Faisalabad Medical University, Faisalabad Pakistan
Physiological and Nutritional Determinants of Stunted Odontogenesis: Associations with Parathyroid Hormone, Calcium, and Weaning Practices in a Community-Based Study
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.
Copyright (c) 2025 Annals of Punjab Medical College
Laparoscopic Posterior Mesh Rectopexy Vs Laparoscopic Suture Rectopexy for Complete Rectal Prolapse: A Randomized Controlled Trial
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
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.
Post-Dural Puncture Headache after Caesarean Section under Spinal Anesthesia: Local Experience at Liaqat Memorial Hospital, Kohat Pakistan
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.
Awareness and Perception of AI among Medical Students of District Swat: A Cross-Sectional Study
Background: Artificial intelligence (AI) is rapidly influencing modern healthcare, yet limited data exist on medical students’ awareness and perceptions of AI in Pakistan. Understanding students’ views is essential to guide future integration of AI into medical education and clinical practice. 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. Settings: Medical students from Saidu Medical College, Swat Medical College, and Saidu College of Dentistry in District Swat, Pakistan. Duration: From Jan 10 to Mar 10, 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%) had prior awareness about AI; the awareness level was 28% (high), 33% (moderate), and 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 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.
Proximal Migration of Plastibell Ring in Appropriate-Size Plastibell Circumcision vs One-Size-Smaller Plastibell Circumcision
Background: Circumcision is one of the oldest and most extensively executed surgeries worldwide, with Plastibell being the most common technique, though not without controversies. Objective: This study aims to see the impact of the size of the Plastibell in proximal migration of the ring, performed with an appropriate-size Plastibell device versus a one-size-smaller Plastibell device. Study Design: Prospective comparative study. Settings: Surgery and Urology Departments of Fauji Foundation Hospital, Lahore Pakistan. Duration: 11 months (February 2024 to December 2024). Methods: Male neonates and infants up to 6 months 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. Data were analyzed using SPSS v23, with significance at p<0.05. Results: Out of 209 patients, proximal bell migration occurred in 12 cases—10 in the appropriate-size group and 2 in the smaller-size group. Bleeding occurred in 6 cases—4 in the appropriate-size group and 2 in the smaller group. Bell separation took longer in the one-size-smaller group. Conclusion: This study demonstrates that a one-size-smaller Plastibell device is safer compared to an appropriately sized Plastibell device regarding bell impaction.
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
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.
A Randomized Controlled Trial of Probiotic Supplementation in Antibiotic-Associated Diarrhea
Background: Bacterial infections account for approximately 525,000 deaths annually among children worldwide, as estimated by the World Health Organization (WHO). Although antibiotics are essential for the treatment of bacterial infections, their use can disrupt the normal gut microbiota by reducing beneficial bacteria and promoting the growth of opportunistic pathogens. This imbalance increases the risk of antibiotic-associated diarrhea (AAD). Objective: To evaluate the effectiveness of probiotic therapy in reducing the incidence and severity of antibiotic-associated diarrhea in pediatric patients. Study Design: Multicenter, single-blinded randomized controlled trial. Settings: Isra Hospital, Hyderabad Pakistan. Duration: April 2021 to July 2024. Methods: A total of 208 children aged 6–12 years receiving antibiotic therapy were enrolled and randomly allocated into probiotic and placebo groups using computer-generated randomization. The primary outcome was the occurrence of antibiotic-associated diarrhea, assessed using the Bristol Stool Form Scale (BSFS), defined as a score of 5–7 stools per day over a 24-hour period. Data were analyzed using SPSS software. Results: Antibiotic-associated diarrhea was observed in 13.6% of participants in the probiotic group and 17.1% in the placebo group, yielding a relative risk (RR) of 0.71 (95% CI: 0.39–1.22). Severe AAD occurred in 10.4% of the probiotic group compared to 11.3% of the placebo group (RR: 0.83; 95% CI: 0.51–1.69). The incidence of mild AAD was comparable between the probiotic and placebo groups (24.3% vs. 23.5%, respectively; RR: 1.01; 95% CI: 0.60–1.41). Conclusion: Probiotic supplementation may lead to a modest reduction in the incidence and severity of antibiotic-associated diarrhea in children; however, the observed differences were not statistically significant.
Comparison of Stone Clearance in Extracorporeal Shock Wave Lithotripsy versus Micro-Percutaneous Nephrolithotomy in Patients with Small Renal Calculi
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.
