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) 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
The Role of AI in Healthcare: Innovation with Human Touch
I am writing in response to the article “Artificial Intelligence in Surgery: Learning and Applications” to express my views on the rapidly evolving role of artificial intelligence (AI) in healthcare which has been published in your prestige journal
Copyright (c) 2025 Huma Azmat, Syed Shujaat Abbas Naqvi (Author) https://creativecommons.org/licenses/by-nc/4.0
Integrating Lifestyle Medicine into Oral Health Care
Integrating lifestyle medicine into oral healthcare highlights a shifting paradigm from disease centered treatment to prevention based, holistic care. Oral diseases such as caries, periodontitis, and oral cancer share modifiable lifestyle factors including diet, tobacco use, alcohol consumption, stress, and inadequate physical activity with heart conditions. Addressing these determinants alongside conventional dental treatments can enhance treatment outcomes and improve overall Patient wellbeing. Lifestyle medicine offers structured, evidence-based strategies such as nutritional counseling, behavioral modification, and stress reduction which can be seamlessly incorporated into dental practice. Dentists are uniquely positioned to identify risk behaviors early and support patients through personalized interventions. Collaborative care models, interprofessional education, and patient centered interventions are essential to overcome implementation barriers. By embracing this shift towards lifestyle medicine, oral health professionals can contribute meaningfully to the prevention of both oral and systemic diseases, ultimately advancing population health and reducing healthcare costs
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
Case of Extensively Drug-Resistant (XDR) Typhoid with Resistance to Azithromycin
An 18-year-old boy from Haripur, Pakistan was diagnosed with extensively drug-resistant (XDR) typhoid fever after presenting with acute febrile illness. Blood culture confirmed the isolates of Salmonella Typhi. Antimicrobial susceptibility testing revealed that the isolates were extensively drug-resistant (XDR) to all the first line antibiotics in addition to azithromycin. Only a few antibiotics such as meropenem, colistin and tigecycline were found effective against the bacterium. Empirical therapy with a first line antibiotic failed to treat the infection. After the antimicrobial susceptibility report, the patient was managed successfully with a costly course of meropenem. Azithromycin and carbapenem are the two antibiotics that are recommended to treat XDR typhoid fever. Therefore, resistance to azithromycin is a worrying sign, limiting the treatment options against XDR typhoid, and increasing the cost of therapy as well as the complications.
Azithromycin, Extensive Drug-Resistance (XDR), Salmonella Typhi, Typhoid fever
Perceptions and Attitudes of Medical and Non-Medical Students towards Aesthetic Interventions; A Cross-Sectional Study
Objective: To evaluate the impact of social media on perceptions, attitudes, and decision-making regarding aesthetic interventions among medical and non-medical students. Study Design and Setting: A cross-sectional study was conducted with students from Sir Syed College of Medical Sciences, Altamash Dental College, and SZABIST University in Karachi, Pakistan. Methodology: An online survey was administered, consisting of three sections: socio-demographics, social media usage, and perceptions of aesthetic interventions. It assessed time spent on social media, preferred platforms, exposure to aesthetic content, and views on beauty standards. A p-value =0.05 considered statistically significant. Result: Among 384 participants (70.3% female, 53.1% medical students), significant differences were found in perceptions of cosmetic surgery (p=0.032), body satisfaction (p=0.016), self-esteem (p=0.022), and social media influence (p=0.004). Conclusion: Social media significantly influences beauty perceptions, self-esteem, and body satisfaction, with professional background impacting views. Further research is needed to explore the psychological and social effects of cosmetic procedures.
Aesthetic interventions, Cosmetic surgery, Medical Students, Non-medical students
Copyright (c) 2025 Shweta Gohil, Sapna Mukhi, Namrita Bai, Monika Kumari, Ghazala Usman (Author) https://creativecommons.org/licenses/by-nc/4.0
Evaluation of Learner Insights on Innovative Teaching Strategies in Integrated Modular Biochemistry Curriculum
Objective: To test new instructional strategies in the integrated modular Biochemistry curriculum based on learner behaviors, knowledge retention, and student-centered education. Study Design and Setting: This was an observational cross-sectional study conducted at the Department of Biochemistry, University Medical & Dental College, a constituent medical college of The University of Faisalabad, utilizing an integrated modular curriculum. Surveys were undertaken of undergraduate medical faculty members and students to explore their perceptions of innovative teaching strategies. Methodology: A total of 352 respondents were invited, comprising 300 learners and 52 teachers. Data was collected using a structured questionnaire that measured perceptions of interactive sessions involving large groups of students, tutorials/SGDs, case-based learning, and flip classrooms. Pearson's Chi-square and likelihood ratio tests were used to test the association between variables. Results: A total of 352 respondents participated. For the integrated modular curriculum, 47.3% of students agreed and 12% strongly agreed that it complemented their knowledge and promoted participation. Regarding tutorials/SGDs, 55% agreed and 15% strongly agreed that these sessions encouraged a student-centered approach. In case-based learning, 48% agreed and 16.3% strongly agreed that it was intellectually stimulating and challenging. For the flipped classroom, 37.7% agreed and 10.3% strongly agreed that it was a useful innovation, although a considerable proportion remained neutral Conclusion: Research indicates that interactive teaching methods in biochemistry are favorably received, enhance active learning, and are of value within integrated curricula. A wider application can improve the performance of medical education.
