Annals of Punjab Medical College

Comparison of Efficacy of Intradermal Tranexamic Acid Versus Oral Tranexamic Acid in the Treatment of Melasma

Farhana Rashid — 2025-09-30

Background: Melasma, a common hyperpigmentation disorder, affects women and is triggered by genetics, hormones, and sun exposure. Tranexamic acid (TXA), used in oral and intradermal forms, has shown promise in treatment. This study compares the efficacy of intradermal versus oral TXA in reducing melasma severity and pigmentation. Objective: To compare the efficacy of intradermal Tranexamic Acid (TXA) and oral TXA in the treatment of melasma, assessing improvements in melasma severity and pigmentation as measured by the modified Melasma Area and Severity Index (mMASI) and Melanin Index (MI). Study Design: Retrospective study. Settings: Department of Dermatology, MTI Khyber Teaching Hospital, Peshawar, Pakistan. Duration: March 2022 to August 2022. Methods: A total of 80 patients with melasma were randomly randomized to either intradermal TXA (4 mg/mL) or oral TXA (250 mg twice daily). Patients were treated for 12 weeks, and mMASI scores and MI were measured at baseline, weeks 4, 8, and 12. Patient satisfaction was also evaluated. We used independent t-tests to analyze the data, setting the level of statistical significance at p < 0.05. Results: Both treatment groups showed significant reductions in mMASI scores and MI over time. The intradermal group showed a decrease in mMASI from 15.8 ± 4.2 to 5.4 ± 2.0 (week 12), and MI from 34.2 ± 5.4 to 18.4 ± 3.9. The oral group showed a decrease in mMASI from 14.9 ± 3.8 to 5.9 ± 2.1, and MI from 33.8 ± 5.2 to 19.2 ± 4.0. However, no statistically significant difference was found between the two groups (p > 0.05 for both mMASI and MI at all-time points). Conclusion: Both intradermal and oral TXA are effective treatments for melasma, with no significant differences in their efficacy. Future research with longer follow-up is needed to confirm these findings.

Accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis Score for Diagnosis of Necrotizing Fasciitis

Muhammad Punoon — 2025-09-30

Background: Necrotizing fasciitis (NF) is a fast-growing infection that mostly affects the subcutaneous tissue and fascia. The Laboratory risk indicator for necrotizing fasciitis (LRINEC) score was initially presented in 2004. Objective: This study aimed to assess the diagnostic accuracy of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for the diagnosis of necrotizing fasciitis, taking histopathology as the gold standard. Study Design: Cross-sectional validation study. Settings: General Surgery Department, Sahiwal Teaching Hospital, Sahiwal Pakistan. Duration: Six months from 13 February 2024 to 12 August 2024. Methods: A total of 165 adult cases with suspected necrotizing fasciitis were included. Patients with <48 hours of hospital stay, prior oral antibiotic use, or previous debridement were excluded. Clinical suspicion was based on rapidly spreading erythema with severe pain. LRINEC score, consisting of white blood cells, hemoglobin, sodium, glucose, creatinine, and C-reactive proteins, was calculated. Debridement findings and histopathology confirmed necrotizing fasciitis. Sensitivity, specificity, predictive values, accuracy, and likelihood ratios of LRINEC (≥6) were determined using histopathology as the gold standard. Results: Mean age was 42.4 ± 9.9 years, and 59.4% (n=98) were males. Diabetes mellitus was present in 73.9%. The mean leucocyte count, hemoglobin, serum sodium, blood sugar, and creatinine were 16.6±7.6/mm³, 12.0±2.1 g/dL, 137.4±9.1 mmol/L, 147.3±45.9 mg/dL, and 1.4±0.6 mg/dL, respectively. Necrotizing fasciitis was diagnosed in 39.4% by LRINEC (≥6) and 60% by histopathology. The sensitivity, specificity, and accuracy of LRINEC (≥6) were 55.6%, 84.8%, and 67.3%, respectively. Conclusion: LRINEC score (≥6) showed moderate sensitivity but high specificity for necrotizing fasciitis. It can be useful as an adjunct assessment tool, but histopathology remains the gold standard to make a diagnosis.

