Journal of Sharif Medical & Dental College
Association of Clinical and Biochemical Parameters with Renal Resistive Index in Type 2 Diabetic patients with Normal Albuminuria
Objective: To determine the association between the renal resistive index (RRI) and different biochemical and clinical parameters in type 2 diabetic patients with normal albuminuria. Methodology: This descriptive cross-sectional study was conducted at the Department of Radiology, Shaikh Zayed Hospital, Lahore with a diabetic clinic collaboration for one year from January to December 2023. After ethical approval, 300 type 2 diabetic patients with normal albuminuria <30 mg/g were included by non-probability convenience sampling. After obtaining informed consent, patient demographic and clinical details were noted on the proforma. All the patients underwent renal Doppler ultrasound and RRI was estimated. Various biochemical parameters of the patients were estimated. The data analysis was done using the Statistical Package for the Social Sciences version 25. Results: The average RRI was >=0.70 in 64(21.3%) patients who were labeled as having nephropathy, >=0.65 to <0.7 in 82(27.4%), and 154(51.3%) had normal RRI. There was a significant association of renal resistive index with duration of diabetes mellitus (DM), serum creatinine, urinary albumin-to-creatinine ratio (ACR), glomerular filtration rate (GFR), fasting blood glucose, glycated hemoglobin (HbA1c), and lipid profile in type 2 diabetic patients with normal albuminuria (p-value=<0.05). Conclusion: Renal resistive index had a significant association with duration of diabetes, serum creatinine, urinary ACR, GFR, fasting blood glucose, HbA1c, and lipid profile. It can be used for early detection of diabetic nephropathy in type 2 diabetic patients with normal albuminuria.
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Hypoalbuminemia and its Relation with Acute Respiratory Distress Syndrome and In-Hospital Mortality in Intensive Care Unit patients
Objective: To evaluate the association of hypoalbuminemia with acute respiratory distress syndrome (ARDS), in-hospital mortality and length of hospital stay in intensive care unit (ICU) patients and to determine the relation of ARDS with demographics and worst clinical outcomes. Methodology: This cross-sectional study was done at the Federal Government Polyclinic Hospital, Islamabad after ethical approval. The study duration was 8 months from March 2024 to October 2024. After taking informed consent from patients or their attendants, 350 patients admitted to the medical ICU were included using non-probability convenience sampling technique. The demographic details of the patients, their co-morbidities and primary diagnoses were noted. The serum samples of the patients were sent to the laboratory for estimation of serum albumin levels. Patients were allocated to group I having serum albumin <3.5 mg/dl (n=210) and Group II with serum albumin levels >3.5 mg/dl (n=140). The outcomes assessed were the frequency of ARDS, length of ICU stay, and in-hospital mortality. The statistical analysis was done by the Statistical Package for the Social Sciences (SPSS) version 25. Results: Out of 350 patients, 136(38.9%) developed ARDS; 34.3% had low albumin levels whereas, only 4.6% had normal serum albumin. In-hospital mortality occurred in 30% of the patients, out of which 20.3% and 9.7% of the patients had low and normal serum albumin, respectively. The mean length of ICU stay was 12.2±1.4 days and 8.9±2.5 days in group I and group II, respectively. These findings were statistically significant. Acute respiratory distress syndrome has a significant association with age, risk factors, serum albumin levels, length of ICU stay, and in-hospital mortality. Conclusion: Acute respiratory distress syndrome, in-hospital mortality, and length of hospital stay have a significant relation with hypoalbuminemia in ICU patients. There was a significant association of acute respiratory distress syndrome with advanced age, risk factors, in-hospital mortality, and length of hospital stay.
