Annals of Punjab Medical College

Physiological and Nutritional Determinants of Stunted Odontogenesis: Associations with Parathyroid Hormone, Calcium, and Weaning Practices in a Community-Based Study

2026-01-20T18:33:57+00:00

Background: Stunted odontogenesis in children has been linked to disturbances in mineral metabolism, nutrition, and hormonal regulation. Objective: This study investigated the relationship between parathyroid hormone (PTH), serum calcium, and related biochemical parameters with stunted odontogenesis in children, with a special focus on the impact of weaning age. Study Design: Cross-sectional study. Settings: Dental outpatient department (OPD) and pediatric clinics of the Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan. Duration: July 1, 2024, to December 31, 2024. Methods: Among 250 children attending dental outpatient and pediatric clinics. BMI and MUAC assessed nutritional status. Serum calcium, PTH, vitamin D, Magnesium, and other biochemical markers were measured. Participants were grouped by weaning age (6 months, 1 year, and 2 years) to explore differences in biochemical parameters. Results: This study population exhibited a lower-normal mean BMI (17.39 ± 2.89 kg/m²) and MUAC (14.91 ± 3.90 cm). Children weaned at 1 year had higher mean serum calcium (8.58 ± 1.01 mg/dL) and Magnesium (1.81 ± 0.32 mg/dL) compared to those weaned earlier or later. Statistically significant differences were found among the weaning groups for PTH (p = 0.048), Magnesium (p = 0.038), calcitonin (p = 0.001), and folic acid (p = 0.004). A moderate male predominance (60.4%) was noted, reflecting local healthcare utilization patterns. Conclusion: The findings highlight a critical interplay between disturbances in the calcium, vitamin D–PTH axis and stunted odontogenesis. Severe vitamin D deficiency and hypocalcemia likely contribute to the defective mineralization of enamel and dentine. At the same time, the timing of weaning appears to modulate levels of mineral-regulating hormones and micronutrients essential for normal dental development.

Laparoscopic Posterior Mesh Rectopexy Vs Laparoscopic Suture Rectopexy for Complete Rectal Prolapse: A Randomized Controlled Trial

2026-01-20T18:33:53+00:00

Background: Complete rectal prolapse refers to the full-thickness extension of the rectal wall through the anus and is more prevalent in older adults, particularly women. Treatment primarily includes surgical correction, and there is still a discussion regarding the most effective one. Objective: This paper compares two laparoscopic methods, including laparoscopic posterior mesh rectopexy (LPMR) and laparoscopic posterior suture rectopexy (LPSR), in terms of recurrence rates and bowel functioning outcomes. Study Design: Randomized controlled trial. Settings: Department of Surgery, Khyber Teaching Hospital, Peshawar Pakistan. Duration: two years from December 2023 to November 2025. Methods: A total of seventy-seven patients were selected who had complete rectal prolapse at random to receive either LPMR or LPSR. Outcomes were recurrence, postoperative constipation scores, and fecal incontinence severity index (FISI) at 30 and 60 days in the postoperative period. Results: Both groups were demographically similar. The LPMR group had significantly lower recurrence rates (p = 0.004), shorter operative time (p < 0.001), and improved bowel function, demonstrated by lower constipation (p < 0.001) and FISI scores (p = 0.001). No significant differences were observed in postoperative pain, hospital stay, or intraoperative blood loss. Conclusion: LPMR appears to offer superior outcomes over LPSR in reducing prolapse recurrence and improving bowel function. Long-term follow-up is recommended to assess the durability and safety of mesh use.

Escalating Risk of Rising Antimicrobial Resistance among UroPathogens: A Retrospective Study from a Tertiary Care Hospital in Lahore

2026-01-20T18:34:00+00:00

Background: Urinary tract infections are common and increasingly complicated by antimicrobial-resistant uropathogens. Monitoring local resistance patterns is essential to guide effective treatment and limit the spread of resistance. Objective: To ascertain the frequency of uropathogens and their antimicrobial susceptibility pattern. Study Design: Retrospective study. Settings: Department of Microbiology at Shalimar Hospital, Lahore Pakistan. Duration: January 2024 to June 2024. Methods: Midstream urine samples were collected from patients who had symptomatic urinary tract infections. Culture and identification of isolates were done as per standard microbiology procedures. Antibiotic susceptibility was performed according to Clinical and Laboratory Standards Institute guidelines 2024. All Information was obtained from the hospital information management system. Results: A total of 349 urine samples were received for culture. Only 146 samples yielded the growth of uropathogens. Escherichia coli was the most commonly isolated microorganism, 65.7% (96/146), followed by Enterococcus spp, 12.3% (18/146). A low level of resistance has been observed for E. coli against meropenem (10%), nitrofurantoin (6%), and Fosfomycin (5%). Conclusion: The continuous surge in antimicrobial resistance among uropathogens is frightening, which highlights the significance of monitoring antibiotic susceptibility trends as a key strategy for implementing antimicrobial stewardship.

