed for 2 months with FBS after 1st week, 2nd week, 14 days and 1 month interval. Results: In metformin group, 32.5% patients were in 1st trimester, 41.25% were in 2nd trimester while 41.25% were in 3rd trimester while in insulin group the frequency of 1st, 2nd and 3rd trimester was 33.75%, 52.5% and 13.75% respectively. The mean age, BMI and FBS in metformin group were 26.74±3.5 years, 24.18±2.21 and 135.16±9.74 mg/dl respectively. There were no statistical differences observed between mean values of both group with p-values 0.96, 0.73 and 0.87 respectively. However, in insulin group there was statistically significant difference achieved in controlling the FBS after two months with p-value 0.04. Conclusion: Insulin significantly controls the FBS but metformin also shows comparable results. Thus, metformin is a good first line drug in terms of cost and compliance to GDM patients especially in financially deprived area.
Gestational Diabetes Mellitus, Hyperglycemia, Insulin, Metformin
Comparison between the Retrieval of the Gallbladder by the Direct Extraction Method and the Bag Method in Laparoscopic Cholecystectomy
Abstract Objective: This study aimed to compare the complications associated with direct versus endobag retrieval methods in laparoscopic cholecystectomy. Study design and setting: A prospective cohort study was conducted at PNS Shifa Hospital, Karachi, from 1st June 2024 to 30th June 2025. Methodology: A total of 270 patients with ultrasound-proven cholelithiasis undergoing laparoscopic cholecystectomy were included. Patients were divided into two groups: Group A (direct retrieval, n=114) and Group B (Endo bag retrieval, n=156). Postoperative complications, including port-site pain, infection, hernia, sinus formation, and intraperitoneal contamination, were assessed and statistically analyzed using SPSS v21. Results Direct retrieval was associated with significantly higher intraperitoneal contamination (15% vs. 5.6%, p<0.05). Endo bag retrieval showed a higher rate of port-site pain (14.5% vs. 22.3%). Rates of surgical site infection and port-site hernia were comparable between both groups. Conclusion Endo bag use significantly reduced intraperitoneal contamination and stone spillage. However, it increased postoperative port-site pain due to larger fascial incisions. Direct retrieval remains cost-effective but carries higher contamination risk. Choice of retrieval technique should balance patient safety, surgical outcomes, and resource availability. Keywords: bile spillage, gallbladder removal, laporoscopic cholecystectomy, port site infection, specimen bag
bile spillage, gallbladder removal, laporoscopic cholecystectomy, port site infection, specimen bag
Clinical Outcomes of Magnesium Sulphate Nebulization in Acute Bronchiolitis Patients Admitted in a Tertiary Care Hospital
Objective: The objective of this research is to analyze the treatment results of nebulized magnesium sulphate for acute bronchiolitis patients requiring hospital admission at a tertiary care medical facility. Study design and Setting: After the ethical approval from the institutional review board of PNS Shifa, this prospective observational study was conducted at PNS Shifa hospital, Karachi, from December 2024 to May 2025. Methodology: This prospective observational study was conducted at PNS Shifa Hospital, Karachi (Dec 2024–May 2025; ERC/2023/Paeds/25-A). One hundred children (1–24 months) with acute bronchiolitis were enrolled; exclusions were congenital heart or lung disease, immunodeficiency, bacterial pneumonia, or prior intubation. Patients received either standard supportive care or standard care plus nebulized magnesium sulphate (150 mg in 2 mL NS every 6 hours for 24–48 h). Respiratory parameters, ICU admission, ventilator need, and hospital stay were assessed. Data were analyzed in SPSS v25 using paired t-test/chi-square with significance at p<0.05. Results: A total of 100 children were enrolled (33 standard nebulization, 67 magnesium sulphate). Baseline demographics, weight, respiratory rate, and oxygen saturation were comparable between groups (p>0.05). Post-treatment oxygen saturation improved significantly with magnesium sulphate (97.2% vs. 95.8%, p=0.003), while respiratory rate reduction was similar (p=0.666). ICU admissions were lower with magnesium sulphate (15% vs. 30%, p=0.017). Length of stay, number of nebulization, need for ventilation, and mortality showed no significant differences. Conclusions: Nebulized magnesium sulphate in addition to standard care significantly improved oxygen saturation and reduced ICU admissions in children with acute bronchiolitis.
