Students' Supplement of Journal of Rawalpindi Medical College

Trends in Hypertensive Renal Disease with Renal Failure-Related Mortality Among Gender Ethnicity and Census Regions in the United States from 1999-2000

Faiza Ikram — Tue, 25 Nov 2025 00:00:00 +0000

Background: Hypertensive renal disease impacts approximately 753 million individuals worldwide each year. In the US, the age-adjusted mortality rate for hypertension-related ESRD rose from 9.7 to 43.7 per 100,000 between 1999 and 2020. This study evaluates trends in hypertensive-renal disease mortality from 1999 to 2020 in the US, focusing on disparities related to gender, race, and urbanization by examination of the Age-Adjusted Mortality Rate (AAMR) to inform targeted intervention and improve outcomes.

Methods: The CDC WONDER database analyzed hypertensive renal disease with renal-failure-related mortality from 1999 to 2020, calculating mortality rates and a 95% confidence interval to assess national trends.

Results: Throughout the study period, males constantly exhibited a higher Age-Adjusted Mortality Rate (AAMR) for hypertensive renal disease with renal-failure-related mortality 148.92 (95% CI: 148.37 – 149.48) than females 106.11 (95% CI: 105.73 – 106.49). African American individuals exhibited the highest overall AAMR at 286.29 (95% CI: 284.68 – 287.9), starting at 186.23 in 1999 (95% CI: 179.34 – 193.13) and increasing to 529.72 in 2020 (APC: 5.27; 95% CI: 520.77 – 538.67). From 1999 to 2020, AAMR rose in metropolitan areas from 197.57 (95% CI: 187.88–207.26) to 1112.12 (APC: 10.00; 95% CI: 1093.39–1130.85), and in non-metropolitan areas from 97.35 (95% CI: 90.63–104.08) to 643.06 (APC: 11.81; 95% CI: 627.76–658.37).AAMRs varied significantly by state, from 61.23 (95% CI: 59.29–63.16) in Connecticut to 225.06 (95% CI: 214.96–235.16) in the District of Columbia.

Conclusion: From 1999 to 2020, the mortality rate from hypertensive-related renal diseases rose uncertainly. Higher deaths were observed in males, African American ethnicity, and individuals living in non-metropolitan areas. Addressing these problems requires a multifactorial public health approach focusing on early detection and targeted intervention to reduce disease burden.

Keywords: Hypertensive Renal Disease; chronic kidney disease; kidney damage;

When the Liver Spills Into the Chest: A Case of Thoracic Empyema Secondary to Ruptured Liver Abscess

Ume Rooman — Tue, 25 Nov 2025 00:00:00 +0000

Background: A liver abscess is an accumulation of pus in the liver and is usually amoebic or pyogenic in origin. It can be life-threatening and has a mortality rate of up to 30%. If the abscess ruptures and spreads into the thoracic cavity, it can lead to pleural empyema, which can be fatal if left untreated.

Case Presentation: We report on the case of an eight-year-old boy who presented with a one-month history of fever, abdominal pain, and vomiting, along with progressive respiratory distress for the past seven days. Despite receiving oral antibiotics before presentation, there was no clinical improvement. Initial imaging, including abdominal ultrasound and CXR, revealed a 10×10 cm cavity in the right hepatic lobe communicating with the pleural cavity, accompanied by complete homogeneous opacity of the right hemithorax. A subsequent chest CT scan confirmed a large hepatic abscess containing approximately 800-1000 ml of pus. The patient was admitted to the intensive care unit, started on intravenous antibiotics, and placed on mechanical ventilation for respiratory support. He underwent Video-Assisted Thoracoscopic Surgery (VATS) for surgical drainage and debridement of the empyema. Intraoperatively, a collapsed right lung and a diaphragmatic defect were identified. Postoperatively, the patient showed marked clinical improvement and was discharged on the third day after surgery. Informed consent was obtained from the patient’s guardian for reporting this case.

Conclusion: This case highlights lung empyema as a rare but serious complication of a liver abscess, resulting from transdiaphragmatic extension. Prompt recognition, appropriate imaging, and timely surgical intervention, i.e., VATS, were critical in achieving a favorable outcome. Early diagnosis and management not only resolved the infection but also prevented potentially life-threatening complications.

MeSH Keywords: Pleural empyema, Liver Abscess, Video Assisted Thoracic Surgery (VATS), Pyogenic Liver Abscess, Amebic Liver Abscess

Unmasking the Triad: A Case of Severe Iron Deficiency Anemia Revealing Underlying Autoimmune Hypothyroidism and Celiac Disease

Raja Nasir Nawaz, Wafa Asjad — Tue, 25 Nov 2025 00:00:00 +0000

INTRODUCTION: Anemia is the most common hematologic disorder globally, with iron deficiency as the leading cause. In women of reproductive age, heavy menstrual bleeding (HMB) is a common contributor. However, underlying systemic conditions such as autoimmune disorders are often overlooked in chronic anemia cases.

OBJECTIVES: The objectives of this study were to highlight the role of autoimmune diseases, particularly hypothyroidism and celiac disease, in the development of chronic anemia, and to emphasize the importance of a multidisciplinary approach when evaluating patients with unexplained or refractory anemia. By integrating perspectives from internal medicine, hematology, endocrinology, and gastroenterology, the study aims to improve early detection, accurate diagnosis, and comprehensive management of anemia related to underlying autoimmune conditions.

STUDY DESIGN: Case Report

STUDY SETTING: Al-Nafees Medical College and Hospital, Islamabad.

CASE DESCRIPTION: A 43-year-old woman presented with symptoms of fatigue, body aches, and heavy menstrual bleeding for 3 months in the gynecology department. Initial labs confirmed severe iron deficiency anemia (Hb 6.1 g/dL), low MCV, low serum iron and ferritin, and high TIBC. Despite IV iron and tranexamic acid, no gynecological cause was identified. On referral to the medicine department, further evaluation revealed hypothyroidism (low T4, positive anti-thyroid antibodies), dyslipidemia, and fatty liver. Persistent musculoskeletal pain prompted testing for celiac disease, confirmed by positive anti-tTG antibodies. She was managed with levothyroxine, statins, calcium, and vitamin D supplements, and a strict gluten-free diet. The case highlights a complex interplay of autoimmune conditions underlying chronic anemia.

