Students' Supplement of Journal of Rawalpindi Medical College

Machine Learning Deconvolution of the Blood Brain Barrier Immune Fibrosis in the Pathogenesis of Neurodegenerative Diseases

Husna Irfan Thalib — 2025-09-14

Background and Objectives: Neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) involve blood–brain barrier (BBB) dysfunction and immune-driven fibrosis, which contribute to neuronal injury and cognitive decline. This study used machine-learning (ML) deconvolution to examine immune and fibrotic signatures at the BBB, aiming to identify biomarkers and therapeutic targets for neurodegeneration.

Methods: Transcriptomic data from brain endothelial cells, cerebrospinal fluid, and peripheral blood of AD and PD patients were analyzed using ML deconvolution algorithms (CIBERSORTx and single-cell RNA sequencing). Immune subsets and fibrotic gene expression were quantified and integrated with clinical profiles. Clustering and predictive modelling identified immune-fibrotic subtypes, and biomarker findings were validated in external datasets with pathway-enrichment analyses.

Results: ML analysis revealed increased macrophages and activated endothelial cells expressing TGF-β, collagen I, and fibronectin at the BBB in both AD and PD. Peripheral monocytes migrated into the CNS, promoting fibrosis. High TGF-β signaling correlated with greater cognitive decline. Two subtypes emerged: (1) an inflammation-dominant subtype with elevated IL-6, TNF-α, marked BBB disruption, and rapid disease progression; and (2) a fibrosis-dominant subtype characterized by excessive collagen deposition, reduced BBB permeability, slower progression, and higher treatment resistance.

Conclusion: Machine-learning deconvolution highlights distinct immune and fibrotic alterations at the BBB in AD and PD. The inflammation-dominant subtype shows accelerated BBB breakdown and cognitive decline, whereas the fibrosis-dominant subtype exhibits slower progression but greater therapy resistance. These findings support the development of personalized, subtype-specific treatment strategies for neurodegenerative diseases.

Histopathological Spectrum and Pain Severity in Oral Lesions: A Cross-Sectional Study from a Tertiary Care Center in Pakistan

Faiz un Nisa, Eman Fatima — 2025-09-14

Introduction: Oral lesions, ranging from benign hyperplasia to malignant neoplasms, represent a significant public health concern. Pain is often the first clinical symptom but is underutilized in diagnostic assessment.

Objectives: To evaluate the histopathological spectrum of oral lesions and assess the prevalence, severity, and predictors of pain among patients with biopsy-confirmed oral lesions.

Material and Methods: This cross-sectional study was conducted at the Pathology Department, Isra University, Hyderabad, with the Nuclear Institute of Medical Radiotherapy (NIMRA), Jamshoro, and included 338 patients with biopsy-proven oral lesions. Sample size was calculated using OpenEpi at 95% confidence, 5% margin of error, and 66.8% expected pain prevalence. Patients of all ages and genders were enrolled; those with recurrent lesions, incomplete data, or systemic pain-modifying conditions were excluded. Pain was rated on a 0–10 numeric scale following the Brief Pain Inventory and MD Anderson Symptom Inventory, and histopathology, lesion site, tumor size, and TNM stage were recorded. Data were analyzed in SPSS v21 using chi-square and logistic regression, with p < 0.05 considered significant.

Results: The mean age was 52.3 ± 12.7 years, with 63.9% males. Malignant neoplasms constituted 39.3% of cases. Pain was reported by 68.3% of patients; 12.1% experienced severe pain. Pain severity was significantly associated with histopathological type, lesion location, and TNM stage (p<0.001). Tongue lesions (OR 2.45), tumor size >4 cm (OR 1.75), and limited mouth opening (OR 3.12) were independent predictors of pain. TNM Stage I tumors were inversely associated (OR 0.32, p=0.003).

Conclusion: Pain is a frequent and diagnostically relevant symptom in oral lesions, particularly in malignancies. Pain assessment should be routinely integrated into clinical evaluation to facilitate early intervention.

Keywords: Oral lesions, histopathology, pain severity, TNM staging

Efficacy of Bioresorbable Vascular Scaffold vs Drug- Eluting Stents After PCI : A GRADE-Assessed Systematic Review and Meta-Analysis of Randomised Controlled Trials

2025-09-14

Background: Drug-eluting stents (DES) are widely used in percutaneous coronary intervention (PCI), but their permanent metallic structure can impair long-term vascular function. The DynamX bioadaptor, a sirolimus-eluting scaffold with bioresorbable links, is designed to restore vessel motion after six months, potentially improving outcomes.
Objectives: To compare clinical outcomes of bioadaptive stents with DES in PCI patients by analysing recent randomized controlled trials (RCTs).
Methods: This meta-analysis followed PRISMA and Cochrane guidelines. RCTs comparing bioadaptive stents with DES in PCI patients were included. Primary outcomes were cardiac death, myocardial infarction (MI), and revascularization. A random-effects model was applied in Review Manager 5.4.1. Certainty of evidence was assessed using GRADE, and publication bias was evaluated with funnel plots and Egger’s test.
Results: Twenty-two RCTs involving 5,068 patients were analyzed. No significant differences emerged between stent types for cardiac death (RR = 0.93; 95% CI: 0.71–1.21), all-cause mortality (RR = 0.92; 95% CI: 0.78–1.10), or target vessel MI (RR = 1.38; 95% CI: 1.18–1.63). Secondary outcomes—including target lesion revascularization (TLR), target vessel revascularization (TVR), and all MI—were likewise not significantly different. Heterogeneity was low (I² = 0%), and evidence certainty ranged from moderate to high.
Conclusions: Although bioadaptive stents are designed to improve vessel healing and motion, current evidence shows no superiority over DES. Earlier bioresorbable vascular scaffolds (BVS) carried higher risks of MI and TLR due to design limitations. Longer follow-up and improved scaffold designs are needed to clarify potential long-term benefits.

Comparative Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin for Stroke Prevention and Major Bleeding in Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Mian Zahid Jan Kakakhel — 2025-09-14

Background: Atrial fibrillation (AF) is one of the most common arrhythmias, affecting over 52 million people worldwide. Direct-acting oral anticoagulants (DOACs) are proposed as add-on therapy to prevent ischemic stroke in AF.
Purpose: To assess the safety of various DOAC regimens compared with warfarin in AF patients.
Methods: A literature search across four databases (inception–January 2025) identified randomized trials comparing DOACs and warfarin. Outcomes included stroke, intracranial haemorrhage (ICH), all-cause mortality, major bleeding, and non-ICH mortality. Risk ratios (RR) with 95% credible intervals (CrI) were estimated. Surface under the cumulative ranking curve (SUCRA) indicated lowest event risk. Analyses used the Bugsnet package in R with a common-effects model and deviance information criterion.
Results: Eighteen studies with 89,985 patients and nine treatment arms were analyzed. Rivaroxaban 15 mg once daily (OD) showed the lowest stroke risk (RR 0.45; 95% CrI 0.20–0.92; SUCRA 83.15%), followed by dabigatran 150 mg twice daily (BD) (RR 0.68; 95% CrI 0.55–0.84) and apixaban 5 mg BD (RR 0.74; 95% CrI 0.62–0.89). Major bleeding risk was lowest but not significant with apixaban 2.5 mg (SUCRA 86.68%); significant reduction occurred with apixaban 5 mg BD versus warfarin (RR 0.70; 95% CrI 0.62–0.91). Rivaroxaban 15/20 mg OD carried the highest major-bleeding risk, exceeding that of dabigatran 110 mg BD and apixaban 5 mg BD. For ICH, dabigatran 110 mg BD had the lowest risk (SUCRA 92.81%), significantly lower than apixaban 5 mg BD, rivaroxaban 15/20 mg OD, and warfarin. Mortality unrelated to ICH was lowest with endoxaban 60 mg OD, followed by dabigatran 150 mg BD and apixaban 5 mg BD; all DOACs outperformed warfarin. All-cause mortality was least with endoxaban 60 mg OD, then apixaban 5 mg BD and dabigatran 150 mg BD.
Conclusion: Apixaban 5 mg provides the best overall safety, combining low major-bleeding risk with favorable stroke and mortality outcomes. Rivaroxaban 15 mg offers the greatest stroke protection. Overall, all DOACs were safer and at least as effective as warfarin.

Optimizing Survival Prediction in Neurotrauma: Comparative Performance of Age, ISS, RTS, and TRISS Using Advanced Regression Models

Muhammad Usman, Ali Abdul Basit — 2025-09-14

Background: Neurotrauma presents a critical burden in emergency care, where early and accurate survival prediction is essential for timely interventions and optimal resource allocation. While established scores such as the Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) are widely used, their relative performance—especially when enhanced with modern statistical models—requires further exploration.

Objectives: To evaluate and compare the predictive accuracy of Age, ISS, RTS, and TRISS in forecasting survival among neurotrauma patients using traditional and spline-based logistic regression.

Materials and Methods: This retrospective study was conducted at a tertiary care hospital between February and June 2022. Trauma patients with head and/or spinal injuries were included. Exclusion criteria were age <12 years, non-trauma admissions, or incomplete records. Data were extracted from electronic records and analyzed using R. One-, two-, three-, and four-predictor models were constructed using Age, ISS, RTS, and TRISS. Model performance was assessed using AUC, Brier score, calibration plots, and nomograms. Sensitivity analyses and internal validation ensured robustness.