Pathological Effects of COVID-19 on Menstrual Cycle: An Exploratory Study

2026-01-20T18:33:52+00:00

Background: COVID-19 is linked to multiple health disruptions, such as menstrual disruptions. The patterns of the cycles may be affected by both infection and vaccination. Objective: The study aimed to investigate the association between COVID-19 infection, vaccination, and menstrual disturbances. Study Design: Cross-sectional study. Settings: Khyber Teaching Hospital, Peshawar Pakistan. Duration: July to December 2021. Methods: 168 female COVID-19 hospitalized patients aged 18-45 years. A questionnaire was used to gather information, which included demographics, details of infection, vaccination history, and menstrual history. The statistical analysis involved descriptive statistical analysis, chi-square, and logistic regression. A p-value of <0.05 was considered statistically significant. Results: Out of 168 individuals, 28.57% had COVID-19, and 71.43% were immunized. Infection-related menstrual abnormalities affected 50% of women, with 28.57% experiencing discomfort. 14.29% stopped or missed periods. 45% of subjects reported cycle length alterations, while 42% reported lengthier cycles. 50% of participants said menstrual abnormalities impaired their quality of life socially and psychologically. Treatment with Tranexamic Acid reduced menstrual change length (p = 0.0019). Tranexamic Acid and OCPs were used to address menstruation issues in 62.5% of subjects. These data suggest that COVID-19 infection and immunization may lead to substantial menstrual abnormalities that can be treated. Conclusion: COVID-19 infection and immunization are associated with menstrual abnormalities, affecting social and psychological well-being. Menstrual care interventions, such as Tranexamic Acid, mitigate these disturbances, underscoring the need for specialized post-COVID care. Additional investigation is required to comprehend the fundamental mechanics.

Post-Dural Puncture Headache after Caesarean Section under Spinal Anesthesia: Local Experience at Liaqat Memorial Hospital, Kohat Pakistan

2026-01-20T18:33:56+00:00

Objective: To assess the incidence and risk factors of Post-Dural Puncture Headache (PDPH) in parturients undergoing caesarean sections under spinal anesthesia. Study Design: Descriptive cross-sectional prospective study. Settings: Department of Medicine, Liaqat Memorial Hospital, Kohat Pakistan. Duration: June to December 2023. Methods: A total of 346 patients were included, with data collected on needle gauge, needle approach, PDPH incidence, Visual Analogue Scale (VAS) scores, and comorbidities. Statistical analysis, including chi-square and t-tests, was used to evaluate the associations between these variables. Results: The results revealed a higher incidence of PDPH in patients who received spinal anesthesia with a 25G Quincke needle (67 cases) compared to those with a 27G Quincke needle (21 cases) on Day 1 (p-value = 0.001). The paramedian approach resulted in fewer cases of PDPH (30 cases) compared to the midline approach (58 cases) (p-value = 0.02). The VAS scores for mild PDPH were significantly lower (mean: 3.2) compared to moderate (mean: 5.6) and severe (mean: 8.2) cases on Day 1. Severe PDPH patients had a higher readmission rate (20 cases) compared to mild (5 cases) and moderate (15 cases) groups (p-value = 0.005). Conclusion: The use of a 27G Quincke needle and the paramedian approach minimizes PDPH. These findings provide valuable insights into the management of spinal anesthesia in secondary care settings and suggest further research into prevention and treatment strategies for PDPH.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction with Bone Patellar Tendon Bone Graft Using Lysholm Score

2026-01-20T18:33:49+00:00

Background: Arthroscopic ACL reconstruction using the "gold standard" Bone-Patellar Tendon-Bone (BPTB) graft is crucial for restoring knee stability. The Lysholm knee scoring scale is a validated global tool for objectively evaluating postoperative functional recovery in these patients. Objective: To evaluate the mean Lysholm score following arthroscopic anterior cruciate ligament (ACL) reconstruction with bone patellar tendon bone (BPTB)graft. Study Design: Descriptive case series. Settings: Department of Orthopedic Surgery at KEMU/Mayo Hospital, Lahore Pakistan. Duration: 06 months (September 2024-January 2025). Methods: The sample had 80 patients. A 95% confidence range, 1% margin of error, and an estimated post-treatment Lysholm score of 85.49±9.0 were used. Non-probability consecutive sampling was utilized. Patients with clinical and arthroscopically verified ACL tears aged 18–70, both genders, were included. Analysis of data using SPSS version 25.0 yielded mean ± S.D. values for BMI and baseline Lysholm score at 3 months. A post-stratification t-test was used, with a significance level of p-value < 0.05. Results: The study has 80 participants. The average age at operation was 28.25 ± 8.32 years. Surgery was conducted 17.5 ± 10.3 weeks post-injury on average. 16 patients had concurrent medial meniscal injuries, while 10 had lateral tears. There were few postoperative problems. Two patients (6.25%) had superficial infections that were treated with oral antibiotics. The most prevalent follow-up symptom was anterior knee pain, reported by eight patients. Lysholm score improved significantly at 3 months. Conclusion: ACL reconstruction using the BPTB graft technique has been shown to produce promising functional outcomes, as evidenced by both objective assessments and patient-reported measures.