Significance of Neutrophil to Lymphocyte Ratio in Acute St-Segment Elevation Myocardial Infarction

Munir Ahmad — 2025-09-30

Background: Myocardial infarction remains a leading cause of global mortality, necessitating reliable prognostic markers. This study evaluates the neutrophil-to-lymphocyte ratio (NLR) as a predictor of in-hospital complications in acute ST-elevation myocardial infarction (STEMI) patients in Pakistan, where research on NLR is limited. Objective: To determine the proportion of STEMI patients with high NLR (≥4.50) and compare complication rates between high- and low-NLR groups. Study Design: Descriptive study. Settings: Faisalabad Institute of Cardiology, Faisalabad Pakistan. Duration: July 30, 2022 to January 30, 2023. Methods: 385 STEMI patients. NLR was calculated from admission blood samples, and complications (arrhythmias, cardiogenic shock, heart failure, re-infarction and mortality) were recorded. Statistical analysis used SPSS v25, with p<0.05 considered significant. Results: Mean age was 52.95±7.85 years (47% male, 53% female). Mean NLR was 4.22±0.85; 43.4% had high NLR. High NLR correlated with higher complication rates: arrhythmias (67.5% vs. 25.0%, p=0.000), cardiogenic shock (58.6% vs. 39.1%, p=0.001), heart failure (79.0% vs. 32.5%, p=0.001), and mortality (33.1% vs. 14.2%, p=0.037). No significant difference was observed in re-infarction rates. Conclusion: High NLR is associated with increased in-hospital complications in STEMI patients, supporting its role as a cost-effective prognostic marker. Routine NLR assessment could aid early risk stratification and improve outcomes in resource-limited settings.

Relationship of BMI & Periodontal Status in Orthodontic & Oral Surgery Children; Correlation with Predisposing Factors

Abdul Rashid — 2025-09-30

Objective: The focus of this research was to assess the relationship between Body Mass Index (BMI) and Periodontal conditions in orthodontic children. An increase in the BMI has been associated with various systemic conditions. High BMI shows a bilateral relationship with inflammatory diseases like periodontitis. Study Design: Cross-Sectional Observational Study. Settings: De Montmorency College of Dentistry, Lahore Pakistan. Duration: 31.1.2023 to 30.12.2023. Methods: 72 subjects, 40 females and 32 males, participated in this study. The Community Periodontal Index was used for Periodontal measurements, which included bleeding on probing, calculus formation, and the presence and depth of periodontal pockets. Complete periodontal examination was performed in all subjects. Anthropometric examination consisted of BMI (kg/m²), which was adjusted for age. The groups were divided into children of normal weight, underweight, and overweight, according to the BMI classification charts provided by the WHO, with respect to specific age groups. Results: The gender-related outcome indicated that male subjects with a weight above the standard mentioned above exhibited noteworthy percentages of CPl code, specifically fifty-three per cent, in contrast to females, who displayed twenty-seven per cent. Weight exceeding the standard criteria mentioned earlier reflected no notable relation with haemorrhage on probing. The pervasiveness of CPl code was noted. Conclusion: No significant association was found between body weight and predisposition to gum disease in the inspected individuals, indicating a negative association between BMI and periodontitis in juvenile subjects.

The Perception of Biochemistry Teachers about the Integrated Modular Curriculum of Undergraduate Medical Students: Advantages and Areas Needing Improvement

Fauzia Jan — 2025-09-30

Background: The teaching and learning process has two pillars, comprising students and teachers. Many studies have been conducted to determine the impact of an integrated modular curriculum. Objective: This study aims to find out the perception of a biochemistry teacher regarding the integrated modular curriculum on students of the first and second year MBBS. Study Design: Cross-sectional study. Settings: Department of biochemistry, University medical & dental college, The University of Faisalabad. Duration: 2 months from January 15, 2025, to March 15, 2025. Methods: The study was started after taking ethical approval from the ethical review board of the University of Faisalabad. The study included 50 biochemistry facilitators teaching under an integrated modular curriculum at various public and private medical colleges of Pakistan. Exclusion criteria involved teachers with experience of teaching in a traditional curriculum only. The purposive sampling method was employed. With informed consent, a structured Google Form questionnaire was emailed to participants. Data was analyzed using IBM SPSS software. Results: Of 50 teachers, 33 (66%) were satisfied with the integrated curriculum. Most biochemists (44, 88%) found it relevant to clinical subjects. Teachers noted benefits like improved interdepartmental interaction (41, 82%), communication skills (31, 62%), theory-practical alignment (33, 66%), and research culture (35, 70%). However, 29 (58%) faced challenges with multidisciplinary timetabling, and 40 (80%) saw a need to revise biochemistry content and objectives. Chi-square analysis proved a strong correlation between overall satisfaction and interdepartmental interactions. Conclusion: Biochemistry facilitators are satisfied with the integrated curriculum, though some areas need improvement.