CONCLUSION: Chronic iron deficiency anemia may signal underlying autoimmune overlap, as seen with coexisting hypothyroidism and celiac disease. Timely diagnosis is key, though financial barriers often delay evaluation. A high index of suspicion ensures better outcomes.

KEYWORDS: Iron-deficiency anemia, autoimmune diseases, hypothyroidism, celiac disease, anti-tTG IgA

Design of Multi-Epitope Peptide Vaccine Against Malaria Plasmodium falciparum Ripr Using in Silico Approach

Omnia Abdelazim, Rawan Nasreldin Alsharif — Tue, 25 Nov 2025 00:00:00 +0000

Malaria is still the most serious public health problem in tropical and subtropical regions. There are different challenges in the progression of the vaccine. Malaria caused by Plasmodium falciparum is more common than that caused by other types of Plasmodium. This study aims to design of multi-epitope peptide vaccine against malaria Plasmodium falciparum RH 5 interacting protein ( PfRipr ) using in silico approach between July and November 2022. Conserved PfRipr sequences were analyzed from the National Centre for Biotechnology Information (NCBI). Then the candidate epitopes were analyzed by different prediction tools from the Immune Epitope Database IEDB analysis resource. The prediction tools selected are B-cell epitope prediction to predict linearity, surface accessibility, and immunogenicity by using BePipred, emini surface accessibility, Kolaskar, and Tongaokar, respectively. T cell epitope prediction tools were used to predict epitopes binding to MHC I and MHC II alleles, and population coverage calculation tools to estimate the coverage of promising epitopes. Finally, PfRipr was searched at the Uniprot website, and the resulting PDB file was applied to the Chimera software to visualize the 3D structure. PfRipr showing activation of T cell more than B cell, the three most promising epitopes bind to 14, 11,11 different alleles of MHC I and 27,22,21 different alleles of MHC II. The combination of the six promising epitopes binding to MHC I and MHC II illustrated respectable results in population coverage calculation, which were 99.65% in the whole world and 98.87% in Sudan. We expect that these multiple epitopes could aid in the development of a vaccine that can help in the fight against malaria. Being a potential target for in vivo and in vitro studies.

Are our Medical Educators Stressed?

Amna Idrees, Minahil Iman Janjua — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Educators face the dual challenge of constant multitasking and time management to maintain their clinical practice along with curriculum development, student assessment, research obligations, and administrative duties. Workload imbalance is one of the foremost causes of stress among medical educators. Although their primary role is teaching, it is undervalued in comparison to research and clinical contributions. This leads to burnout and stress and may lead to health compromise.

Objectives: The objectives of this study were to determine the stress levels in teachers of RMU while teaching MBBS students, to assess the correlation of these stress levels with demographic and professional variables such as age, teaching experience, gender, and specialty, and to identify the major stress-causing factors faced by RMU teachers in their academic roles.

Materials and methods: A cross-sectional study was conducted in Rawalpindi Medical University from April 2023 to December 2023 through random sampling on 168 teachers of basic sciences, using the DASS-21 questionnaire. Teachers on a month or longer leave during the past three months from data collection were excluded. Data was analyzed on SPSS version 2023. Descriptive analysis was performed, and the Kruskal-Wallis test was used to check the normality of the data. Student t-test and ANOVA were used for significance.

Results: The mean distress in the population was scored to be 34.73 ± 24.589, which was highest in the Pharmacology and Pathology Departments, in the age group 31-40 years, and among associate Professors. Excessive workload was reported to be the chief stress-causing factor for most of the participants (n=57, 68.7%), which is a major problem of the repeated examinations in the Integrated Modular Curriculum.

Discussion: The study reported normal to moderate distress levels in most of the population. However, a major challenge reported was the excessive amount of workload, with a lack of necessary training for the newly implemented integrated modular systems, which may cause detriment to the personal well-being of the teacher. A good work-life balance and realistic expectations in the workplace may significantly help in reducing stress levels and can prove beneficial to the overall growth of participation satisfaction.

Conclusion: Normal to moderate distress levels recorded among most of the medical professionals indicated that while the ever-advancing era of education may be challenging, our educators are well-versed in dealing with such problems. A major challenge proposed may be the increased workload, which can be easily curbed by increasing the number of the taskforce involved.

Mesh keywords: Stress, health educator

Association Between Irritable Bowel Syndrome and Burn Out in Post Graduate Trainees of Allied Hospitals of RMU: A Cross-Sectional Study

Faryha Aslam, Ayesha Hassan — Tue, 25 Nov 2025 00:00:00 +0000

INTRODUCTION: Healthcare professionals, especially postgraduate trainees, are vulnerable to burnout due to their busy work schedules, frequent on-calls, lack of sleep and emotional stress, which can lead to IBS.

OBJECTIVES: To determine the frequency of IBS-related symptoms. To assess the degree and intensity of burnout. To determine the IBS subtype. To investigate professional and demographic factors linked to burnout and IBS.

Methods: This descriptive cross-sectional study was conducted over a period of three months among postgraduate trainees at RMU and its allied hospitals. A total of 29 participants were recruited using non-probability consecutive sampling. Postgraduate residents of RMU and allied institutions were included, while individuals diagnosed with inflammatory bowel disease, other gastrointestinal disorders, or depression, as well as residents on rotation outside RMU, house officers, and exam-going residents, were excluded. Data collection tools included the 28-item Burnout Questionnaire developed by the American Welfare Association and the WGO “IBS Questionnaire for Healthcare Providers,” along with the ROME IV criteria for diagnosing irritable bowel syndrome and the Bristol Stool Form Scale for subtype classification. Statistical analysis was performed using SPSS version 25. Descriptive statistics were applied to summarise demographic variables, and chi-square testing was used to assess the association between burnout and IBS. Mean burnout scores of IBS-positive and IBS-negative participants were compared using independent t-tests. Receiver operating characteristic (ROC) curve analysis was performed to identify a burnout score cutoff predictive of IBS, along with corresponding sensitivity and specificity values.