Biochemistry, Curriculum, Faculty, Medical Education, Instructional Methods, Students
Impact of Blended Learning on Academic Achievement and Self-Assessed Confidence: Evidence from Postgraduate Family Medicine in Pakistan
Objective: To evaluate the impact of a one-year blended learning program on academic achievement and self-assessed confidence among postgraduate Family Medicine students in Pakistan. Study design and setting: A retrospective analysis conducted at a public sector Pakistani university. Methodology: Data from 20 students who completed a six-module Family Medicine certificate program (2022–2024) were analyzed. Each module included a 15-item multiple-choice pre- and post-test and a self-assessment of confidence level using a three-point scale. The Wilcoxon Signed Rank Test compared pre- and post-test scores, while frequency distributions examined changes in self-assessed confidence. Results: Mean test scores increased significantly from 8.1 ± 3.2 to 11.3 ± 3.8 (p<0.001). Self-assessed confidence levels rose markedly: the proportion of students reporting comfort increased from an average of 16% pre-module to 54% postmodule, while discomfort decreased from 12% to 2%. Improvements were consistent across most modules, though Module 2 showed a smaller, non-significant gain. Conclusions: Blended learning significantly enhances academic performance and self-assessed confidence in postgraduate Family Medicine education. These parallel improvements suggest the approach effectively bridges theoretical knowledge and professional confidence, supporting its adoption in specialized medical training programs. The findings underscore blended learning’s potential to address both cognitive and affective learning domains simultaneously.
Education, Family Practice, Self-assessment, Medical, Graduate
Diagnostic Accuracy of Imprint Cytology in Determining Margin Positivity in Patients Undergoing Breast Conservation
Objectives: To determine the diagnostic accuracy of imprint cytology in identifying margin positivity in patients undergoing breast-conserving surgery for breast cancer, using histopathology as the gold standard. Study Design and Setting: This cross-sectional validation study was conducted in the Department of Surgery at Khyber Teaching Hospital, Peshawar Methodology: A total of 154 women aged 30–80 years diagnosed with malignant breast lumps and undergoing breastconserving surgery were enrolled using non-probability convenience sampling. Imprint cytology was performed intraoperatively by pressing clean glass slides against the resected margins of the lumpectomy specimen. Slides were air-dried, stained with hematoxylin and eosin, and examined microscopically. Final margin status was determined by histopathological examination, which served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of imprint cytology were calculated. Results: The mean age of participants was 51.15 ± 11.87 years. Imprint cytology demonstrated a sensitivity of 40.8%, specificity of 78.3%, PPV of 61.7%, NPV of 60.7%, and overall diagnostic accuracy of 61.0% in detecting margin positivity. The chi-square test showed a statistically significant association between imprint cytology and histopathology findings (p = 0.010). Conclusions: Imprint cytology provides a rapid and economical method for intraoperative margin assessment during breastconserving surgery, particularly useful in resource-limited settings. However, its diagnostic reliability is operator-dependent and requires standardization for broader clinical application.
Biopsy, Breast Conservation, Breast Neoplasms, Diagnostic Accuracy, Histopathology, Intraoperative Care, Lumpectomy
Copyright (c) 2025 Rizwana Khan, Sadaf Afridi, Warda Ali, Ishrat Alam, M. Furqan Ullah Babar, Mah Muneer Khan (Author) https://creativecommons.org/licenses/by-nc/4.0
Assessment of PDL-1 expression in Triple-negative breast cancer via immunohistochemistry
Objective: To assess the frequency of PDL-1 positivity triple-negative breast carcinoma (TNBC) and correlate it with the clinicopathological parameters. Study Design and Setting: Cross-sectional study conducted at Histopathology Department of Rehman Medical Institute, Peshawar. Methodology: The study period was from September 2023 to October 2024. Biopsy specimen of 41 female patients diagnosed with TNBC were received in the Histopathology department. Specimens underwent eosin/hematoxylin staining and immunohistochemistry analysis. Demographic and histopathological parameters were recorded and analyzed using SPSS version 23. Results: Mean age was 54.58(6.14) years, and the most common type of TNBC was invasive breast carcinoma of no special type in 23(56.1%). Out of 41 specimens, we observed that stage N2 and stage T3 were the most prevalent as observed in 18(43.9%) and 19(46.3%) specimens respectively. Frequency of PDL-1 positivity was observed in 16(39.02%) with a trend towards higher PDL-1 positivity observed in invasive ductal carcinoma of no special type and tumors exhibiting size of >20mm. Lymphovascular invasion was seen in 17 (41.46%) out of which 09 (56.3%) were PDL-1 positive. Tumor-infiltrating lymphocytes of the moderate category were significantly associated with PDL-1 positivity with a p-value of 0.024. Conclusion: PDL-1 expression is observed in a substantial number (39.02%) of TNBC patients. Our research concludes an important association between PDL-1 expression and tumor-infiltrating lymphocytes in TNBC which enlightens new avenues for immunotherapy. This association may have profound implications in the future for prompt diagnosis and targeted treatment.