Personality Predictors of Stress, Burnout, and Academic Outcomes in Medical Students: A Big Five Trait Analysis

Kumayl Abbas Meghji — 2025-09-30

Background: Personality traits influence how individuals handle stress, burnout, and academic challenges, particularly in high-pressure fields like medicine. Objective: To examine the relationship between personality traits and levels of stress, burnout, and academic performance among medical students. Study Design: Cross-sectional study. Settings: Isra University, Hyderabad Pakistan. Duration: From June to November 2024. Methods: This study was conducted among 360 medical students, assessing personality traits using the Big Five framework. Perceived stress, burnout, and academic performance (GPA) were measured through validated questionnaires and institutional records. Associations between personality traits and outcome variables were analyzed using chi-square tests. Results: Agreeableness was the most prevalent trait (32%), followed by conscientiousness (27%). Neuroticism showed a strong positive association with high stress (χ² = 15.4, p < 0.001) and burnout (χ² = 12.8, p = 0.002), while conscientiousness and extroversion were linked to lower stress (χ² = 10.2, p = 0.014). Academic performance was highest among conscientious (χ² = 9.6, p = 0.021) and agreeable (χ² = 8.1, p = 0.032) individuals, whereas neuroticism and extroversion were negatively associated with GPA. Women scored higher in neuroticism (38%, p = 0.004) and agreeableness (34%, p = 0.009) than men. Conclusion: Personality traits significantly influence stress, burnout, and academic performance in medical students. Identifying these associations can guide tailored interventions, such as stress management for neurotic students and structured productivity plans for conscientious individuals, to enhance resilience and academic success.

Orthodontic Treatment Adherence among Local Patients: Key Influences

Maria Tanveer — 2025-09-30

Background: Patient commitment to orthodontic treatment is essential for achieving the greatest outcomes. Missed appointments can prolong treatment duration, increase risk of complications, and compromise results. Despite its significance, local data on adherence patterns and contributing factors remains limited.Objective:To determine the frequency of adherence to orthodontic appointments among local orthodontic patients and to identify the key factors associated with irregular attendance.Methods:This cross-sectional research comprised 231 individuals getting orthodontic treatment at the Orthodontics Department of de'Montmorency College of Dentistry in Lahore. Data was collected via structured questionnaires and clinical attendance records. Adherence was categorized as always attending, sometimes attending, or rarely attending. Demographic and behavioural variables—including age, gender, education level, oral hygiene habits, motivation, and treatment duration—were analysed using Chi-square tests to identify associations with attendance. Results: The mean age of participants was 12.44 ± 4.64 years; 56.7% were females. Only 9.1% always attended their appointments, while 44.2% sometimes attended and 46.8% rarely attended. Significant associations were found between better attendance and female gender (p = 0.011), age under 12 years (p = 0.001), and higher educational level (p = 0.001). Poor oral hygiene also correlated with irregular attendance (p = 0.024). No significant association was observed with motivation, brushing frequency, treatment duration, or reason for treatment. Conclusion: Adherence to orthodontic appointments was suboptimal in the studied population. Younger age, female gender, better education, and good oral hygiene were linked to improved attendance. Identifying and addressing these modifiable factors can enhance compliance and improve treatment outcomes.

Assessment of Dietary Habits among Male Medical Students Residing in Hostels at Ameer-Ud-Din Medical College: A Cross-Sectional Study, Lahore 2023

Rozina Shahadat Khan — 2025-09-30

Background: Diet strongly affects the overall health of an individual. Medical students are expected to have good dietary habits. The diet of medical students living in hostels is often compromised. Objective: To assess the dietary habits of hosteller male medical students of Ameer-Ud-Din Medical College in relation to demographics. Study Design: Cross-sectional comparative study. Settings: Boys’ hostels of Ameer-Ud-Din Medical College, Lahore Pakistan. Duration: Six months after approval by ethical review board. Methods: 79 hostel residing male medical students for two months after ethical clearance. Data collected by the researcher using proforma having demographics and dietary habits’ variables. The Chi square test used for seeing the relation of students’ eating habits with demographics taking P value of < 0.05 as significant. Results: Out of a total of 79 students, 26.6% were second year MBBS students. Those having a monthly family income of ≥ 50,000 rupees were 79.7% and 78.5% of the students had non-working mothers. Only 19% had home cooked meals supplied by vendors daily while 43% of the students ate out daily. Only 21.5% had breakfast daily. Daily consumption of roti/bread was by 79.5% of participants, rice (any form) consumption was by 2.5%, daily meat/chicken by 12.7% and daily vegetables and fruits by only 2.5% of the participants. Chi square value was not significant for eating habits with demographic variables like monthly household income and mothers’ employment status. Conclusion: Majority of the students did not have breakfast in morning and ate out daily. Only few had home cooked meals, fruits and vegetables daily. Demographics had no significant relation with students’ eating habits.