RESULTS: The mean burnout score was 68.90 ± 24.78, while the mean WGO IBS score was 35.21 ± 5.12. ROC curve analysis demonstrated that a burnout score of ≥46.50 predicted the presence of IBS with 80% sensitivity and 80% specificity, suggesting a strong association between burnout and IBS in this population.

CONCLUSION: There is a significant association between IBS and burnout among postgraduate residents of allied hospitals of RMU

KEYWORDS: Irritable Bowel Syndrome, Burnout

Tigecycline for Extensively Drug-Resistant Typhoid: In vitro Evidence and Clinical Relevance

Samaha Khalid — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Salmonella enterica serovar Typhi, a Gram-negative bacillus causing enteric fever, poses an increasing global health threat due to rising antimicrobial resistance (AMR). The emergence of extensively drug-resistant (XDR) strains, resistant to nearly all first- and second-line antibiotics, has left azithromycin and carbapenems as the last remaining options. This study evaluates the in vitro susceptibility of XDR S. Typhi to tigecycline, a broad-spectrum agent effective against multidrug-resistant pathogens, to inform treatment choices and strengthen resistance surveillance.

Objectives: To evaluate the in vitro susceptibility of XDR S. Typhi isolates to tigecycline. To assess tigecycline’s potential role as an alternative treatment when azithromycin or meropenem are ineffective. To highlight emerging resistance trends in XDR S. Typhi.

Methods: This retrospective cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi, from July 2023 to June 2024. A total of 99 XDR S. Typhi blood culture isolates were analysed from patients aged 1–70 years, selected through consecutive non-probability sampling. Identification was confirmed using API 20E. Among these, 60 isolates underwent tigecycline susceptibility testing using EUCAST disk diffusion using Mueller-Hinton agar. Since specific breakpoints are lacking for S. Typhi, non-species-related breakpoints were applied. Data analysis was performed using SPSS v27.0.

Results: Of the 99 XDR S.Typhi blood culture isolates that were obtained, paediatrics accounted for 57.6%, medicine for 29.3%, and surgery for 13.1%. Males made up 56.6%, with the 1–10 age group predominating (47.5%) and followed by the 11–20 age group (31.3%). 2024 had a peak in infections in April (18.2%) and May (17.2%). The XDR status was confirmed by the fact that all isolates were resistant to ampicillin (66.7%), ceftriaxone (69.6%), chloramphenicol (79.4%), ciprofloxacin (78.4%), and co-trimoxazole (77.4%). In addition to imipenem (100%, n=80) and meropenem (100%, n=59), tigecycline demonstrated 100% susceptibility (n=60), demonstrating its effectiveness against XDR S. Typhi.

Conclusion: Tigecycline exhibited complete in vitro efficacy against XDR S. Typhi isolates, supporting its potential role in managing resistant infections, especially among pediatric cases. Maintaining the utility of last-line agents demands strong antimicrobial stewardship and further research into resistance mechanisms and optimized dosing in resource-limited settings.

Keywords: Extensively Drug-Resistant (XDR) Typhoid, Tigecycline, Salmonella Typhi, Antimicrobial Resistance (AMR), In vitro Susceptibility

Assessment of Quality of Life and Psychological Distress in Chronic Suppurative Otitis Media Patients: A Cross-Sectional Study

Tue, 25 Nov 2025 00:00:00 +0000

Background: Chronic Suppurative Otitis Media (CSOM) is a debilitating middle ear condition associated with hearing loss and persistent ear discharge. While its physical aspects have been thoroughly investigated, the psychological impact it produces on the patients remains widely unexplored in developing countries like Pakistan. This study aims to evaluate the link between CSOM and psychological distress using the DASS-21 scale, and also the Quality of Life (QoL) in patients using the Chronic Ear Survey (CES).

Methodology: A cross-sectional descriptive study was carried out in Fauji Foundation Hospital, Islamabad, from February to July 2025. A total of 110 patients who were clinically diagnosed with Chronic Suppurative Otitis Media (CSOM) were recruited using a non-probability convenience sampling technique, and written informed consent was obtained from them. Those with a history of severe psychiatric conditions, acute otitis media, or serious comorbid medical conditions were not included. Data was collected using the Depression Anxiety Stress Scales (DASS-21) and CES scales. Data was analyzed using SPSS version 26 with descriptive and inferential statistics.

Results: Most of the patients, out of 110, have had CSOM for over 10 years (62%) and suffered mild to moderate symptoms. Signs of psychological distress were more common in females and those with prolonged illness. A significant association was found between prolonged ailment and depression (r =.354), stress (r =.376), and anxiety (r =.317). Females exhibited higher scores in DASS-21 and CES scales than males, which heavily impacted QoL in these patients.

Conclusion: In conclusion, Chronic Suppurative Otitis Media (CSOM) significantly impacts the psychological health and quality of life (QoL) of its victims, particularly females and long-term sufferers. The results highlight the importance of a multidisciplinary approach that includes psychological support alongside medical treatment to reduce psychological distress and improve the physical well-being of the patients. The study was conducted at a single tertiary care hospital (Fauji Foundation Hospital), which may limit the generalizability of the findings.

Key Words: Chronic suppurative otitis media, Quality of life, Psychological distress

Antibiotic Resistance Developed in Klebsiella: A Retrospective Study of the Past 8 Years

Nimra Taseen — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Klebsiella pneumoniae is a Gram-negative, encapsulated bacterium causing a broad range of severe infections, including pneumonia, liver abscess, and UTIs. Its virulence is driven by factors like a hyper-viscous capsule, pili, LPS, and iron carriers. The emergence of multidrug-resistant and hypervirulent strains (MDR-hvKP), especially carbapenem-resistant variants (CR-hvKP), poses a major global health threat. These strains are increasingly linked to hospital outbreaks and community-acquired infections, with rising prevalence in countries like Pakistan. Understanding antibiotic resistance trends is vital for guiding empirical treatment and improving infection control.

Objective: To evaluate the antimicrobial resistance patterns of Klebsiella pneumoniae isolates from clinical samples collected over eight years, highlighting trends in resistance and implications for treatment in a tertiary care hospital.