Results: TRISS demonstrated the highest predictive performance (AUC: 0.95), followed by RTS (AUC: 0.91), ISS (AUC: 0.87), and Age (AUC: 0.76). Two-predictor models combining TRISS with Age or RTS improved discrimination. Three- and four-predictor models offered marginal improvement, suggesting TRISS-based models are most efficient.

Conclusion: TRISS remains the most reliable tool for survival prediction in neurotrauma. Its predictive power can be enhanced by incorporating Age and applying flexible modeling techniques. These findings support the use of refined prediction tools in acute neurotrauma management.

Keywords: Neurotrauma, TRISS, Survival Prediction, Logistic Regression, Trauma Scoring Systems.

An Assessment of the Association Between Respiratory Health and Duration of Exposure to Traffic-Related Air Pollution Among Taxi Drivers of Rawalpindi: A Cross-Sectional Study

Muhammad Talha Farrukh, Sohaib Mushtaq, Ayan Habib, Ehtisham Khan — 2025-09-14

Introduction:
Traffic-related air pollution is a major public health hazard, causing millions of deaths annually. Workers with prolonged exposure are more prone to respiratory symptoms, yet research on drivers—especially the link between exposure duration and respiratory health—is limited. Rapid urbanisation and growing traffic highlight this gap.

Methods:
This cross-sectional study was approved by the ethics committee. Using OpenEpi and a total driver population of 300, a sample size of 115 was calculated. Data were collected via a standardized respiratory health questionnaire and peak flow measurements, using non-random convenience sampling. Taxi drivers who worked part-time, smoked, or had chronic respiratory disorders were excluded. SPSS 21 was used for analysis.

Results:
Among 115 taxi drivers, mean age was 39.1 ± 12.34 years, mean expiratory flow rate 433.5 L/min, and average respiratory symptom score 3.17. Fifty-five (48%) reported at least one symptom. Hours spent driving per day showed a borderline correlation with symptoms (r = 0.181, p = 0.053), while tenure showed no overall association (r = 0.110, p = 0.247). Linear regression confirmed these findings. In the subgroup aged <40 years (n = 58), however, occupational tenure significantly predicted symptoms (p = 0.009), with each additional year increasing the score by β = 0.341.

Conclusions:
In taxi drivers younger than 40, respiratory symptoms rise with longer occupational tenure, whereas no linear relationship exists in older drivers.

Keywords:
Occupational exposure, traffic-related air pollution, taxi drivers.

Exploring Panic Attack Prevalence, Symptoms, Risk Factors, and Impact Among Medical Students of Islamabad; a Cross-Sectional Study

2025-09-14

INTRODUCTION: Panic attacks are episodes of intense fear that may reflect a state of severe distress and become a risk for depression. People who experience panic attacks have impaired physical and emotional health. In medical students, these episodes interfere with their academic performance and eventually lead to burnout and decreased productivity.

OBJECTIVES: To determine the prevalence of panic attacks, their relationship with associated risk factors among medical students, and to assess panic attacks’ impact on their health.

METHODS: A quantitative cross-sectional study was conducted over six months among medical students enrolled at a medical college in Islamabad. The sample size was calculated to be 255 using OpenEpi. Data were collected from medical students, whereas non-medical students were excluded from the study. Data collection was mediated through a questionnaire, after obtaining approval from the ERC, containing questions related to panic attack symptoms, duration, risk factors, and impact on health. All descriptive statistics, such as chi-square tests, were applied using SPSS 31, with p<0.05 considered significant for all measures.

RESULTS: The sample consisted of medical students from all five years of MBBS. Of the participants, 74.2% (n=190) had experienced the symptoms of a panic attack. Among them, 54.7% (n=140) had a panic attack for the first time after entering medical college. In addition, 44.1% (n=113) experienced panic episodes during exams or while giving a presentation. A total of 84% (n=215) considered panic attacks in some way harmful to their physical or mental health. Moreover, 45.3% (n=116) reported occasional fear and avoided places because of fear of having a panic attack. A statistically significant result was observed in the responses of the students about the impact of panic attacks on their academic and clinical performance (p<0.05).

CONCLUSION: Our study reveals that panic attacks are common among medical students, with a majority experiencing onset after entering medical college. Most students perceive panic attacks as harmful to their health and note a significant impact on their academic and clinical performance, highlighting the need for targeted mental health support along with the curriculum.

KEYWORDS: Panic, Prevalence, Medical Students

Assessing Quality of Life Post-Myocardial Infarction: A Study of Physical Activity And Emotional Well-Being in Patients

Hamza Chaudhary, Ariba Waheed — 2025-09-14

Introduction: Studying changes in quality of life post-myocardial infarction is crucial as it informs patient-centered care, rehabilitation strategies, and predicts long-term outcomes. These assessments also guide healthcare resource allocation and quality improvement initiatives to optimize recovery and overall well-being for individuals affected by myocardial infarction. The objective of this study is to assess and quantify the changes in quality of life experienced by individuals following myocardial infarction, informing strategies for enhanced patient care and rehabilitation outcomes.

Objective: To visualize the factors causing issues in patients for their better lives.

Materials and Methods: A survey was used as a tool to collect data from post-MI patients. It is a cross-sectional study conducted at the Punjab Rangers Teaching Hospital, Lahore, for 2 months. The sample size is 150. A questionnaire/survey was filled out by patients. Medically confirmed cases with a diagnosis of myocardial infarction (MI) based on clinical records or diagnostic tests (e.g., ECG, cardiac enzymes) were included in the study. A simple random sampling technique was used. Data were analyzed using SPSS version 25. IRB approval from the hospital IRB committee was obtained. Descriptive analysis was performed on each question of the survey.

Results: A total of 150 individuals with diagnosed MI participated in the survey. Thirty-two (21.33%) individuals reported being restless most of the time. Thirty-one (20.67%) individuals reported being tearful or emotional most of the time. Thirty-four (22.67%) reported being extremely limited in sports and other physical activity. Fifty-five (36.67%) reported being very limited in sports and other physical activity.

Conclusion: The results revealed a negative impact on the quality of life of patients after myocardial infarction. The quality is affected in terms of physical activity as well as emotionally. Guidelines should be established to provide psychiatric, emotional, and physiotherapy-related interventions to ensure a better quality of life for patients after suffering from myocardial infarction.

Keywords: Rehabilitation, Healthcare.

Conception Timing and Autism Spectrum Disorder: Unraveling the Connection

Hamza Chaudhary, Ariba Waheed — 2025-09-14

Introduction: The purpose of this research is to determine whether the age of conception and the frequency of autism are correlated. This research is important because it will assist parents in making healthy family planning decisions and reduce the huge financial burden associated with the health and education of these children.

Objectives: To check the association of paternal and maternal factors with autism.

Materials and Methods: It is a comparative cross-sectional study conducted in the Mayo Hospital Psychiatry Ward of patients with autism from ages 4 to 11. The duration of the study was 1.5 months after the approval of the synopsis. Ethical approval was taken from the IRB of KEMU. The calculation yielded a sample size of 300. A preformed questionnaire proforma was given to parents/guardians to obtain data on demographic information, pregnancy, delivery, delivery intervals, and ASD according to the ADI-R International Questionnaire. SPSS version 25 was used. The chi-square test was applied to determine the association between childbirth, demographic and other gestational factors, and ASD measured with the ADI-R scale. Children with any severity of ASD and normal school-going children were included in this study. Children with severe neurocognitive disorders were excluded.

Results: A significant association between maternal age at conception and ASD was reported (p = 0.000). A significant association between paternal age at conception and ASD was also reported (p = 0.000). All other childbirth factors also had a significant association with ASD. No significant association between the birth weight of the child and ASD was reported (p = 0.064).

Conclusion: The results showed a significant association of ASD with prenatal and postnatal factors and other gynaecological and obstetric factors, including the mother’s and father’s age at conception. We suggest the implementation of our findings in the clinical guidelines, family planning, and prenatal and postnatal care of the mother and the child.

Keywords: Autism Spectrum Disorder, prenatal factors, postnatal factors.

Nephroprotective Effects of Equisetum ramosissimum L. Ethanolic Extract Against Cisplatin-Induced Nephrotoxicity in Albino Rats: A Quasi-Experimental Study

Mariyam Bachani — 2025-09-14

Background: Cisplatin, a widely used chemotherapeutic agent, is associated with significant nephrotoxicity, limiting its clinical utility. Medicinal plants like Equisetum ramosissimum L. have been explored for their antioxidant and nephroprotective properties. This study aimed to evaluate the protective effects of E. ramosissimum ethanolic extract on cisplatin-induced renal damage in albino rats.

Methods: A quasi-experimental study was conducted at Isra University, Hyderabad, from February to July 2025, using 30 adult albino Wistar rats randomly divided into three equal groups. Group A served as the control. Group B received a single intraperitoneal dose of cisplatin (20 mg/kg). Group C received cisplatin followed by E. ramosissimum ethanolic extract (300 mg/kg/day orally) for seven days. Renal function was assessed via serum creatinine, blood urea nitrogen (BUN), and histopathological examination of renal tissue.

