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
Revolutionizing healthcare; Overcoming Obstacles and Advancing the Electronic Health Record System in Pakistan
Electronic health record (EHR) is defined as an electronic patient record that is housed in a system created especially to assist health care staff with the availability of full and accurate patient data, clinical history, investigations, alerts and reminders and connections to repositories of medical knowledge.
Copyright (c) 2026 Muhammad Younas Sujra, Muhammad Hammad, Rashid Ashraf, Muhammad Imran Haider (Author) https://creativecommons.org/licenses/by-nc/4.0
Anaesthesia management of a Patient with Hypertrophic Obstructive Cardiomyopathy Undergoing c2-c5 Decompression in Cervical Myelopathy
Hypertrophic obstructive cardiomyopathy (HOCM) presents unique challenges in perioperative management due to its dynamic left ventricular outflow tract obstruction, diastolic dysfunction, and susceptibility to arrhythmias. This report highlights the anesthetic considerations in an 80-year-old female with HOCM and cervical spondylotic myelopathy undergoing C2-C5 decompressive surgery. The patient, an ASA-III with poorly controlled hypertension, experienced acute hemodynamic instability post-induction, necessitating emergent optimization. Re-attempted surgery under transesophageal echocardiography guidance, invasive hemodynamic monitoring, and tailored anesthetic techniques ensured uneventful completion. This case underscores the critical role of echocardiographic assessment, precise fluid management, and pharmacological strategies in minimizing perioperative risks in HOCM patients. The report aims to contribute to the limited literature on HOCM anesthetic management and to guide clinicians facing similar complexities
Cervical Spondylotic Myelopathy, Hypertrophic Obstructive cardiomyopathy (HOCM), Perioperative care
Copyright (c) 2026 Sayed Makarram Ahmed Bukhari, Atif Nazir (Author) https://creativecommons.org/licenses/by-nc/4.0
A Study on the Association between Internet Addiction and Its Impact on Cognitive Absorption in Young Adults
Objectives: In today's digital era, Internet has become a basic necessity. With the prevalence of internet addiction of 11.3% among young adults, it is alarming to note the ramifications that comes with it. One of many, is the neurological abnormalities that may result in onset of cognitive deficits from young age. This study was conducted to see the association between Internet Addiction Disorders and the related neurocognitive deficits between young adults aged 18-26. Study design and setting: This study was conducted by filling out 154 questionnaires, using random sampling techniques, from university students of Karachi, Pakistan. Methodology: Data analysis was performed by IBM SPSS statistics v27. Mean and standard deviation were calculated for quantitative variables. Frequency and percentages were reported for qualitative variables. Chi-square/fisher exact test was applied to check association between qualitative variables. Our findings indicate that 98.4% participants use the Internet every day with a mean screen time of 5.42±2.47 hours. Six-item Cognitive Impairment Test (6CIT) and internet addiction test(IAT20) were used to assess cognitive impairment and internet addiction, respectively. Results: The mean cognitive impairment and internet addiction test scores were 4.75±3.78 and 43.19±17.92, respectively, with 32.5% subjects exhibiting substantial cognitive impairment. Moreover, our research noted significant correlation of internet addiction with aggression, slowness with everyday tasks and headache. Conclusion: Our study highlighted the grave reality of today’s generation where excessive use of the Internet is turning Young Adults into addicts and causing neural abnormalities which results in behavioral changes, memory deficits, lack of concentration and poor reasoning.
Cognitive Dysfunction, Internet Addiction Disorder, Media Exposure, Neurocognitive Disorders, Young Adult
Copyright (c) 2026 Areeshah Tariq, Sara Ansari, Shahira Zainab, Hafsa Akbar, Fatima Abid (Author) https://creativecommons.org/licenses/by-nc/4.0
Accuracy of Knee MRI Findings in Detecting Soft Tissue Injury, Taking Arthroscopy as the Gold Standard
Objective: To assess the diagnostic validity of Magnetic Resonance Imaging (MRI) in detecting soft tissue knee injuries using arthroscopy as the gold standard. Study Design and Setting: A cross-sectional validation study was conducted at Khyber Teaching Hospital, Peshawar. Methodology: A total of 192 patients with clinical suspicion of soft tissue knee injury were enrolled using non-probability consecutive sampling for six months from 1st January 2025 to 30th June 2025. Inclusion criteria involved patients aged 18–60 years presenting with knee pain (VAS >4) and a popping sound, with normal X-ray findings. MRI scans were interpreted for the presence of soft tissue tears based on hyperintense signals on T2-weighted images and fiber discontinuity. All patients subsequently underwent arthroscopic evaluation. The diagnostic accuracy of MRI was determined using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s Kappa for agreement. Results: MRI showed high sensitivity for the medial meniscus (91.8%), anterior cruciate ligament (88.6%), and posterior cruciate ligament (83.3%), while the lateral meniscus had moderate sensitivity (68.2%). Specificity ranged from 74.3% (medial meniscus) to 86.7% (lateral meniscus). Agreement between MRI and arthroscopy was substantial for medial meniscus injuries (ê = 0.81) and moderate for anterior cruciate ligament, posterior cruciate ligament, and lateral meniscus. Conclusion: MRI has high diagnostic utility and a substantial agreement with arthroscopy, specifically for anterior cruciate ligament and medial meniscus injuries. Given its non-invasive nature and strong predictive validity, MRI should be considered an effective first-line diagnostic tool when evaluating soft tissue knee injuries.