Breast carcinoma, Lymphocytes, Triple-negative breast neoplasms
Risk Factors and Outcomes Associated with a Short Umbilical Cord
Objectives: To investigate risk factors and outcomes associated with a short umbilical cord. Study design and setting: This study was conducted cross-sectionally at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital (KTH), Peshawar. Methodology: A total of 134 pregnant women with singleton pregnancies were included in this study, using consecutive non-probability sampling, over six months from August 2, 2024, to January 31, 2025. Umbilical cord length was measured immediately after delivery and categorized as short (<35 cm), normal (35–80 cm), and long (>80 cm). Maternal outcomes assessed included mode of delivery, labor complications, and intrapartum events. Neonatal outcomes included birth weight, Apgar score, small for gestational age status, NICU admission, and perinatal mortality. Data were analyzed using SPSS version 26. Chi-square test was applied, and a p-value <0.05 was considered significant. Results: Short cords were associated with higher rates of cesarean delivery (38.8%), fetal distress (29.9%), and NICU admission (16.4%). Long cords were more often linked to intrapartum complications such as cord prolapse (7.5%) and abnormal labor progression (12.7%). Neonatal outcomes revealed 23.1% low birth weight, 14.9% low Apgar scores, 9.7% small for gestational age, 16.4% NICU admissions, and 3.7% perinatal mortality. All associations were statistically significant (p <0.05). Conclusions: Abnormal umbilical cord length is significantly associated with adverse maternal and neonatal outcomes. Early identification and monitoring may improve perinatal prognosis and guide timely interventions
Apgar score; Birth weight; Maternal outcomes; Neonatal outcomes; Umbilical cord
Copyright (c) 2025 Mehr, Sadaf, Ambreen Samad, Nayyab Nafees, Hajira Hidayat (Author) https://creativecommons.org/licenses/by-nc/4.0
Pattern of Hyperandrogenemia in Patients with Polycystic Ovary Syndrome at a Tertiary Care Hospital
Objectives: To assess the pattern of hyperandrogenemia in women diagnosed with polycystic ovary syndrome (PCOS). Study Design and Setting: This was a descriptive cross-sectional study conducted at Hayatabad Medical Complex, Medical Teaching Institution (MTI), Peshawar. Methodology: A total of 133 women aged 18–50 years with PCOS, diagnosed using the Rotterdam criteria, were enrolled through non-probability convenience sampling. Women with prior hormone therapy, hysterectomy, ovarian dermoid, or pelvic inflammatory disease were excluded. Serum levels of total testosterone (>88 ng/dl), free testosterone (>0.66 ng/dl), and DHEAS (>2750 ng/ml) were measured and stratified with age, BMI, and menopausal status. Data were analyzed using SPSS version 26, applying the chi-square test with a significance level of p < 0.05. Results: Elevated free testosterone was observed in 34.6% of participants, followed by total testosterone in 24.8% and DHEAS in 24.1%. A statistically significant association was found between age and raised DHEAS (p = 0.046), while no significant associations were observed with BMI or menopausal status. Conclusions: Free testosterone was the most frequently elevated androgen marker in women with PCOS, supporting its role in biochemical assessment. The age-related rise in DHEAS suggests the need for individualized hormonal interpretation to enhance diagnostic accuracy and guide management
Androgens, Body Mass Index, Cross-Sectional Studies, Dehydroepiandrosterone Sulfate, Polycystic Ovary Syndrome, Testosterone, Women's Health
Effect of Prophylactic Labetalol on Hemodynamics during Nasal Septal Cartilage Harvesting in Rhinoplasty
Objective: to evaluate the effect of prophylactic intravenous labetalol (5mg), administered two minutes before septal harvesting, on intraoperative blood pressure and heart rate in rhinoplasty procedures. Study Design & Settings: Retrospective observational study conducted at Care Medical Centre, Riyadh, Saudi Arabia, from 1 January 2025 to 30 June 2025. Methodology: Fifty ASA I and II patients (aged 20-45 years) undergoing rhinoplasty with septal harvesting were included. Labetalol (5 mg IV) was administered two minutes before harvesting. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded at three intervals: pre-labetalol, two minutes post-administration, and post-harvesting. Surgical field quality and haemostasis were evaluated using surgeon-reported subjective assessments. Results: Prophylactic labetalol effectively reduced intraoperative elevations in BP and HR in 80% of cases, with significant drops in systolic blood pressure (from 85 ± 3 to 82 ± 3 mmHg), diastolic blood pressure (from 45 ± 2 to 43 ± 2 mmHg), and heart rate (from 65 ± 3 to 63 ± 3 bpm) within two minutes. These values stayed within 5% of baseline at the end of harvesting, indicating stable and adequate hemodynamics. Surgeons noted improved visibility, less bleeding, and faster septal harvesting in patients who received labetalol. Conclusion: Prophylactic low-dose intravenous labetalol reliably controls and stabilises intraoperative hemodynamics, while improving surgical field conditions during septal harvesting in rhinoplasty. Its favourable safety and performance profile support its use as a helpful adjunct in nasal surgeries. Further randomised trials are needed to validate these findings and compare the safety of labetalol to that of other agents
Blood pressure, controlled hypotension, heart rate, labetalol, rhinoplasty, septal harvesting
Copyright (c) 2025 Ehsan Ahmad, Ahmad Naseem, Abdullah Alqahtani (Author) https://creativecommons.org/licenses/by-nc/4.0
Impact of Radical and Partial Nephrectomy on Renal Function Outcome
Objective: To evaluate renal function outcomes and new-onset CKD in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN). Methodology: In this prospective cohort study, 204 renal tumor patients underwent RN or PN, eGFR was recorded preoperatively and up to 1 year postoperatively. Variables included age, gender, surgery type, and eGFR values. Data were analyzed using IBM SPSS 20. Continuous variables were reported as mean, median, SD, and IQR; categorical variables as frequencies and percentages. Student’s t-test, chi-square, and multivariate analysis were applied. p<0.05 was significant. Results: Of 204 patients, 154 (75.5%) had RN and 50 (24.5%) had PN. Mean age was 50.41±12.21 years. Baseline median eGFR was lower in RN (82.46 mL/min/1.73m²; IQR 74.98–93.31) than PN (88.44; IQR 79.07–101.61, p<0.002). At 72 hours, RN median eGFR was 63.03 (IQR 53.78–73.08) vs PN 78.23 (IQR 64.87–94.75, p<0.001). At 1 month, RN: 59.93 (IQR 48.87–70.58) vs PN: 76.72 (IQR 61.43–94.97, p<0.001). At 6 months, RN: 57.48 (IQR 46.36–67.21) vs PN: 73.98 (IQR 62.66–87.51, p<0.001). At 1 year, RN: 58.41 (IQR 46.24–67.66) vs PN: 74.40 (IQR 63.09–90.45, p<0.001). Conclusion: Partial nephrectomy, when feasible, better preserves renal function than radical nephrectomy and should be preferred for suitable kidney tumors
CKD (chronic kidney disease); eGFR (estimated glomerular filtration rate); PN (Partial Nephrectomy); RCC (Renal cell carcinoma); RN (Radical Nephrectomy)
Evaluation of Sleep Disorders in Patients with Chronic Kidney Disease
Objective: To assess the prevalence of sleep disorders in Patients with Chronic Kidney Disease Study Design and Setting: This was a cross-sectional observational study conducted over six months (1st August 2024 to 31st January 2025) at the Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad. Methodology: A total of 200 adult patients with CKD (stages 3 to 5) were enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness with the Epworth Sleepiness Scale (ESS), and restless leg syndrome (RLS) using IRLSSG diagnostic criteria. Sociodemographic, clinical, and laboratory data were collected. Statistical analysis was performed using SPSS version 26, with t-tests and chi-square tests applied where appropriate. A p-value <0.05 was considered significant. Results: Among the 200 participants, 84% had at least one sleep disorder. Poor sleep quality (PSQI > 5) was reported in 76%, excessive daytime sleepiness (ESS > 10) in 39%, and RLS in 32%. Sleep disorders were significantly associated with dialysis status (p=0.006), CKD stage 5 (p=0.009), lower hemoglobin levels (p=0.001), higher serum phosphate (p=0.001), and reduced serum calcium levels (p=0.001). Dialysis patients had significantly worse PSQI and ESS scores compared to non-dialysis patients. Conclusion: Sleep disorders are highly prevalent in CKD, particularly in dialysis and advanced-stage patients. The regular assessment and proactive management of associated factors, such as anemia and mineral imbalances, are critical to optimizing patient care.