Comparison of Stone Clearance in Extracorporeal Shock Wave Lithotripsy versus Micro-Percutaneous Nephrolithotomy in Patients with Small Renal Calculi

2026-01-20T18:34:02+00:00

Background: Renal calculi are a common urological problem, and the choice between minimally invasive options depends mainly on stone size and location. Extracorporeal shock wave lithotripsy (ESWL) and micro-percutaneous nephrolithotomy (Micro-PCNL) are standard treatments for small renal stones, but their comparative efficacy remains uncertain. Objective: To compare stone clearance outcomes of ESWL and Micro-PCNL in patients with small renal calculi. Study Design: Quasi-experimental study. Settings: Department of Urology, Sir Ganga Ram Hospital, in collaboration with Jinnah Hospital, Lahore, Pakistan. Duration: 16th July 2021 to 15th August 2022. Methods: Following ethical approval, 92 patients aged 18–65 years with renal stones <1.5 cm and normal renal anatomy were enrolled through non-probability consecutive sampling and divided equally into ESWL and Micro-PCNL groups (n = 46 each). Stone-free status was assessed by X-ray KUB. Data were analyzed using the Chi-square test, with p < 0.05 considered significant. Results: Mean stone size was 14.5 ± 0.50 mm in the Micro-PCNL group and 11.8 ± 2.64 mm in the ESWL group. Stone-free rates were 63% and 65.2%, respectively (p = 0.82). However, for stones >13 mm, Micro-PCNL achieved significantly higher clearance (63%) compared to ESWL (29.4%) (p = 0.018). Conclusion: Both ESWL and Micro-PCNL are effective for small renal stones, with no significant difference in overall clearance rates. Micro-PCNL, however, provides better outcomes for stones larger than 13 mm, making it a more suitable choice for slightly larger calculi within the small-stone category.

The Outcome of Using the Modified Mini-Peer Assessment Tool (mini-PAT) on the Performance of Demonstrators Working at a Public Sector Medical College of Punjab

2026-01-20T18:33:55+00:00

Background: The non-standardization in the existing assessment methods of healthcare workers highlights the need to develop a modified methodology that can assess healthcare professionals working in public/private sector medical colleges based solely on their professional development. Objective: To assess the performance of demonstrators by using a modified mini-PAT at a public sector medical college. Study Design: Quasi experimental study. Settings: Department of Medical Education, Sahiwal Medical College, Sahiwal, Pakistan. Duration: July,2024 to December,2024. Methods: After obtaining approval from the institutional ethical review board and informed consent from the participants, we conducted a quasi-experimental study from July 2024 to December 2024 at Sahiwal Medical College, Sahiwal. After the first round of using mini-PAT on a total of 54 demonstrators, results were collated, and feedback sessions were carried out. We then conducted the second round of assessment using mini-PAT and compared the results with those of the first round through statistical analysis using IBM SPSS version 26. Results: A total of fifty-four (54) demonstrators (42.6% males and 57.4% females) were evaluated through the modified mini-PAT via pre- and post-assessment questionnaires. Both pre- and post-mini-PAT forms were compared through the Related samples Wilcoxon Signed Rank Test, and a significant increase in mean values of the scores from 15.00±2.00 to 23.5±3.00 was obtained (p value=0.000). Conclusion: A noticeable variation between pre-feedback and post-feedback mean assessment scores was noted, which gave us the idea regarding the abilities and deficiencies of the demonstrators, their workplace relations with other coworkers, including their teaching and training practices. Educational bodies can also use this tool as a method for assessing professional behaviors.

Effect of Iodine Povidone Mouthwash on the Periodontal Health of Orthodontic Patients

2026-01-20T18:33:56+00:00

Objective: To evaluate the effect of iodine povidone mouthwash on periodontal health in orthodontic patients. Study Design: Quasi-experimental pre-post study. Place and Duration of Study: Department of Orthodontics, Allied Hospital, Faisalabad, over a period of four weeks. Methodology: A total of 34 orthodontic patients with fixed appliances were assessed. Orthodontic Plaque Index (OPI) and Gingival Index (GI) were recorded before and after 4 weeks of using iodine povidone mouthwash twice daily. A paired t-test was applied for statistical analysis. Results: A statistically significant reduction was observed in both OPI (from 1.93 ± 0.45 to 1.52 ± 0.46, p = 0.0001) and GI (from 1.48 ± 0.40 to 1.21 ± 0.38, p = 0.008). Conclusion: Iodine povidone mouthwash significantly improves periodontal health in orthodontic patients with fixed appliances.