Restoration of Teeth with Cention-N and Tetric N Ceram Bulkfill Materials on Tooth Surface: An In-Vitro Comparative Evaluation of Physico-Mechanical Properties

Urooj Waseem — 2025-09-30

Objective: The study aimed to evaluate and compare the shear bond strength, degree of conversion, microleakage, sorption, and solubility between Cention N and Tetric N Ceram Bulk Fill restorative materials. Study Design: Quasi-experimental study. Settings: de’ Montmorency College of Dentistry, University College of Dentistry, and Institute of Dentistry, CMH Lahore Medical College, Lahore Pakistan. Duration: From January 2022 to December 2024. Methods: The study was conducted after the approval of IRB on a sample of 111 extracted molars and premolars, which were divided into four groups, each treated with different combinations of adhesives and restoration: Group A (Cention N with total-etch), Group B (Cention N with self-etch), Group C (Tetric N Ceram with total-etch), and Group D (Tetric N Ceram with self-etch). The samples were subjected to micro shear bond strength testing, FTIR spectroscopy, microleakage using dye penetration, and water sorption and solubility tests. Statistical analyses were performed using ANOVA and post-hoc Tukey tests. Results: Cention N demonstrated significantly higher micro shear bond strength (p<0.001) compared to Tetric N Ceram. The degree of conversion was highest in Tetric N Ceram (p=0.008). Microleakage analysis revealed that Cention N with adhesive showed the least leakage (p=0.218), while water sorption and solubility were lowest in Cention N (p<0.001 for both). Conclusion: Cention N outperformed Tetric N Ceram in terms of micro shear bond strength, microleakage, sorption, and solubility, making it a more reliable and durable restorative material. However, factors such as ease of use, cost, and patient comfort should also be considered.

The Prakash Technique for Reducing Anterior Shoulder Dislocation: Efficient, Safer, Time-Saving, and Needing no Assistance, Sedation, or Traction

Muhammad Ali — 2025-09-30

Objective: To evaluate the effectiveness and safety of the Prakash method of shoulder reduction in patients having anterior shoulder dislocation and presenting within the first twenty-four hours of injury. Study Design: Prospective interventional study. Settings: Mayo Hospital/King Edward Medical University, Lahore, Pakistan. Duration: Two years, from November 2021 to October 2023. Methods: In this study, the Prakash technique was attempted to reduce all anteriorly dislocated shoulders without anaesthesia, sedation, traction, or assistance. The outcomes were evaluated in terms of successful reduction (in the first attempt) and documentation of any post-reduction complications. Results: A total of 50 patients with mean age of 30.3 ± 11.8 years were included in this study. Males were 46(92%) and female 4(8%). The right shoulder was involved in 82% of the patients, while the left shoulder was dislocated in 18% of patients. The majority, 94% (n=47) of the shoulders were successfully reduced with the Prakash method. The mean time of reduction was 118 ± 32 seconds. There were no post-reduction complications observed related to the technique. The pain felt during the procedure, as per the Visual Analogue Scale, ranged from 4 to 7 with a mean of 4.58 ± 1.6. Three cases (6%) could not be reduced and were relocated with other manoeuvres of shoulder reduction under sedation. Conclusion: Prakash's method can be used safely and effectively as a method of choice to reduce anterior shoulder dislocations without any sedation, assistance, or traction.