Attitudes of Medical Faculty Enrolled in Masters in Health Professions Education towards Professionalism in a Private Pakistani University: a Mixed-Methods Study
Objective: To examine the attitudes of medical faculty enrolled in the Masters in Health Professions Education (MHPE) program towards professionalism at Shifa Tameer-e-Millat University, Islamabad. Methodology: The study was conducted at Shifa Tameer-e-Millat University, Islamabad from August 2024 to January 2025 after ethical approval. After taking informed consent, universal sampling technique was used to enroll all 40 MHPE faculty members. Using a convergent parallel mixed-methods design, both quantitative and qualitative data were gathered to explore dimensions of professionalism including excellence, altruism, honor & integrity, accountability, duty and respect. A 36-item validated Likert-scale questionnaire assessed attitude of MHPE faculty, complemented by four in-depth semi-structured interviews. Quantitative data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. For the analysis of qualitative data, Notta software was used. Results: Quantitative analysis revealed most of the participants were females [28(70%)] and belonged to MBBS background [21(52.5%)]. Our participants exhibited poor professional attitudes indicated by low mean scores of professionalism (2.07-/+0.45) and its six domains. A significant positive correlation was present between professionalism and variables such as excellence (r=0.77), duty (r=0.68), and altruism (r=0.68). Regression analysis confirmed these as key predictors. Qualitative themes highlighted challenges in curriculum integration, resource gaps, and the influence of institutional culture. Conclusion: Our results showed poor attitudes of MHPE enrolled medical faculty towards professionalism indicated by low mean scores of professionalism and its six domains of altruism, respect, honor & integrity, accountability, duty, and excellence. Our thematic analysis identified professionalism as one of the fundamentals of medical education. Time & resource constraints and role ambiguity were major challenges towards integration of professionalism into medical courses and the role of institutional support was also highlighted.
Cardiac Defects in Neonates Born to Mothers with Gestational Diabetes Mellitus and their Association with Maternal Treatment Regime
Objective: To determine the type of cardiac anomalies on echocardiography in neonates delivered to mothers diagnosed with gestational diabetes mellitus (GDM) and evaluate the association of neonatal cardiac defects with maternal treatment during pregnancy. Methodology: This cross-sectional study was conducted at the Department of Pediatrics, Ittefaq Trust Hospital, Lahore from August 2024 to January 2025 after ethical approval. A total of 108 neonates delivered to mothers with gestational diabetes were included using non-probability consecutive sampling technique. After taking informed consent from parents, they were screened by using echocardiography and neonatal cardiac anomalies were noted, if present. All the neonates with cardiac anomalies were followed-up in outpatient department (OPD) for spontaneous closure of defect for 3 months. The data was analyzed by the Statistical Package for the Social Sciences (SPSS) version 25. Results: The mean age of neonates at presentation was 2.00±0.72 days. Gestational diabetes was diagnosed in the second trimester in 72(66.7%) and the third trimester in 36(33.3%) mothers. Out of 108 females, 12(11.1%) were only on insulin, 76(70.4%) were prescribed metformin only, 16(14.8%) were taking combination of metformin with insulin and 4(3.7%) were on diet control. On echocardiography, patent ductus arteriosus (PDA) was detected in 56(70%) cases, ventricular septal defect (VSD) in 8(10%) neonates, septal hypertrophy with PDA in 8(10%) cases, VSD with PDA in 8(10%) cases while 28(25.9%) had normal cardiac functioning. At follow-up, spontaneous closure of defect occurred in 68(85%) neonates with congenital cardiac defects. On comparison, PDA was significantly more common in neonates of diabetic mothers on metformin (p <0.05). Conclusion: Neonates born to diabetic mothers had a high frequency of cardiac abnormalities (74%). The risk of cardiac anomalies was significantly high in neonates born to females with GDM who were treated with metformin alone.
Hepatoprotective role of Silybum Marianum against Azithromycin-Induced Histological and Biochemical Changes in Albino Wistar Rats
Objective: To observe the harmful effects of azithromycin on the liver of albino Wistar rats and analyze the protective effect of silybum marianum against azithromycin-induced histological and biochemical changes in their liver. Methodology: This experimental study was conducted at the Baqai Medical University, Karachi from December 2023 to March 2024. After ethical approval, 30 male albino Wistar rats were categorized into three groups with 10 rats each. Group A was kept as a control, group B was given azithromycin 200 mg/kg/day for 7 days orally, group C received azithromycin 200 mg/kg/day for 7 days, and silybum marianum (seed extract) 100 mg/kg/day for 21 days orally. After the experiment, all the rats were sacrificed and 3 ml blood was drawn out by cardiac puncture for estimation of liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST) & alkaline phosphatase (ALP) and superoxide dismutase (SOD). The liver of the sacrificed rats was removed and stained with hematoxylin and eosin (H&E). Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Results: The mean levels of liver enzymes were significantly raised and SOD levels were significantly reduced in group B as compared to group A and C rats. The liver parenchyma of group B rats exhibited significant histopathological changes such as inflammation, hemorrhage, and steatosis, whereas, all group A and most of the group C rats showed no histopathological changes with statistical significance. Conclusion: Azithromycin-treated rats showed significant biochemical and histopathological changes in the liver parenchyma as compared to control group rats. In azithromycin and silybum marianum-treated rats, the biochemical and histopathological changes were significantly reduced as compared to azithromycin-treated rats alone, indicating the hepatoprotective effects of silybum marianum.