Bronchiolitis, Children, Magnesium Sulphate, Nebulization.
Safety and Efficacy of Mini Percutaneous Nephrolithotomy Using Smaller Nephroscope for Kidney Stones in Children
Objective: To evaluate the safety and effectiveness of mini percutaneous nephrolithotomy (mini PCNL) with a smaller nephroscope in children aged 12 years and under with kidney stones Study Design and Setting: It is a Prospective Cohort Study conducted at the department of Paediatric Urology, Bahawal Victoria Hospital Bahawalpur from 11th August 2020 to 10th August 2024. Methodology: This study included 52 children (=12 years) with kidney stones =2.5 cm. Exclusions were children with non-functional kidneys, positive urine cultures, or coagulation disorders. After obtaining parental consent and assessing anaesthesia fitness, MPCNL was performed under general anaesthesia. A rigid 8/9.8 Fr nephroscope, 12 Fr amplatz sheath, and 1.5 mm pneumatic lithoclast probe were used. A supra-costal tract (above the 12th rib) was made in 36 patients and sub-costal in 16. Postoperative care included nephrostomy tube, ureteric catheter, and set tube removal protocol. Outcome measures included operative time, hospital stay, blood transfusion need, and stone clearance on follow-up ultrasound. Results: The mean age was 5.2 years. Thirty two (61%) were male, with a male-to-female ratio of 1.6:1. Average hospital stay was 48 hours, and mean operative time was 42 minutes. Stone clearance was complete in 69.23% of cases, with 36.76% having >85% clearance. Blood transfusions were needed in 19.23%, with no pleural effusions or chest tube placements. Conclusion: Mini PCNL is safe and effective for well-selected pediatric patients. Additional comparative studies are recommended for further validation.
Percutaneous Nephrolithotomy; Nephrolithiasis; Pediatrics; Minimally Invasive Surgical Procedures; Lithotripsy; Kidney Calculi; Treatment Outcome
Hormone Receptor Status in Breast Cancer Patients and Its Association with Age and Histopathological Grade in a Tertiary Care Setting
Objective: Hormone receptor testing plays a central role in the classification and treatment planning of breast cancer. This study aims to assess the frequency of estrogen receptor (ER) and progesterone receptor (PR) expression in breast carcinoma and examine their association with age and histopathological grade in a tertiary care setting. Study design and setting: This study design is cross-sectional, and it took place at Jinnah Postgraduate Medical Centre, Karachi. Methodology:. A total of 175 breast carcinoma cases diagnosed at a tertiary care center were reviewed. Information regarding patient age, tumor characteristics (type, size, lymph node status, metastasis, histological grade), and ER/PR expression was recorded. Associations between receptor status and clinicopathological parameters were examined using the chi-square test. Results: The majority of patients (59.4%) were aged 51–80 years. Most tumors were of ductal type (55.4%) and hormone receptor–negative, with 64.6% ER-negative and 70.3% PR-negative. ER and PR positivity were significantly higher in older patients (p = 0.02 and p = 0.04, respectively). However, no significant association was found between histopathological grade and either ER or PR status. Conclusion: Hormone receptor negativity was prevalent, especially in younger women: ER and PR expression increased with age and showed no association with tumor grade. These findings support the routine use of hormone receptor testing for informed treatment decisions.
Breast Neoplasms, Receptors, Progesterone, Immunohistochemistry, Receptors, Estrogen, Prognosis
Outcomes and Complications of Early Cholecystectomy versus Conservative Management in Diabetic Patients with Asymptomatic Gallstones
Objective: To compare gallstone-related complication rates, emergency cholecystectomy conversions, morbidity, mortality, hospital stay duration, and 30-day readmissions between early laparoscopic cholecystectomy and conservative management in diabetic patients with asymptomatic gallstones. Study design and setting: This was a prospective, comparative cohort study in which participants were recruited from the Department of General Surgery, Lady Reading Hospital, Peshawar, between January 2024 and December 2024. Those meeting inclusion criteria were allocated to either early laparoscopic cholecystectomy or conservative management groups, and outcomes were assessed at 3, 6, and 12 months. Methodology: A total of 170 diabetic patients with ultrasound-confirmed asymptomatic gallstones were allocated equally into early cholecystectomy and conservative management group. The primary outcomes included gallstone-related complications, emergency cholecystectomy, and 30-day readmissions. Secondary outcomes included length of hospital stay and morbidity rates. Results: The early cholecystectomy group showed significantly lower rates of complications (7.1% vs. 18.8%; p = 0.02) and emergency cholecystectomy (0% vs. 10.6%; p = 0.001) compared to the conservative group. Readmissions were also reduced in the early surgery group (2.4% vs. 8.2%; p = 0.04), and the mean hospital stay was shorter (2.5 ± 1.1 vs. 5.2 ± 1.8 days; p < 0.001). No mortality was observed in either group. Conclusions: This study suggests that early cholecystectomy in diabetic patients with asymptomatic gallstones significantly lowers the risk of complications and healthcare utilization compared to conservative management, supporting the adoption of early elective surgery in high-risk populations.