Frequency of Urinary Tract Infections among the Patients of Type-II Diabetes Mellitus taking Sodium-Glucose Co-Transporter-2 inhibitors(SGLT-2 inhibitor), Attending the Out-Patient Department, Government General Hospital, Samanabad, Faisalabad.

2026-01-20T18:33:54+00:00

Abstract:

Introduction: Sodium Glucose Co-Transporter-2 (SGLT-2) inhibitors are group of medications that are frequently used to treat Type-II Diabetes mellitus. Their primary mechanism of action is to inhibit Sodium Glucose Co-transporter 2 Protein, located in Proximal convoluted tubules, the main function of which is to reabsorb glucose from PCT into blood stream. The inhibition of SGLT-2 proteins results in loss of glucose through urine, hence control the blood glucose levels. Due to their cardio protective and renal protective profile, these agents are widely used these days for the treatment of Diabetes mellitus especially in the patients of cardiac and renal failure. But because of their glycosuric effect, these drugs have documented side effects of recurrent urinary tract infections and normoglycemic Diabetic Ketoacidosis. Objective: To assess the frequency of Urinary Tract infections among the patients of Type-II Diabetes Mellitus taking SGLT-2 inhibitors, attending the Out-Patient Department, Government General Hospital, Samanabad, Faisalabad. Material and Method: Study design: Cross-sectional descriptive study Sampling technique: Non-probability consecutive sampling. Setting: Out-patient Department, Government General Hospital, Samanabad, Faisalabad. Duration: 06 months i.e. 12-01-2025 to 12-07-2025. Sample size: 138. Procedure: 138 patients were enrolled on the basis of inclusive and exclusive criteria. After the commencement of SGLT-2 inhibitors in the first month of study, patients were observed to see whether they develop urinary tract infections or not. Diagnosis of urinary tract infections was made on the basis of signs/symptoms and on urine complete examination. Data regarding age, gender, Hba1c levels and presence of signs/symptoms of urinary tract infection was recorded. Frequency and percentages were calculated and data was analysed using the chi-square test. p-value of <0.05 was statistically significant.

Results: Out of 138 patients, only 11 patients reported to have Urinary Tract Infections (7.97%). Out of 11 patients, 10 were female and only one was male.

Key words: Sodium-GlucoseCo-Transporter-2 inhibitors, Urinary tract Infections, Diabetes Mellitus

EFFICACY OF TOPICAL VORICONAZOLE 1 % AS COMPARED TO TOPICAL NATAMYCIN 5% IN THE TREATMENT OF FUNGAL KERATITIS

2026-01-20T18:33:48+00:00

Background: Infectious keratitis is a leading cause of monocular blindness worldwide. In some settings, as many as 50% of all corneal ulcers are due to fungal infection. Various centers have reported that an increasing proportion of infectious keratitis is caused by fungus. Treatment of fungal keratitis is generally more difficult than that of bacterial ulcers, and resulting visual impairment is, on average, more severe.

Methods: After taking approval from Hospital Ethical Review Committee, patients coming through Eye OPD who fulfill the inclusion criteria were enrolled 120 patients were included in the study. Group A patients having fungal keratitis were treated with topical Voriconazole 1% while Group B patients having fungal keratitis were treated with topical Natamycin 5%. Best corrected visual acuity, scar size and pain perception was assessed at the time of procedure and after 1 and 3 months of procedure. Follow up was done by taking patient’s contact number and all the information was recorded on performa.

Results: Independent sample t test comparison suggests that topical Voriconazole is more effective in improving BCVA in fungal keratitis patients when compared to topical Natamycin.(p<0.05) Mean ulcer scar size in Group A at 0,1 and 3 months post treatment was 5.035±0.460, 3.506±0.121 and 2.990±0.310 mm respectively as compared to 5.051±0.450, 4.143±0.244 and 3.518±0.12 mm respectively in Group B (p<0.05). Mean modified pain perception score at 0 and 3 months post treatment in Group A was 4.416±0.497 and 4.483±0.536 respectively versus 1.283±0.454 and 1.483±0.503 respectively in Group B with statistically significant p-value (p<0.05).

Conclusion: Topical 1% Voriconazole was found to be superior than 5% Natamycin in terms of clinical outcomes such as best corrected visual acuity, ulcer scar size improvement and pain perception in the treatment of fungal keratitis in patients presenting to Eye OPD.