Association of Serum Cortisol, Interleukin-6, and Serotonin with Depression
Objective: To explore the relation between serum cortisol, interleukin-6 (IL-6), and serotonin (5-HT) levels in patients with melancholic depression, atypical depression, and healthy controls. Methodology: This cross-sectional comparative study was conducted from August 2023 to July 2024 at the Combined Military Hospital, Muzaffarabad. After ethical approval of the study, a total of 105 participants were enrolled using a non-probability convenience sampling method, including 35 healthy individuals, 35 with melancholic depression, and 35 with atypical depression. Serum levels of cortisol, IL-6, and serotonin were measured using enzyme-linked immunosorbent assay. The Statistical Package for the Social Sciences (SPSS) version 25 was used to analyze the data and determine associations between these biomarkers across different depression groups. Results: Elevated serum IL-6 levels were found in both depression groups compared to healthy controls (p <0.001). Serum cortisol levels were significantly higher in both depression groups as compared to controls, with a notable difference between the two depression types (p <0.001). Serum serotonin levels were lower in both depression groups as compared to controls with no significant variation between melancholic and atypical depression (p <0.001). Positive correlations were observed between serum IL-6 and cortisol (p =0.001; r=0.629) in melancholic depression, while IL-6 exhibited a negative correlation with serotonin (p =0.014; r= -0.411) in atypical depression. Serum cortisol also displayed a negative correlation with serotonin in melancholic depression but the results were statistically insignificant (r=-0.33, p= 0.05). Conclusion: This study revealed elevated cortisol & interleukin-6 levels and decreased serotonin levels in depression groups as compared to healthy controls. The melancholic & atypical depression subtypes did not significantly differ for interleukin-6 and serotonin levels. However, a significant elevation in serum cortisol levels was observed in patients with melancholic depression versus those with atypical depression.
Diagnostic Accuracy of Alanine Aminotransferase in Intrahepatic Cholestasis of Pregnancy and its Association with Maternal & Fetal/Neonatal Complications
Objective: To estimate the accuracy of alanine aminotransferase (ALT), using bile acid levels as the gold standard in the diagnosis of intrahepatic cholestasis of pregnancy (ICP) and to assess the maternal & fetal/neonatal complications between ICP cases and healthy pregnant females as well as cases with high and very high ALT levels. Methodology: After approval from the ethical committee, this cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Mohi-ud-Din Islamic Medical College, Mirpur during six months from September 2024 to February 2025. Using non-probability convenience sampling, 2500 pregnant women were included after taking their informed consent. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of ALT were evaluated using bile acid levels as a gold standard. The frequencies of maternal and fetal/neonatal complications were compared between cases of ICP and healthy pregnant females and cases with high ALT (41-100 IU/L) and very high ALT levels (>100 IU/L). Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: The frequency of ICP was 2.4%. Serum ALT has a sensitivity of 83.3%, specificity of 99%, and diagnostic accuracy of 98.6%. A receiver operating characteristic (ROC) curve showed an area under the curve of 0.911 indicating excellent diagnostic accuracy. Preterm delivery, induction of labor, low birth weight, and respiratory distress were more significant in patients with ALT levels >100 IU/L. Conclusion: Serum ALT is a reliable marker for the diagnosis of ICP with high sensitivity, specificity, and diagnostic accuracy. The maternal and fetal/neonatal complications were significantly higher in patients with ICP particularly those with very high ALT levels.