Results: Group B exhibited significantly elevated serum creatinine (2.5 ± 0.3 mg/dL) and BUN (45 ± 5.2 mg/dL) compared to Group A (0.7 ± 0.1 mg/dL and 22 ± 3.4 mg/dL, respectively; p < 0.001). In contrast, Group C showed substantial improvement in renal markers (creatinine: 1.1 ± 0.2 mg/dL; BUN: 28 ± 4.1 mg/dL; p < 0.01 vs. Group B). Histological analysis confirmed reduced tubular necrosis and glomerular damage in Group C compared to Group B.

Conclusion: Equisetum ramosissimum ethanolic extract demonstrated significant nephroprotective effects against cisplatin-induced nephrotoxicity in albino rats. These findings support its potential as an adjunctive therapy to mitigate cisplatin-associated renal injury.

Keywords: Equisetum ramosissimum, nephrotoxicity, cisplatin, nephroprotection, herbal extract, albino rats.

Moral Injury in Medical Students Witnessing Unethical Practices: Insights From A Cross-Sectional Survey

Easha Masood, Muhammad Hanzla Masood — 2025-09-14

Background: Moral distress arises when an individual recognizes the ethically appropriate action but feels powerless to act due to institutional or psychological barriers. Though first described in palliative care, it now affects all medical fields. This study evaluates the impact of witnessing unethical practices on medical students’ resilience, burnout, and career intentions.

Objectives: To identify the unethical practices encountered by medical students during clinical rotations, assess the severity of moral injury from such experiences, and examine its relationship with burnout and concerns about future careers.

Method: A nationwide, convenience-based cross-sectional survey was conducted in July 2025 among undergraduate medical students who had completed clinical rotations and provided informed consent. A pretested electronic questionnaire collected demographic data and used the Moral Injury Outcome Scale (MIOS), along with measures of coping, burnout, and career impact. The MIOS includes shame-related and trust-violation subscales (scores 0–56), with severity classified as mild (14–28), moderate (29–42), or severe (43–56). Pearson’s chi-square test evaluated associations between variables. Ethical approval was obtained.

Results: Of 78 responses, 67 were analyzed (mean age 22.0 ± 0.1 years; 94% female; 74.6% fourth-year students). Age positively correlated with the number of departments worked in (r = 0.36, p = 0.003). Reported unethical practices included disrespect toward patients (55.2%), discrimination (29.9%), lack of consent (19.4%), breaches of confidentiality (26.9%), aggression or care delays (38.8%), and record falsification (7.5%). Severe moral discomfort was noted in 38.8%, yet only 34.3% reported incidents. Mean shame and trust scores were 20.0 ± 8.8 and 24.0 ± 9.5, respectively; mean MIOS total score was 43.0 ± 18.3. Mild and moderate moral injury occurred in 52.2% and 16.4% of students. Witnessing unethical behavior was significantly associated with moral injury severity (χ² = 12.7, p = 0.005; Fisher’s p = 0.007), burnout (χ² = 8.95, p = 0.030), and future career concerns (r = 0.48, p < 0.001).

Conclusion: These findings highlight the urgent need for reforms in clinical training environments to reduce unethical practices and protect the moral integrity of future healthcare professionals.

Keywords: Moral Injury, Burnout, Medical Students

Disparities and Determinants of Hypertensive Renal Disease Mortality in the United States: A Nationwide Retrospective Study (1999–2020)

Zarhaish Barkat Ullah — 2025-09-14

Introduction: Hypertensive renal disease (HRD), coded as ICD-10 I12, is a severe complication of chronic, uncontrolled hypertension that lies at the intersection of cardiovascular and renal pathology. Despite improved hypertension management, HRD-related mortality in the United States continues to rise, disproportionately affecting older adults, racial and ethnic minorities, and people in underserved areas. Prior studies have focused mainly on hypertension or chronic kidney disease overall, often neglecting HRD-specific trends and key demographic or regional vulnerabilities.

Objectives: This study aimed to (1) quantify national trends in age-adjusted mortality rates (AAMRs) from HRD in the U.S. from 1999 to 2020, (2) identify disparities by gender, race/ethnicity, and urban–rural status, and (3) detect inflection points in mortality trends using Joinpoint regression.

Materials and Methods: A retrospective, population-based analysis used CDC WONDER Multiple Cause of Death data. All adult deaths (≥18 years) with ICD-10 code I12 from 1999–2020 were included. AAMRs per 100,000 were standardized to the 2000 U.S. population. Joinpoint regression calculated annual percent changes (APCs) and identified significant trend shifts. Subgroup analyses examined gender, race/ethnicity, and urban–rural categories. Only publicly available, de-identified data were used, adhering to STROBE guidelines.

Results: From 1999 to 2020, 618,157 HRD deaths were recorded. National AAMR rose from 5.28 to 29.6 per 100,000 (APC: 9.65%; 95% CI: 7.48–11.48). Males consistently had higher AAMRs than females (15.59 vs. 11.12). Non-Hispanic Black individuals showed the highest AAMRs (29.55) but the lowest APC (5.25%), indicating persistently high mortality. Non-Hispanic Whites had the fastest rise (APC: 11.25%). Urban–rural disparities were evident, with the highest AAMRs in Large Central Metros and the lowest in Large Fringe Metros.

Conclusion: HRD mortality increased sharply in the U.S. from 1999 to 2020, with marked and evolving disparities across racial, gender, and geographic lines. Equity-focused public health strategies are urgently needed to address these widening gaps.

Keywords: Hypertension, Renal Insufficiency, Mortality, Health Disparities, Epidemiology

Comparative Analysis of Etiological Factors, Clinical Presentation, and Complications of Cholelithiasis in Adult and Pediatric Patients: A Multicenter Study in Hyderabad, Pakistan

Muhammad Rizwan, Vinod saroop , Abdul Haseeb, Muhammad Hassan, Muhammad Jaan — 2025-09-14

Background: Cholelithiasis presents differently in adults and children because of distinct etiologies, physiology, and risk factors. While well-documented in adults, its rising incidence in pediatric patients warrants further study. This research compared etiological factors, clinical symptoms, and complications of cholelithiasis between adult and pediatric cohorts.

Methods: A cross-sectional observational study was conducted from January to June 2025 across three tertiary care centers in Hyderabad: Isra Hospital, Civil Hospital, and Khidmat-e-Khalq Foundation Hospital. Using non-probability consecutive sampling, 240 ultrasonography-confirmed patients were enrolled—180 adults (>18 years) and 60 children (<18 years). Data on demographics, risk factors (obesity, hemolytic disorders, family history, diet), clinical symptoms, and complications (cholecystitis, pancreatitis, obstructive jaundice) were collected and analyzed using SPSS v26.

Results: Obesity (65%) and sedentary lifestyle (58%) were predominant risk factors in adults, whereas hemolytic disorders (40%) and family history (33%) were more frequent in children (p < 0.001). Abdominal pain was the most common symptom in both groups (90% adults vs. 83% children). Pediatric patients showed a higher rate of asymptomatic cases (18% vs. 4%, p = 0.003). Adults experienced significantly more complications, especially acute cholecystitis (32% vs. 12%, p = 0.005).

Conclusion: Pediatric cholelithiasis is being diagnosed more often and exhibits distinct etiological patterns with fewer complications than adult disease. Early detection and age-specific prevention strategies are essential to reduce long-term morbidity.

Keywords: Cholelithiasis; Gallstones; Pediatrics; Adults; Risk Factors; Complications; Abdominal Pain

The Role of Activated Charcoal in Mitigating Lead-Induced Нераtоtоxicity In Albino Wistar Rats

Simran Devi, Nimrata Rani , Mahik Sandeep ,Naveen Lohana — 2025-09-14

Background: Lead is a pervasive environmental toxin with severe effects on human health, particularly the liver. Through oxidative stress—an imbalance between reactive oxygen species (ROS) and antioxidant defenses—lead induces hepatocellular damage via lipid peroxidation, protein oxidation, DNA injury, and inflammation.

Objective: To evaluate the hepatoprotective effects of activated charcoal against lead-induced hepatotoxicity in albino Wistar rats.

Methods: A quasi-experimental study was conducted from February to August 2024 on 36 male albino Wistar rats, divided into three groups (n = 12 each): Group A (control), Group B (lead-acetate), and Group C (lead-acetate + activated charcoal). Blood samples and liver tissues were collected for biochemical and histological analysis.

Results: Group B showed significant increases in AST (79.31 ± 9.79 U/L), ALT (38.28 ± 2.29 U/L), ALP (209.09 ± 8.49 U/L), and bilirubin (0.98 ± 0.43 mg/dL), along with reductions in albumin (2.88 ± 0.28 g/dL) and total proteins (6.92 ± 0.22 g/dL) (p < 0.05). Group C displayed intermediate values between Groups A and B. Antioxidant enzymes—glutathione peroxidase and superoxide dismutase—were highest in Group A, lowest in Group B, and intermediate in Group C (p < 0.05). Histology revealed marked vacuolar degeneration and lymphocyte infiltration in Group B, while Group C exhibited milder changes with fewer infiltrates.

Conclusion: Activated charcoal significantly mitigates lead-induced hepatotoxicity in albino Wistar rats, demonstrated by improved biochemical markers and reduced histological damage.