Materials and Methods: It is a Retrospective cross-sectional study done in the Department of Microbiology, Fauji Foundation Hospital, Islamabad, from 1^st July 2017 to 30^th June 2025. The study included inpatients aged 11–80 years from general and specialized wards (e.g., ICU, CCU, Eye, ENT, Burns, etc.) who consented, excluding those under 11, over 80, or visiting OPDs for routine check-ups. Klebsiella pneumoniae isolates obtained from various clinical specimens were subjected to antimicrobial susceptibility testing using the disk diffusion method on Mueller-Hinton agar. Plates were incubated at 35–37°C for 16–18 hours, and zones of inhibition were measured to determine resistance profiles. Data were recorded, digitized using Microsoft Excel, and analyzed using SPSS version 28.0. Chi-square tests were applied.

Results: High resistance rates were observed against third-generation cephalosporins: Cefotaxime (82%), Ceftriaxone (79%), and Ceftazidime (77%), indicating widespread ESBL production. Ciprofloxacin resistance was noted in 74% of isolates. Alarmingly, carbapenem resistance was found in 48% of isolates against Imipenem and 44% against Meropenem, demonstrating the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Amikacin (22% resistance) and Colistin (16% resistance) showed the highest susceptibility but remain at risk of reduced effectiveness.

Conclusion: The study highlights a significant increase in multidrug-resistant and hypervirulent Klebsiella pneumoniae strains, necessitating urgent implementation of antimicrobial stewardship, regular susceptibility testing, and molecular surveillance to prevent treatment failures and hospital outbreaks.

Keywords: Klebsiella pneumoniae, ESBL, carbapenem resistance, susceptibility testing.

Unraveling disparities in ventricular fibrillation-related mortality among US adults(>25 years) with DM. A longitudinal analysis of Gender and geographic inequities using CDC WONDER (1999-2020)

Faiza Ikram — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Ventricular fibrillation (VF) is a fatal arrhythmia, with adults diagnosed with diabetes mellitus (DM) facing heightened mortality risk. Despite advances in cardiac and diabetes care, improvements have not been uniformly distributed. Persistent disparities by sex and geography remain insufficiently examined in national, long-term studies.

Objective: To evaluate temporal trends and disparities in VF-related mortality among U.S. adults aged ≥25 years with DM from 1999 to 2020, with emphasis on sex and geographic variations.

Methodology: Data were extracted from the CDC WONDER Multiple Cause of Death database, identifying decedents aged 25–85+ with both VF (ICD-10: I49.0) and DM (ICD-10: E10–E14) listed. Age-adjusted mortality rates (AAMRs) per 100,000, standardized to the 2000 U.S. population, were calculated and stratified by sex, urbanization level, census region, and state. Join point regression was used to analyze trends and estimate annual percentage change (APC) with 95% confidence intervals.

Results: Between 1999 and 2020, ventricular fibrillation contributed to 35,339 diabetes-related deaths among adults aged ≥25 years, with most occurring in medical facilities [80.06%]. The age-adjusted mortality rate (AAMR) declined from 1.42 [95% CI: 1.37–1.48] in 1999 to 0.64 [95% CI: 0.61–0.67] in 2020, with an average annual percent change (AAPC) of −4.16 [−4.72 to −3.60] (p < 0.000001). Men had higher AAMRs than women [1.04 vs. 0.47] (Men: AAPC −3.44; Women: AAPC −4.32; both p < 0.000001). Regional AAMRs varied [West: 0.82; Midwest: 0.74; South: 0.73; Northeast: 0.6]. Rural deaths [6,888; 19.3%] were four times lower than urban deaths [28,451; 80.5%], though nonmetropolitan areas had higher AAMRs [0.82; 95% CI: 0.80–0.84] than metropolitan areas [0.71; 95% CI: 0.71–0.72]. Mortality rates declined steadily over time, with Tennessee showing the highest and Nevada the lowest rates.

Conclusion: Despite overall declines in VF-related mortality among adults with diabetes, disparities persist. Men, those in nonmetropolitan areas, and residents of certain regions—especially the South and West—continue to face higher mortality. Targeted interventions are needed to address these enduring inequities.

Evolving Burden and Disparities of Fall-Related Mortality in Hypertensive Elderly Adults Across the United States: A 25-Year Epidemiological Perspective

Faiza Ikram — Tue, 25 Nov 2025 00:00:00 +0000

Background: Falls are a major health concern in older adults and a leading cause of death, particularly among those with hypertension. However, national trends in fall-related mortality with co-existing hypertension remain understudied. This study examines these trends in U.S. adults aged ≥65 from 1999 to 2023.

Methods: A retrospective analysis of deaths from 1999-2023 was conducted using the CDC WONDER database. The study population included adults aged ≥65 years, stratified by age group, sex, ethnicity, geographic region, and place of death. Mortality rates were reported as AAMR per 100,000 population, along with 95% confidence intervals (CI). Temporal trends were analyzed using Joinpoint regression to calculate APC and AAPC.

Results: Between 1999-2023, falls with co-existing hypertension accounted for 215,214 deaths, often occurring in medical facilities (50.47%), with an overall AAMR of 18.50 with an AAPC of 10.86% (10.27–11.73, p<0.001). he AAMR increases steadily from 2.89 (2.71–3.07) in 1999 to 38.63 (38.09–39.16) in 2023 with two notable surges were observed an initial spike from 1999–2001 (APC: 43.4%, 95% CI: 27.88–57.90, p<0.001) and a second sharp increase from 2018–2021 (APC: 13.6%, 95% CI: 11.26–15.15, p<0.001). Men consistently had higher AAMR than women (20.39 vs. 17.13), with AAPC of 11.24% and 10.57%, respectively. Mortality rates increased across all racial groups, with the highest AAMR in non-Hispanic (NH) White (20.10), Hispanic (13.50), NH Asian or Pacific Islander (12.74), and NH Black or African American (10.38), with corresponding AAPCs of 11.31%, 8.90%, 6.42%, and 7.68%, respectively. Regionally, the Midwest had the highest AAMR (22.88), followed by the West (18.58), South (18.15), and Northeast (14.11). Metropolitan areas had consistently higher AAMRs than nonmetropolitan areas. State-level trends revealed the highest AAMR in Oklahoma and the lowest in Alabama.