Comparison of Wound Healing with ‘Autologous Platelet-Rich Plasma’ versus Conventional Dressing in Chronic Diabetic Foot Ulcer

Muhammad Saleem Iqbal — 2025-09-30

Background: Innovative approaches, such as cellular therapies like platelet-rich plasma (PRP), are emerging to enhance wound healing in diabetic foot ulcers. Objective: To compare the effectiveness of autologous PRP with conventional dressing for chronic diabetic foot ulcers. Study Design: Randomized controlled trial. Settings: Allied Hospital, Faisalabad Pakistan. Duration: January 2024 to June 30, 2024. Methods: 124 diabetic patients aged 18- 80 with non-healing foot ulcers were included. Exclusions were made for those with bleeding disorders, uncontrolled diabetes (HbA1c > 9), and severe infections, among others. Group A received PRP treatment, while Group B underwent conventional dressing. The wound area was measured weekly for 3 weeks. Results: Mean age was similar between groups (Group A: 52.92 ± 9.21 years; Group B: 52.63 ± 9.86 years). Most patients (70.97%) were aged 46 to 80. Out of 124 patients, 37.90% were male, and 62.10% were female. PRP showed an efficacy of 88.71%, compared to 67.74% for conventional dressing, with a p-value of 0.0034. Conclusion: Platelet-rich plasma is more effective than normal saline dressing for treating chronic diabetic foot ulcers.

Investigating Altered Passive Eruption: Prevalence and Correlation with Crown Dimensions of Maxillary Anterior Teeth in Punjab

Khalfan Haider — 2025-09-30

Objective: This study aims to explore the prevalence of Altered Passive Eruption (APE) and its relationship with the width, length, and width-to-length (W/L) ratios of maxillary anterior teeth in the Punjab population. Study Design: Cross-sectional study. Settings: Institute of Dentistry, CMH Lahore Medical College, Lahore Pakistan. Duration: June 1, 2023 to December 30, 2023. Methods: This study after the approval of the Institutional Review Board of the Institute of Dentistry, CMH Medical College, on a sample of 128 participants using a consecutive sampling technique. Inclusion criteria required participants to be over 20 years old, non-smokers, and have intact maxillary front teeth. Exclusion criteria included recent orthodontic treatment, systemic conditions, and medications affecting gingival health. Clinical assessments were performed to measure tooth dimensions, and data was analyzed using SPSS v24. Results: The study found a 30.47% prevalence of APE in the sample population. Significant gender differences were observed, with males exhibiting larger maxillary anterior teeth dimensions than females. However, age and height did not show significant associations with tooth dimensions. The W/L ratio of central incisors and other dimensional differences between genders were statistically significant (p < 0.001). Conclusion: The prevalence of APE is notably high, emphasizing the need for awareness among clinicians. Gender-specific differences in tooth dimensions should be considered in dental assessments and treatments. Future research should explore the genetic and environmental factors influencing APE and employ advanced measurement techniques to enhance diagnostic and treatment strategies.

Multimodal Assessment of Spinal Degeneration: Correlation among Radiological, Macroscopic and Microscopic Evaluation Scores

Amber Salman — 2025-10-06

Background: Spinal degeneration is a complicated and multifactorial process that is associated with chronic pain and disability. To understand its exact pathogenesis, a comprehensive multimodal (radiological, macroscopic, and microscopic) approach is required that integrates evaluations to elucidate the underlying pathophysiology. Objective: To assess lumbar spinal degeneration through radiological, macroscopic, and microscopic approaches, analyze age- and level-related variations, and establish correlations among modalities to refine diagnosis and guide targeted therapies. Study Design: Cross-sectional analytical study. Settings: Department of Anatomy, University of Health Sciences, Lahore Pakistan. Duration: Twelve months from March 12, 2022 to March 11, 2023. Methods: 72 lumbar human endplate and intervertebral disc composites were taken from adult male cadavers which were free from spine deformity, fracture, infection, or metastasis. After X-ray imaging, the individual motion segments were separated and were cut mid-sagittally (Fig. 1), and both endplates and IVDs were assessed for macroscopic grades and microscopic scores and grades. Results: Significant increase in the mean radiological, macroscopic, and microscopic degeneration scores with age and spinal level. Sclerosis increased significantly with age while osteophytes increased with spinal levels. Significant correlations were observed among radiological, macroscopic, and microscopic scores (p<0.001). Macroscopic findings include fissures, fibrosis, brown discoloration, and calcification. Histological evaluation revealed advanced degeneration characterized by fissures, herniation, calcification, and matrix disorganization. Conclusion: Multimodal assessment offers a robust framework for understanding spinal degeneration, facilitating accurate diagnosis, and the development of targeted therapeutic strategies.