Keywords: Activated Charcoal; Lead; Oxidative Stress; Lead-Acetate; Heavy Metals

Efficacy of Nanoparticle-based Localized Immunomodulation to Reduce Graft-versus-host Disease in Bone Marrow Transplantation: A Systematic Review

Farwa Saleem — 2025-10-14

Background and Aim

Graft-versus-host disease (GVHD) is a serious, life-threatening complication following bone marrow transplantation (BMT) that terribly increases transplant-related mortality and morbidity. Despite being common, conventional immunosuppression frequently results in unsatisfactory disease control and more importantly are associated with systemic toxicity and infection. Nanoparticle (NP) -based therapeutics while been explored in solid organ transplantation, remains under investigated in BMT. This study aims to compare the effectiveness of traditional immunosuppression with NP based localized treatment in GVHD mitigation in standard murine models.

Methods

Database search was carried out via PubMed, Science Direct, and Springer using a restriction of standard strain and the following keywords: (bone marrow transplantation OR hematopoietic stem cell transplantation) AND graft vs host disease AND nanoparticles. Search was conducted from 2000 to 2025. From the 66 studies retrieved, 15 were selected and included in this research. Based on PRISMA criteria, this review included peer-reviewed English studies using standard murine models (e.g., C57BL/6, BALB/c) undergoing allogeneic BMT with experimentally induced GVHD. Studies used IV or IP nanoparticle delivery (e.g., immunosuppressants, biopolymers) with appropriate comparators; exclusions included non-murine models, oral/subcutaneous routes, combination therapies, and non-primary literature. Data on study design, animal models, interventions, and outcomes were extracted from full texts and supplements into a structured Excel sheet. Discrepancies were resolved through discussion with a third reviewer. Risk of biased assessment was also done using SYRCLE tool.

Results

Murine models received different types of NPs treatment: Fullerol NPs, Bilirubin NPs, Fe₃O₄ Magnetic NPs, Carbon Nanotubes and Nanoencapsulation of T Cells. Studies indicated significantly reduced GVHD clinical scores (n=5), improved survival (n=4), and alleviation of inflammatory processes (n=4) compared to controls. Not all studies outperformed conventional immunosuppression. Surprisingly, noteworthy secondary outcome made this planned one-to-one analysis, two-dimensional by getting the Graft-versus-Leukemia (GVL) activity preserved without compromising the GVHD mitigation (n=2). No adverse effects were reported in all studies.

Conclusion

NPs therapy, in BMT seems to have a potential for managing GVHD effectively and more precisely compared to traditional immunosuppression. It underscores the need for in-depth translational studies.

Key-Words

Bone Marrow Transplantation OR Hematopoietic Stem Cell Transplantation AND Graft vs Host Disease AND Nanoparticles

Clinical and Angiographic Outcomes of SCBs versus PCBs in Coronary Artery Disease: A Comprehensive Meta-Analysis

2025-10-14

Introduction:
Coronary artery disease (CAD) remains a leading global cause of mortality, with percutaneous coronary intervention (PCI) as a key treatment. Although drug-eluting stents (DES) have reduced restenosis, in-stent restenosis (ISR) persists. Drug-coated balloons (DCBs), particularly sirolimus-coated balloons (SCBs), offer a promising alternative to paclitaxel-coated balloons (PCBs) due to superior pharmacologic properties. This meta-analysis evaluates the safety and efficacy of SCBs versus PCBs in ISR and de novo coronary lesions.
Objective:
1. To synthesize evidence comparing SCBs and PCBs in coronary artery disease..
2. To evaluate whether SCBs offer superior clinical and angiographic outcomes, including TLF, MI, TLR, LLL, and MLD..
Methods:
A thorough search was performed throughout PubMed, Embase, Web of Science, Scopus, Google Scholar, and Cochrane. Angiographic results included diameter stenosis, in-segment LLL, and MLD; clinical results included TLF, cardiac mortality, TVMI, and TLR. CMA software's random-effects model was used to compute pooled odds ratios (ORs) and standardised mean differences (SMDs) with 95% CIs. At p < 0.05, statistical significance was established.
Results:
Six RCTs and four observational studies with a total of 6,256 participants were included in this meta-analysis. The pooled analysis revealed that there was no statistically significant difference in TLR (OR: 0.986, 95% CI: 0.800–1.215, p = 0.894; I² = 0%), cardiac death (OR: 0.825, 95% CI: 0.351–1.937, p = 0.658; I² = 0%), MI (OR: 0.603, 95% CI: 0.299–1.215, p = 0.157; I² = 0%), and TLF (OR: 1.006, 95% CI: 0.813-1.245, p = 0.957) between the two intervention groups. Although not statistically significant, SCBs demonstrated better angiographic outcomes including lower LLL (SMD: –0.180, 95% CI: –0.420 to 0.060, p = 0.141), greater MLD ( SMD: 0.112, 95% CI: –0.055 to 0.280, p = 0.188), and lower diameter stenosis (SMD: –0.088, 95% CI: –0.334 to 0.158, p = 0.484).
Conclusion:
Although SCBs and PCBs demonstrated comparable efficacy and safety and efficacy in patients undergoing PCI, current evidence suggests that SCBs may lead to superior angiographic outcomes. Further well-designed, large-scale trials are needed to validate these findings and improve clinical guidelines.
Keywords:
Sirolimus-coated balloon, Paclitaxel-coated balloon, In-stent restenosis,Percutaneous coronary intervention

Safety and Clinical Outcomes of Low-Intensity Versus Standard Monitoring Following Thrombolysis in Acute Ischemic Stroke: A Systematic Review

Syed Akbar Imam, Rutbaa Ayaz Shaikh, Bilal Khan — 2025-10-14

Introduction:
Intravenous thrombolysis is the cornerstone of acute ischemic stroke (AIS) treatment, but standard post-thrombolysis monitoring is resource-intensive and difficult to implement in low- and middle-income countries (LMICs) with limited ICU access. Low-intensity monitoring (LIM) protocols have been proposed as alternatives, but evidence on their safety and clinical outcomes remains limited and fragmented.
Objective:
This systematic review evaluates whether LIM offers a viable, resource-efficient alternative to conventional monitoring in thrombolysed AIS patients.
Methods:
Following PRISMA 2020 guidelines, a systematic search was conducted in June 2025 across PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov for studies involving adult AIS patients treated with IV thrombolysis. Search terms included combinations of “low-intensity monitoring,” “standard monitoring,” and “acute ischemic stroke.” Eligible studies compared LIM and standard protocols and reported outcomes like 90-day modified Rankin Scale (mRS), symptomatic intracerebral hemorrhage (sICH), NIHSS, ICU admission, or hospital stay. Case reports, editorials, animal studies, and non-comparative designs (except single-arm safety trials used for contextualizing safety) were excluded. After screening, three studies were included: one cluster RCT, one retrospective cohort, and one single-arm safety trial. Three reviewers independently extracted data. Risk of bias was assessed using Cochrane
RoB 2.0 and the Newcastle-Ottawa Scale. Due to design and outcome heterogeneity, a meta-analysis was inappropriate; instead, a narrative synthesis was performed
Results:
Across the three studies, 5,161 patients were analyzed. The OPTIMISTmain RCT reported similar 90-day functional independence (mRS 0–2) in LIM (31.7%) and standard care (30.9%) groups (RR 1.03; 95% CI, 0.92–1.15; p=0.61). sICH was rare in OPTIMISTmain (0.2–0.4%) but higher in the cohort study (4.9%). ICU admissions were comparable, though early escalation occurred more in the cohort. The safety trial reported favorable outcomes without critical events. Nurses in OPTIMISTmain found LIM acceptable due to reduced burden.
Conclusion:
LIM appears feasible in resource-constrained settings. However, limited studies restrict
generalizability. Patient selection, staff training, and structured protocols are essential.
Further large-scale studies are needed to validate implementation and risk stratification tools.
Keywords:
Stroke, Thrombolytic Therapy, Developing Countries

Machine Learning in the Prediction and Management of Sepsis: A Meta-Analysis

Aamina Haq, Zahan Khan, Raafay Jamil, Maira Zainab, Hayyan Asif — 2025-10-14

Introduction:

Sepsis remains a leading cause of morbidity and mortality worldwide, requiring early identification for effective management. In recent years, machine learning (ML) has emerged as a tool for improving diagnostic and prognostic accuracy in sepsis care. This meta-analysis aimed to evaluate the performance of ML models in predicting sepsis diagnosis and related clinical outcomes.

Methods:

A systematic literature search was conducted using PubMed, ScienceDirect, and Google Scholar for studies published from 2013 to 2024. Original research articles employing machine learning algorithms to predict sepsis diagnosis, mortality, ICU admission, or length of stay were included. Exclusion criteria were non-human studies, reviews, and non-ML models. PRISMA guidelines were followed. Risk of bias was assessed using the PROBAST tool. Model performance was evaluated using metrics such as area under the curve (AUC), sensitivity, specificity, and accuracy.

Results

Out of approximately 350 screened articles, 20 met the inclusion criteria. The most frequently used models were tree-based algorithms such as Random Forest and XGBoost. Across studies, the pooled AUC values commonly exceeded 0.85, suggesting high diagnostic accuracy. ML models also showed consistent performance in predicting sepsis-related mortality and ICU admissions. Variability was observed due to differences in sepsis definitions, sample sizes, and model validation strategies.