Anemia, Quality of Life, Restless Legs Syndrome, Sleep Disorders, Uremia
Percutaneous Nephrostomy Audit: Evaluating Quality and Technical Proficiency
Objective: The objective of this clinical audit was to assess the quality and technique of percutaneous nephrostomy (PCN) procedures in accordance with international standards in order to identify deficiencies in existing practices, adopt standardized quality improvement protocols, and evaluate their effects by a re-audit to optimize procedural outcomes and minimize problems. Study design and setting: This retrospective cross-sectional clinical audit conducted in the Urology Department of Allied Hospital, Faisalabad. Study included 50 patients who underwent PCN and was carried out in two phases: an initial audit (January–February 2023) to assess baseline compliance with international PCN guidelines, followed by the implementation of quality improvement interventions and a re-audit (May–June 2023) to evaluate improvements in procedural quality and technique. Methodology: Procedures were assessed via an audit proforma based on European Association of Urology (EAU), Society of Interventional Radiology (SIR), and Smith and Tanagho’s guidelines, grading outcomes as Good, Moderate, or Poor. After identifying common errors, quality improvement measures were implemented. A re-audit of another 50 patients was conducted. Results: The preliminary audit revealed suboptimal PCN quality and technique. Following the implementation of quality improvement measures, the re-audit demonstrated substantial enhancements in all grades, with a significant increase in good quality protocols. Conclusion: This clinical audit and quality improvement initiative significantly enhanced the quality and technique of PCN. Regular training sessions, dissemination of guidelines and ongoing evaluations are recommended to reduced complications and improved patient experienc
Clinical Audit, Hydronephrosis, Nephrostomy, Percutaneous, Patient Safety, Quality Improvement, Ultrasonography, Interventional
Comparative Evaluation of Regional versus General Anesthesia on Maternal Hemodynamic Stability and Transfusion Requirements in Cesarean Hysterectomy for Placenta Accreta Spectrum Disorders
Objectives: This study aimed to compare the effects of regional versus general anesthesia on maternal hemodynamic stability and transfusion requirements in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS) disorders. Study design and setting: A retrospective comparative cohort study was conducted at the Department of Anesthesia and Obstetrics, Combined Military Hospital (CMH), Sialkot, Pakistan. Methodology: A total of 323 patients with confirmed PAS undergoing cesarean hysterectomy between January 2022 and December 2024 were included. Patients were categorized into two groups based on the anesthesia technique: regional anesthesia (RA) or general anesthesia (GA). Intraoperative hemodynamic parameters, estimated blood loss (EBL), transfusion requirements, and postoperative outcomes were analyzed. Ethical approval was obtained from the CMH ERC (Ref: ERC/43/2025), and informed consent was secured. Results: RA was associated with significantly more stable intraoperative hemodynamics compared to GA, reflected in higher mean arterial pressure and lower heart rate variability (p < 0.05). The mean EBL was markedly lower in the RA group (1340 mL) than in the GA group (2600 mL), with corresponding reductions in packed red blood cell transfusion requirements (1.6 ± 1.2 units vs. 4.5 ± 1.5 units, p < 0.001). ICU admissions were also lower in the RA group, while 13% required conversion to GA. Conclusions: Regional anesthesia demonstrated better intraoperative hemodynamic stability, reduced blood loss, and lower transfusion needs compared to general anesthesia. Careful patient selection and preparedness for GA conversion remain essential in PAS surgeries.
Cesarean Section; General Anesthesia; Hemodynamic Stability; Hysterectomy; Placenta Accreta
Use of Artificial Intelligence among Dental Clinicians and Oral and Maxillofacial Surgeons: A Cross-Sectional Survey
Objective: To evaluate the utilization, knowledge, and attitudes of dental clinicians and oral/maxillofacial surgeons regarding AI in clinical practice. Study Design and Setting: A Cross-Sectional Online Survey. Methodology: The study was conducted over six months on 303 participants using a non-probability consecutive sampling technique. Participants were recruited via digital platforms. A structured, 21-item questionnaire, adapted from a validated tool, was distributed through online professional networks. Data were analyzed using SPSS v21, employing descriptive statistics and inferential tests (chi-square) to explore associations, with a significance threshold of p < 0.05. Results: A total of 70% of participants were aged 18–25, with the majority still in training or having less than five years of experience. General Dentistry was the most represented specialty (60.1%), and 81.5% practiced in urban areas. AI usage was limited, with 42.6% reporting no use in daily practice; radiographic interpretation was the most common application (25.8%). A significant association was found between specialty and AI usage (p = 0.023) and between experience and AI knowledge (p < 0.001), while no significant link was observed with age or work area. Conclusion: the growing awareness and cautious optimism toward AI among Pakistani dental professionals, particularly among younger and early-career clinicians. While AI use remains limited, there is strong recognition of its potential to enhance diagnostics and efficiency. Differences in AI adoption across specialties and experience levels underscore the need for targeted education and infrastructure development to support broader integration.
Algorithms, Computer, Operative, Surgical Procedures, Surgeons.