Anterior Cruciate Ligament Injuries, Arthroscopy, Diagnostic Imaging, Knee Injuries,
Copyright (c) 2026 Zeeshan Haider, Abbas Ali, Shehryar Khan, Luqman Khan, Ubaid Ullah, Waqas Ahmad (Author) https://creativecommons.org/licenses/by-nc/4.0
Incidence of Early-Onset Neonatal Sepsis in Neonates with Meconium-Stained Liquor
Objective: The incidence of clinically suspected and culture-proven early-onset sepsis in newborns born through meconiumstained liquor compared to clear liquor controls. Study Design and Setting: A comparative cross-sectional study was conducted at the Department of Pediatric Medicine and Neonatal Unit, PNS Shifa Hospital, Karachi, Pakistan, from 15 April 2025 to 15 Oct 2025. Methods: A comparative cross-sectional study was conducted at the PNS Shifa Hospital. The study enrolled consecutive liveborn neonates delivered during the study period, with 42 MSL and 65 clear-liquor controls. Ineffective antibiotic treatment and clinical findings of sepsis were included. Other outcomes included admission rate to the neonatal intensive care unit, occurrence of meconium aspiration syndrome, and mortality. For statistical analyses, Fisher’s exact test and Mann-Whitney U test were employed. Results: MSL neonates displayed a higher incidence of suspected sepsis compared to controls (57.1% vs. 13.8% p<0.01). The MSL group had considerably larger rates of culture-proven sepsis (21.4% vs 3.1%, p<0.01). The MSL group had a much higher rate of having meconium in the lungs with both of those results above. There was no difference in mortality rates (4.8% versus 1.5%; p=0.56). Conclusion: Neonates with meconium-stained liquor are at higher risk of early-onset neonatal sepsis. Thus, increased clinical suspicion and intervention are indicated in such cases
Meconium-stained liquor; early-onset neonatal sepsis; meconium aspiration syndrome; neonatal outcomes; intra-amniotic infection
Copyright (c) 2026 Hajra Begum, Saadia Karim, Nadeem Sadiq, Rida Ali, Nadia Iqbal, Inshal Jawed (Author) https://creativecommons.org/licenses/by-nc/4.0
Constellation of Neurological Signs in Patients with Diabetes Mellitus of more than 5 Year
Objective: To identify the prevalence and related characteristics of peripheral neuropathy among diabetes mellitus patients with over five years of duration. Study Design and Setting: A cross-sectional study at the Abbas Institute of Medical Sciences in Muzaffarabad, Azad Jammu and Kashmir. Methodology: Non-probability consecutive sampling was used to select 266 patients with a diagnosis of either type 1 or type 2 diabetes mellitus of a duration of greater than five years. Patients with a history of vitamin B12 deficiency, cerebrovascular accident, or motor neuron disease were excluded. Sociodemographic data, clinical history, smoking, family history of diabetes, and comorbidities data were obtained. The data analysis was conducted using SPSS version 22. Poststratification Chi-square test was used, and p= 0.05 was regarded as significant. Results: The mean age of participants was 52.6 ± 10.8 years, with a mean diabetes duration of 9.4 ± 3.2 years and a mean HbA1c of 8.6 ± 1.4%. Peripheral neuropathy was detected in 53.4% of patients. Significant associations were observed with age =50 years (p = 0.012), rural residence (p = 0.042), illiteracy (p = 0.021), smoking (p = 0.011), hypertension (p = 0.034), diabetes duration =10 years (p < 0.001), and HbA1c =8% (p < 0.001). Gender and family history were not significantly associated. Conclusion: Long-term diabetes patients are very susceptible to peripheral neuropathy. Its burden should be mitigated by implementing early screening and managing all risk factors, particularly those that are modifiable, i.e., glycaemic control, hypertension, and smoking.
Diabetes Mellitus, Diabetic Neuropathies, Glycated Hemoglobin
Copyright (c) 2026 Zakia Kanwal, Abdul Khalid Awan, Syeda Aiman Naqvi, Shaista Imtiaz, Zainab Shahab, Tayyaba Haroon (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparative Study between Prophylactic Ilioinguinal Neurectomy and Nerve Preservation in Lichtenstein Tension-Free Meshplasty for Inguinal Hernia Repair
Objective: To compare prophylactic ilioinguinal neurectomy with nerve preservation in lichtenstein tension-free meshplasty for inguinal hernia repair Study design and Setting: The present comparative study was carried out at the surgical department in Mayo Hospital Lahore for a period of 6 months after approval of synopsis. Methodology: Non-probability consecutive sampling technique was used. The sample size was 60 and was determined by using the WHO calculated. Patients were divided randomly into 2 groups by using lottery method. In group A, patients underwent surgery and prophylactic ilioinguinal neurectomy was performed. In group B, patients had done surgery via conventional method with nerve preservation. Operative time and intra-operative blood loss were noted. Patients were followed-up in OPD for 1, 3 and 6 months and evaluated for outcomes. Data was entered and analyzed in SPSS -26. Results: The mean age of the study participants in PINE group was 42.2 ±4.39 and INPE was 41.8±7.45 years. 10% of the participants in Ilioinguinal Nerve Preservation had pain at rest between the three and six months following surgery but no individuals experienced pain in the PINE. The incidence of pain from any kind of hernia in either group did not differ significantly. Conclusion: The current study concluded that one serious and incapacitating side effect after inguinal hernia repair was chronic groin pain. The frequency and severity of pain were greater in ilioinguinal nerve preservation group than prophylactic ilioinguinal neurectomy group.
Inguinal hernias, neurectomy, ilioinguinal nerve preservation
Copyright (c) 2026 Muhammad Talha Khan, Noor-ul-Ain Mujahid, Hamza Mustafa, Balakh Sher Zaman, Ali Akbar, Ameer Afzal (Author) https://creativecommons.org/licenses/by-nc/4.0
Assessment of Complications of Transurethral Resection of Prostate (TURP) Using Clavien Dindo Classification
Objective: To evaluate the magnitude of complications that manifest in patients undergoing Transurethral Resection of the Prostate (TURP), the Clavien-Dindo Classification System (ranging from Grades I to V) shall be employed. Methodology: This cross-sectional investigation was performed within the Department of Urology at the Jinnah Postgraduate Medical Center (JPMC) located in Karachi. The selection criteria included male patients aged between 40 and 65 years presenting with benign prostatic hyperplasia and who were deemed eligible for Transurethral Resection of the Prostate. Postoperatively, patients were treated and followed closely for any TURP related complications by classifying them according to the Clavien-Dindo Classification System (Grade I–V). The data were analyzed using SPSS software, version 26, with 5% level of significance. Results: In 87 male patients, the mean age was 59.32 ± 6.44 years. Complications occurred in 33.33% of cases. Grade I complications were most frequent (48.3%), followed by Grade II (24.1%) and Grade III (13.8%), with Grade IV and V each at 3.4%. No significant association was found with age, prostate volume, or operative time (P >0.05). Conclusion: The investigation elucidates that Transurethral Resection of the Prostate (TURP) continues to be a procedure characterized by a generally favorable safety profile and efficacy, albeit accompanied by the potential for complications. The implementation of the Clavien-Dindo classification system facilitated a methodical evaluation of postoperative morbidity. These results underscore the imperative for diligent perioperative management and the adoption of standardized protocols for complication assessment to enhance patient care and surgical results within the domain of clinical urology
Prostatic hyperplasia, Transurethral resection of prostate, Postoperative complications, Clavien-Dindo classification
Copyright (c) 2026 Bashir Ahmed, Arif Ali, Ayesha Khan, Naresh Kumar Valecha, Abdul Mujeeb, Shahid Hussain (Author) https://creativecommons.org/licenses/by-nc/4.0