AWARENESS AND PERCEPTION OF AI AMONG MEDICAL STUDENTS OF DISTRICT SWAT: A CROSS-SECTIONAL STUDY

2026-01-20T18:34:00+00:00

Abstract:

Objective: To evaluate the awareness, perception, and concerns regarding Artificial Intelligence (AI) among medical students in District Swat, Pakistan.

Study Design: A cross-sectional survey.

Setting: Medical students from Saidu Medical College and Swat Medical College in District Swat, Pakistan.
Duration: From 10 January to 10 March 2025
Methods: A cross-sectional survey was conducted among 252 medical students from three institutions in Swat. A structured questionnaire assessed their AI awareness, understanding, perceived benefits, and associated concerns. Data were analyzed using SPSS for descriptive statistics, regression, and ANOVA tests.

Results: The majority of students (95.3%) were having prior awareness about AI, the awareness level was 28% (high), 33% (moderate), 39% (low) though their understanding of AI research methods was moderate (M=2.99, SD=1.01). Most students believed AI would improve healthcare (M=3.75, SD=0.95) and supported AI education in medical curricula (M=3.69, SD=0.99). Diagnosis (32.3%) and surgery (21.1%) were identified as the most impacted areas. Concerns about AI replacing physicians were low (M=2.69, SD=1.18), though apprehensions about AI-assisted errors persisted (M=3.27, SD=1.2). ANOVA analysis showed no significant correlation between AI awareness and concerns about AI errors (p=0.585).

Conclusion: Medical students in Swat acknowledge AI’s role in medicine and express a strong interest in learning more about it. While they recognize AI’s benefits in enhancing healthcare efficiency, concerns about AI-related risks remain. The findings highlight the need for AI-focused education in medical curricula to prepare future doctors for AI-integrated healthcare.

Keywords: Artificial Intelligence (AI), Medical Students, Awareness, Perception

The Proximal Migration of Plastibell Ring In Appropriate-Size Plastibell Circumcision Vs One-Size-Smaller Plastibell Circumcision

2026-01-20T18:34:01+00:00

Background: Circumcision is the oldest known and commonly performed surgery in various communities worldwide, and plastibell circumcision remains the most commonly performed procedure now a days. However, the plastibell method is not without controversies.

Aims: This study aims to see the impact of size of the plastibell in proximal migration of the ring, performed with an appropriate-size plastibell device versus a one-size-smaller plastibell device.

Methods: A prospective comparative study was conducted at the Surgery and Urology Departments of Fauji Foundation Hospital, Lahore for a period of 11 months (February 2024 to December 2024) after approval from the Ethical Review Committee (FFH/STATE/FIL/20). Male neonates and infants up to 6 months of age were enrolled and divided into two groups: Group A with appropriate-size plastibell circumcision and Group B with one-size-smaller plastibell circumcision. Patients were followed up for 1 week. Statistical analysis of data was performed by using SPSS Version 23. P-value was considered a significant difference at <0.05.

Results: 209 patients were included in this study. Proximal migration of bell was noted in total 12 cases, out of which 10 cases were in appropriate-sized plastibell group (Group A) and 2 cases were in one-size-smaller plastibell group (Group B). Bleeding was noted in total 6 cases, out of which 4 cases were in appropriate-size plastibell group (Group-A) and 2 cases were in one-size smaller plastibell group (Group-B). Number of days taken for the spontaneous fall of the bell was more in one-size-smaller plastibell group (Group-B) compared to appropriate-size plastibell group (Group-A).

Conclusion: This study demonstrates that one-size-smaller plastibell device is safer compared to appropriate-size plastibell device regarding bell impaction.

Decoding dental dreams: Exploring Specialty Choices Among Pakistani Dental Students

2026-01-20T18:33:59+00:00

Background: The field of Dentistry is a rapidly expanding field with development of various specialties. Various factors impact the choice of that field and understanding and modifying those factors will help with the advancement of field.

Objective: To understand the causes behind the choice made by dental students regarding their career.

Study Design: Cross sectional descriptive study

Sampling technique: Consecutive purposive sampling

Settings: Various dental colleges of public and private sector

Duration: 6 months after ethical approval

Results: Oral and maxillofacial surgery was the preferred field while public health and basic sciences were the least preferred fields among young dentists.

Conclusion: authorities must pay attention to the less preferred fields of specialties to avoid any disparity.

Keywords: Specialty, Dental Graduates, Career in dentistry

A Randomized Controlled Trial of Probiotic Supplementation in Antibiotic Associated Diarrhea

2026-01-20T18:33:58+00:00

Background

Bacterial infections are said to be a cause of deaths in approximately 525,000 children annually as estimated by WHO^.Antibiotic therapy, while essential for treating infections, can disrupt this delicate balance by reducing beneficial bacterial populations and allowing opportunistic pathogens to proliferate. The risk of antibiotic-associated diarrhea (AAD) is elevated by this dysbiosis. Therefore, the current study examines the effectiveness of probiotic therapy in young AAD patients.