Cholecystectomy, Laparoscopic; Diabetes Mellitus; Gallbladder Calculi; Gallstones; Pancreatitis, Biliary
Copyright (c) 2026 Waseem Ullah, Muhammad Daud, Aahan Attaullah, Faseeh Muhammad, Fazal Ahmad, Muneeb Ur Rehman (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparison of Intra-Operative Hemorrhage by Blunt and Sharp Expansion of Uterine Incision at Caesarean Section
Objective: To determine the difference in mean drop in post-operative haemoglobin level after caesarean section with blunt and sharp expansion of uterine incision during the operation. Study Design and Setting: The study design was a randomized controlled trial, which was carried out at the Department of Obstetrics and gynecology, CMH Rawalakot, between 01- October-2024 and 31-March-2025. Methodology: 130 women who had elective lower segment caesarean section were recruited and randomly divided into two equal groups: blunt expansion (n=65) and sharp expansion (n=65). Females between 20 and 40 years old with singleton pregnancies of 37 weeks and above with hemoglobin of 10 g/dL and above were included. Haemoglobin was determined before and after the operation (24 hours later). A decrease of more than 1.5 g/dL was regarded as a clinical significance. Analysis of data was done in SPSS version 22; independent-sample t-test was used. Results: The mean haemoglobin drop in the blunt expansion group (1.37+0.79 g/dL) was significantly less than in the sharp expansion group (1.72+0.85 g/dL; p=0.016). Stratified analysis showed that there were significant differences in favor of blunt expansion in women aged >30 years (p=0.003), gestational age >39 weeks (p=0.008), and parity >2 (p=0.002). Conclusions: Blunt expansion of the uterine incision is related to much less intraoperative blood loss than sharp expansion, which is why it should be used as a safer method of reducing blood loss during a caesarean section, especially in more atrisk subgroups
Keywords: Caesarean section; Haemorrhage; Hemoglobin; Uterine incision; Uterotomy
Copyright (c) 2026 Summaira Shabbir, Syeda Maryam Batool, Arooj Naseem (Author) https://creativecommons.org/licenses/by-nc/4.0
Clinical Utility of Pleural Fluid Protein in Differentiating Tuberculous and Malignant Pleural Effusion in a Resource-Limited Setting
Abstract Objective: To evaluate the diagnostic performance of pleural fluid protein in differentiating tuberculous pleural effusion (TBPE) from malignant pleural effusion (MPE). Methodology: This cross-sectional analytical study was conducted at the Department of Pulmonology, Ayub Teaching Hospital, Abbottabad, Pakistan, from October 2020 to March 2021. A total of 109 patients aged 20–75 years with pleural effusion were enrolled through consecutive non-probability sampling. Patients with end-stage renal, hepatic, or cardiac failure, terminal illness, or psychiatric disorders were excluded. Pleural biopsy with histopathological examination was used as the reference standard for diagnosing TBPE or MPE. Pleural fluid total protein was measured and categorized as <5 g/dL or =5 g/dL. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: The mean age was 45.65 ± 15.34 years, with a near-equal gender distribution. Histopathology confirmed TBPE in 61 (56.0%) patients and MPE in 48 (44.0%). Pleural fluid protein levels =5 g/dL were observed in 46 (42.2%) patients, while 63 (57.8%) had levels <5 g/dL. Using a cutoff value of =5 g/dL, pleural fluid protein demonstrated a sensitivity of 81.97%, specificity of 72.92%, PPV of 79.37%, NPV of 76.09%, and diagnostic accuracy of 77.98% for identifying TBPE. Conclusion: Pleural fluid protein estimation shows acceptable diagnostic performance in differentiating TBPE from MPE and may serve as a useful adjunct in resource-limited settings. Although histopathology remains the gold standard, pleural fluid protein measurement can support earlier clinical decision-making when interpreted with clinical and radiological findings