Functional Outcome of Limb Operated with Ilizarov Ring Fixation Method in Patients Presenting with Tibial Aseptic Non-Unions Fractures at Tertiary Care Hospital, Karachi
Objectives: This study looked at how patients with tibial non-union fractures recovered after treatment with the Ilizarov ring fixation method at a tertiary care hospital in Karachi, Pakistan. It also aimed to find factors that affect recovery, such as age, health conditions, lifestyle, and vitamin levels. Study Design and Setting: This was a descriptive cross-sectional study done at the Orthopedics Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi. It was carried out over six months and included 137 patients with tibial non-union fractures treated by the Ilizarov method. Methodology: Patients between 20 and 80 years with post-traumatic tibial non-unions were included. Information on age, gender, health conditions, and lab results was collected. Data were analyzed with different statistical tests. Recovery was rated as poor, fair, good, or excellent. Results: The average age of patients was 41.5 years. Smoking (p = 0.013), diabetes (p = 0.014), and vitamin D deficiency (p = 0.002) were strongly linked to poor recovery. Age and physical activity before surgery also affected recovery (p = 0.001). Diabetes and smoking were found to be independent predictors of poor outcomes. Patients with fractures in the middle part of the tibia (diaphyseal) had worse results (p = 0.020). Conclusion: The study showed that smoking, diabetes, and vitamin D deficiency make recovery harder for tibial non-union patients treated with the Ilizarov method. Managing these risk factors can improve healing. More research, with larger studies and long-term follow-up, is needed to confirm these results
Tibial non-union, Ilizarov fixation, functional outcomes, smoking, diabetes, vitamin D deficiency
Copyright (c) 2026 Muhammed Haris, Saeed Ahmed Shaikh, Syed Ghulam Mujtaba Shah, Muhammad Fahad Javed, Subhan Jakhrani, Madiha Muzammil (Author) https://creativecommons.org/licenses/by-nc/4.0
Surgical Intervention for Arterial Thoracic Outlet Syndrome: A Retrospective Observational Study on Post-operative Outcomes and Quality of Life; Single Center Experience from Karachi Pakistan
Objective: Thoracic outlet syndrome results from compression of the brachial plexus and/or subclavian vessels. Arterial thoracic outlet syndrome carries the most severe consequences. To assess the surgical outcomes and its impact on quality of life in patients with aTOS undergoing surgical treatment. Study design and Setting: A retrospective study was conducted on patients undergoing surgical decompression with/without arterial reconstruction at the Department of Vascular & Endovascular Surgery SMBBIT, Karachi from July 2019 to December 2023. Methodology: Limb salvage, complication rates and QoL using DASH score were assessed retrospectively. P-value of less than 0.05 was considered significant Results: A total of 22 patients underwent surgery for aTOS over the past five years. The cohort was predominantly male (59.1%) with a mean age of 32.05 ± 14.3 years. All patients presented with Acute or acute on chronic limb ischemia, the most common symptoms being pain (90.9%), numbness (45.5%) and blackish discoloration (27.3%). Imaging showed post-stenotic aneurysm as the most prevalent arterial pathology (54.5%). All patients had a cervical rib, and the supraclavicular approach was used exclusively for surgery with infraclavicular incision for axillary artery control and distal anastomosis where needed. Arterial reconstruction was performed in 90.5% of patients. Postoperative complications occurred in 27.3% of patients. No in-hospital or 30-day mortality was observed. Limb salvage was achieved in 95.5% of patients. Followup data showed a progressive improvement in post operative DASH scores (p= <0.001). Conclusion: Surgical decompression of aTOS with/without arterial reconstruction is associated with high limb salvage rates and QoL improvement
Copyright (c) 2026 Muhammad Muqeem, Waryam Panhwar, Fahad Tariq Berlas, Fahad Memon, Misbah Nizamani, Asif Ali Khuwaja (Author) https://creativecommons.org/licenses/by-nc/4.0
Frequency of Treatment Patterns of Kidney Protective Therapies among Patients with Chronic Kidney Disease at Tertiary Care Hospital, Karachi.
Objective: To determine the frequency and treatment patterns of kidney-protective therapies, including ACE inhibitors, ARBs, and SGLT2 inhibitors, among patients with chronic kidney disease (CKD) at a tertiary care hospital in Karachi. Study Design and Setting: This cross-sectional study was conducted in the Department of Nephrology, Aga Khan University Hospital, Karachi, from 12TH May 2025 to 10th October 2025. Methodology: A non-probability consecutive sampling was used to recruit 133 clinically confirmed CKD patients aged 40-80 years. Demographic information, clinical features, lifestyle, and kidney-protective drugs were documented using a structured proforma. Anthropometric measurements were made following standard procedures and the status of smoking and physical activity was determined by interviewing the patients. Prescriptions and comorbidities were proven by medical records. The data were analyzed using SPSS version 22 descriptive statistics and chi-square/Fisher exact test, p<0.05 was significant. Results: Of the 133 patients, 68.4% were aged 61–80 years, and 51.1% were female. ACE inhibitors were prescribed to 39.8% of patients, ARBs to 15%, and SGLT2 inhibitors to 34.6%. The use of ACE inhibitors was significantly higher among patients with diabetic nephropathy and those with a shorter duration of disease. SGLT2 inhibitor prescriptions were more common in younger and urban populations and among diabetic patients, suggesting awareness of newer therapeutic options. Conclusion: Patients with CKD were undertreated with key kidney-protective therapies, particularly ARBs and SGLT2 inhibitors. Younger, diabetic, and urban patients were more likely to receive evidence-based treatments, indicating gaps in guideline adherence and inequitable access.
Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor
Copyright (c) 2026 Sana Moin, Sonia Yaqub (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparative Study between the Effects of Dexmedetomidine and Lidocaine Infusion on Intraoperative Hemodynamic and Requirement of Nalbuphine for Postoperative Analgesia in Upper Limb Orthopaedic Surgeries
Objectives: To compare the intraoperative and postoperative hemodynamics and requirement of nalbuphine for postoperative analgesia in upper limb orthopedic surgeries between dexmedetomidine and lidocaine. Study Design: Comparative analytical study Place and duration of study: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi, Pakistan from 17th Oct 22 to 15th July 23. Methodology: Patients undergoing upper limb orthopedic surgeries in our tertiary care setup. Ninety patients undergoing upper limb orthopaedic surgeries were divided into two equal groups of forty-five patients each. Group A received Dexmedetomidine infusion, while Group B received Lidocaine infusion. Data collection involved gathering information related to upper limb orthopaedic procedures, including both intraoperative and postoperative parameters. Results: Ninety patients undergoing upper limb surgeries were randomized into two groups (Dexmedetomidine: Group A, Lidocaine: Group B). Group A experienced statistically significant reductions in intraoperative mean arterial pressure (MAP) by 20% (p<0.05) and heart rate (HR) by 15% (p<0.01) compared to Group B at all time points (10-120 minutes). Postoperative pain scores were significantly higher in Group B (mean difference: 1.5 points, p<0.001) across all time points (2-24 hours). Group A also exhibited significantly higher sedation scores (mean difference: 2 points, p<0.001) and required significantly less postoperative analgesia (one dose vs. multiple doses, p<0.001) than Group B. Conclusion: The findings affirm dexmedetomidine infusion's advantages in achieving optimal outcomes: improved hemodynamics, reduced pain, and lowered postoperative analgesic demands, reinforcing its role in effective pain management.