Effect of Iodine Povidone Mouthwash on the Periodontal Health of Orthodontic Patients
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
Background: Sodium Glucose Co-Transporter-2 (SGLT-2) inhibitors are medications commonly used to treat Type II Diabetes mellitus. Their primary action is to inhibit the Sodium Glucose Co-transporter 2 protein. Due to their glycosuric effect, these drugs are associated with recurrent urinary tract infections and normoglycemic Diabetic Ketoacidosis. Objective: To assess the frequency of urinary tract infections among patients with Type II Diabetes Mellitus taking SGLT-2 inhibitors. Study Design: Cross-sectional descriptive study. Settings: outpatient department of Government General Hospital, Samanabad, Faisalabad Pakistan. Duration: 6 months, from 12-01-2025 to 12-07-2025. Methods: We enrolled 138 patients based on inclusion and exclusion criteria. After starting SGLT-2 inhibitors during the first month, patients were monitored for urinary tract infections. Diagnosis was made using signs, symptoms, and a complete urine examination. Data collected included age, gender, HbA1c levels, and presence of urinary tract infection signs or symptoms. We calculated frequencies, percentages, and analyzed data using the chi-square test. A p-value of <0.05 was considered statistically significant. Results: Out of 138 patients, only 11 patients reported having Urinary Tract Infections (7.97%). Out of 11 patients, 10 were female and only one was male. Conclusion: This study found a 7.97% incidence of UTIs in T2DM patients initiated on SGLT-2 inhibitors, with a significantly higher risk observed in female patients. These findings highlight the importance of patient counseling and monitoring for UTIs, particularly in women, when prescribing this class of medication.
Efficacy of Topical Voriconazole 1% As Compared to Topical Natamycin 5% in the Treatment of Fungal Keratitis
Background: Infectious keratitis is a major cause of monocular blindness globally, with fungal infections accounting for a significant proportion of corneal ulcers. Fungal keratitis is challenging to treat and often results in severe visual impairment. Objective: To compare the clinical efficacy of topical 1% Voriconazole versus 5% Natamycin in the treatment of fungal keratitis. Study Design: Cross-sectional prospective study. Settings: Ophthalmology Department, Madina Teaching Hospital, Faisalabad Pakistan. Duration: Jul 31, 2025, to Dec 31, 2025. Methods: 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 were assessed at the time of the procedure and after 1 and 3 months of the procedure. Follow-up was done and all the information was recorded on proforma. Results: 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 in Group B with statistically significant p-values (p<0.05). Conclusion: Topical 1% Voriconazole was found to be superior to 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.
Early Detection of Pulmonary Fibrosis: Biomarkers and Imaging Techniques
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. Study Design: Retrospective cohort study. Settings: Department of Pulmonology, Saidu Teaching Hospital, Swat Pakistan. Duration: June 2024 to June 2025. Methods: 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.
Comparison of Postoperative Outcomes with and Without Enhanced Recovery after Surgery (ERAS) Protocols in Patients Undergoing Laparoscopic Cholecystectomy
Background: The application of ERAS protocols has revolutionized perioperative care but their role in laparoscopic cholecystectomy (LC) remains underexplored in many settings. Objective: Comparing the postoperative results of patients having laparoscopic cholecystectomy with and without the use of ERAS protocols. Study Design: Randomized controlled trial. Settings: Department of Surgery, Allied Hospital, Faisalabad Pakistan. Duration: 01-12-2024 to 31-07-2025 (eight months). Results: 160 patients, 51 Male and 109 female patients participated. In Group A, only one patient was placed on a drain, while in Group B, 49 patients had a drain. Pain score mean in Group A was 2.4 after 04hrs,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 four 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 four 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 four hrs., 0.86 after 08 hrs., 1.6 after 12 hrs., 2.3 after 24 hrs. Rescue analgesia mean is 0.17 (0.44) and 2.3 (SD = 0.62)in groups A and B, respectively. Mean postoperative hospital stay was 1.1 and 1.7 in groups A and B, respectively. Mean postoperative ileus was 2 and 1.9 in groups A and B, respectively. 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.