Comparison of a Single 2mm Locking Miniplate with Two 2mm Non-Locking Miniplates in Symphysis or Para symphysis Fracture of Mandible
Objective: To assess the treatment success between locking and non-locking miniplates when used for the constructive repair of mandibular symphysis and parasymphysis fractures of the mandible. Study Design and Setting: This study is designed as a quasi-experimental conducted in the Oral and Maxillofacial Surgery Department of Punjab Dental Hospital and De Montmorency College of Dentistry, Lahore. Methodology: This quasi-experimental was conducted in the Oral and Maxillofacial Surgery Department of Punjab Dental Hospital and De Montmorency College of Dentistry, Lahore. It enrolled 60 patients into each group consisting of locking and non-locking variants for a total of 120 participants. The data was evaluated through SPSS version 25 by applying the Chi-square test and one-way ANOVA test. Results: Fracture stability was achieved in of patients in the locking miniplate group compared to in the non-locking group, with statistical significance (p=0.040). The need for additional IMFs was significantly lower in the locking group, with only required additional fixation, compared to the non-locking group (p=0.00095). Pain scores, measured using the VAS, were significantly lower in the locking miniplate group compared to the non-locking group with a p-value of 0.0001. Soft tissue healing was significantly better in the locking group, showing proper healing compared to the non-locking group (p=0.008). Conclusion: The superior locking miniplate design achieves better fracture stability through increased mechanical stability as well as reducing postoperative discomfort and improving the healing of soft tissue structures, thus establishing their advantage over traditional non-locking miniplate methods.
Fracture stability, locking miniplates, mandibular fractures, non-locking miniplates,
Copyright (c) 2025 Anam Shahzad, Shahid Ali, Muhammad Mustafa, Adnan Haider, Fatima Imran, Kashif Adnan (Author) https://creativecommons.org/licenses/by-nc/4.0
Thyroid Profile Abnormalities in Pediatric Population and their Correlation with Age: A Cross-Sectional Study at a Tertiary Care Hospital of South Punjab
Objective: To determine prevalence and pattern of thyroid profile abnormalities (hypothyroidism, hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism) in pediatric population and to correlate these abnormalities with age in children presenting to a tertiary care hospital of South Punjab. Study design and setting: This cross-sectional study was conducted for two months from 5-Dec-2024 to 5-Feb-2025 in Pathology department of Children Hospital and Institute of Child Health (CH & ICH) Multan. Methodology: All the patients of 1-14 years whose thyroid profile was requested for any clinical indication were included in the study using consecutive sampling technique. Participants were divided into 3 age groups of 1-5 years, 6-10 years and 11-14 years. Data was entered and analyzed using SPSS 22. P-value of <0.05 was considered statistically significant. Results: Among 200 children included in the study 60(30%) were found to have thyroid disorders. Subclinical hypothyroidism was seen in 36(60%) children and was most common thyroid disorder. Thyroid disorders were slightly more common in females. Difference of Mean T3, T4 and TSH in various thyroid disorders was statistically significant with p value of 0.000. Majority of the children (44%) were in 1-5 years age group. No correlation was found between age of the patients and thyroid disorders (r=0.004, sig. 2 tailed=0.966). Conclusion: Subclinical hypothyroidism is the most common thyroid disorder among children and thyroid profile abnormalities are not related to age.
Autoimmune thyroiditis, Hyperthyroidism, Hypothyroidism, Thyroid function tests
Copyright (c) 2025 Mehvish Sana, Zille Rubab, Ayesha Fayyaz, Waqas Imran (Author) https://creativecommons.org/licenses/by-nc/4.0
Anatomical and Morphological Study of the Sternal Foramen Using Computed Tomography Imaging
Objective: This study aims to determine the prevalence and anatomical variations of the sternal foramen (SF) in Pakistani population, and to emphasize its critical clinical significance in preventing complications-such as cardiac tamponade and pneumothorax-during anterior chest wall interventions. Study Design and Setting: This retrospective, observational CT based morphometric study on human sternum was carried out in Pakistani population at M. Islam Teaching Hospital, Gujranwala from December 2023 to October 2024. Methodology: The evaluation of images was done using coronal multiplanar reconstruction (MPR) over axial images. The diameters of the detected sternal foramina along with its distance from suprasternal notch and xiphisternum were measured. Male and female groups were compared for differences in various dimensions of the sternal foramina. For statistical analysis, SPSS version 27.0 was used. Results: In the present study, 580 CT scans were observed. The incidence of sternal foramina in our study is 9.31% (54 out of 580) with 19 men and 35 women. The results showed that both transverse and vertical diameters are generally larger in males than females, with p-value statistically significant. A larger proportion of females (68.6%) have the sternal foramen in the body of the sternum compared to males (52.6%). Maximum number of sternal foramina were observed at the level of the 5th intercostal space 16.67% (n=9). Conclusion: Awareness of sternal foramina, a congenital defect, is essential for medical professionals to diagnose and prevent complications during surgery, particularly when considering varying prevalence and characteristics across populations
Congenital defect, CT, Human sternum, Morphology, Sternal foramen, Suprasternal notch, Xiphisternum.