Comparison of Soft Tissue Healing in Immediate Implant Placement in Fresh Extraction Socket with and without the Use of Platelet-Rich Fibrin
Objective: To compare soft tissue healing in immediate implant placement in fresh extraction socket with and without the use of platelet-rich fibrin (PRF) by evaluating cover screw exposure on 7th post-operative day and pink esthetic score on 3rd and 6th post-operative month. Methodology: This quasi-experimental study was conducted at the Department of Oral & Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi over 10 months from June 2022 to March 2023 after ethical approval. Total 60 patients aged 18-60 years with maxillary or mandibular teeth indicated for extraction without active infection and with adequate gingival architecture and bone volume were included. Thirty participants were included in intervention and control groups. Written informed consent and demographic details were acquired from patients and recorded. Participants were non-randomly allocated via non-probability convenience sampling to receive immediate implant placement with or without PRF based on the availability of intervention material and clinical scheduling. Follow-up evaluations were done on the 7th post-operative day for presence or absence of cover screw exposure and at 3 and 6 months for mean pink esthetic scores (PES). Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Results: The mean age of the participants was 37.97±13.37 years. The sample consisted of 27(45%) males and 33(55%) females. Among the PRF intervention group (n=30), 4(13.3%) had cover screw exposure on the 7th post-operative day, while 26(86.7%) did not. While for the control group, the presence and absence of cover screw exposure was 15(50%). Participants who received PRF treatment demonstrated significantly higher mean PES scores at both the 3rd month (11.73±1.143) and the 6th month (10.93±0.907), compared to 9.17±0.747 and 8.90-/+0.845, respectively, in those without PRF. A statistically significant difference between the mean PES of the groups (p <0.001) was observed between study groups. Conclusion: The mean PES of the intervention (PRF) group in post extraction immediate implant placement was significantly higher than the control group at 3rd & 6th month follow-up, indicating better soft tissue healing with PRF use. Platelet-rich fibrin-treated group also demonstrated significantly lesser occurrence of cover screw exposure on 7th post-operative day highlighting the beneficial impacts of PRF adjunct in immediate implant placement.
Outcomes of Percutaneous Coronary Intervention in Chronic Total Occlusion among Women
Objective: To determine the outcomes in female patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion. Methodology: This longitudinal descriptive study was conducted at the Department of Cardiology, Fauji Foundation Hospital, Rawalpindi from July 2024 to March 2025 after taking approval from the ethical committee. A total of 56 female patients with a diagnosed chronic total occlusion (CTO) who had persistent angina symptoms despite optimal medical therapy were included using non-probability convenience sampling. All these patients were eligible to undergo CTO-PCI with normal kidney function and gave informed consent. The patients underwent CTO-PCI by interventional cardiologists. All the patients had a monthly follow-up for 3 months post-procedure. The outcomes assessed were rate of procedural success, in-hospital major adverse cardiovascular events (MACE) and cardiac mortality & symptom-free at 3 months. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: The procedural success rate was found in 37(66.1%) patients. In-hospital MACE occurred in 5(8.9%) patients. Two (3.6%) patients died whereas, 40(71.4%) patients were symptom-free at 3 months. In-hospital MACE was significantly less in the successful CTO-PCI group (p-value=0.04) and the majority [34(94.4%)] of the patients in the successful CTO-PCI group were symptom-free at 3 months (p-value=0.001). However, there was no significant difference in mortality at 3 months between the two groups with a p-value of 0.53. The procedural failure was significantly associated with the elderly age group >60 years (p-value=0.02) and diabetes mellitus (p-value=0.004). Conclusion: The CTO-PCI has a procedural success rate of 66.1% and the majority of the patients were symptom-free after the procedure. The statistically significant outcomes were reduction in the frequency of in-hospital MACE and symptom-free at 3 months in the successful CTO-PCI group. The procedural failure was significantly associated with the elderly age group and diabetes mellitus.