Conclusion: Fall-related deaths with co-existing hypertension have risen sharply, with notable disparities by sex, race, region, and rurality. Enhancing access to care, particularly in western and rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.

Keywords: hypertension, fall, mortality

A Rare Case of Neurofibromatosis Type 1 with Multiple Primary Tumors: A 29-Year Disease Course

Shafna Saif, Hamna Saif — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder affecting 1 in 3,000 individuals and predisposing patients to both benign and malignant neoplasms. While cutaneous neurofibromas and optic pathway gliomas are commonly observed, the development of multiple, distinct, and aggressive primary tumors across organ systems is exceedingly rare.

Objectives: To report a rare case of NF1 presenting with three primary tumors over 29 years and highlight the need for standardized surveillance in NF1 patients.

Materials and Methods: This case report was conducted at a tertiary care hospital and involved a longitudinal follow-up of a single female patient with neurofibromatosis type 1 (NF1) from 1995 to 2024. The patient included in the report had a confirmed diagnosis of NF1 with histopathologically verified tumors. Data were obtained retrospectively through a detailed review of medical records, imaging studies, and biopsy reports. Since the study focused on a single case, the analysis was descriptive in nature and aimed at documenting the clinical course, tumor progression, and management over nearly three decades of follow-up.

Results: At age 29, the patient developed angiosarcoma in the left arm, confirmed histologically after surgical excision. Recurrence necessitated multiple resections and radiotherapy. At age 55, she presented with rectal bleeding; colonoscopy revealed bleeding colonic polyps managed via coiled embolization. At 59, the patient developed seizures and cognitive decline; neuroimaging revealed a space-occupying lesion. Biopsy confirmed glioblastoma multiforme, leading to rapid deterioration and death within 10 days. No systemic surveillance had been conducted between tumor events.

Conclusion: This case underscores the unpredictable and multisystemic nature of NF1, exemplifying the risk of multiple life-threatening tumors over time. It highlights the urgent need for a structured, multidisciplinary surveillance protocol incorporating neurologic, oncologic, dermatologic, and gastrointestinal evaluations. Proactive and early screening could have facilitated timely interventions and may have significantly altered the patient's clinical outcome. Lifelong monitoring is essential to improve prognosis and survival in NF1 patients.

Keywords: Neurofibromatosis 1, Glioblastoma, Angiosarcoma, Colonic Polyps, Multisystem Tumors

Assessing the Psychological and Functional Impact of Low Vision in a Developing Country: Congenital vs. Acquired Cases

Rabia Faheem, Muhammad Saad, Saad Tariq — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Low vision significantly affects mental health, with acquired cases often leading to greater psychological distress than congenital ones. Despite its impact, mental health in low-vision patients remains under-addressed.

Objective: To evaluate the impact of the age of onset of low vision on vision-related quality of life (VR-QoL) and mental health, considering educational and socioeconomic factors.

Methods: This cross-sectional study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, including 225 participants: 75 with congenital low vision (CLV), 75 with acquired low vision (ALV), and 75 controls with normal vision. Patients were categorised based on the age of onset. VR-QoL was assessed using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), while mental health was evaluated with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Educational level and socioeconomic status were recorded. Group comparisons were performed using independent t-tests and chi-square tests.

Results: ALV patients had lower NEI VFQ-25 subscale and composite scores than CLV patients, though differences were not statistically significant. However, BDI and BAI scores were significantly higher in ALV patients (13.42 ± 12.21 vs. 8.91 ± 9.78, P = 0.017; 10.23 ± 11.04 vs. 6.24 ± 7.62, P = 0.025). The proportion of ALV patients requiring expert consultation for depression was also significantly higher (P = 0.008). Lower educational levels and socioeconomic status were associated with significantly worse mental health scores and poorer VR-QoL (P < 0.05), particularly in the ALV group.

Conclusion: ALV patients experience greater psychological distress than CLV patients, with higher levels of depression and anxiety. Socioeconomic and educational disparities were more pronounced in the ALV group, where financial instability and lower education correlated with poorer VR-QoL and mental health outcomes. Age of onset is a crucial factor, as CLV patients develop coping mechanisms from an early age, whereas ALV patients face a sudden disruption in daily life, leading to a significant psychological burden. While objective measures assess visual function, they do not capture the full impact of low vision. Integrating mental health assessment and psychosocial support into rehabilitation programs is essential for improving patient well-being. A comprehensive, multidisciplinary approach addressing both visual and psychological aspects is critical for successful low-vision rehabilitation.

Keywords: Low Vision, mental health, anxiety, rehabilitation

Frequency of Normal Findings in Brain CT Accompanied with Headache and Potential Risk of Unnecessary Exposure: A Cross-Sectional Study

Ali Rashid, Abid Ali, Taiba Zulfiqar, Ahmed Rashid — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: The introduction of CT imaging has greatly improved diagnostic accuracy in medicine. However, its widespread use raises concerns due to potential risks such as radiation exposure, incidental findings, and unnecessary follow-up testing. CT is often used even when it may not significantly impact patient outcomes, and its use is liberal even in patients with minor symptoms. There are concerns about the potential overuse of CT imaging with little to no diagnostic benefits.

Objective: To estimate the frequency of normal head CT and positive CT findings in patients with headache and the potential risk of unnecessary exposure.

Methods: This cross-sectional study was conducted in the Radiology Dept of Gondal Medical Complex, Gujranwala, over a four-month period from November 2023 to February 2024. After approval from the institution's ethics review board committee, the results of approximately 100-125 patients were to be included in the study. ^1-3 Data was collected through the results of head CT scans of patients who came with a presenting complaint of headache and was analyzed retrospectively. The data was analyzed through SPSS (Statistical Package of Social Sciences) version 20. Descriptive Statistics were used to analyze the data.