Copyright (c) 2025 Saman Ali, Zumirah Atiq, Zunaira Z, Aniba Zahid, Maria Binte Tariq, Athar Maqbool (Author) https://creativecommons.org/licenses/by-nc/4.0
Visual Prostate Symptom Score versus International Prostate Symptom Score with Lower Urinary Tract Symptoms
bjective: Benign prostatic enlargement is a common issue in ageing men, causing significant lower urinary tract symptoms (LUTS). This study compares the effectiveness of the International Prostate Symptom Score (IPSS) and the Visual Prostate Symptom Score (VPSS) in assessing LUTS severity among BPH patients in Pakistan, focusing on ease of use, symptom grading, and correlation with uroflowmetry results. Study design and setting: Prospective observational study conducted at the OPD of Urology, Gujranwala Teaching Hospital and Gujranwala Medical College Teaching Hospital, from April 24 to September 24. Methodology: A total of 220 patients over 40 years with LUTS completed IPSS and VPSS assessments, with time taken recorded. Uroflowmetry (Qmax), post-void residual volume (PVRV), and bladder wall thickness were measured before and after one month of á-blocker therapy. Data were analysed using paired t-test, Pearson’s correlation, and chi-square test to evaluate association. Results: VPSS took 3-4 minutes for those with primary education, compared to 8-10 minutes for IPSS. Symptom severity grading between IPSS andVPSS showed positive correlation (r = 0.582, P< 0.001). VPSS scores showed significant correlation with post-treatment improvements in Q max, bladder wall thickness and improvement in PMRV after treatment, confirming its reliability in symptom assessment and treatment monitoring. Conclusion: VPSS is a reliable, quicker alternative to IPSS, especially for populations with lower literacy. It correlates well with symptom severity and treatment outcomes, making it suitable for broader clinical use in diverse settings.
Benign prostatic enlargement, Internal prostate scoring system, Visual prostate scoring symptom
Comparison of Mean Postoperative Pain Score in Patients Undergoing Thyroidectomy with and Without Superficial Cervical Block
Objectives: To compare the average postoperative pain scores in patients undergoing thyroidectomy with the use of a superficial cervical block. Study design and setting: This randomized controlled study was conducted in the Department of Anesthesiology at Lahore General Hospital, Lahore, over six months, from May 3, 2021, to November 2, 2021. Methodology: After the hospital's ethical committee approval, a study was conducted involving 60 patients (both genders) belonging to ASA class I-II aged (18-60) years, scheduled for elective thyroidectomy under general anesthesia; randomly assigned to two groups by lottery method. Patients in Group-I received additional superficial cervical plexus block while those in Group-II were taken as controls. Outcome variable was mean Visual Analogue Scale (VAS) score for post-operative pain, which was assessed after 2 hours of surgery in the recovery room in both groups. Written informed consent was taken from each patient. Results: The mean age of patients ranged between 36.6 ± 12.6 years, with the majority (58.3%) aged 26-50 years. Most were female (80%), with a male to female ratio of 1:4. Patients receiving superficial cervical plexus block had significantly lower post-operative pain (mean VAS 2.17±0.84) compared to controls (3.60±1.04), with similar significant differences across age, gender, body mass index, ASA status, and surgery duration. , Post-Operative Pain, Superficial Cervical Plexus Block, Thyroidectomy Conclusions: Superficial cervical plexus block significantly reduces post-operative pain in thyroidectomy patients under general anaesthesia, potentially decreasing opioid use and promoting faster recovery, making it a preferred part of anaesthetic technique for future practice.
Association of Acupressure at Sanyinjiao Point 6 with C-Reactive Protein, Interleukin 6, Prostaglandin F2 , and Vasopressin in Medical College Students with Primary Dysmenorrhea
Objective: To observe the changes in biochemical markers after applying acupressure in Primary Dysmenorrhea (PD) at Sanyinjiao Point 6 (SP6) and ascertain whether pain relief is biochemically mediated. Study design and setting: A quasi-experimental design was adopted. The study was carried out from September 2022 to April 2023, in Karachi, Pakistan, at a private medical college. Methodology: After ethical approval (BMU-EC/04-2022), 50 participants were selected using a modified menstrual symptom questionnaire, who were healthy, experienced regular PD, and abstained from analgesics. Written informed consent was taken, then in the first month of the study, blood samples (pre-intervention) were taken on day one of the menstrual cycle (MC). In the following three MCs, acupressure was self-applied at acupoint SP6, taught by a qualified acupressurist. During dysmenorrhea, it was applied on both legs, three times/day, for two to five minutes. In the third month of acupressure, second (post-intervention) blood samples were taken. Plasma levels of C-reactive protein (CRP), Interleukin- 6 (IL-6), Prostaglandin F2 (PGF2 ), and Vasopressin (VP) were measured and compared with pre-intervention samples using Statistical Package for Social Sciences 23 (SPSS 23). Results: Median with interquartile ranges (IQR) of PGF2 , IL-6, VP, and CRP were obtained and compared, reporting a statistically significant increase in the post-intervention plasma CRP level (p=0.03), whereas plasma levels of PGF2 , IL- 6, and VP showed no significant change (p=0.60, p=0.84, p=0.19, respectively). Conclusions: Except CRP, the biochemical markers showed no significant change; hence, acupressure mediates its pain relief through additional mechanisms.