Maternal Malnutrition: Burden on Maternal and Neonatal Health in Pakistan
Maternal malnutrition is a major public health concern in Pakistan, contributing to adverse pregnancy outcomes, increased maternal and neonatal mortality, and long-term health issues in children. It includes undernutrition, overweight and obesity, and micronutrient deficiencies, with a significant proportion of women of reproductive age affected due to poverty, food insecurity, low education, and inadequate antenatal care. Poor maternal nutrition is strongly associated with low birth weight, preterm birth, and intrauterine growth restriction, creating a cycle of poor health and reduced human capital. Addressing this challenge requires integrated strategies including nutritional education and supplementation, strengthened antenatal services, community engagement, effective policy implementation, and ongoing research. Expanding national initiatives such as the Aaghosh program can help reduce regional disparities and support Pakistan’s progress toward achieving maternal and neonatal health targets under the Sustainable Development Goals.
Ticagrelor versus Clopidogrel in Complex Percutaneous Coronary Intervention in terms of Mortality and Stent Thrombosis
Objective: To compare the effects of ticagrelor and clopidogrel on major adverse cardiovascular events (MACE), 30 day mortality, and stent thrombosis in patients with ST-elevation myocardial infarction (STEMI) undergoing complex percutaneous coronary intervention (PCI). Methodology: This quasi-experimental study was conducted at the Rawalpindi Institute of Cardiology, Rawalpindi in 3 months from June to August 2025 after ethical approval. After obtaining informed written consent, 376 patients with STEMI treated with complex PCI were included by non-probability convenience sampling technique. The patients were assigned to two groups: Group A received aspirin & clopidogrel, whereas group B received aspirin and ticagrelor. The outcomes assessed were MACE, 30 day mortality, and stent thrombosis. Follow-up was done till 1 month. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Bifurcation stenting was present in 80(42.6%) patients in clopidogrel group, while it was seen in 46(24.5%) patients in ticagrelor group. The left main PCI was also more prevalent in the ticagrelor group [81(43.1%)]. The thrombolysis in myocardial infarction (TIMI) 3 flow was restored in 53.7% versus 30.3% of the patients taking ticagrelor and clopidogrel, respectively. Stent thrombosis and MACE were significantly higher in the clopidogrel group (8.5% versus 2.7%) and (19.1% versus 11.2%), respectively. In contrast, no substantial difference was noted regarding 30 day mortality (9% vs. 8%) between the two groups. Conclusion: Ticagrelor is associated with improved post-PCI TIMI flow, lower incidence of MACE and stent thrombosis in STEMI patients who underwent complex PCI as compared to clopidogrel. However, 30 day mortality is not significantly different in the two groups.
Early Clinical Exposure through Modular Curriculum in Undergraduate Medical Students: Student Experiences
Objective: To explore experiences and perceptions of early clinical exposure (ECE) in undergraduate medical students under a modular curriculum through a mixed-methods approach. Methodology: This cross-sectional mixed-methods study was conducted at Rashid Latif Khan University Medical College, Lahore from July to September 2025, following a recently introduced modular curriculum after ethical approval. The participants were second-year MBBS students who had completed at least one year of learning under the modular system with early clinical exposure components. After obtaining written, informed consent, 100 students were included using non-probability convenience sampling technique. Quantitative data was collected through a structured questionnaire using 5-point Likert scale assessing integration of basic and clinical sciences, motivation to learn, communication with patients, and overall satisfaction. Qualitative perceptions were obtained through focus group discussions (FGDs), transcribed verbatim and analyzed thematically using NVivo software. Quantitative data was analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Results: The majority of the students were of the opinion that ECE resulted in enhanced incorporation of basic and clinical sciences (mean Likert score 4.3/5), it also improved the motivation to learn (4.5/5), and better-quality communication skills with patients (4.2/5). Qualitative data analysis with thematic analysis discovered four major themes, i.e. (1) Linking theory and practice; students recognized the significance of learning in a specific context (2) Motivation through realistic exposure - clinical learning environment stimulated them for enhanced learning (3) Professionalism and communication - students felt an improvement in their self-confidence, communication skills and empathy with the patients; and (4) Challenges and barriers - despite major positive outcomes overcrowding, lack of time, and inconsistent faculty input posed difficulties. Conclusion: The majority of the students perceived early clinical exposure within modular curricula positively. It enhanced students' motivation, understanding, and communication skills. Fixing the logistical and faculty training challenges can maximize the impact.