Treatment of Pediatric Supracondylar Fractures - A Comparison of Conventional Cross K-Wiring Versus Dorgan’s Technique

Khair Ul Inam — 2025-09-30

Background: Pediatric supracondylar fractures are commonly managed with closed reduction and internal fixation (CRIF) with Kirchner's wires (K-wires), in different configurations, while the main objective remains stable fixation. Objective: This study aimed to compare functional and radiological outcomes, rate of iatrogenic ulnar nerve injury, operative time, and radiation exposure between conventional cross K wiring and Dorgan’s Technique. Study Design: Prospective study. Settings: Department of orthopedic surgery, Mayo hospital (King Edward Medical University), Lahore, Pakistan. Duration: From April 2024 to December 2024. Methods: Patients were divided into the standard group (group S) and Dorgan's technique group (group D), each with 36 patients. Results were compared, and statistical tests were applied with significance at p < 0.05. Results: Of 72 children, 48 were boys and 24 were girls. The mean age was around 7 years in both groups. Differences in mean surgical duration and radiation exposure were not significant between the two techniques. (p = 0.359 and 0.897, respectively). Post-operative iatrogenic ulnar nerve injury occurred in 3 cases (8.5%) in group S and none in group D. The Difference in Flynn's criteria results for both groups was not significant. (p = 0.190). The difference in post-operative radiological outcome was also statistically not significant between the two groups. (p=0.309 for Bowman's angle and p = 0.55 for Anterior humeral line). Conclusion: Dorgan’s technique has comparable results to standard cross-K wiring and is better regarding the safety of the ulnar nerve in the surgical management of supracondylar fractures.

Frequency of Gastroesophageal Reflux Disease in Children with Persistent Cough and Wheezing

Raheel Malik — 2025-09-30

Objective: To determine the frequency of gastroesophageal reflux disease (GERD) in children with persistent cough and wheezing. Study Design: Cross-sectional study. Settings: Department of Pediatric Medicine, Children's Hospital & The Institute of Child Health, Multan Pakistan. Duration: Six-months from 1st December 2023 to 31st May 2024. Methods: A total of 113 children aged 6 months to 12 years of either gender presenting with persistent cough and/or wheeze were consecutively enrolled. Children with developmental delay, congenital heart disease, or other congenital malformations were excluded. GERD was diagnosed on barium swallow study if any one or more of the following findings were present: reflux of gastric contents into the lower esophagus, hiatal hernia, signs of reflux esophagitis, or impaired gastric motility. Descriptive statistics in the form of mean ± SD for numerical and frequency and percentages were calculated for qualitative data. Confounding was assessed through stratification using a chi-square test at a 5% significance level. Results: The study enrolled children with a mean age of 3.9±1.8 years, 69% male, a mean BMI of 17.1±0.7 kg/m², and a mean illness duration of 3.3±0.6 weeks. GERD was diagnosed in 45.1% of cases, with significantly higher prevalence among premature children (82.5% vs. 24.7%, p <0.001) and those with positive family history of atopy (71.4% vs. 29.6%, p < 0.001). Conclusion: GERD is a common finding in children presenting with persistent cough and wheeze. The condition is notably more prevalent in children born prematurely and with a family history of atopy.

Comparison of Mean Post-Operative Pain Score with or Without Bupivacaine Infiltration at Incisional Site in Patients Undergoing Midline Laparotomy for Clean and Clean Contaminated Wound

Sultan Mahmood Khan — 2025-09-30

Background: In abdominal surgery, midline incision is most often used and it is a major contributor to postoperative pain. Objective: The purpose of the study was to evaluate the effect of local anesthesia by comparing mean post-operative pain scores in patients undergoing midline laparotomy for clean and clean contaminated wounds. Study Design: Randomized controlled trial. Settings: Department of Surgery, Allied Hospital, Faisalabad, Punjab, Pakistan. Duration: From April 6^th, 2018 to October 5^th, 2018. Methods: A total of 80 patients undergoing midline laparotomy and classified as ASA physical status I–II were randomly divided into two equal groups. Before wound closure, patients in Group A received local infiltration of 20 ml of 0.25% bupivacaine with epinephrine (maximum dose 1 mg/kg) into the skin and rectus sheath. Group B received a placebo (2 ml of normal saline). Postoperative pain was assessed using the Visual Analogue Scale (VAS) every hour for 24 hours. Analgesics were administered only when necessary and recorded. Data were analyzed using SPSS version 21. Results: Of the 80 patients, the mean age was 45.83 ± 9.13 years. There were 37 (46.2%) males and 43 (53.8%) females. The mean VAS pain score over 24 hours was significantly lower in the bupivacaine group (4.1 ± 1.52) compared to the placebo group (6.88 ± 1.23), with a p-value of 0.0001. Conclusion: Incisional site bupivacaine instillation significantly decreases the painful sensations as well as requirements for analgesia in comparison with the placebo group thus making it a simple, well-tolerated, and safe treatment in relieving pain after midline laparotomy.