Acupressure, C-Reactive Protein, Interleukin 6, Dysmenorrhea, Prostaglandins F, Vasopressins
Outcomes of Endoscopic Variceal Band Ligation for Esophageal Varices in Children
Objective: To determine outcomes of endoscopic variceal band ligation (EVBL) for esophageal varices (EV) in children presenting to a tertiary childcare hospital of Pakistan. Study Design and Setting: A prospective observational cohort study was conducted at the Department of Pediatric Gastroenterology, The Children’s Hospital and Institute of Child Health, Faisalabad (June 2023–March 2025). Methodology: Children aged 2–16 years with endoscopically confirmed EV scheduled for EVBL were analyzed. Baseline demographics, EV grade, and etiology were recorded. Follow-up endoscopies were performed at 4-week intervals. Outcomes included number of sessions, grade reduction, obliteration, and rebleeding. Data were analyzed using SPSS v26 with p=0.05 considered significant. Results: In a total of 97 children, the median age was 11 years (interquartile range: 8-13 years), while 51.5% children were female. Endoscopic grading showed Grade III, and IV varices in 67% cases. The mean follow-up was 8.8±2.6 months. Variceal grade reduction was achieved in 93.8%, and complete obliteration in 87.6%. One or two EVBL sessions were sufficient in 82.4%; 17.5% required =3. Rebleeding occurred in 8.2%, with no mortality. Higher-grade varices significantly required more sessions (p=0.0332), though other outcomes showed no significant grade-wise association. Conclusion: EVBL is a safe, well-tolerated, and effective modality for the management of EV in children
Children, esophageal varices, endoscopic variceal band ligation, hematemesis, melena
Maternal and Fetal Outcomes Following Caesarean Section in Second Stage of Labour
Objectives: The primary objectives of this study were to establish the frequency of caesarean sections conducted during the second stage of labour, identify the reasons leading to this intervention, and evaluate the maternal and fetal outcomes associated with second-stage caesarean deliveries. Study Design and Setting: Cross sectional study in Combined Military Hospital Abbottabad. Methodology: After approval from ethical committee, this study was conducted from 1st January 2024 to 30th June 2024. Via non-probability consecutive sampling, pregnant women between ages 20-45 years, with a singleton pregnancy, and gestation age greater than 37 weeks were included. The study evaluated indications for caesarean section, preoperative instrumentation, intraoperative complications (uterine incision extension, haemorrhage, atonic post-partum haemorrhage), and postoperative complications (wound infection, febrile illness, and neonatal morbidity and mortality). Results: There were a total of 1195 deliveries over the research period. 642 (54%) babies born via cesarean section. Amongst these, 25 (3.8%) cesarean sections were performed in the second stage. The most common indication for secondstage CS in the present study was non-progress of labour (36%). Among women undergoing second-stage CS, the most common maternal complication was atonic PPH (32%), followed by blood transfusion (28%). In our study, there was no case of maternal and neonatal deaths. For neonates, the most common causes of NICU admission were RDS (36%) and HIE (32%) Conclusion: Several intra-operative maternal problems and neonatal morbidity are linked to cesarean sections that are performed during the second stage of labour
Caesarean Section, Fetal Health,“Labor Stage, Second”, Pregnancy Outcome, Fetomaternal Outcome, Maternal
Risk Factors and Frequency of Vitamin B12 Deficiency among Patients Visiting Primary Care Clinics in Karachi, Pakistan
Objective: To examine the associations of sociodemographic factors, comorbidities, diet, medications, vitamin D levels, hematological indices, and symptoms with vitamin B12 status among primary care patients in Karachi, Pakistan. Methods: This cross-sectional study was conducted in 2023 at the Family and Internal Medicine clinics of Indus Hospital and Health Network. Adults recently tested for vitamin B12 as advised by physicians were enrolled (n=252). Data on demographics, comorbidity, medications, diet, and symptoms were collected through structured interviews, alongside BMI and laboratory results. Associations were analyzed using descriptive statistics, Chi-square, and correlation coefficient, with p<0.05 considered significant. Results: Of 252 participants (71.4% female, median age 46 years), fatigue (79.5%), muscle weakness (73.2%), and numbness/tingling (69%) were the most frequent symptoms in those with B12 deficiency or insufficiency. Decreased appetite (p=0.003) and weight loss (p=0.010) were significantly associated with low B12 levels. Dietary patterns showed strong associations: reduced milk intake (72% deficient) and infrequent red meat consumption (49.6% deficient) were linked to deficiency. Vitamin D correlated positively with B12 levels (r=0.215, p=0.006), while mean corpuscular volume correlated negatively (r=-0.151, p=0.019). No significant associations were found with BMI (p=0.175), comorbidities (p>0.05), or metformin/PPI use (p>0.05). Conclusion: Low vitamin B12 levels were associated with specific dietary insufficiencies, constitutional and neurological symptoms, and hematological indices. These findings highlight the need for heightened clinical awareness and integration of dietary counseling within primary care. These findings highlight the need for targeted screening and interventions to prevent deficiency in underprivileged populations.
Cobalamin deficiency, B12 deficiency, macrocytic anemia, megaloblastic anemia, nutritional anemia, vitamin B12 deficiency, Pakistan
Copyright (c) 2025 Fakhrunnisa Waheed, Mohammad Minhaj, Nida Ghouri, Faridah Amir Ali, Muhammad Junaid Patel (Author) https://creativecommons.org/licenses/by-nc/4.0
Pattern of Congenital Heart Diseases in Patients Presenting in a Tertiary Care Hospital of Karachi
Objective: To identify the frequency and pattern of congenital heart defects (CHD) in referred cases at a tertiary care hospital in Karachi, Pakistan. Methodology: To carry out this research, we reviewed the medical records of referred patients from various regions of Sindh province from September 2023 to August 2024. The data was collected from the Pediatric Cardiology Department of a tertiary care hospital via a computerized data system and was analyzed to calculate the frequency and pattern of CHD. Results: A total of 1,423 echocardiograms were reviewed; however, only 1,400 patients met the inclusion criteria and were included in the final analysis. Among these 1400 cases, 791(56.5%) were consistent with normal echo, and 609 (43.5%) were found to have a single or a combination of two or three CHDs. Among 609 CHD cases, 346 (56.8%) were male and 263 (43.1%) were female. Among these 609 cases, a total of 824 heart defects were diagnosed, 655 (79.4%) were acyanotic CHD, 119 (14.4%) were cyanotic CHD, and 50 (6.0%) others. In acyanotic heart defects, septal defects including VSD and ASD were most prevalent. However, among cyanotic heart defects, TOF was the most common abnormality identified. Conclusion: CHD is very prevalent in Karachi and is among the most common causes of mortality and morbidity. Early detection and screening of heart defects through fetal and neonatal echocardiography allows timely interventions to improve this overall burden of mortality and morbidity