The Comparison of Risk Factors for Molar Pregnancy in PRIMI And Multi-gravid Women, A Comparative Cross-Sectional Study
Background: Molar pregnancy denotes a spectrum of abnormal placentation ranging from benign partial and complete hydatidiform mole to choriocarcinoma. Incidence varies worldwide, influenced by genetic, environmental, and socioeconomic factors. Objective: To compare the association of risk factors with molar pregnancies in PRIMI and multigravida women. Study Design: Comparative cross-sectional study. Settings: Obstetrics & Gynecology Department at Sahiwal Teaching Hospital, Sahiwal Pakistan. Duration: Two years (July 2023 to June 2025). Methods: 160 cases were included. Demographic and clinical parameters, including participants' age, gestational age at presentation, parity, and educational and socioeconomic status, were noted. Results: Of the 160 patients included, 70 were primigravida and 90 were multigravida. 70.0%, n=112, were 18–30 years with a mean age of 28.67 ± 3.87 years. The mean gestational age was 10.52 ± 1.54 weeks. Different risk factors noticed as 5.0% previous molar pregnancy, 46.3% poor socioeconomic status, 45.6% had blood group A, 20.0% prior abortion, 41.9% illiterate, 6.9% had age 35 years, and 35.0% had a history of oral contraceptive use. When compared between two groups, multiparous women had significantly more prior abortions as compared to primiparous (35.6% vs. 0.0%, p < 0.001); on the other hand, primiparous women were more illiterate as compared to multiparous (52.9% vs. 33.3%, p = 0.013). No significant differences were found among the remaining factors. Conclusion: Most of the risk factors did not differ significantly between the two groups. Sociodemographic factors may be more influential in determining risk.
Frequency of Bone Marrow Infiltration by Non-Hematopoietic Small Round Blue Cell Tumors in the Pediatric Population
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
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. Study Design: Retrospective study. Settings: ENT Department at Hayatabad Medical Complex, Peshawar Pakistan. Duration: January 2023 and March 2024. Methods: 100 patients diagnosed with nasal polyposis who underwent FESS. 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) versus Secondary (Delayed) Nailing in the Management of Gustillo-Anderson Type 3A Open Tibial Fractures – A Comparative Study
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 Pakistan. 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 were 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%) were females. Mean age was 32.24 ± 10.76 years, ranging from 17 to 60 years. The right tibia was involved in 42 (70%) patients while 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 single-staged nail group was 12.67 ± 5.36 weeks compared to 13.18 ± 3.61 weeks in two-staged 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 a significant negative association between soft-tissue infection and union time was observed (p < 0.001). 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.
Diagnostic Accuracy of Sonomammography in Differentiation of BI-RADS 4 Suspicious Breast Lesions as Benign or Malignant Keeping Histopathology as Gold Standard
Background: Breast cancer is the most common malignancy among females worldwide, with about 2.3million new cases and about 685,000 fatalities documented in the year 2020. Pakistan, with 220 million, reported 178,000 new cases and 117,149 fatalities. Early detection of breast cancer plays a key role in its survival outcomes. Mammography is a standard screening tool, but sonomammography, being a radiation-free modality, has better diagnostic efficacy in characterizing lesions in dense breasts. Objective: To assess the diagnostic accuracy of sonomammography in distinguishing benign from malignant lesions in all BI-RADS 4 cases, with histopathology serving as the gold standard. Study Design: Cross-sectional study. Settings: Radiology Department of CMH, Lahore Pakistan. Duration: 01-03-2025 to 31-08-2025. Methods: 360 women aged 30-70 years who presented with BI-RADS 4 breast lesions. All subjects underwent an ultrasound, followed by an ultrasound-guided core biopsy. The sonographic results were classified as low (4A) or moderate/high (4B/4C) suspicion. Results: Malignancy was confirmed in 218 of 360 patients (60.6%). Sonomammography detected 207 malignant and 128 benign lesions, yielding 11 false negatives and 14 false positives. It shows sensitivity of 95.0%, specificity of 90.1%, PPV of 93.7% and NPV of 92.1% with overall diagnostic accuracy of 93.1%. These results highlight strong agreement between sonographic and histopathologic findings, supporting sonomammography’s value in lesion stratification. Conclusion: Sonomammography has an excellent diagnostic performance for BI-RADS 4 lesions, especially in dense breasts, and it can help in reducing unnecessary biopsies.
Decoding Dental Dreams: Exploring Specialty Preferences of Dental Interns of Pakistan
Background: Dentistry is a rapidly expanding field with the development of various specialties. Multiple factors impact the choice of that specialty. Understanding and modifying those factors will help with the advancement of the dental profession. Objective: To understand the factors behind the choice made by dental students regarding their specialty career path. Study Design: Cross-sectional descriptive study. Settings: Various dental colleges of the public and private sectors of Pakistan. Duration: Six months from 01-07-2024 to 31-12-2024. 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.
Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction with Bone Patellar Tendon Bone Graft Using Lysholm Score
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.
Pathological Effects of COVID-19 on Menstrual Cycle: An Exploratory Study
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.