Conclusion

Machine learning models demonstrate promising potential for early sepsis prediction and outcome forecasting, with high diagnostic accuracy across multiple algorithms. However, significant heterogeneity in study designs, model interpretability, and lack of real-world validation limits their current clinical utility.

Limitations: Variability in sepsis definitions, model heterogeneity, potential publication bias, and absence of standardized external validation protocols.

Ethical Statement:

As this meta-analysis used only publicly available data, institutional review board (IRB)approval was not required.

Pathogenesis and Treatment of Non-Alcoholic Steatohepatitis and Its Fibrosis: A Systematic Review

2025-10-14

Introduction:

Non-Alcoholic Steatohepatitis is a slow-developing liver disease characterized by fat in the liver, inflammation, and scarring. Although there are many treatments, no standard pharmacotherapy is approved globally.

Objectives:

This systematic review aims to enhance critical care practice by synthesizing evidence from recent trials on the pathogenesis and treatment of Non-Alcoholic Steatohepatitis and its fibrosis.

Methodology:

This systematic review was conducted according to the PRISMA principles. The literature was searched using text terms and controlled vocabulary, employing Boolean operators "AND," "OR," and various combinations across PubMed, Embase, and the Cochrane Library. Open-access, full-text English papers from 2014 to 2024, involving humans, were selected. The quality was assessed using ROB 2.0, and the evidence was appraised using GRADE. Fourteen RCTs were analyzed for methodological quality. The GRADE tool categorized two high ROB RCTs as "low quality." However, two RCTs had low ROB and were classified as "High quality." Ten RCTs had uncertain ROB, lowering the evidence by one point to "Moderate quality."

Results:

This review discusses clinical trials involving GLP-1 receptor agonists, THR-β agonists, pan-PPAR agonists, FGF21 analogues, and bariatric surgery. While GLP-1 agonists and resmetirom improve liver fat reduction, lanifibranor can also decrease fibrosis. Bariatric surgery is the best option for NASH in 56-70% of cases, but there are issues like incomplete fibrosis reversal and lack of long-term evidence.

Conclusion:

Non-alcoholic steatohepatitis (NASH) remains a challenging condition influenced by multiple factors, and there is currently no universally accepted treatment. Promising results have been seen with certain metabolic drugs and agents targeting multiple pathways, and bariatric surgery continues to show strong results for those who qualify. Future research should focus on combination therapies, exploring new antifibrotic therapies, and genetically based treatments.

Efficacy and Safety of Intravenous Immunoglobulin and Eculizumab in the Treatment of Guillain-Barré Syndrome: A Systematic Review and Meta-Analysis

Syed Hassan Ali, Sughra Memon, Atiqa Noor, Mushk Fatima, Shanza Shakir. — 2025-10-14

Introduction:
Guillain-Barré Syndrome (GBS) is an acute autoimmune polyradiculoneuropathy that causes increasing deterioration and sudden paralysis. Current standard therapy includes intravenous immunoglobulin (IVIG) and plasma exchange, making partial recoveries in GBS patients, reflecting the need for advanced therapies. Eculizumab is a monoclonal antibody that targets complement component C5, though the safety and effectiveness of it in conjunction with IVIG remain unknown.
Objective:
The study’s objective is to evaluate the efficacy and safety of Eculizumab+IVIG with placebo+IVIG in GBS patients.
Methods:
Following PRISMA guidelines and registering with PROSPERO CRD420251073535
Databases including PubMed, Google Scholar, Scopus, and Cochrane Library were thoroughly searched from inception to May, 2025. Three RCTs comparing Eculizumab+IVIG against placebo+IVIG in GBS patients comprising 99 adult patients (≥18 years) with onset of GBS symptoms within 2 weeks were included. Non-RCTs, pediatric population, and trials using Eculizumab with other immunotherapies were excluded. RevMan software was used for data analysis. Pooled risk ratios with 95% confidence intervals were estimated using a random-effects model for the dichotomous outcomes. I 2 statistics assessed the heterogeneity. GRADEpro and Cochrane RoB 2.0 assessed the certainty of evidence and risk of bias, respectively.
Results:
At 4 and 24 weeks, Eculizumab in combination with IVIG did not significantly improve primary outcomes including GBS disability grade (RR = 0.99; 95% CI: 0.82-1.19) or walking ability (RR = 1.28; 95% CI: 0.88-1.85). Secondary outcomes including ventilation, headache, rash, and SAEs, showed no significant results, though trends toward increased adverse events were found. The study’s reliability is based on low heterogeneity (I 2 = 0%) in all the possible outcomes. Additionally, the inclusion of only three RCTs limits bias assessment. The GRADEpro evaluated a very low certainty in GBS grade and all secondary outcomes, and low certainty in walking ability.

Conclusion:
Eculizumab+IVIG compared to IVIG alone shows non-significant outcomes results in GBS patients, mainly GBS disability grade and walking ability, but might increase the adverse effects. Future trials should focus on large and biomarker-based RCTs to evaluate Eculizumab efficacy in GBS sub-phenotypes.
Keywords:
Eculizumab, Guillain-Barré Syndrome, Efficacy.

Machine Learning-Based Deconvolution of Immune Infiltrates in Cardiac Fibrosis

Husna Irfan Thalib — 2025-09-14

Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by myocardial fibrosis and diastolic dysfunction, with limited effective therapies. Immune-mediated mechanisms are increasingly recognized as key contributors to HFpEF pathogenesis. This study focuses on using machine learning (ML)-based immune deconvolution to identify specific immune cell populations and their interplay with fibrotic pathways to provide important insights regarding HFpEF mechanisms and potential therapeutic targets.
Methods: RNA sequencing datasets from myocardial tissues of HFpEF patients and healthy controls were analyzed using machine learning deconvolution algorithms (CIBERSORTx and xCell). Immune cell proportions were correlated with fibrotic gene expression, including collagen I, fibronectin, and TGF-β1. Clustering analysis identified immune-fibrotic phenotypes. Predictive models were developed to assess the role of specific immune infiltrates in fibrosis
severity and clinical outcomes.
Results: Machine learning identified increased infiltration of M2 macrophages and regulatory T cells (Tregs) in fibrotic myocardial regions of HFpEF patients, alongside reduced cytotoxic NK cell activity. M2 macrophage abundance strongly correlated with collagen I and fibronectin expression (r = 0.89, p < 0.01), suggesting a pivotal role in driving myocardial fibrosis. Tregs were associated with enhanced TGF-β1 signaling, further promoting fibrotic remodeling. Clustering analysis revealed two distinct immune-fibrotic subtypes: Inflammatory-dominant subtype: Marked by elevated pro-inflammatory cytokines (IL-6, TNF-α) and moderate fibrosis, associated with early-stage HFpEF and Fibrosis-dominant subtype: Characterized by excessive ECM deposition, advanced myocardial stiffness, and poor diastolic function, correlating with worse clinical outcomes.
Conclusion: This study highlights the role of M2 macrophages, Tregs, and TGF-β1 signaling in HFpEF-associated myocardial fibrosis, identifying distinct immune-fibrotic phenotypes with potential diagnostic and therapeutic relevance. Targeting macrophage polarization and fibrotic signaling pathways could potentially be identified as a new treatment strategy to prevent HFpEF progression.

Digital Health: Opportunity or Overload for Young Doctors

Aayet Zulfiqar — 2025-09-13

Predictors of infodemic and misinformation against Covid–19 among general public of Rawalpindi

Muhammad Ali Riaz — 2025-09-13

Objective:

This study aimed to identify predictors of infodemic and misinformation related to COVID-19 among Rawalpindi's general public by analyzing their behavioral attributes and assessing their reliance on different types of evidence regarding the pandemic.

Materials and Methods:

This descriptive cross-sectional study was conducted in Rawalpindi, Punjab, Pakistan from April to June 2024. The study assessed perceived information gathering capacity and risk perception related to COVID-19 among individuals aged 18 and above. A sample size of 377 was calculated. Convenience non-random sampling was used. The questionnaire covered demographics, information gathering capacity, and risk perception. Ethical approval was obtained from the Institutional Review Board of Rawalpindi Medical University, and data analysis was performed using SPSS version 26 applying descriptive statistics and Spearman’s rank correlation analysis to explore relationships between variables.

Results:

The study surveyed 394 individuals, with 55.3% males and 44.7% females. Most participants were in the 18-24 age group with varying educational backgrounds. Findings showed confidence in gathering information about COVID-19, distinguishing facts from rumors, and awareness of information sources. Perceptions of COVID-19 severity and susceptibility varied, with mixed emotions towards the pandemic and trust levels in information sources. Positive correlations were found between information gathering capacity, judgment frequency, and preventive behaviors against COVID-19.

Conclusion:

Relying on statistical, experimental evidence, and preventive measures enhances information gathering capacity. However, there is no direct link between reliance on scientific evidence and the ability to differentiate rumors from facts. The study also highlights public dissatisfaction with the Pakistani government's pandemic response and distrust in official information sources.

Reported Self-care Practices in Pregnancy and Their Relationship With Birth Outcomes in Women Presented to Allied Hospitals of Rawalpindi Medical University

2025-09-14

Introduction

Self-care is crucial for promoting health, preventing disease, and maintaining health during pregnancy. Understanding specific healthcare behaviors adopted by women is necessary to improve maternal healthcare delivery and birth outcomes.