Dexmedetomidine, Heart rate, Lidocaine, Mean Arterial Pressure, Numeric rating scale
Copyright (c) 2026 Komal Mumtaz, Liaqat Ali, Saima Zia, Ramisha Afzal, Soman Nadim Iqbal, Malaika Nasir (Author) https://creativecommons.org/licenses/by-nc/4.0
Role of Tranexamic Acid in Prevention of Seroma Formation after Ventral Herioplasty
Objective: The aim of this study was to explore the role of tranexamic acid in prevention of seroma formation after ventral herioplasty. Study design and setting: The present cross-sectional study was carried out at the department of general surgery Bacha Khan Medical Complex / Gajju Khan Medical College – SWABI from January 2025 to June 2025 after taking permission from the research team of the hospital. Method: In our study, Non-probability consecutive sampling approach was used for sample collection. A total of 100 individuals diagnosed with ventral hernia repair were included. All individuals were treated with the standard-only mesh. A vacuum drain was used to measure the seroma's volume. One gram of intravenous tranexamic acid was administered following skin closure, and 500 mg of oral tranexamic acid was administered for 12 hours on the 5th post-operative day. On daily basis the drain output was recorded. When the output was less than 30 milliliters per day, the drain was removed. SPSS version 24 was used for analysis of data. Results: A total of 100 individuals participated in this study out of which 70(70%) were females and 30 (30%) were males. The mean age of the study participants was 81.05±41.75 years. In 84 individuals (84%) the seroma resolved within five days after surgery, but in 16 individuals (16%) it took longer than five day. Conclusion: The current study concluded that Tranexamic acid significantly lowers the development of for seromas following surgery ventral hernia repair.
ventral hernia repair, seromas, tranexamic acid
Copyright (c) 2026 Faiz ur Rahman, Aamir Ali Khan, Muhammad Kashif, Zia Ullah, Muhammad Ali, Muhammad Ibrahim Shuja (Author) https://creativecommons.org/licenses/by-nc/4.0
Effect of Preoperative Steroid Injection on Wound Drainage after Modified Radical Mastectomy
Objective: The aim of this study was to determine the Effect of Preoperative Steroid Injection on Wound Drainage after Modified Radical Study design and setting: The current Quasi-experimental study was carried out at the department of surgery Ibn e siena hospital and research institute Multan and Bakhtawar Ameen Medical and Dental College Multan for a period of six months from January, 2023 -June, 2024 after taking permission from the ethical board of the hospital. Methodology: A total of 62 females with breast cancer, planned for modified radical mastectomy were included. The patients were assigned computer-generated numbers to form two equal groups, A and B. An hour before to surgery, group A received a 120 mg a day (3 ml) injection of depomedrol, while group B received 3 ml of regular saline. The same consultant surgeon conducted MRM on both groups using the same dissection technique, which is steel scalpel dissection. Two suction drains, one at the breast site and one at the axillary area, were positioned at the end of the treatment. Data was analyzed through SPSS 25. Results: In our study, 48.3% females were diagnosed with stage II, and 51.7% had stage I breast cancer. In a modified radical mastectomy, a single preoperative steroid dose reduced mean drainage volume more than control. (P=0.048). Conclusion: Our findings showed that that the preventive steroid injections prescription in women following modified radical mastectomy were more effective in lowering mean drainage volume for female participants with stage I and II breast cancer when compared to normal saline
Steroid injections; Mastectomy; drainage volume
Copyright (c) 2026 Asma Aziz, Muhammad Waqas Arshad, Muhammad Shahzeb Asghar (Author) https://creativecommons.org/licenses/by-nc/4.0
Effects of Delayed Skin Closure of Midline Laparotomy Incisions for Peritonitis
Objective: To compare outcomes of delayed versus early primary closure of midline laparotomy wounds in peritonitis. Study Design and Setting: A randomized controlled trial was carried out during the period from 26th February, 2025 to 30th August, 2025 using consecutive sampling at the Department of Surgery, GMMMC Hospital, Sukkur. Methodology: After getting ethical approval and consent, eighty patients aged 20-70 years (ASA I-III) were enrolled in this study, undergoing upper midline laparotomy closure for peritonitis. They were randomly placed in Group A (delayed primary closure) and Group B (early primary closure). All were taken up under one team of general anesthesia in the operating theatre. A 15-day follow-up was done for infection and dehiscence of the wound. Results: Out of 80 patients, the overall wound infection rate was 33.8 %, which was significantly higher in Group B (45 %) compared with Group A (22.5 %); p = 0.033. The incidence of wound dehiscence was higher in Group B as compared to Group A (p = 0.019). Anemia was associated with increased complications, especially early closure. The time taken for surgery was same but blood loss was more with delayed closure (354.10 ± 42.36 ml vs. 305.25 ± 35.46 ml; p < 0.001). Conclusion: Delayed primary closure of the wound can reduce the incidence of infection and dehiscence in case of peritonitis, although there is a slight increase in blood loss observed.