Atrial septal defect, Congenital heart defect, Tetralogy of Fallot, Ventricular septal defect,
Use of Dexmedetomidine as adjunct with Bupivacaine in TAP block for postoperative pain relief in patients undergoing laparoscopic cholecystectomy
Objective: To analyze adjunct effect of Dexmedetomidine along with Bupivacain in TAP block for postoperative analgesia in laparoscopic cholecystectomy. Study Design and Setting: Prospective interventional study was conducted 1st September 2022 to 31st January 2023 at Anesthesia department of PAF Hospital Islamabad, affiliated with Air University. Methodology: A total of 60 patients undergoing elective laparoscopic cholecystectomy between age 18 to 60 years were included. Patients having hypertension, heart disease, diabetes were excluded. Group A patients were given TAP block using 10ml 0.25 % Bupivacaine on each side.Group B patients were given 10ml of 0.25% Bupivacaine with injection Dexmedetomidine 0.5 µg/kg in divided dose on each side under ultrasound guidance. Patients were followed for postoperative pain in first 24 hours. Results: Data was analyzed on SPSS 25.Mean ± SD of pain score on VAS was 6.54 ± 1.98 versus 3.54 ± 1.87 at 4 hours ( p value =0.0001) , 5.51 ± 1.16 versus 2.89 ± 1.65 at 8 hours ( p value=0.0001) , 4.89 ± 1.11 versus 2.13 ± 1.25 at 12 hours ( p value=0.0001) ,4.47 ± 1.07 versus 1.63 ± 0.85 at 24 hours ( p value=0.0001) in group A and B respectively. Stratification was done with age, gender, ASA status and duration of surgery .Results of study were not affected by these factors. Conclusion: Dexmedetomidine when added as an adjunct to Bupivacaine is better than Bupivacaine alone in TAP block for postoperative analgesia after laparoscopic cholecystectomy
Dexmedetomidine, laparoscopic cholecystectomy, transverses abdominas plane block
Clinical Evaluation of injectable Mitomycin-C in Trabeculectomy for Glaucoma Patients
Objective: To evaluate the efficacy of injectable Mitomycin-C (MMC) administered at the bleb site during trabeculectomy in patients with glaucoma. Study Design and Setting: This cross-sectional study was conducted at the Department of Ophthalmology, Unit-1, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital Karachi, and SMBB Trauma Centre from January to June 2022. Methodology: Data were obtained through non-probability consecutive sampling. After obtaining informed consent, patients meeting the diagnostic criteria and undergoing trabeculectomy were enrolled. Demographic data, including age, gender, and eye laterality, were recorded. Efficacy was defined as a postoperative intraocular pressure (IOP) reduction of more than 30% compared to preoperative values. Ophthalmic examinations included visual acuity, refraction, slit-lamp biomicroscopy, gonioscopy, and IOP measurement. The effect of MMC across different subgroups was analyzed using an independent t-test, with a p-value =0.05 considered statistically significant. Results: A total of 62 patients underwent trabeculectomy with injectable MMC. The mean preoperative IOP was 32.81 ± 13.13 mmHg, while the mean postoperative IOP at one month was 13.88 ± 5.90 mmHg, indicating a significant reduction (p = 0.01). Over 30% IOP reduction was achieved in the majority of cases. Only five patients developed postoperative complications, including fibrosis and flat blebs. Conclusion: Injectable Mitomycin-C is an effective adjunctive therapy in trabeculectomy, significantly lowering intraocular pressure and enhancing surgical success while minimizing postoperative scarring and surgical failure.
Efficacy, Glaucoma, Intraocular Pressure (IOP), Mitomycin C and Trabeculectomy
Comparative Cross-Sectional Study Evaluating the Efficacy and Safety of Sublingual Misoprostol versus Intravaginal Dinoprostone for Labor Induction
Objective: The investigation aimed to evaluate the effectiveness and safety of sublingual misoprostol compared with intravaginal dinoprostone for labor induction at Maroof International Hospital. Study Design and Setting: A comparative cross-sectional study was carried out in the Obstetrics Department, Maroof International Hospital from 1 August 2023 to 30 September 2024, including 219 pregnant women aged between 18 and 40 years and gestation periods ranging from 37 to 42 weeks. Methodology: Participants were randomly allocated to receive either sublingual misoprostol (50 mcg every 4 hours, up to 6 doses) or intravaginal dinoprostone (3 mg every 6 hours). The study assessed the interval between induction and delivery, delivery method, induction failure, and adverse consequences including gastrointestinal problems and fetal distress. Data analysis was conducted utilizing SPSS, with a significance threshold established at p < 0.05. Results: Misoprostol markedly decreased the induction-to-delivery interval (8.4 vs. 10.2 hours, p < 0.05). Nonetheless, it was linked to an increased incidence of cesarean sections (12.5% compared to 5%), predominantly attributable to fetal discomfort. Misoprostol also elevated the occurrence of nausea and vomiting in comparison to dinoprostone. Conclusion: Sublingual misoprostol reduced induction-to-delivery time but increased adverse effects and cesarean sections. Misoprostol for labor induction requires careful monitoring to balance efficacy and safety.
Cesarean Section, Dinoprostone, Fetal Distress, Labor Induction, Misoprostol, Pregnancy
Assessment of Anterior Maxillary Bone Thickness and Cemento Enamel junction–Crest Distance Using Cone Beam Computed Tomography
Objective: To evaluate and compare thickness of palatal and labial bone, along with the cementoenamel junction (CEJ) – bone crest distance of anterior maxillary teeth using cone-beam computed tomography (CBCT) technique. Methods: This study is a retrospective cross-sectional study including 140 CBCT scans fulfilling the inclusion criteria. For each pair of anterior maxillary teeth, the thickness of palatal and facial bones was taken at three points along with distance between CEJ and bony crest. To ensure validity and reliability of measurements, single operator performed and recorded the measurements for each included CBCT scan. Results: The mean age calculated from 140 CBCT scans was 34.84±8.0 years (age range 15-55 years), out of which there were 76 (54.3%) and 63 (45.0%) males and females, respectively. Most of the mean values at each measurement point of palatal and facial bone thickness were similar for both right and left teeth. Significant differences were noted in mean values among gender. For males, most of these values were higher as compared to the females. In terms of age, some values correlated positively with age including palatal thickness of CI and LI, while some correlated negatively with age including labial thickness of CI and LI. Conclusion: The bone measurements significantly differed among males and females, and varied across age as well. The bone thickness measurements vary across populations therefore it is vital to know the anatomical bone dimensions in anterior maxilla for optimal 3-dimensional placement of the implant
Maxilla, cuspid, incisor, cone - beam computed tomography, dental implants