Headache: Prevalence, Patterns and Symptoms of Headache in Patients Presenting to Outdoor of Neurology Department at Allama Iqbal Memorial Teaching Hospital Sialkot

Sajjad Ali — 2025-09-30

Objective: To assess the prevalence, patterns and symptoms of headache in patients presenting with headache. Study Design: Cross-sectional study. Settings: Department of Neurology, Allama Iqbal Memorial Teaching Hospital, Sialkot Pakistan. Duration: 1^st July 2023 to 1^st March 2024. Methods: A total of 326 consecutive patients aged 13-65 years and belonging to either gender presenting to the outdoor of neurology department were included in this study. A predesigned questionnaire was used to record the data regarding prevalence, patterns and symptoms of headache. Results: Prevalence was highest in age group 31-60 with 131 (40.2%) patients. Majority of the patients 196 (60.1%) suffered from headache 1 to 4 weeks. Most of the patients 210 (64.4%) suffered this headache daily. This headache would continue 1-3 days to most of the patients, 233 (71.5%). The most common headache pattern was of whole head and suffered 125 (38.4%) patients. According to pain assessment scale, 224 (68.8%) patients had severe (7-10), 66 (20.2%) had moderate (4-6) and 36 (11.0%) patients had mild (0-3) headache. The most common symptoms during headache were nausea, vomit and dizziness found in 111 (34.0%) and 73 (22.4%) patients, respectively. Majority of the patients 204 (62.6%) felt headache during stress. 31 (9.5%) patients had family history of headache. It was seen that fatigue was the most common warning symptom before headache as 106 (32.5%). Conclusion: Headache has variety of patterns and symptoms with variable with migraine headache type occurring most commonly followed by tension type headache.

Effects of Liraglutide on Thyroid Stimulating Hormone and Level of Depression

Uzma Dost Muhammad Rajar — 2025-09-30

Background: Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is widely prescribed for obesity and type 2 diabetes mellitus due to its glucose-lowering and weight-reducing properties. Recent evidence suggests that GLP-1 analogs may influence thyroid function and mood regulation through their effects on the hypothalamic-pituitary-thyroid (HPT) axis and central neurotransmitter pathways. Objective: The study aimed to evaluate the effects of Liraglutide on thyroid-stimulating hormone (TSH) levels and depressive symptoms, exploring the interactions between the hypothalamic-pituitary-thyroid (HPT) axis, metabolic factors, and mental health. Study Design: Randomized controlled trial. Settings: Department of Dermatology, Isra University Hospital, Hyderabad, Pakistan. Duration: June 2024 to January 2025. Methods: 60 participants divided into three groups (n=20 each), randomized via the envelope method. Participants received Liraglutide in varying doses (0.6mg, 1.2mg, and 1.8mg), with or without exercise, over six months. TSH levels and depressive symptoms (PHQ-9) were assessed at baseline, three and six months. Results: TSH levels decreased significantly (p<0.05) with higher Liraglutide doses (1.8 mg) and exercise, showing a dose-dependent response. At baseline, group A subgroup (i) had a mean TSH level of 5.4±1.5mIU/L, decreasing to 4.8±3.2mIU/L, while subgroup (ii) saw a reduction from 5.5±1.98mIU/L to 4.5±2.04mIU/L. Comparable reductions were observed across other groups, with exercises enhancing the effects. Depression severity showed significant increases in some subgroups, but exercise mitigated these effects, highlighting its role in managing depressive symptoms. Conclusion: Liraglutide demonstrated a dose-dependent effect on TSH levels and variable impacts on depression. Combining Liraglutide with exercise yielded better outcomes, supporting its use as an adjunctive therapy in managing metabolic and mental health conditions.