Methods

This multicenter single blinded randomized controlled trial was conducted at Isra University Hospital Hyderabad from April 2021 to July 2024. A total of 208 participants with age between 6-12 years were recruited and randomly allocated into two groups; i.e. probiotics and placebo using computer based random sequence generation. AAD was the main outcome measure, and it was evaluated using a Bristol Stool Form Scale (BSFS) score of 5-7 per day in a 24-hour period. The data was analyzed on SPSS. Relative risk was assessed for the outcome.

Results

Antibiotic-associated diarrhea occurred in 13.6% of participants in the probiotic group and 17.1% in the placebo group, with a relative risk (RR) of 0.71 (95% CI: 0.39–1.22). Severe AAD was reported in 10.4% of the probiotic group and 11.3% of the placebo group (RR: 0.83, 95% CI: 0.51–1.69). Meanwhile, the incidence of mild AAD was similar between the groups, at 24.3% and 23.5%, respectively (RR: 1.01, 95% CI: 0.6–1.41).

Conclusion

The findings suggest that while probiotics may contribute to a modest reduction in the incidence and severity of antibiotic-associated diarrhea, their effect is not statistically significant.

Early Detection of Pulmonary Fibrosis: Biomarkers and Imaging Techniques

2026-01-20T18:33:51+00:00

Early Detection of Pulmonary Fibrosis: Biomarkers and Imaging Techniques

Abstract

Objective: To assess the diagnostic value of biomarkers (KL-6, SP-A, SP-D, MUC5B, and telomere length) and High-Resolution Computed Tomography (HRCT) imaging for distinguishing pulmonary fibrosis from healthy controls.

Methodology: A retrospective cohort study was conducted at Saido Teaching Hospital Swat from June 2024 to June 2025. The study included 150 patients, with 75 diagnosed with pulmonary fibrosis and 75 healthy controls. Biomarkers were measured, and HRCT imaging was performed for all participants. Statistical analysis included t-tests for continuous variables and chi-square tests for categorical variables, with p-values of less than 0.001 considered significant.

Results: The study revealed significant differences in biomarkers between the fibrosis and control groups. KL-6 (240 ± 45 vs. 120 ± 35), SP-A (95 ± 15 vs. 45 ± 10), SP-D (60 ± 25 vs. 35 ± 20), MUC5B (70 ± 30 vs. 40 ± 15), and telomere length (12000 ± 2500 vs. 8000 ± 2000) showed p-values of less than 0.001. HRCT scans demonstrated distinct fibrotic patterns in the fibrosis group, with honeycombing (50.67%) and reticular patterns (28%).

Conclusion: Biomarkers and HRCT imaging are effective tools for the early detection of pulmonary fibrosis. These findings support their use in clinical practice to diagnose and monitor disease progression, particularly in resource-limited settings. Future research should focus on larger, multicentre studies to further validate these diagnostic tools.

Comparison of Postoperative Outcomes With and Without Enhanced Recovery After Surgery (ERAS) Protocols in Patients Undergoing Laparoscopic Cholecystectomy

2026-01-20T18:33:53+00:00

The application of ERAS protocols has revolutionized perioperative care by improving patient outcomes. However, their role in laparoscopic cholecystectomy (LC) remains underexplored in many settings. Study Design: Randomized controlled trial. Setting: Allied Hospital, Faisalabad. Study Duration: 01-12-2024 to 31-07-2025 (eight months).Sample Size:160 patients (80 in each group). Sampling Technique: Non-probability consecutive sampling. Results: In our study, male patients were 51 and female patients were 109. 10 patients were of 15-25 years of age,126 were between 26-40 years of age, and 24 were 41-50 years of age. In Group A, only one patient was placed drain, while in Group B, 49 patients had a drain. Pain score mean in Group A was 2.4 after 4 hrs.,2.3 after 08 hrs,1.6 after 12 hrs,1.1 after 24 hrs. Pain score mean in Group B was 3.7 after 4 hrs., 3.1 after 08 hrs., 2.8 after 12 hrs., 2.2 after 24 hrs. Activity score mean in Group A was 1.6 after 4 hrs.,2.3 after 08 hrs,2.8 after 12 hrs,3.8 after 24 hrs. Activity score mean in Group B was 0.86 after 4 hrs., 0.86 after 08 hrs., 1.6 after 12 hrs., 2.3 after 24 hrs. In group A Rescue analgesia mean is 0.17 (0.44) while in Group B mean is 2.3(SD -0.62).In group A Postoperative hospital stay mean was 1.1(SD-0.15), while in group B, it was 1.7(SD-.46). The postoperative ileus mean was 2 in group A, while it was 1.9 in group B. Conclusion: The application of ERAS protocols resulted in less postoperative pain, earlier mobility and the ability to perform routine activities, a reduced need for rescue analgesia, and an earlier oral-free status, as well as earlier discharge from the hospital, compared to those without ERAS protocols.