Association of Radial Artery Diameter with Radial Artery Spasm in Patients Undergoing Transradial Cardiac Catheterization
Objective: To assess the association of radial artery spasm (RAS) with radial artery diameter and other factors in patients undergoing transradial cardiac catheterization. Methodology: This descriptive, cross-sectional study was conducted at the Fauji Foundation Hospital, Rawalpindi from June to September 2025 after ethical approval. After taking informed written consent, 150 patients who underwent coronary angiography or percutaneous coronary intervention using transradial approach were included. Prior to the procedure, radial artery diameter was assessed by the linear probe of Xario 100g Ultrasound machine. Radial artery spasm was assessed clinically by the operator and radial artery angiograms. Patients were divided into two groups: group I with no RAS and group II with RAS. The association of RAS with the radial artery diameter and other variables were determined. Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. Results: Radial artery spasm occurred in 35(23.3%) patients. The time to vascular access was significantly higher (150.60±49.77 seconds) in patients with RAS as compared to those without spasm (43.69±29.61 seconds) (p=0.001). The number of procedure attempts, episodes of vasovagal syncope (3.3% versus 0%) and access site crossover (6% versus 0%) were also significantly higher in patients with RAS. The radial artery spasm had a significant positive association with radial artery diameter, ejection fraction, angiographic findings, and treatment plan. The ROC curve showed an area under the curve of 0.876, showing the excellent ability of radial artery diameter to predict RAS. Conclusion: Radial artery spasm affects a significant proportion of patients (23.3%) undergoing transradial cardiac catheterization. The radial artery diameter, vascular access time, need for ultrasound assistance to secure vascular assistance, additional vasodilator & glide wire, vasovagal syncope, and access site crossover were significantly higher in patients with RAS.
Comparison of Effectiveness between Diclofenac Suppositories and Injection Diclofenac in Abdominal Surgeries
Objective: To compare the effectiveness of diclofenac suppositories and injection diclofenac in pain relief after abdominal surgeries. Methodology: This quasi-experimental study was conducted at the West Surgical Ward, Mayo Hospital, Lahore from June 2022 to January 2023 after taking approval from ethical committee. Total 136 patients undergoing elective and emergency abdominal surgeries were enrolled in the study via non-probability convenience sampling technique. Informed written consent was taken from all the patients. The patients were divided into two groups (group A & B). Group A was given diclofenac suppositories and group B was given injection diclofenac via the intramuscular (I/M) route. The pain scores were recorded by using visual analogue scale (VAS) at 0, 8, 16, and 24 hours. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Results: There was a significant decrease in mean pain scores at 0, 8, 16, and 24 hours post-operatively in group A as compared to group B. The maximum difference in the means was observed at 16 hours post-operatively (p <0.001). Only 15(11.1%) patients in group A required rescue analgesia, while more than half the patients in group B required rescue analgesia for effective pain relief (p=0.001). The proportion of patients experiencing adverse effects of the drug in group A was significantly smaller (8.1%) as compared to group B (25.7%) (p=0.001). Conclusion: Rectal suppositories of diclofenac were significantly more effective for post-operative pain relief among patients undergoing abdominal surgeries as compared to diclofenac intramuscular injection.
Diagnostic Accuracy of Retrograde Urethrogram in Determination of Urethral Stricture taking Cystoscopy as Gold Standard
Objective: To assess the diagnostic accuracy of retrograde urethrogram in determination of urethral strictures taking cystoscopy as the gold standard. Methodology: This cross-sectional study was conducted at the Department of Radiology, Sharif Medical & Dental College, Lahore from May to October 2024. After ethical approval and written informed consent, 189 patients meeting the inclusion criteria were recruited through non-probability convenience sampling technique. These patients underwent retrograde urethrogram (RUG) with contrast injection, followed by cystoscopy 4-5 days later. Demographic details and history of risk factors were recorded. Radiographic findings were assessed by a radiologist, and patients were classified as positive or negative for urethral strictures. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. A 2x2 table was made and diagnostic accuracy was calculated. Chi-square test was used to compare categorical variables. Results: Retrograde urethrogram detected urethral strictures in 24.3% of cases with a sensitivity of 75.56%, specificity of 91.67%, positive predictive value (PPV) of 73.91%, and negative predictive value (NPV) of 92.31%. The overall diagnostic accuracy of RUG was 87.83%. Age groups, history of urinary tract infections, and prostate surgeries had significant association with the presence/absence of strictures on RUG (p <0.05). Conclusion: The diagnostic accuracy of retrograde urethrogram was high in determination of urethral strictures taking cystoscopy as the gold standard. Urethral strictures were significantly more prevalent among older males with history of urinary tract infections and prostate surgeries.