Results: A total of 132 patients were included in the study, which fulfilled the inclusion criteria. There were 51.5% female (68) and 48.5% male(64), with a mean age of 41±16.44. Of the total 132 patients, most patients (25% n=33) were between 30-39 years of age where whereas the age groups of 0-9 and 80> had 1 patient each, respectively. Among 132 patients (87.9%, n=116) were presented with headache was the only complaint, and with additional complaints like vertigo (1.5%,n=2), headache and vertigo(5.3%,n=7), headache and hypertension (5.3%,n=7).In total, 85.6% (n=113/132) were normal brain CT scans, and (14.4%,n=19) were abnormal. The total percentage of patients with significant findings was (9.6%,n=12), while the remaining had insignificant findings such as brain atrophy.

Conclusion: A large number of normal scans of CT brain suggest the possibility of inappropriate overuse of brain scanning. A more careful and responsible approach is needed by the referring physicians to avoid the harmful effects to the patients and to decrease the burden of imaging and then reporting on the Radiology staff personnel.

Keywords: Computed tomography, headache, normal study.

Factors Causing Delay to Surgical Treatment in Geriatric Neck of Femur Fracture Patients: A Case Control Study

Hamza Chaudhary, Ariba Waheed — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Neck of femur fracture is a common orthopaedic condition that is treated operatively; the annual incidence rate is estimated to be 6.26 million by 2050.

Objectives: To know and work on actual facts causing delay in treatment and work on them.

Materials and Methods: This was a retrospective review of patient records at a General Hospital in Dudley West Midlands, UK. Patients undergoing Surgical treatment for intra-capsular (IC) or extra-capsular (EC) hip fractures were included. Sample size is 300. The chi-square test is applied to show the association between the factors involved. The case group includes patients with a surgery time of more than 36 hours, and the control group is the one patients with a less than 36 hours of surgery time. The p-value less than 0.05 is considered to be significant. The permission for the data for this case-control study was taken from the hospital and no IRB approval is required and no data collection tool or technique was needed. The population consists of people suffering from the Neck of femur fracture.

Results: A Significant association exists between time to surgery (TTS) and length of hospital stay, with a p-value of 0.036. No significant association exists between TTS and Mortality, with a p-value of 0.924. Among the factors causing delay for the surgery, only gender has been significantly associated with TTS, with a p-value of 0.001.

Conclusion: TTS greater than 36 hours significantly affects the duration of hospital stay for more than 2 weeks but has no significant association with the overall Mortality. So when comparing it with the guidelines, if the surgery gets delayed by more than 36 hours, it won’t have a significant impact on the mortality, and other factors might be considered and pre-operative cardiovascular risk assessment and haemoglobin level assessment can be done, ensuring a better outcome for the patient.

Key Words: Hip fracture, Mortality.

Demographic and Regional Mortality Trends in Adult Epilepsy-Related Mortality in the United States (1999–2020)

Syeda Fadak Zahra Hujjat — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: This study utilizes data from the CDC WONDER database to assess epilepsy-related mortality trends in U.S. adults aged 25 to 85+ from 1999 to 2020. By stratifying mortality patterns demographically and geographically, the study aims to provide actionable insights to inform health policy and guide targeted interventions to reduce epilepsy-related mortality nationwide.

Objective: To evaluate epilepsy-related mortality trends among U.S. adults (1999–2020) by age, sex, race/ethnicity, and geography.

Materials and Methods: Retrospective observational analysis using CDC WONDER mortality data (ICD-10 codes G40–G41). Crude death rates (CDR) and age-adjusted mortality rates (AAMR) were calculated per 100,000 adults (≥25 years) to assess national trends in epilepsy-related mortality among U.S. adults. These rates were examined across multiple age groups, with 95% confidence intervals (CIs) calculated for each estimate. Age-adjusted mortality rates (AAMRs) were computed to evaluate mortality trends independent of age distribution. Trends were stratified by demographics and geography. Joinpoint regression identified temporal inflection points.

Results: Nationally, CDR nearly doubled (0.6 to 1.1/100,000), with accelerated AAMR increases post-2011 (APC +9.56%, p<0.001). Demographics: Males had persistently higher mortality (AAMR 10.5 vs. 6.0 in 2020). Black individuals bore the highest burden (AAMR 13.0/100,000 in 2020). The 25–34-year age group saw the sharpest rise (AAMR: 3.0 to >14.0). Geography: High-burden states included Michigan (AAMR 1113.26), California (746.46), and Florida (518.55). Central/Northwestern states had suppressed data due to low counts.

Conclusion: Epilepsy-related mortality increased significantly, with marked disparities among young adults, males, Black populations, and specific states. The inflection point (2011) suggests evolving risk factors or care gaps. Targeted interventions addressing structural inequities and geographic resource allocation are urgently needed.

Keywords: Epilepsy/mortality, Health Status Disparities, United States/epidemiology, Retrospective Studies, Population Surveillance

Who Manages the Pressure? Gaps, Challenges and Policy Needs in Inpatient Hypertension Care

Tue, 25 Nov 2025 00:00:00 +0000

Background: Elevated blood pressure (BP) during hospitalization affects 50–70% of adults, yet formal international guidance on its management remains absent. Increases in BP may reflect true hypertension, transient physiological stress, or inaccuracies in measurement. This study assessed how hypertension is managed in clinically stable hospitalized patients in a tertiary care setting.

Methods: We conducted a prospective, observational, cross-sectional study at Shalamar Hospital, Lahore, Pakistan from November 2024 to March 2025. Adult inpatients (≥18 years) with a prior or new diagnosis of hypertension were enrolled consecutively. Data were collected at a single time point using structured questionnaires and medical record review. Statistical analysis was performed using JMP Version 13 (SAS), p<0.05 considered significant.

Results: Of the 151 hypertensive patients (mean age 58.2 ± 12.8 years; 68.9% female), 90.7% had pre-existing hypertension, and 83% were on treatment. Common comorbidities included type 2 diabetes (81.9%) and chronic kidney disease (13.8%). Half of the patients had BP <140/90, mmHg during hospitalization, but adverse events included hypertensive urgency (5.3%), creatinine rise (23%), and myocardial infarction (2.6%). Inpatient prescribing showed a significant decline in angiotensin receptor blocker (44.4% vs. 36.4%, p<0.01) and beta-blocker (19.9% vs. 13.2%, p<0.05) use, and a rise in calcium channel blocker (38.4% vs. 47.7%, p<0.01) and diuretic (7.3% vs. 11%, p=0.06) use. Despite this, 25% had uncontrolled BP at discharge; 70% had no documented outpatient follow-up, and only 19% were referred to specialist care.