The Frequency of Risk Factors Associated with Molar Pregnancies among Primiparous and Multiparous women, A Cross Sectional Comparative study

2026-01-20T18:34:34+00:00

Abstract:

Background
Molar pregnancy involves abnormal placental development, ranging from benign to malignant gestational trophoblastic disease, with incidence varying worldwide due to genetic, environmental, and socioeconomic influences.

Objective
To determine the frequency of risk factors associated with molar pregnancies among primiparous and multiparous women.

Methods
This cross-sectional comparative study was conducted in the Department of Obstetrics & Gynecology, Sahiwal Teaching Hospital, from July 2023 to June 2025. A total of 160 women meeting inclusion criteria were enrolled after informed consent. Demographic and clinical characteristics, including age, gestational age, parity, education, socioeconomic status, and obstetric history, were recorded. Associations with parity were analysed using the Chi-square test.

Results
Of the 160 participants, 70 were primiparous and 90 multiparous. Most women (70.0%, n=112) were aged 18–30 years, with a mean age of 28.67 ± 3.87 years. The mean gestational age was 10.52 ± 1.54 weeks. Identified risk factors included prior molar pregnancy (5.0%), low socioeconomic status (46.3%), blood group A (45.6%), prior abortion (20.0%), illiteracy (41.9%), extreme maternal age (<20 or >35 years, 6.9%) and oral contraceptive use (35.0%). Comparison by parity showed that prior abortion was significantly more common among multiparous women (35.6% vs. 0.0%, p < 0.001), while maternal illiteracy was higher among primiparous women (52.9% vs. 33.3%, p = 0.013). Others showed no significant difference.

Conclusion
Two risk factors—prior abortion and maternal illiteracy—differed significantly by parity. These findings suggest that sociodemographic rather than biological determinants may play a stronger role in influencing molar pregnancy risk.

Keywords: Molar pregnancy, risk factors, Primiparous, Multiparous.

Frequency of Bone Marrow Infiltration By Non Haematopoitic Small Round Blue Cell Tumors In The Paediatric Population

2026-01-20T18:34:02+00:00

Background: Bone marrow metastasis (BMM) of non-hematopoietic small round blue cell tumors poses significant diagnostic and therapeutic challenges in pediatric oncology. Objective: This study aimed to evaluate the frequency and characteristics of bone marrow infiltration by non-hematopoietic round blue cell tumors in a pediatric population, excluding lymphomas. Study Design: Retrospective cross-sectional descriptive study. Settings: Department of Hematology and Transfusion Medicine, University of Child Health Sciences and Children Hospital, Lahore Pakistan. Duration: Two-year period from October 2021 to October 2023. Methods: A total of 198 diagnosed cases of small round blue cell tumors, aged newborn to 16 years, were included. Data were collected on clinical findings, imaging results, and hematological parameters. Bone marrow aspirates and biopsies were performed, followed by histological examination and immunohistochemical analysis. Results: The study analyzed 198 pediatric patients with small round blue cell tumors, revealing that neuroblastoma was the most prevalent, comprising 90 cases with a 22.2% rate of positive bone marrow infiltration. Clinical findings indicated fever (75.8%) and pallor (65.7%) as common symptoms. Hematological parameters showed mean hemoglobin levels of 9.5 ± 1.5 g/dL, with neuroblastoma patients exhibiting the lowest levels at 8.5 ± 1.0 g/dL. CD56 positivity was observed in 66.7% of cases, mainly in neuroblastoma, emphasizing the role of histopathological evaluation in diagnosis and management. Conclusion: Early detection of bone marrow metastasis in non-hematopoietic small round blue cell tumors is vital for appropriate treatment planning.

Management of Nasal Polyposis through FESS: Surgical Outcomes and Challenges

2026-01-20T18:33:57+00:00

Abstract

Objective: To evaluate the effectiveness of functional endoscopic sinus surgery (FESS) in the management of nasal polyposis, focusing on symptom relief, quality of life improvement, and recurrence rates.

Methodology: This retrospective study included 100 patients diagnosed with nasal polyposis who underwent FESS between January 2023 and March 2024. The study assessed pre-operative and post-operative outcomes using the NOSE (Nasal Obstruction Symptom Evaluation) score and SNOT-22 (Sinus and Nasal Outcome Test) score at 6 months (March 2024) and 12 months (March 2025) post-surgery. Data on recurrence rates and demographic details were also collected.

Results: Significant improvements were observed in both NOSE and SNOT-22 scores. The mean NOSE score decreased from 74.3 pre-surgery to 38.4 at 6 months and 32.6 at 12 months. Similarly, the mean SNOT-22 score improved from 62.8 pre-surgery to 33.1 at 6 months and 28.7 at 12 months. The recurrence rate of nasal polyps was 12% at 6 months and 18% at 12 months. Paired t-tests showed statistically significant improvements in both scores (p < 0.001).