Delayed Primary Closure, Laparotomy, Peritonitis, Wound Dehiscence, Wound Infection
Copyright (c) 2026 Liaqat Ali , Imamuddin Baloch, Javeria Memon, Ahsan Ali, Muhammad Sheeraz, Altaf Hussain (Author) https://creativecommons.org/licenses/by-nc/4.0
Pre-Operative Scoring to Anticipate Intraoperative Difficulty of Elective Laparoscopic Cholecystectomy
Objective: To evaluate the diagnostic accuracy of the Nassar preoperative scoring system in predicting intraoperative difficulty in elective laparoscopic cholecystectomy, using the intraoperative Sugrue score as the reference standard. Study Design and Setting: A prospective validation study conducted in the Department of Surgery, Khyber Teaching Hospital, Peshawar. Methodology: A total of 274 patients aged 20–60 years scheduled for elective laparoscopic cholecystectomy were enrolled over six months. Exclusion criteria included prior hepatobiliary surgery, peritonitis, and cholangitis. Preoperative difficulty was assessed using the Nassar scoring system based on clinical and ultrasound findings. Intraoperative difficulty was assessed using the Sugrue scoring system. A Nassar score >6 predicted difficulty. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Difficult laparoscopic cholecystectomy (Sugrue score >4) was observed in 16.1% of patients. The Nassar score showed 84.1% sensitivity, 85.6% specificity, 52.9% PPV, and 96.6% NPV. Stratified analysis showed that age >40 years (p=0.008), male gender (p=0.018), and BMI =30 kg/m² (p=0.032) were significantly associated with increased difficulty. Conclusion: The Nassar preoperative scoring system is a reliable and clinically useful tool for predicting intraoperative difficulty in elective laparoscopic cholecystectomy. Its high sensitivity and NPV make it particularly valuable in ruling out difficult cases, facilitating better surgical planning and resource allocation in resource-limited settings
Body Mass Index; Cholecystectomy, Laparoscopic; Risk Assessment; Sensitivity and Specificity; Ultrasonography
Copyright (c) 2026 Ahmad Yar, Syed Asad Maroof, Muhammad Zarin, Kausar Noor, Muhammad Mazher Irshad, Sheema Gul (Author) https://creativecommons.org/licenses/by-nc/4.0
Characteristics of Connective Tissue Diseases Interstitial Lung Diseases (CTD-ILD) Presenting in a Tertiary Care Hospital
bjective: To determine the characteristics of connective tissue diseases–interstitial lung diseases (CTD-ILD) presenting in a tertiary care hospital. Study design and setting: This descriptive cross-sectional study was conducted at the Department of Pulmonology, Ojha Institute of Chest Disease, Dow University of Health Sciences, Karachi, from 11th February 2025 till 26th July 2025. Methodology: For 6 months study patients aged 18–80 years diagnosed with ILD on the basis of clinical presentation and radiological features were included. High-resolution computed tomography (HRCT) was performed to confirm ILD, while connective tissue disease diagnoses were based on clinical criteria. Demographic data, clinical features, comorbidities, and HRCT findings were recorded. Data were analyzed using SPSS version 25. Frequencies, percentages, and mean ± SD were calculated. Chi-square test was applied for categorical variables with p = 0.05 considered significant. Results: Among 54 CTD-ILD patients (mean age 51.9 ± 12.4 years, 70.4% females), rheumatoid arthritis (53.7%) was the most common underlying disease. Honeycombing (87.0%) and septal thickening (75.9%) were the predominant HRCT abnormalities. On stratified analysis, diabetes mellitus (p = 0.026) and smoking (p = 0.021) were more frequent in RAILD. Younger patients (18–40 years) more often had IPAF and SLE compared to older patients (p = 0.002). Conclusion: RA was the main cause of CTD-ILD, with honeycombing and septal thickening as key HRCT patterns. CTDILD subtypes were significantly linked to diabetes, smoking, septal thickening, and age.
Autoimmune Disorders; Connective Tissue Diseases; Interstitial Lung Diseases; Rheumatoid Arthritis; Systemic
Copyright (c) 2026 Feroz Raza, Faisal Faiyaz Zuberi, Arif ul Islam, Asim Shafeeque (Author) https://creativecommons.org/licenses/by-nc/4.0
Association of Obesity with Outcomes in Patients with Chronic Kidney Disease
Objective: The present study was designed to clarify the impact of obesity with outcomes among hospitalized patients with chronic kidney disease (CKD). Study design and setting: A 6 months prospective cohort study from From April to September 2024, which took place in the Department of Medicine, Aga Khan University Hospital, Karachi Pakistan. Methodology: The patients were enrolled from inpatient and outpatient medical wards of AKUH and 200 hospitalized CKD patients were recruited and divided equally into obese (BMI >30 kg/m²) and non-obese (BMI <30 kg/m²) groups. Baseline characteristics were contrasted, and 30-day in-hospital mortality was assessed. We conducted subgroup analyses for age, sex, diabetes and hypertension. p-values were computed by SPSS version 25 and the results of = 0.05 determined significance. Results: Compared with non-obese patients, obese patients were younger, more likely to be male, and had a higher mean estimated glomerular filtration rate (eGFR). Diabetes occurred less frequently in the obese group (21% vs 47%) and hypertension was present in both groups. Obese patients had a 7% 30-day mortality compared to 3% for non-obese patients [RR = 2.33 (p =.20)]. The risk of mortality was higher in women, younger individuals and those with diabetes but the associations did not reach statistical significance. Conclusions: Obesity was significantly associated with increased short-term mortality in hospitalized CKD patients, especially for women and diabetics.
Body Mass Index, Diabetes Mellitus, Hypertension, Kidney Disease, Mortality, Obesity
Copyright (c) 2026 Rameen Aijaz, Bushra Jamil (Author) https://creativecommons.org/licenses/by-nc/4.0
Effect of Septoplasty versus Septoplasty with Turbinate Reduction for Relief of Nasal Obstruction due to Deviated Nasal Septum
Objective: Nasal obstruction has significant impact on life quality, with deviated nasal septum being the third most common cause. This condition involves nasal structural abnormalities that reduce airflow. This study evaluates the comparative effectiveness of septoplasty alone versus septoplasty combined with turbinectomy in patients presenting with a deviated nasal septum. Study Design and Setting: This was a prospective, randomized comparative study conducted in ENT Department at CMH Hospital Malir. Patients underwent septoplasty with and without turbinectomy. Methodology: A total of 88 patients underwent septoplasty for a deviated nasal septum. Participants were randomly assigned into two groups, with 44 patients in each. Group A underwent septoplasty alone, while Group B received septoplasty with turbinectomy. The nasal obstruction severity was evaluated using the NOSE score, with a mean preoperative score of (11.16±1.1) for septoplasty and (8.6±1.19) for septoplasty with turbinectomy. Surgical outcomes were assessed one month postoperatively using NOSE scores to compare the effectiveness of both procedures. Results: Results revealed significant postoperative improvement in nasal obstruction symptoms, with both septoplasty alone and septoplasty with turbinectomy showing relief in symptoms. However, patients who underwent combined procedure experienced greater reductions in nasal blockage, congestion, trouble sleeping, and difficulty breathing during exertion. Statistical analysis confirmed that septoplasty with turbinectomy provided significant symptomatic improvement compared to septoplasty alone (P<0.05), emphasizing added benefit of turbinate reduction in improving nasal airflow. Conclusion: Combining inferior turbinectomy with septoplasty is more effective than performing septoplasty alone in patients with nasal obstruction due to deviated nasal septum.