Prevalence and Fetomaternal Outcomes of Pregnancies Complicated with Thrombocytopenia

Maimoona Qadir — 2025-09-30

Background: Thrombocytopenia, defined as a blood platelet count below 150 × 10³ per μL, is an important cause of blood disorders in pregnancy after anemia. It complicates 7 to 10% of pregnancies. Objective: To determine the etiological factors of thrombocytopenia in pregnancy and the fetomaternal outcomes. Study Design: Cross-sectional, prospective observational research. Settings: Gynae Department of Khyber Teaching Hospital, Peshawar Pakistan. Duration: January 2021 to December 2023. Methods: It included antenatal women of any age or parity with thrombocytopenia in pregnancy. Patient’s lab and clinical profiles were also collected. Results: The mean age of the antenatal women with thrombocytopenia was 26.3 + 5.54 years. The clinical signs were pallor 64.7%, bruising 22.6%, edema 6.3%, epistaxis 5.6%, and melena 3.4%. The mean WBC count was 12.2 ± 3.7x109/L, the mean platelet count was 47.0±24 /uL, and the mean Hb was 10.4±3.6 g/dL.42 patients (40%) had mild, 47 (43.5%) had moderate, and 19 patients (17.5%) had severe counts < 30x109/L.77 (71.2%) of the 150 individuals with thrombocytopenia had pregnancy-related reasons. There were 45 (41.6%) cases of GT, 1 (1%) patients with fatty liver, 19 (17.5%) patients with pre-eclampsia, and 12 (11%) patients with eclampsia. Conclusion: The study demonstrates that Gestational thrombocytopenia is the most prevalent etiological factor of thrombocytopenia in pregnancy, and no treatment is required. In contrast, pre-eclampsia and eclampsia are life-threatening disorders with dangerous consequences. The other reasons, such as infections and ITP, need customized care.

Sonographic and Cadaveric Study of High-Origin Radial Artery

Shakeela Nazir — 2025-09-30

Background: The radial artery usually branches from the brachial artery near the neck of the radius in the distal antecubital fossa. However, anatomical variations are common, with high-origin radial arteries reported in 0.5–14.27% of cases. Objective: The purpose of this study was to investigate the prevalence of high-originating radial arteries (HORA) in vivo via ultrasound in living subjects and through cadaveric dissections. Study Design: Case control study. Settings: Northumbria University's St. George's International School of Medicine (UK), RLMC Lahore, FJMU Lahore Pakistan. Duration: Two and a half years from 2019-2022. Methods: Using GE LOGIQ e and SonoSite MicroMaxx ultrasound equipment with 12L-RS & A L38e 10-5MHz transducer, respectively, 300 upper limbs on both sides of 150 persons were investigated. The radial artery was located, followed by a proximal and distal trace to its origin, noting its course and relationships with other anatomical structures. This variance was examined in 95 cadaveric limbs using a standard dissection procedure. Results: HORA was found in 23/300 upper limbs. In the participants studied, the HORA were found to occur unilaterally, predominantly on the left side (15/23 cases). Conclusion: For radiologists, anatomists, and surgeons, variations in the radial artery's anatomical route and relationships are significant. The presence of HORA affects cardiac catheterization and artery grafting therapies both surgically and clinically. Its narrow course makes it more prone to injury during medication delivery and cannulation, as well as trauma. Bedside ultrasonography techniques can be useful for both identifying before such interventions and for future anatomical analysis.

Extradural Hematoma in Patients Presenting with Linear Skull Fracture after Head Injury

Syeda Ruba Irfan — 2025-09-30

Background: Head trauma is a major cause of morbidity and mortality worldwide, with skull fractures serving as key indicators of possible intracranial injury. Linear skull fractures are among the most common fracture types and are frequently associated with extradural hematoma (EDH), a life-threatening condition requiring timely diagnosis. Determining the frequency and relationship between linear skull fractures and EDH can improve early detection and management, especially in tertiary care settings. Objective: To determine the frequency of extradural hematoma in patients with linear skull fractures presenting to a tertiary care hospital. Study Design: Cross-sectional study. Settings: Department of Neurosurgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan. Duration: May 30, 2020, to May 29, 2021. Methods: All patients meeting inclusion criteria were enrolled after informed consent. Each underwent a head CT scan for assessment of linear skull fracture and the presence of EDH. Fractures were confirmed radiologically, and data were collected by an independent observer not directly involved in the research. All information was documented on a structured proforma and analyzed statistically. Results: The mean age of participants was 31.77 ± 12.63 years. Of 224 patients, 198 (88.4%) were male and 26 (11.6%) were female. Extradural hematoma was present in 76 (33.9%) patients. The frontal bone was the most frequently fractured site (34.3%) and also the location most commonly associated with EDH (9.8%). Conclusion: Linear skull fracture shows a strong association with extradural hematoma. Patients presenting with linear fractures should undergo CT evaluation for EDH to ensure early diagnosis and appropriate management.