Intestinal Parasitic Infections among Children and Young Adolescents Visiting Provincial Headquarter Hospital in Gilgit, Pakistan and their Associated Factors
Objective: To detect the frequency and species distribution of intestinal parasites among children and young adolescents visiting a provincial Headquarter Hospital in Gilgit, Pakistan and determine their association with socio-demographic and environmental factors Methodology: This descriptive, cross-sectional study was done among patients visiting the Provincial Headquarter Hospital in Gilgit-Baltistan, Pakistan after ethical approval. The study duration was 6 months from August 2024 to January 2025. After taking informed consent, 227 children and young adolescents with ages ranging from 1 to 18 years were included using non-probability convenience sampling technique. Data was collected using a structured questionnaire including demographic factors, hygiene practices, healthcare access, and other relevant factors. Specimen bottles labeled with participant names and identification numbers were provided to parents and they were guided for stool sample collection. The collected specimens were processed in the Pathology Department of a healthcare facility for stool routine analysis. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Intestinal parasitic infections (IPIs) were present in 74(32.6%) children and young adolescents. Ascaris lumbricoides (46%) and Giardia lamblia (29.7%) were the most prevalent intestinal parasites. Access to clean drinking water and hygienic conditions had a significant relation with IPIs (p-value=0.001). No significant association was seen with other variables such as gender, age, education level, and family income. Conclusion: Intestinal parasitic infections were prevalent in 32.6% children and young adolescents. Ascaris lumbricoides and Giardia lamblia were the most common parasites. There was a statistically significant influence of environmental factors, particularly access to clean drinking water and poor personal hygienic conditions, on the frequency of these infections.
Efficacy of Lacosamide in Patients with Diabetic Neuropathy
Objective: To compare the efficacy of lacosamide versus placebo in patients with diabetic neuropathy in terms of reduction of the mean pain score. Methodology: This randomized controlled trial (RCT) was conducted at the Department of Medicine, Nishtar Hospital, Multan from April to August 2025. After informed written consent, 60 patients with diabetic neuropathy were included and their baseline pain levels at recruitment were assessed using the visual analogue scale (VAS). The patients were enrolled using non-probability convenience sampling technique and subsequently randomized equally through a lottery method. Randomization was used to assign patients to either group A (lacosamide) or group B (placebo). Participants were administered either lacosamide (LCM; brand name atcomid) or a placebo that contained microcrystalline cellulose, which was commercially available and widely used in clinical trials involving diabetics. Both placebo & lacosamide were started at 100 mg daily and escalated to 400 mg/day over four weeks. Both were maintained at 400 mg for 12 weeks. The VAS was used to measure baseline and post-treatment pain scores. The variables of age, gender, duration of diabetes, obesity (body mass index ≥30 kg/m2), and diabetes control were documented. Statistical Package for the Social Sciences (SPSS) version 26 was used for the analysis of the data. Results: The age distribution of the study population was statistically similar in the two groups (46.67±9.66 years vs. 49.30±8.38 years; p=0.264). Majority of the participants were males in both groups (66.7% vs. 56.7%). The baseline VAS values were almost similar across the groups (group A: 7.40±1.96 vs. group B: 6.87±2.01; p=0.31). The lacosamide group showed a notable decrease in post-treatment pain scores as compared to placebo (3.90±1.92 vs. 6.73±1.72; p <0.001). Conclusion: Lacosamide provided a statistically and clinically significant reduction in pain intensity among patients with diabetic neuropathy compared to placebo. The marked decrease in post-treatment VAS scores highlighted its potential as an effective adjunctive option for managing neuropathic pain in this population.