Diagnostic accuracy; Malignant pleural effusion; Pleural effusion; Pleural fluid protein
Copyright (c) 2026 Bushra Arif, Sada Saeed, Hamid Nisar Khan, Sabeen Sajjad, Muhammad Mamoon, Fazal Mustan (Author) https://creativecommons.org/licenses/by-nc/4.0
A Randomized Control Trial Comparing Effectiveness of Cross K-Wire and Lateral KWire Fixation Techniques in Reducing Gartland Type 3 Supracondylar Fractures of children
Objective: To compare the effectiveness of cross K-wire fixation versus lateral entry K-wire fixation in maintaining postoperative reduction of Gartland type III supracondylar humerus fractures in children. Study Design and Settings: A randomized control trial was conducted at Orthopaedics Department, Bahawal Victoria Hospital, Bahawalpur, from 25th June 2025 to 10th December 2025. Methodology: Ninety children aged 2–13 years with closed Gartland type III supracondylar fractures were randomly allocated into two groups: cross K-wire fixation (n = 45) and lateral entry K-wire fixation (n = 45). All patients underwent closed reduction and percutaneous pinning under general anesthesia. Standardized 1.5 mm K-wires were used in both groups. Results: Loss of reduction occurred in 20% of patients in the cross-pin group compared to 71.1% in the lateral entry group (p < 0.01). Baumann’s angle remained more stable in the cross-pin group (p = 0.01), and anterior humeral line integrity was preserved 73.3% patients of Cross K-Wire group as compared to 55.5% of Lateral Entry K-Wire group. No permanent ulnar nerve injuries were reported in either group, although transient postoperative concerns were slightly higher in the cross-pin group. Conclusion: Cross K-wire fixation was more effective than lateral entry K-wire fixation in maintaining postoperative reduction in Gartland type III supracondylar fractures in children. Keywords: Humeral fractures, Postoperative complications, Treatment outcomes
Humeral fractures, Postoperative complications, Treatment outcomes
Copyright (c) 2026 Muhammad Junaid Khan, Shahid Mahmood, Muhammad Naeem Malik, Irfan Ali Shujah, Zahid Iqbal, Muhammad Arslan Ghori (Author) https://creativecommons.org/licenses/by-nc/4.0
To Calculate Total Dose Delivered to Carcinoma Cervix Patients Treated with Volumetric Modulated Arc Therapy (VMAT) and Image-Guided Brachytherapy (IGBT)
Abstract Objective: To calculate the total radiation dose delivered to carcinoma cervix patients treated with Volumetric Modulated Arc Therapy (VMAT) and MRI-guided brachytherapy (IGBT), and to evaluate cumulative EQD2 to tumor and organs-atrisk. Study Design and settings: This Descriptive, cross-sectional study was conducted at Department of Radiotherapy, INMOL Hospital, Lahore, from 1st August 2024 to 10th January 2025. Methodology: Fifty patients with histologically confirmed carcinoma cervix, ECOG 0–II, aged 45–65 years, receiving VMAT-based external beam radiotherapy (45 Gy/25 fractions) followed by MRI-guided brachytherapy were included. EQD2 values for the high-risk target volume and organs-at-risk (bladder, rectum, sigmoid) were calculated using DVH parameters. Results: The mean age of patients was 55.1 ± 5.8 years, with Stage IIIB being the most common stage (50%). A total of 64% received three brachytherapy insertions, while 36% required four. The mean cumulative tumor EQD2 was 84.9 ± 2.8 Gy. Mean bladder, rectum, and sigmoid EQD2 values were 78.1 ± 4.3 Gy, 67.3 ± 4.4 Gy, and 62.5 ± 4.2 Gy, respectively. More than 90% of patients met internationally recommended tumor and OAR dose constraints. Conclusion: It is concluded that VMAT combined with MRI-guided brachytherapy delivers adequate cumulative tumor dose while maintaining organ-at-risk exposure within acceptable limits
Cervical cancer, patients, population, Radiotherapy, VMAT, MRI
Copyright (c) 2026 Sana Naeem, Ayesha Anees, Ahmad Farooq, Tahir Sheikh, Rub Nawaz Maken (Author) https://creativecommons.org/licenses/by-nc/4.0