Conclusion: Managing hypertension in hospitalized patients remains a clinical challenge, particularly in the presence of multimorbidity, acute illness, and evolving treatment priorities. The absence of formal guidelines, limited prescribing oversight, and lack of structured discharge planning contribute to suboptimal control and follow-up. Our findings highlight the need for clear institutional protocols, better integration of inpatient and outpatient care, and enhanced clinical support to ensure safe, consistent, and evidence-based management of hypertension during hospitalization.

Phenotypes, Predictors and Outcome of Hypertension in the Inpatient Setting

Mohammad Mujtaba Khokhar, Zafar Aleem Suchal — Tue, 25 Nov 2025 00:00:00 +0000

Background: Hypertension (HTN) is a leading preventable cause of cardiovascular disease and mortality globally. It poses a massive burden of disease in Pakistan, with the National Diabetes Survey of Pakistan 2016-2017 conducted on 10,834 participants nationwide, reporting an overall age-adjusted weighted prevalence of 46.2%. Yet, data on its management in hospitalized non-cardiac patients remains underexplored. Understanding the inpatient non-cardiac population patterns of hypertension management is hence crucial for enhancing outcomes and patient management protocols.

Objectives: This study thus aims to evaluate the prevalence, treatment patterns, and outcomes of hypertension in the non-cardiac inpatient population, with a focus on complications, medication adherence, and discharge planning.

Methods: A cross-sectional study was conducted over five months (November 2024 to March 2025) at Shalamar Hospital, Lahore. Adult patients (≥18 years) admitted with known or newly diagnosed hypertension were enrolled. Data on demographics, clinical characteristics, inpatient BP trends, treatment modalities, and outcomes were collected through structured questionnaires and medical record review. Statistical analyses were performed using SPSS v27.

Results: Among 151 hypertensive inpatients (mean age 58.2 ± 12.8 years; 68.9% female), 77.5% had a prior HTN diagnosis, and 67.5% reported treatment adherence pre-admission. Diabetes (81.9%) and chronic kidney disease (13.8%) were the most common comorbidities. Hypertension was actively managed in 78.2% of patients, yet 18.5% received no treatment during admission. Oral antihypertensives were used in 72.1%, with 37.7% receiving monotherapy. Complications included hypertensive emergencies (5.3%), renal failure (8.0%), and myocardial infarction (2.6%). Only 29.1% had documented follow-up plans at discharge. Poor BP control correlated with renal dysfunction, inadequate medication use, and lack of specialist referrals (p<0.05).

Conclusion: Despite a high prevalence of hypertension among inpatients in Pakistan, gaps exist in the management of such patients, such as improper treatment, less robust follow-up planning, and high rates of complications. These findings urge the need for apt utilization and implementation of standardized inpatient hypertension management protocols in Pakistan to improve patient outcomes and decrease the healthcare burden.

A Cross-Sectional Study of Prevalence of Gastro-Oesophageal Reflux Disease and Associated Risk Factors Among Medical Students of Pakistan

Sana Fatima, Roumman Ashraf — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Gastroesophageal reflux disease (GERD) is a common condition involving the backward flow of stomach contents into the esophagus, causing symptoms like heartburn and regurgitation. If untreated, it can lead to complications such as Barrett’s esophagus and esophageal cancer. Risk factors include stress, obesity, poor diet, smoking, and NSAID use. GERD affects 13.98% of the global population, with up to 24% prevalence in Pakistan. Medical students are especially vulnerable due to academic stress, sedentary routines, and irregular meals. However, limited data exists on GERD in this group. This study aims to evaluate its prevalence, risk factors, and impact on medical students’ daily life.

Objectives: To evaluate the prevalence of GERD among medical students in Pakistan. To assess the risk factors and the impacts of GERD on the lives of medical student. To suggest necessary lifestyle modifications to reduce symptoms of GERD.

Method: A nationwide study was conducted among undergraduate medical students. Using Cochran formula, the calculated sample size was 220 students (CI-95%; ERR-5%).Non-random convenience-based sampling was applied, electronic pretested questionnaire was distributed to various medical institutes in May 2024. It comprised questions regarding demographic data, risk factors, GERD Questionnaire, and 10-item-Cohen's perceived stress scale (PSS). IBM SPSS, version-27 employed for data analysis. Participants with cut-off value ≥ 8 were considered having GERD. Scores 0-13, 14-26, 27-40 were classified low, moderate, and high perceived stress. Association between categorical values was evaluated using Pearson’s Chi Square test. Approval was obtained from Ethical Review Committee of Rawalpindi Medical University; informed consent was taken, anonymity was maintained.

Result: Total 249 responses were received, majority being females 212 (85.1%) and 189 (75.9%) having healthy BMI (18-25 kg/m²). Prevalence of GERD calculated was 20.5% (n=51). Similarly, 178 (71.5%) and 31 (12.4%) participants reported experiencing moderate and high perceived stress respectively. Statistically Prevalence of GERD was significantly associated with midnight snacking (p-value= 0.007), mode of exercise (p-value=0.034), and perceived stress (p-value= 0.025).

Conclusion: Gastroesophageal reflux disease is prevalent among medical students, attributed to stress and unhealthy lifestyle habits. Despite limitations such as recall bias and lack of formal diagnosis, this study contributes valuable insights to existing research. Raising awareness of the risk factors and management strategies is essential to mitigate the increasing prevalence of the disease, particularly among future healthcare professionals.

Keywords: Gastroesophageal Reflux (D005764), Gastric Acid (D005744), Esophagitis (D004941), epidemiology (Q000453)

Prevalence of Undiagnosed ADHD: a Cross-sectional Study Among the Adult Population in Peshawar

Saaim Sikandar — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: ADHD is a lifelong neurodevelopmental disorder affecting academic, occupational, and social functioning. Often undiagnosed in adults, especially in Pakistan, it remains understudied among university students. This study explores the prevalence and functional impact of undiagnosed ADHD in Peshawar, aiming to inform screening, raise awareness, and guide local interventions

Objectives: This study aimed to assess the prevalence of undiagnosed ADHD among undergraduate students and adults in Peshawar and to evaluate the associated functional impairments and socio-academic triggers.