Association of HbA1c Levels with Complexity of Coronary Artery Disease in Diabetic Patients Presenting with Acute Coronary Syndrome
Objective: To determine the association of Hemoglobin A1c (HbA1c) levels with the complexity of coronary artery disease (CAD) in diabetic patients presenting with acute coronary syndrome (ACS), in terms of higher synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score measured during coronary angiography. Methodology: This cross-sectional comparative study was conducted at Fauji Foundation Hospital, Rawalpindi from July to September 2025 after approval from the ethical committee of the institution. Patients were divided into two groups. Those with HbA1c ≤7% were labeled as group 1 and group 2 had patients with HbA1c >7%. After informed written consent, 122 confirmed diabetic patients who presented with ACS and underwent coronary angiography were included using non-probability convenience sampling. The SYNTAX score was estimated to determine angiographic disease complexity. The patients with scores of 0-22 were labeled as low risk, 23-32 as intermediate, and >32 as high-risk CAD. The blood samples of patients were taken and sent for HbA1c levels and fasting lipid profile. Data analysis was carried out with the Statistical Package for the Social Sciences (SPSS) version 26. Results: When CAD risk categories were compared with HbA1c groups, the majority of the patients in group 1 (34.4%) and group 2 (24.6%) had low risk and intermediate risk CAD, respectively. There was a significant and moderate positive correlation (r=0.528) between HbA1c and SYNTAX scores (p-value=0.001). Only the lipid profile showed a significant relationship with CAD risk categories. Conclusion: The majority of patients with HbA1c ≤7% had low-risk CAD, while patients with HbA1c >7% had intermediate-risk CAD. The SYNTAX score significantly increased with increasing HbA1c levels. In addition, the patients with intermediate and high-risk CAD also had dyslipidemia.
Rising Rates of Antimicrobial Resistance: A Slow Crisis Demanding Urgent Action
Antimicrobial resistance is a growing global and national public health crisis that threatens the effectiveness of modern medicine and increases mortality, healthcare costs, and treatment failure. According to global estimates, antimicrobial resistance caused 1.27 million deaths worldwide in 2019, with projections indicating a substantial rise by 2050 if urgent action is not taken. In Pakistan, antimicrobial resistance ranks among the leading causes of death, driven by widespread antibiotic misuse, over-the-counter availability, inadequate diagnostics, poor infection control, and antibiotic use in agriculture. Resistant pathogens such as Mycobacterium tuberculosis, Staphylococcus aureus, and Enterobacterales are increasingly common, leading to prolonged hospital stays, limited treatment options, and higher mortality. Addressing this challenge requires a coordinated One Health approach that strengthens surveillance, promotes antimicrobial stewardship, improves diagnostic capacity, enforces infection prevention measures, and supports antibiotic innovation. Immediate collective action by healthcare providers, policymakers, and communities is essential to preserve antibiotic effectiveness and prevent a future where common infections become life-threatening.
Effect of Internal Limiting Membrane Peeling on Functional and Structural Outcome of Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment
Objective: The purpose of this study was to evaluate the effect of internal limiting membrane peeling on visual acuity and structural macular surface anatomy in patients with rhegmatogenous retinal detachment. Methodology: A total of 20 patients divided in 2 equal Groups A and B comprising of 10 patients each were included in this study. All patients had rhegmatogenous retinal detachment of less than one month duration with minimal or no proliferative retinopathy. Both Groups A and B underwent pars plana vitrectomy and silicone oil / gas tamponade with Group A also undergoing internal limiting membrane peeling as an adjunct to surgery. A minimum of 6 months followup was planned for both groups to evaluate and compare the effect of internal limiting membrane peeling on visual acuity and epiretinal membrane formation at end of 6 months. Results: At the end of 6 months followup, there was statistically significant difference in pre and post operative visual acuity in both the groups (p-value <0.001). But there was no difference in post operative visual acuity in both groups when evaluated for the effect of internal limiting membrane peeling (p-value=0.27). Also, the frequency of epiretinal membrane formation in Group A was significantly less when compared to group B. Conclusion: We did not find ILM peeling as a useful adjunct to retinal reattachment surgery for improving post operative best corrected visual acuity. Although internal limiting membrane peeling had statistically significant results in preventing post operative epiretinal membrane formation. Internal limiting membrane peeling should be reserved for those cases only where epiretinal membrane already exists before retinal reattachment surgery.
Proliferative vitreoretinopathy retinopathy
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