Airway resistance, Nasal obstruction, Nasal septum, Turbinates, Septoplasty, Nasal septal deviation
Copyright (c) 2026 Aiman Fatima Naqvi, Muhammad Waqas Ayub, Asim Abbas, Haider Ali, Fizza BatooL, Bakhtawar Meraj (Author) https://creativecommons.org/licenses/by-nc/4.0
Diagnostic Delay in Chronic Inflammatory Rheumatic Diseases Presented to the Tertiary Care Rheumatology Unit in PIMS
Objective: To quantify the therapeutic and diagnostic delays among patients with CIRDs in Pakistan. Study Design and Setting: Cross sectional study. PIMS Hospital Islamabad Rheumatology OPD. Duration 8th June 2025 to 8th September 2025. Methodology: This cross-sectional study comprised 220 patients. Informed consent was obtained; demographic details like age and sex were noted. All Patients previously diagnosed with conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or similar diseases were selected from various rheumatology clinics and departments over six months. Data collection was done using a structured face-to-face interview which included data on demographic information, age of symptom onset, consultation times, and treatment commencement, dividing delays into diagnostic and therapeutic categories. For the analysis in SPSS v21, Shapiro–Wilk, Chi-square, and Fisher’s Exact Test were performed, and the results were presented as the median for continuous variables and percentages for categorical data. A p-value = 0.05 was taken as statistically significant. Results: A total of 220 participants were included in this study. Among the 220 patients, 40.5% had diagnostic delay exceeded 18 months with only 6.4% diagnosed within 6 months. Patients who visited homeopaths had the highest delay rate (56.1%). Psoriatic arthritis (71.4%) and ankylosing spondylitis (53.8%) had longest delays. Joint pain led to early referral in 54.6%, whereas atypical symptoms caused prolonged delays. Conclusions: The findings of this study revealed that both diagnostic and therapeutic delays are common in CIRDs in Pakistan, often caused by multiple reasons before reaching a rheumatologist and referral system inefficiencies.
Ankylosing Spondylitis, Diagnostic Delay, Psoriatic Arthritis, Rheumatoid Arthritis, and Therapeutic
Copyright (c) 2026 Alina Fakhar, Shazia Zammurrad, Uzma Rasheed, Muhammad Sufyan Khan (Author) https://creativecommons.org/licenses/by-nc/4.0
Efficacy of Intrathecal Dexmedetomidine on Post-operative Pain Relief in General Surgical Cases
Objectives: To compare the efficacy of intrathecal bupivacaine combined with dexmedetomidine versus bupivacaine alone in providing postoperative analgesia for patients undergoing general surgical procedures under spinal anesthesia. Study design and setting: A single-blind interventional study was conducted by the Anesthesiology Department at Farooq Hospital (ASMC), Rawalpindi, from January 16th to December 25, 2024. Methodology: After ethical approval from the Research Advisory Committee of Akhtar Saeed Medical College, Rawalpindi,60 patients (placed in ASA classes I-III) undergoing elective general surgical cases in spinal block were enrolled and randomized into two groups (by lottery method). Group A received intrathecal 1.5 mL hyperbaric bupivacaine 0.75% (15 mg) alone, while Group B received the same dose of bupivacaine with 5ìg dexmedetomidine. Standard ASA monitoring, preloading with isotonic crystalloids, and spinal anaesthesia at the L3–L4 level were employed using a 26-G spinal needle. Hemodynamic parameters, adverse effects and need for rescue analgesia were documented. Statistical analysis done by SPSS v26(with p<0.05 as significant). Results: Demographic parameters (age, weight, BMI) were comparable between groups. Mean postoperative analgesia duration was significantly longer in the dexmedetomidine group (20.18 ± 3.48 h) compared to group B (11.78 ±1.64 h, p < 0.05). The dexmedetomidine group required fewer rescue opioid doses, reflecting an opioid-sparing effect. Conclusions: Intrathecal dexmedetomidine to bupivacaine in spinal anaesthesia for general surgical cases significantly prolongs the postoperative analgesia period
Bupivacaine, Bromage scale, Dexmedetomidine, Lumbar puncture, Postoperative rescue analgesia
Copyright (c) 2026 Muhammad Salman Maqbool, Fahad Zubair, Kainat Irshad, Hozaifa Iqbal (Author) https://creativecommons.org/licenses/by-nc/4.0
Depression, Anxiety, and Stress in Beta Thalassemia Patient in Comparison to Siblings
Objective: Our study assessed psychological outcomes and health-related quality of life (HRQoL) in transfusion-dependent â-thalassemia patients as compared to their siblings in Pakistan, and identified whether stress and the frequency of transfusions are independent predictors of physical functioning in thalassemia patients. Study Design and Setting: This analytical cross-sectional survey was conducted at PNS Shifa Hospital, Karachi (JanuaryJuly 2025). Methodology: 70 patients aged between 7 and 25 years of confirmed â-thalassemia major, intermedia, or minor were enrolled. Standardized scales have been used: PHQ-9, GAD-7, PSS-10, and SF-12. Mann-Whitney, Kruskal-Wallis, t-tests, and ANOVA were used where appropriate, and a hierarchical linear regression modeled predictor of PCS-12. Results: The study included 70 patients with transfusion-dependent thalassemia (mean age, 13.4±2.67; 58.6% males), with 78.6% of them having â-thalassemia major. No significant difference was found between the psychological outcomes of the patients as compared to their siblings (p >0.05). The higher the frequency of transfusion, the higher the depression, anxiety, stress, and the lower the mental HRQoL(p<0.05). In multivariable analyses, stress had an independent relationship to lower PCS-12 (beta=-0.383, p=0.009). Perceived stress (beta= -0.511, p<0.001) and worse mental HRQoL (beta= -0.433, p<0.001) explained 42.7 percent of the variance in PCS-12. When stress was entered alone, it accounted for 27 percent. Conclusion: Transfusion-related perceived stress appears to be the strongest psychosocial determinant of physical functioning, which undermines mental HRQoL. Moreover, the patients and their famili of PCS-12 variance (0.607, p<0.001)
beta-Thalassemia, Mental Health, Physical Health, Psychological outcomes
Copyright (c) 2026 Ahsan Ali Shaikh, Muhammad Ahmad, Khurram Fayyaz, Inshal Jawed, Abu Huraira Bin Gulzar, Saira Zubair (Author) https://creativecommons.org/licenses/by-nc/4.0
Relationship between Vitamin D Level and Recurrent Wheezy Chest in Pediatric Patients
Objective: To determine the association between serum vitamin D deficiency and recurrent wheezy chest in children aged 6-36 months. Study Design and Study Setting: This case-control study was conducted at the Department of Paediatrics. Khyber Teaching Hospital, Peshawar, from August 2024 to February 2025. Methodology: Seventy children (35 cases with =3 wheezing episodes in the last year; 35 age-matched controls without wheeze) were evaluated. They were enrolled after excluding those with chronic lung disease, allergies, or recent vitamin D supplementation. Serum 25-OH-vitamin D <20 ng/mL defined deficiency. The sample size was calculated to have 80% power and an á = 0.05. Data was analysed with IBM SPSS 25.0; an independent t-test and X2 test were applied; association was quantified by odds ratio (OR) with CI 95%. Results: Mean age was 16.7 ± 7.0 D in cases (18.8 ± 5.9 ng/mL) was lower than in controls (23.6 ± 5.8 ng/mL; p = 0.001). Vitamin D deficiency was present in 66% cases versus 37% controls (p = 0.017). Children with deficiency had 3.24-fold higher odds ratio of recurrent wheeze (95% CI 1.28-8.21; p = 0.013). Conclusion: Vitamin D deficiency is significantly associated with recurrent wheezy chest in early childhood. Screening and supplementation may decrease the wheezing burden in this age group.