Objectives

This study aimed to assess self-care practices during pregnancy and analyse the relationship between mother self-care and birth outcomes.

Materials and Methods

A descriptive cross-sectional study was conducted in postnatal wards of gynaecology departments of Allied hospitals of Rawalpindi Medical University from March 2024 to June 2024. Our study population included post-partum primigravida and multigravida women, excluding those having a previous history of comorbidities. For sample size calculation, we used Epi info sample size calculator. Data was collected using a validated self-structured questionnaire. Statistical analysis of data was done using SPSS version 27.

Results

The study found that 48% of participants had moderately healthy lifestyles, followed by 31.4% with healthy lifestyles, and 20.57% with least healthy lifestyles. Similarly, 57.14% had moderately healthy behaviours, 29.14% had healthy behaviours, and 13.71% had unhealthy behaviours. The relationship between healthy lifestyles and number of pregnancies was significant. PCOS prevalence was higher in participants with moderately healthy or healthy lifestyles. Stillbirths were more prevalent in participants with unhealthy lifestyles. The relationship between pregnancy-induced hypertension, pregnancy-induced diabetes, and healthy behaviours was significant.

Conclusion

The study suggests that education regarding childbirth is needed, especially for first-time mothers. Healthy lifestyles lead to better birth outcomes.

Association between Antenatal Care Utilization and Maternal Anemia in Pregnant Women: A Cross-sectional study in RMU & Allied Hospitals

2025-09-13

Background: Antenatal care (ANC) is important for preventing maternal complications and improving health outcomes. In Pakistan, although many women contact ANC, there are still significant issues with timing, quality, and fairness in access.
Objectives: This study looks at the relationship between ANC use and maternal complication of anemia, at RMU & Allied Hospitals.
Materials and Methods: We carried out a retrospective cross-sectional study using hospital records of 385 women who were admitted for delivery between January 2024 and March 2025. We gathered data on sociodemographic, ANC details, maternal complications, and delivery outcomes. We used R software for statistical analyses, applying chi-square, Fisher’s exact, and Wilcoxon rank sum tests to find significant associations.
Results: Anemia was present in 15.3% of the participants. It was notably more common among women from rural areas (22.1%), those with low education (27.9% among those with only primary education), and those from low-income backgrounds (17.1%) (all p < 0.05). Even though 98.06% of women had at least one ANC visit, those who started care later (after three weeks) and had more visits (a median of 6 for anemic women compared to 4 for non-anemic women, p = 0.010) were paradoxically linked to anemia, suggesting that they sought care after complications developed. Anemic women were more likely to arrive in poor condition, be in advanced labor, and have complications such as bleeding after 28 weeks and threatened miscarriage.
Conclusion: Inadequate and delayed ANC was strongly tied to negative maternal outcomes, particularly anemia. Factors like living in rural areas, low education, and poverty increased the risks. These findings stress the need for early, fair, and effective antenatal care to enhance maternal health in Pakistan.
Keywords:
Antenatal care, anemia, Pregnancy complications, Healthcare Disparities, Pakistan, Rural health

Clot Formation Within Tracheostomy Tube in Surgical Unit 1 of HFH Hospital Rawalpindi; a Quality Improvement Project

Abdul Hafeez Soomroo, Shanza Nazih, Ahsan Hameed, Rai Asghar, Aayet Zulfiqar — 2025-09-13

Clotting inside tracheostomy tubes is a major problem that can block the airway and trigger breathing problems, more especially among critical care patients. This clinical audit is a full report of the Tracheostomy Care Practice in the Surgical Intensive Care Unit (ICU) of Holy Family Hospital (HFH) Rawalpindi, where we evaluated the current situation, identified risk factors for clot formation, and made recommendations for improvement. It was a combined retrospective and prospective review, and it was from January to February 2025, the period when 50 patients who underwent tracheostomy and remained in the ICU for more than 48 hours were involved. The data were primarily based on patient’s medical records, clinical documentation, and incident reports. The study found out that the incidence rate of clot formation was 20% because of the lack of enough humidification (50%), infrequent suctioning (30%), and airway trauma (20%) as the most significant risk factors. The support of recommended measures was still ineffective with 60% of the oxygen that was only humidified and suctioning being done at appropriate intervals was in 70% of cases. The outcomes contained in the research impress the significance of standard tracheostomy care protocols, better-equipped staff, and frequent audits so that the patients’ safety is improved and the obstructions of the airways risk is minimized. The implementation of these measures is the key to obtaining better results for the ICU patients undergoing tracheostomy surgery.

Factors Affecting Healthy Lifestyle among Medical Students in Rawalpindi Medical University, a Cross Sectional Study

Ali Abdul Basit — 2025-09-13

University is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in Health University in Rawalpindi, Pakistan.

Methodology:

A total of 375 students participated in this descriptive cross-sectional study. Data gathering was conducted at Rawalpindi Medical University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors.

66℅females and 33%males were included in this study. 74% of the participants were of normal weight and 7.9% were overweight. The analysis showed that there was a significant association between gender wise and year of study wise comparison with regards to the factor of health responsibility. Students were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Pakistan.

Conclusion:

The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

Evaluation of Knowledge, Attitude and Vaccination Status among Pre Clinical Medical Students of Rawalpindi Medical University

Amna Idrees — 2025-09-13

Abstract

Introduction

Hepatitis refers to viral liver inflammation leading to acute and chronic illness. In Pakistan its prevalence is 4.9% for hepatitis C and 2.5%. Reuse of contaminated needles, syringes, or sharp objects in healthcare settings causes the spread of this virus. Vaccination is an effective tool for its prevention but unfortunately a low vaccination rate is observed in developing countries. Healthcare workers, because of negligence and non-vaccination are severely exposed to it. In medical practice, medical students are more prone to hepatitis because of lack of awareness, vaccination and high prevalence of needle stick injuries. Thus, proper knowledge and outlook is important for safety. Working on medical students' apprehension is significant for hepatitis control in future as they can raise consciousness regarding disease in themselves and their patients.

Methodology

We conducted a cross-sectional study using an online questionnaire-based survey recording the demographic details, knowledge, attitude, practice and vaccination status of non clinical year medical students. Total data of 249 students was collected through convenience sampling. Statistical analysis was performed.

Results

Out of 266 participants, ranging from age 17 to 27, the majority were females 202 (75.9%). Among these, 66.5% strongly agreed that hepatitis was caused by a virus whereas, hepatitis causes liver inflammation was also supported by majority (43.2% strongly agree, 41% agree). Regarding attitude, only 38% considered healthcare workers to be at an increased risk for hepatitis B but 52.6% believed in the efficacy of Hepatitis B vaccination. Assessment of vaccination status showed 92 (34.6%) people not being vaccinated while 174 (65.4%) were vaccinated.

Conclusion

A mixed response was achieved from pre-clinical year students about their knowledge in regards to Hepatitis B. Majority students were found vaccinated, showing a positive attitude towards vaccination.

Association of Blood Clotting Time with Gender and Blood Group among Young Healthy Individuals

2025-09-13

Introduction:

Blood clotting is a crucial homeostatic process that prevents excessive bleeding after injury. This study investigates the influence of physiological parameters like blood type and gender on Clotting Time. While previous studies suggest potential associations between pathologic conditions and Blood Clotting Time, the evidence remains inconclusive for such an association between physiologic conditions like blood group and gender, and Blood Clotting Time. Additionally, regional variations in Clotting Time are understudied. This study aimed to investigate the relationship between clotting time, blood type, and gender in a Pakistani population.

Objectives:

The objectives of our study were to investigate the association between blood group ( ABO and Rh) and Clotting Time in a healthy young adult population from Pakistan and to determine if there are significant differences in Clotting Time of males and females.

Material and Methods:

A Cross-sectional, observational study was conducted on 208 healthy subjects, 108 males and 100 females. Blood groups were self-reported by participants while Blood Clotting Time was measured by the Capillary Tube Method. The Association of Clotting Time with gender and blood group was checked.

Results:

Clotting Time was highest in the O blood group and lowest in AB and this relation was significant (p value=0.001). Among Rh blood groups, Rh negative had higher Clotting Time than Rh positive, but this relation was not significant (p value=0.564). Females had higher Clotting Time than males with high significance ( p value=0.00).

Conclusion:

Females and O blood group individuals are more susceptible to abnormal bleeding in cases of trauma or surgery, therefore necessary measures should be taken before undergoing invasive procedures. Studies with a larger number of participants need to be done to determine risk groups more accurately.

Knowledge about First Aid among Medical, Nursing and Allied Health Sciences Students of Rawalpindi Medical University, Pakistan.