Conclusion: FESS effectively improves symptoms of nasal obstruction and quality of life in patients with nasal polyposis, with significant improvements observed at both 6 and 12 months post-surgery. Although recurrence remains a challenge, FESS remains a highly effective treatment. Future research should focus on longer follow-up and the impact of co-morbidities.

PRIMARY (IMMEDIATE) VERTSUS SECONDARY (DELAYED) NAILING IN THE MANAGEMENT OF GUSTILLO-ANDERSON TYPE 3A OPEN TIBIAL FRACTURES – A COMPARATIVE STUDY

2026-01-20T18:33:51+00:00

ABSTRACT:

OBJECTIVE: To compare the outcomes of open tibial fractures managed with immediate versus delayed intramedullary nailing in adults.

Study design: Prospective Cohort study

Settings: Department of orthopedic surgery Mayo hospital Lahore

Duration: January to December 2023.

Methods: 60 patients (30 in each cohort) were observed. In primary (one-staged) nail group, intramedullary nailing was performed after debridement. In secondary (two staged) nail group, initial debridement and external fixation was done followed by conversion to intramedullary nailing after one week. Bone and soft tissue infection, radiological union and functional outcome were observed after surgery.

RESULTS: Of the 60 patients, 48 (80%) were males and 12 (20%) females. Mean age was 32.24 ± 10.76 years, ranging from 17 to 60 years. Right tibia was involved in 42 (70%) patients, left in 18 (30%). Road Traffic Accident (RTA) caused 46 (76.6%) cases, followed by firearm injuries 7 (11.6%) and falls 4 (6.6%). Mean union time in the single-stagged nail group was 12.67 ± 5.36 weeks compared to 13.18 ± 3.61 weeks in the two-stagged group. There was no significant difference in union time between the groups (p=0.226). No correlation existed between age and union time (p=0.478) while significant negative association between soft-tissue infection and union time (p < 0.001) was observed. Outcomes between groups showed no significant difference (p=0.827).

CONCLUSION: Primary nailing can be safely and effectively performed in Gustilo-Anderson type IIIA open tibial-shaft fractures under antibiotic cover and timely debridement of wound.

KEY WORDS: Tibia, Open fractures, Intramedullary nail, Functional outcome

Diagnostic Accuracy of Sonomammography in Differentiation of BI-RADS 4 Suspicious Breast Lesions as Benign or Malignant Keeping Histopathology as Gold Standard

2026-01-20T18:33:50+00:00

Background: Breast cancer continues to be the most prevalent malignancy among women worldwide, with an estimated 2.3 million new cases and 685,000 fatalities reported in 2020. In a population of 220 million, Pakistan alone reported approximately 178,000 new cancer cases and 117,149 fatalities. Early detection through imaging is essential for enhancing survival outcomes. Although mammography is the standard screening method, its diagnostic efficacy deteriorates in women with dense breast tissue. In such instances, sonomammography, a real-time imaging technique that is radiation-free, provides a more accurate characterization of the lesion. Nevertheless, its diagnostic potential for BI-RADS 4 (suspicious) lesions is still underexplored in local environments.

Objective: To assess the diagnostic accuracy of sonomammography in distinguishing benign from malignant BI-RADS 4 lesions, with histopathology serving as the reference standard.

Methods: A cross-sectional investigation was conducted at the Department of Radiology, CMH Lahore, involving 360 women aged 30–70 years who had sonographically detected BI-RADS 4 lesions. All participants underwent high-frequency linear-array ultrasound (≥10 MHz), which was followed by an ultrasound-guided core biopsy for histopathological confirmation. Sonographic findings were classified as low suspicion (BI-RADS 4A) or moderate/high suspicion (BI-RADS 4B/4C). The diagnostic performance measures—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—were computed.

Results: The prevalence of malignancy was 60.6% among the 360 women. A total of 207 true positives and 128 true negatives were identified by sonomammography, with 11 false negatives and 14 false positives. The sensitivity was 95.0%, the specificity was 90.1%, the PPV was 93.7%, the NPV was 92.1%, and the overall accuracy was 93.1%. These results are in close agreement with previous regional data that reported diagnostic indices that were similar.

Conclusion: In dense breasts, sonomammography exhibits high diagnostic accuracy in the evaluation of BI-RADS 4 lesions, particularly in the differentiation of malignant from benign pathology. When employed as a complementary imaging modality to mammography, it can effectively decrease the number of superfluous biopsies. It is advised that additional large-scale and multicenter studies be conducted to verify these findings and refine the BI-RADS subcategorization in ultrasound diagnostics.