Paediatrics, Vitamin D deficiency, wheezing
Copyright (c) 2026 Ikram Ullah, Sabir Khan, Zia Muhammad, Muhammad Shabir, Aimal Khan, Arooj Khan (Author) https://creativecommons.org/licenses/by-nc/4.0
Association of Hypocalcemia and Elevated Parathyroid Hormone with Delayed Tooth Eruption in Children. A Cross-Sectional Study from a Pediatric and Dental Cohort
Objectives: This study aimed to evaluate the association between biochemical parameters and stunted odontogenesis in children attending dental and pediatric clinics. Study design and setting: This cross-sectional study was conducted at the dental OPD of LUMHS, Jamshoro, Sindh. Methodology: After approval from the research ethics committee (DREC/113, dated 17/06/24), this study was conducted among 250 children aged 2–16 years, from 1st July 2024 to 31 December 2024. Clinical assessment included dentine scoring and evaluation of delayed tooth eruption. Biochemical analysis measured serum calcium, PTH, vitamin D, magnesium, sodium, potassium, iron, folic acid, calcitonin, urea, and creatinine. Comparative analysis, ANOVA, and regression were performed using SPSS, with significance set at p < 0.05. Results: Delayed tooth eruption was observed in 88.4% of participants. Mean serum calcium was below normal (7.98 ± 1.10 mg/dL), with elevated mean PTH (18.90 ± 22.78 pg/mL). Children with delayed eruption had lower calcium levels (p = 0.001) and higher PTH levels (p = 0.021) than those without delay. Regression analysis revealed a positive linear relationship between PTH and serum calcium (y = 7.38 + 0.03x, R² = 0.429). Conclusion: This study highlighted that disturbances in mineral metabolism, particularly hypocalcemia and compensatory PTH elevation, are associated with delayed tooth eruption and dentine defects
Dentine Score, Hypocalcemia, Parathyroid Hormone, Tooth Eruption
Copyright (c) 2026 Shakil Ahmed Shaikh , Sidra Jabeen, Aqeela Memon, Kalsoom Jawed, Muhammad Hanif, Hira Saeed Khan (Author) https://creativecommons.org/licenses/by-nc/4.0
Diagnostic Accuracy of Twinkling Artefect in Diagnosis of Ureteric Calculus Keeping Non-Contrast CT as A Gold Standard
Objective: To determine the diagnostic accuracy of the twinkling artifact on Doppler ultrasound using non-contrast CT as the gold standard for detecting ureteric stones. Study Design & Setting: This cross-sectional diagnostic accuracy study was conducted at the Department of Radiology, a tertiary care hospital, from 2 October 2021 to 1April 2022. Methodology: A total of 141 patients with clinically suspected ureteric colic were enrolled. All underwent Doppler ultrasound followed by Non contrast enhanced CT. Findings of twinkling artifact were recorded and compared with Non contrast enhanced CT outcomes. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Subgroup analysis was performed based on age, gender, and stone size. Results: The mean age was 38.59 ± 9.97 years; 55.3% were male. The twinkling artifact was observed in 94 (66.7%) patients. Non contrast enhanced CT confirmed ureteric stones in 81 (57.4%) cases. Sensitivity, specificity, PPV, NPV, and overall accuracy of the twinkling artifact were 90.1%, 93.3%, 94.8%, 87.5%, and 91.5%, respectively. Stratified analysis showed diagnostic accuracy above 89% across all subgroups. Conclusion: The twinkling artifact on Doppler ultrasound demonstrated excellent diagnostic accuracy and can be considered a reliable, radiation-free alternative to Non contrast enhanced CT for detecting ureteric stones.
Accuracy, Doppler ultrasound, Non contrast enhanced CT, Sensitivity, Specificity, Twinkling artifact, Ureteric stones
Copyright (c) 2026 Naveed Hussain, Usman Shakil, Sana Sharif, Mohammad Uzair, Nosheen Sadiq, Muhammad Saeed (Author) https://creativecommons.org/licenses/by-nc/4.0
Efficacy of Topical Insulin Eye Drops In Dry Eye Disease
Objective: To seesee( ASSESS/ EVALUATE)evaluate the treatment efficacy of topical insulin eye drops in patients suffering from dry eye disease (DED) by assessing improvement in corneal epithelialization, conjunctival hyperemia and corneal staining assessed before and after 3 months of therapy. Study Design and setting: Prospective analytical study, Department of Oophthalmology, Combined Military Hospital Lahore from January-June 2025. Methodology: A total of 390 patients with dry eye disease received topical insulin drops 1 U/ml, one drop in each eye to be taken 6 hourly for a total duration of 3 months. Primary variables studied were improvement in epithelial defects, corneal staining and hyperemia by comparing before and after 3 months of topical insulin therapy. Results: Median hyperemia grade before therapy was 3.00 (1.00) before therapy and it was 1.00 (0.00) when assessed after treatment at 3 month follow-up (p<0.001). Similarly, median corneal staining grade showed median scores of 9.00 (1.00) before therapy and scores were 5.00 (2.00) at the 3 months follow-up after end of topical insulin treatment (p<0.001). Corneal epithelialization defect was improved by 50% in patient with mild, moderate and severe grading score before therapy. Conclusion: We conclude that topical insulin can be recommended as an effective first line management option in patients with dry eye disease improving hyperemia, corneal staining and epithelial defects.