Tayyab Rasool — 2025-09-13

Background: First aid is an important life-saving skill that can make a profound impact in emergency situations. It involves giving rapid medical care at the site of the accident. Medical and nursing students often get training inside controlled hospital environments. However, the scope of first aid education entails effectively responding to many emergency situations outside the hospital. Objectives: The objective of this study is to assess the knowledge of undergraduate students in the fields of MBBS, Nursing, and Allied Health Sciences (AHS) with regards to first aid. Materials and Method: A cross-sectional questionnaire-based study was conducted from April 2023 to August 2023 at Rawalpindi Medical University. A validated, self-structured 16 items questionnaire regarding first aid was used to assess the knowledge of the students. Data analysis was done using Microsoft Excel and SPSS version 26. Results: The study included a total of 309 individuals enrolled in the MBBS, AHS, and Nursing programs. The mean knowledge score among all students was 8.72 ± 1.878. Only 10 (3.23%) students had High knowledge, 216 (69.9%) students had Moderate knowledge, and 83 (26.8%) students had Low knowledge of first aid. Significant differences were observed in knowledge scores among degree programs, with MBBS students (M = 9.02, SD = 1.61) scoring significantly higher than AHS (M = 8.0, SD = 2.33) and Nursing students (M = 8.06, SD = 2.11). However, no significant difference was found between AHS and Nursing students. A positive correlation was identified between academic year and knowledge scores, indicating increasing proficiency with each academic year.

Conclusion: This study sheds light on the current state of first aid knowledge among undergraduate healthcare students and underscores the need for tailored educational strategies to equip them with the essential knowledge for effective emergency response.

Awareness of Breast Cancer in Patients at a Tertiary Care Hospital in Pakistan; a Cross-sectional Study

Rameen Khalid — 2025-09-13

The Knowledge, Attitude and Practice about cervical cancer among women of reproductive age living in Rawalpindi, Pakistan: A Cross-sectional study

Fatima Nazir — 2025-09-13

Abstract

Background: Cervical cancer is a malignant epithelial tumor caused by Human papilloma virus. It is a gradually progressive disease. Since it is a prevalent health problem and can be prevented, it is necessary that women are aware of the disease and its prevention. This cross-sectional survey aimed to evaluate the knowledge, attitudes, and practices regarding cervical cancer among women of reproductive age group in Rawalpindi, Pakistan.

Objectives: To assess knowledge, practice, and attitude of women of Rawalpindi regarding cervical cancer and to determine the association between knowledge, attitude and practices regarding cervical cancer and demographic factors

Methods: A self-structured questionnaire was developed from a previous study (1). Random women of reproductive age (15-49) visiting Holy family Hospital, Rawalpindi were interviewed, and data was collected after informed consent in the time span of 3 months. Data was analyzed using SPSS (Statistical Package for Social Sciences) version 26. To find the association between independent variables (demographic characteristics) and dependent variables (Knowledge score, attitude score, practice score) an independent t test was used. Also, Pearson correlation was used to find association between knowledge score , attitude score and practice score .

Results: Overall study showed that 152(66.6%) women had adequate level of knowledge, 119(52.1%) women showed adequate level of attitude towards cervical cancer and 204(89.4%) women showed adequate level of practice. Among these women majority of women were younger, unmarried, literate, and nulliparous. On using independent t test significant (p<0.05) association was found between marital status, parity, age, and knowledge score also, significant (p<0.05) association between parity and attitude score was found. And significant (p<0.05) association was found between age, marital status, parity, and practice score. Pearson correlation showed signification relation between knowledge score and attitude score , knowledge score and practice score .

Conclusion: There is a dire need to increase awareness among women regarding cervical cancer to decrease the incidence of cervical cancer and to decrease mortality.

Keywords: Cancer of Cervix , Cancer of the Uterine Cervix , Pap Smear , HPV

Effectiveness of Soft Arch Insoles in the Management of Pediatric Pes Planus: A Descriptive Observational Study

Muqadas Mazhar — 2025-09-13

Abstract:
Objective

To evaluate the effectiveness of foot insoles in improving foot alignment, enhancing arch formation,
reducing pain and discomfort, and improving functional capacity in the pediatric population with pes planus
(flatfoot).
Study Design

A Descriptive Observational Study
Place & Duration of Study: This study took place at Benazir Bhutto Hospital Rawalpindi and lasted six months,
from May 1st, 2023 to November 31st, 2023.
Material and Methods

This study, conducted at Benazir Bhutto Hospital (BBH) Rawalpindi, examined the effects
of shoe insoles on 50 children aged 6 to 12 years with flexible pes planus who selected using nonprobability
consecutive sampling after providing informed consent. Children with flexible pes planus and no additional deformities were included, while those with rigid pes planus or noncompliance with insole use were excluded. A standardized questionnaire was used to gather data at baseline, 3 months, and 6 months, which included demographic information, the Foot Function Index (FFI), and the Visual Analog Scale (VAS). Statistical analysis was carried out using SPSS version 25.0, with descriptive statistics and paired sample t-tests used to analyze changes in VAS and PFFI scores
over time and the effectiveness of the intervention.
Results

The study comprised 50 pediatric patients with flexible pes planus, ranging in age from 8.94 ± 1.69 years.
There were 44% boys and 56% girls, with 68% coming from urban and 32% from rural areas. In 60% of
participants, the disease affected the right side, whereas 40% affected the left. Foot pain VAS scores dropped
significantly, from 5.2 ± 1.1 at baseline to 3.1 ± 0.9 at 3 months and 2.3 ± 0.8 at 6 months (p < 0.01). The Pediatric
Foot Function Index (PFFI) scores improved considerably from 72.5 ± 10.3 at baseline to 50.3 ± 8.7 at 6 months (p < 0.01). There were no major side effects observed, while 15% of individuals experienced moderate discomfort that resolved within a few weeks. P-values < 0.05 were considered significant.
Conclusion

The study found that using shoe insoles in children with flexible pes planus significantly reduced foot
discomfort and improved foot function over a 6month period. Foot pain VAS scores dropped significantly, from 5.2
± 1.1 at baseline to 3.1 ± 0.9 at 3 months and 2.3 ± 0.8 at 6 months (p < 0.01). The Pediatric Foot Function Index
(PFFI) scores improved considerably from 72.5 ± 10.3 at baseline to 50.3 ± 8.7 at 6 months (p < 0.01). There were
no major side effects observed, while 15% of individuals experienced moderate discomfort that resolved within a few weeks. P-values < 0.05 were considered significant.
Conclusion: The study found that using shoe insoles in children with flexible pes planus significantly reduced foot
discomfort and improved foot function over 6 months.
Keywords

foot insoles, pediatric pes planus, flat foot, medial longitudinal arch

Complementary Feeding: Is it Healthy and Adequate? Attitudes, Knowledge and Practices of Families of Rawalpindi

Shehzadi Shehar Bano — 2025-09-13

Background: This study examines the factors contributing to inappropriate complementary feeding practices for infants and young children, which can lead to impaired growth, delayed motor and cognitive development, stunting, malnutrition and other nutritional deficiencies.
Objectives: The objectives of this study are to assess the knowledge, attitudes and practices of complementary feeding habits in families of Rawalpindi, to determine demographic variables and child characteristics that influence complementary feeding, and to determine whether child feeding practices are adequate concerning a child's overall health or not.
Materials and Methods: This cross-sectional study was conducted from March to August 2023 in allied hospitals of Rawalpindi Medical University and a total of 308 mothers with index children between the ages of 4 months and 1 year participated. Convenience sampling was used to enroll eligible mothers. Data was collected through a verified self-administered questionnaire or interview-based approach as all mothers were not able to read and understand English. The data was analyzed through SPSS version 25.
Results: Among 308 study participants, majority of mothers (86.4%) were housewives and only 13.6% were working women. About two-thirds of the study population, i.e. 211 participants (68.5%) correctly stated the recommended time to initiate breastfeeding and nearly two-thirds of the mothers, 198(64.3%) knew the recommended duration for exclusive breastfeeding. Only half of the study population 170(55%) correctly answered the recommended time to initiate complementary feeding. The difference in knowledge between the housewives and working women was statistically significant (p<0.016) at the 0.05 significance level.
Conclusion: The current knowledge and practices of complementary feeding are insufficient. To develop a more positive attitude towards complementary feeding it is advisable to organize health education and awareness campaigns.
Keywords: Complementary feeding, Impaired Growth, Delay motor development, Malnutrition, Nutritional deficiencies.

Quality of life index in patient with scabies

Maryam Sadiq — 2025-09-13

Title; Quality of Life index in patient with scabies

Introduction; Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. It places a psychological and emotional toll on patients similar to any other disease. Quality of life index helps to make an estimate about the physical, psychological, emotional and social impact of a disease for the patient.

Objectives;

• To assess QoL impairment in scabies patients and its variability with gender.

Methodology; With cross-sectional study design, a total of 297 diagnosed patients of scabies presenting in Benazir Bhutto Hospital, Rawalpindi were assessed using DLQI questionnaire defined by World Health Organization with a maximum score of 30 and cut-off values of 1,5,10 and 20. Patients of scabies with other skin diseases, underlying neuropsychiatric illnesses, functional disability and pregnancy were excluded. Data was stored and analyzed using SPSS version 27. Descriptive analysis was used for describing the study variables. Independent t-test was used for comparison between males and females, p value of <0.05 was taken as significant.

Results; Out of total 297 participants, number of males were 156 and females were 141. Out of total, 1.7% had no effect,22.2% had small effect, 36% had moderate effect, 30% had very large effect and 9.4% had extremely large effect on their quality-of-life due scabies disease. The p-value was found to be significant i.e., p-value<0.01.

Conclusion; Scabies has a significant negative impact on the lives of affected individuals. Anxiety, depression and significant psychological consequences are binding in these patients. Assessment of quality of life enables the treating physician to devise the best possible management plan individually.

Key words;

Quality of life; Quality of life is defined by World Health Organization as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.

Scabies; A contagious cutaneous inflammation caused by the bite of the mite SARCOPTES SCABIEI

Assessment of Awareness Regarding Hepatitis B and C among the Urban Community of Rawalpindi

2025-09-13

OBJECTIVE: Hepatitis B and C can cause lethal liver infections leading to permanent liver tissue damage.Globally, two billion individuals have encountered the Hepatitis B virus and 100 million individuals have encountered the Hepatitis C virus.The objective of this study was to evaluate knowledge,attitudes and practices of urban community in Rawalpindi towards Hepatitis B and C.
METHODS: A descriptive cross-sectional study was conducted in July 2023 among 277 participants. Data was collected through a questionnaire assessing knowledge, attitudes, and practices related to Hepatitis B and C. The responses to the questionnaire were recorded in SPSS version 25. Responses of participants were compared on the basis of both gender and educational level through Chi square test. Responses were also compared on the basis of age via Kruskal- Wallis H test. P-value<0.05 was considered statistically significant.
RESULTS: Among the participants, 135 (48.7%) were male, and 142 (51.3%) were female, with a mean age of 38.13 years ±12.76 years. The majority had not received Hepatitis B vaccination (61%), and only 27.1% had undergone screening. Participants from the secondary education level demonstrated higher knowledge levels in various aspects of Hepatitis B and C. There was no significant difference between genders, except for female participants being more informed about the potential lifelong persistence of the diseases.
CONCLUSION: This study provides valuable insights into the knowledge, attitudes, and practices regarding Hepatitis B and C within the urban community of Rawalpindi. The results indicate a need for enhanced vaccination coverage and screening accessibility. Tailored educational initiatives can significantly contribute to improved public health outcomes in this context.
KEYWORDS: Hepatitis B, Hepatitis C, Health Knowledge, Attitudes, Practices, Urban population.

Estimation of mean scores of blood pressure and knowledge of health risks associated with high blood pressure among medical students of RMU

2025-09-13

Introduction:

Hypertension is a problem faced by many people in our society. This study examines the mean scores of blood pressure and knowledge of health risks associated with hypertension among 1st year medical students at Rawalpindi medical university.

Objectives:

The objectives of this study are to measure the mean scores of blood pressure, and assess the risk factors associated with high blood pressure.

Materials and Methods:

The descriptive cross-sectional survey was conducted in April-June ,2024 at Rawalpindi Medical University, Rawalpindi, Pakistan. A total of 70 medical students responded to this survey. Data was analyzed using IBM SPSS statistics version 27. Inferential statistics was done and threshold for statistical significance was set at p value less than 0.05.

Results:

More than half of the population whose data is obtained are females. Approximately 3/4 of the people had their blood pressure checked by professionals. More than 50% had normal blood pressure and only less than 1% were on blood pressure medications.

Conclusion:

The study demonstrated that blood pressure scores were mostly normal among the students. Moreover, students had a significant knowledge regarding health risks associated with high blood pressure

Keywords:

Blood Pressure, Systolic Blood Pressure, Diastolic Blood Pressure, Sphygmomanometer.

Determination of Mean Bleeding Time and Knowledge of Conditions Associated with Variations in Mean Bleeding Time

2025-09-13

Bleeding time is a vital haemostatic parameter used to assess the platelet function and the overall blood coagulation. Bleeding time is defined as the average time taken by incision to stop bleeding.

This study aimed to evaluate mean bleeding time, conditions that might cause the fluctuation in the mean bleeding time and how early indication of such conditions might help elevate the medicine sector.

The population of the study were the universities students of first year MBBS of Rawalpindi Medical University involving the standard age group of 18 to 22 years. The Duke’s method was used to assess bleeding time. This method involves pricking participants’ earlobe or finger with a special needle or lancet, and the bleeding time is measured using a stopwatch.

To observe the several factors affecting the main bleeding time, a specifically designed questionnaire keeping in view the principles of ethics including confidentiality, autonomy and beneficence was developed which assess the participant’s lifestyle: including their physical activities, habits, medications, and addictions of drugs (if any). The family history, genetic disorders, and the health problems such as anaemia would be taken into the account. These factors would be analysed and their role in fluctuating the mean bleeding time would be linked.

The data collected contributed to understanding bleeding time variations and optimizing treatment strategies for early intervention, ultimately improving patient’s outcomes.

Assessment of Mental Health among Medical Students of RMU Rawalpindi

2025-09-13

ABSTRACT

Introduction

Mental health is an essential part of our general health. Students, especially those studying in medical colleges, are more prone to disturbed mental health, which can further affect the performance of medical students when they enter professional practice.

Objectives

The objective of this study is to assess the mental health and psychosocial well-being of MBBS students studying at Rawalpindi Medical University and to analyse factors affecting it.

Methods and Materials

In this cross-sectional study, a total of 315 students were enrolled across five medical years of study using consecutive sampling. Data was collected in a 3-part questionnaire; Demographics data, General Health Questionnaire-28 (GHQ-28) and a self-structured Factors Affecting Mental Health (FAMH) Questionnaire with 14 items was used. Likert Scoring was used for GHQ (cutoff=24).

Descriptive Statistics of mean, median, frequency, and percentage were applied to further describe the data. Chi-Square, T-test (Mann-Whitney U test and Kruskal-Wallis H test) on FAMH, and Binary Logistic Regression analysis, were applied to the data to find the association of GHQ score with the demographics of the students and FAMH.

Results

A total of 315 students participated with 34% (107) male and 66% (208) female. Mean age was 21.1 years (SD=2.65). 72.1% (227) non-boarders and 27.6% (87) boarders were included.

A significant difference was observed in year of study, where 50.7% basic years students and 35.2% clinical years students showed GHQ scores less than 24 (p=0.006). Only 34.5% of boarders and 46.2% of non-boarders had GHQ scores below 24 (p=0.060).

Physical appearance (p<0.001), preference in choosing MBBS (p=0.002), fear of failure of exams (p=0.003), support from staff (p=0.001), social habits (p=0.030), sports (p=0.001), physical health, financial issues, and chronic illnesses (p<0.001 respectively), were the factors that affected mental health with a clear statistical significance. Family structure (p=0.064), demand of studies (p=0.078), some foreign exam (p=0.096), family support (p=0.556), substance abuse (p=0.465), had no statistical significance on mental health.

Conclusion

Clinical year students are at higher risk of mental health issues. Physical appearance, fear of failure of exams, financial stress, and social habits affect mental health adversely. Moreover, stress of medical education and lack of awareness also affects mental health.

Keywords

Mental health, GHQ, Factors affecting mental health, medical students, university.

Comparison of efficacy and adverse effects of Triptans and Gepants – Anti-migraine drugs

Pakeezah Tabasum — 2025-09-13

Migraine, the 2nd largest cause of Years Lived in disabilities (YLD) in 195 countries of world with a prevalence rate of 1040 Million. It is unilateral neurological disorder of head. 75% of patient of migraine are female who are in their reproductive stage. Most probably, the accepted cause behind pathophysiology of migraine is dilation of cephalic and intracranial arteries. By decades, the commonest used drugs for acute treatment of migraine are Triptans, 5-HT 1B and 5-HT1D receptor antagonist. Triptans for the treatment of migraine, cause relief from pain and other symptoms of migraine such as, nausea, vomiting, photophobia and photophobia within 2 hours. However, newly approved Drugs: Zavegepant and Rimegepant cause greater adverse effect than Triptans. Hence, rarely used for the treatment of migraine due its greater complications.

Metastatic Papillary Thyroid Microcarcinoma Mimicking Brachial Cleft Cyst: A Case Report

Rabia Mahmood — 2025-09-13

INTRODUCTION:

Papillary thyroid carcinoma (PTC) is the most common and well-differentiated type of thyroid cancer, with tumors ≤10 mm classified as papillary thyroid microcarcinoma (PTMC) by the World Health Organization. This case highlights a BCC initially diagnosed as benign but later found to harbor metastatic PTC. It emphasizes the need for careful evaluation of atypical neck masses to avoid delayed diagnosis and treatment.

CASE PRESENTATION

This case involves a 35-year-old woman with a three-year history of right-sided neck swelling and breathing difficulty, initially presumed to have a branchial cleft cyst (BCC) based on clinical findings and FNAC. Surgical removal of the cystic mass confirmed a type 2 BCC. However, continued symptoms led to further imaging and thyroid evaluation, which revealed a small nodule. Histopathology confirmed a unifocal papillary thyroid microcarcinoma (PTMC) in the right lobe. The case underscores the importance of considering hidden malignancy in seemingly benign lateral neck masses.

DISCUSSION

Although PTMC typically follows an indolent course, cystic lymph node metastases may signal aggressive behavior. Misdiagnosis as benign neck cysts can delay appropriate treatment. This case emphasizes the need for thorough evaluation of adult-onset lateral neck masses and supports early surgical intervention for accurate diagnosis and optimal management.

KEYWORDS :

Papillary Thyroid Microcarcinoma (C563277 ) , Metastasis ( D009362 ) , Branchial Cleft Cyst (D001935 ), Thyroidectomy (D013965)