Copyright (c) 2026 Samar Fatima, Muhammad Jahanzaib , Khalid Baloch, Maeirah Shafique, Fakhar Humayun, Junaid Afsar (Author) https://creativecommons.org/licenses/by-nc/4.0
Comparison of Colostomy Reversal Outcomes in Paediatric Patients with Enhanced Recovery after Surgery (ERAS) vs. Traditional Care Protocol (TCP)
Objective: Comparing postoperative outcomes, particularly hospital length of stay (LOS), between paediatric patients undergoing colostomy reversal following Enhanced Recovery After Surgery (ERAS) and Traditional Care Protocol (TCP). Study Design and Setting: This randomized clinical trial (RCT) was conducted at the Children’s Hospital & Institute of Child Health, Faisalabad. Methodology: Sixty paediatric patients (aged 2–13 years) who underwent colostomy reversal were enrolled in the study, over a period of three months from the date of commencement. A non-probability consecutive sampling technique was used to recruit patients and randomize them into the ERAS group (n = 30) or the TCP group (n = 30). Categorical variables, such as gender and diagnosis, were summarised as frequencies and percentages. Results: The study was completed by all sixty randomised patients, with a mean age of 6.78 ± 0.43 years, and 51.7% were male. The ERAS group had a significantly shorter mean hospital length of stay (5.3 ± 0.8 days) compared with the TCP group (7.1 ± 1.1 days; p < 0.001). Conclusion: The application of the Enhanced Recovery After Surgery (ERAS) protocol in paediatric colostomy reversal resulted in a shorter hospital stay and earlier commencement of oral intake, without increasing postoperative complications compared to the Traditional Care Protocol (TCP)
Anorectal malformation, Colostomy, Hirschsprung disease
Copyright (c) 2026 Salman Ali, Hamza Sohail, Tahir Shahzad Nawaz Babar, Anum Manzoor, Ismael Asif, Sayed Elyas (Author) https://creativecommons.org/licenses/by-nc/4.0
Expression of Vascular Endothelial Growth Factor (VEGF) in Individuals with Squamous Cell Carcinoma of Esophagus
Objective: The aim of the study was find out the vascular endothelial growth factor (VEGF) expression in individuals with esophageal squamous cell carcinoma. Study Design and Setting: The current prospective study was carried out at the department of Histopathology, Rehman College of dentistry / Rehman Medical Institute (RCD/RMI) from July 2024 to December 2024 after taking approval from the ethical board of the institute. Methodology: A total of 53 esophageal squamous cell carcinoma samples were collected and placed at -80oC. For culturing, humidified five percent carbon dioxide in air was used for cells in monolayer culture at 37°C. Esophageal squamous cell carcinoma tissue samples that were kept at -80°C and EC9706 cells were used to extract total RNA. Gel electrophoresis was used to assess the quality of the extracted RNA. Immunohistochemistry, RT-PCR and in situ hybridization were used to find out the VEGF expression. Data was analyzed using SPSS version 16. Results: Vascular endothelial growth factor was expressed and secreted by EC9706 cells, confirmed by RT-PCR, in situ hybridization and immunohistochemistry staining. Using in situ hybridization, out of 53 cases with esophageal squamous cell carcinoma, 39(73.5%) had positive immunohistochemistry for VEGF. The VEGF positive rate for both metastatic and non-metastatic lymph node patients was 91% (20/22) and 61.2% (19/31) respectively. A significant difference observed in the VEGF expression between the lymph node-positive and node-negative groups (p<0.05). Conclusion: This study concluded that in individuals with esophageal squamous cell carcinoma, expression of VEGF is an important and helpful prognostic factor.
Expression; vascular endothelial growth factor; Squamous cell carcinoma; esophagus
Copyright (c) 2026 Aisha Jamil, Maria Tasneem Khattak, Shams ul Hadi, Maria Khan, Sidra Mashal, Iqbal Muhammad Khan (Author) https://creativecommons.org/licenses/by-nc/4.0
Hourly Low-Dose Oral Misoprostol Solution for Induction of Labour at Term: A Prospective Observational Study from a Pakistan
Objectives: To evaluate the effectiveness and short-term safety of an hourly 20 µg oral misoprostol solution protocol for induction of labour (IOL) in primigravid term pregnancies at a Pakistani tertiary center. Study design and setting: Prospective observational study conducted in the Department of Gynecology & Obstetrics, Sadiq Abbassi Hospital / Quaid-e-Azam Medical College, Bahawalpur, from 21-Nov-2024 to 21-May-2025. Methodology: Primigravida with singleton, cephalic, 37–42-week gestations, Bishop score >5, and reactive CTG were enrolled; women with prior uterine surgery or other contraindications to vaginal birth were excluded. Misoprostol 200 µg was dissolved in 200 mL of water; 20 mL (20 µg) was given orally every hour until adequate uterine activity or a maximum of 10 doses. Oxytocin was started if contractions became inadequate after active labour onset. Results: One hundred women were included (mean age 27.20 ± 3.62 y; mean gestation 38.65 ± 1.51 weeks; mean estimated fetal weight 2511.05 ± 265.42 g). Mean pre-induction Bishop score 6.32 ± 0.98 improved to 7.43 ± 1.65 at 6 h. The mean induction-to-delivery interval was 12.43 ± 3.21 h; the mean misoprostol doses were 5.52 ± 1.62. Vaginal birth within 24 h occurred in 79/100 (79%; 95% CI 71–87). Oxytocin augmentation was required in 28% and meconium-stained liquor occurred in 18%. Conclusion: Hourly 20 µg oral misoprostol solution achieved high 24-h vaginal-delivery rates with generally reassuring short-term outcomes within recorded parameters in primigravid women at term in this tertiary-care Pakistani cohort. Larger comparative studies are warranted
Cesarean Section, Labor, Induced, Misoprostol, Pakistan, Pregnancy, Term
Copyright (c) 2026 Saba Nadeem, Iqra Aslam, Sumreen Akram, Salma Jabeen, Irum Manzoor (Author) https://creativecommons.org/licenses/by-nc/4.0
Mean Healing Time of Autologous PRP on Wounds in Terms of Split-Thickness Skin Graft Adhesion and Complications as Compared to Conventional Fixation Technique
Objective: To compare mean healing time and complication rates in patients undergoing Split thickness skin grafting with autologous PRP versus conventional fixation methods. Study design and Setting: Two groups comprising of 50 patients (Total 100) in each undergoing split thickness skin grafting were formed, Group A (PRP infiltration prior to STSG) and Group B (STSG with conventional fixation). Mean healing time and graft take were the primary outcomes; infection, seroma, hemorrhage, and graft loss were the secondary events. Methodology: Non-probability consecutive sampling was used in a quasi-experimental study at PNS Shifa Hospital's Plastic Surgery Department. One hundred patients with open wounds aged 18 and 60 years were randomly divided into two groups by lottery method: Group B had STSG with conventional fixation, while Group A received autologous PRP infiltration prior to STSG. Mean healing time and graft take were the primary outcomes; infection, seroma, hemorrhage, and graft loss were secondary events. Results: Mean healing time for Group A was 9.88 ± 1.56 days, substantially faster than that of Group B (mean 11.92 ± 2.68 days, p < 0.001). The PRP group's graft success rate was higher (85.17±9.83) than the control group (72.63±14.57). Group A experienced significant decrease in complications such infection, seroma, and haematoma. Conclusion: In patients undergoing STSG, autologous PRP significantly reduced the healing period and increased graft success while lowering postoperative complications. It provides a biologically active substitute for traditional fixation techniques.
Autologous PRP, Conventional Fixation, Haematoma, Seroma, Split Thickness Skin Graft
Copyright (c) 2026 Sadia Khan, Danish Almas, Santosh Kumar Sidhwani, Asad Ashraf, Rimsha Irfan, Ali Muhammad (Author) https://creativecommons.org/licenses/by-nc/4.0