Methods: A cross-sectional study was conducted in urban Peshawar from February to June 2025. Ethics clearance (reference number: No 175/RC/NWSM/2024) to carry out the research was obtained from the host organization's Institutional Review Board (IRB) of Northwest School of Medicine prior to data collection. Verbal consent was obtained from participants, and anonymity was maintained in the process of data collection as well as data analysis. A total of 349 adults aged 20–40 years were recruited using convenience sampling. Participants completed a modified version of the WHO Adult Self-Report Scale (ASRS v1.1), which included an additional section assessing functional difficulties in daily life, social interaction, emotional regulation, and task performance. Data were analyzed using SPSS v25, with chi-square tests and descriptive statistics applied.

Results: ADHD symptoms were highly prevalent, with 176 (50.4%) participants classified as borderline ADHD and 16 (4.6%) as moderate ADHD. Statistically significant associations were found between ADHD symptoms and educational level (χ² = 0.025) and occupation (χ² = 0.026), with medical professionals reporting higher symptom burden. Functional impairments were significantly more common in participants with borderline or moderate ADHD (p < 0.001), especially in emotional regulation (94.1% of the moderate ADHD group). No significant associations were found with gender or age.

Conclusion: A substantial proportion of adults in Peshawar, especially within medical and academic communities, exhibit undiagnosed ADHD symptoms. These symptoms are associated with meaningful impairments in emotional and functional domains, highlighting the need for improved screening and support services. Culturally sensitive awareness and early intervention strategies are essential to address this neglected mental health burden.

Keywords: Attention-deficit hyperactivity disorder, Functional Impairment, Medical Students

Blue Screen Blue Mood: Investigating the Association of Daily Screen Time with Sleep Quality and Mental Distress in Students

Marvi Talpur — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: The pervasive influence of technology on daily life, particularly through screens, and its implications for sleep quality and mental health are critical.

Objective(s): To evaluate the daily screen time of students from different fields of study and to assess its association with demographic variables as well as sleep quality and mental health symptoms.

Materials and Methods: This Cross-sectional study was conducted in Isra University, Hyderabad, from August 2023 to February 2024, in an academic setting among undergraduate students. A total of 152 participants who provided informed consent and were enrolled in academic programs were included in the study. Individuals with diagnosed psychiatric conditions or sleep disorders were excluded. Data regarding demographic details, sleep quality, mental distress, and daily screen time was collected after informed consent, using self-administered printed questionnaires. Standardized tools used included the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and the Depression Anxiety Stress Scale (DASS-42) to evaluate mental distress. Statistical analysis, conducted using SPSS (version 22), determined correlations between daily screen time, PSQI, and DAS scores (p≤0.05, 95% confidence).
Results: The mean age of the participants was 20.59±2.16 years. The vast majority of participants belonged to urban areas (87.5%) and were day scholars (74.34%). The mean daily screen time of the study participants was found to be 5.85±1.14 hours. The mean scores of depression, anxiety, stress, and PSQI were found to be 13.34±12.01, 11.17±9.41, 15.32±11.09, and 6.45±3.48, respectively. There was a statistically significant positive correlation observed between screen time and depression (r = 0.81, p < 0.01), anxiety (r 0.78, p < 0.01), stress (r = 0.83, p < 0.01), and PSQI (r = 0.75, p < 0.01).
Conclusion: Increased screen time was associated with poorer sleep quality and higher levels of mental distress.
Keywords: Screen Time; Mental Health; Sleep Quality; Depression; Anxiety.

Comparing Nissen Rossetti and Floppy Nissen Techniques in Laparoscopic Reflux Surgery: A Systematic Review and Meta-Analysis

Husna Irfan Thalib — Tue, 25 Nov 2025 00:00:00 +0000

Background: Gastroesophageal reflux disease (GERD) is one of the most prevalent disorders globally, affecting approximately 13.98% of the adult population. The predominant cause is the dysfunction of the lower oesophagal sphincter (LES). GERD commonly presents with symptoms such as heartburn, regurgitation, and dysphagia. Initial treatment often involves lifestyle modifications and proton pump inhibitors (PPIs). However, surgical intervention becomes necessary for many patients to achieve symptomatic relief. Laparoscopic Nissen fundoplication is the gold-standard surgical treatment for GERD. Despite its widespread use, a debate persists regarding the optimal surgical technique between the Nissen-Rossetti and Floppy Nissen procedures.

Objectives: This study systematically evaluates and compares the Nissen-Rossetti and Floppy Nissen fundoplication techniques to determine which provides the best surgical approach for GERD. The objectives include analysing differences in operative parameters, post-operative complications, long-term symptom resolution, and quality of life outcomes.

Methodology: A systematic review and meta-analysis were conducted, adhering to PRISMA guidelines. Databases including PubMed, Ovid Medline, Ovid Cochrane, and Scopus were comprehensively searched. Studies reporting demographic characteristics, operative outcomes, complications, and symptoms were included. Data were screened, extracted, and assessed for quality using the Cochrane RoB 2 tool for randomised controlled trials and MINORS for non-randomised studies. Statistical analysis was performed using random- and fixed-effects models via Review Manager (RevMan).

Results: Twelve studies involving 1,165 patients met the inclusion criteria. Among these, 320 patients underwent the Nissen-Rossetti procedure, while 600 had the Floppy Nissen procedure. The Nissen-Rossetti technique demonstrated a significantly shorter operative time (mean difference -25.29 minutes, p < 0.00001). However, it was associated with higher rates of postoperative oesophagal dilation (16.3% vs. 4.4%; odds ratio [OR] 3.58, p = 0.0002) and dysphagia (25.1% vs. 15.6%; OR 1.87, p = 0.009).

In contrast, the Floppy Nissen procedure resulted in shorter postoperative hospital stays (mean difference -0.18 days, p = 0.01). Symptom resolution rates, including relief from heartburn and regurgitation, were comparable between the techniques. Rates of reoperation and major adverse events showed no significant differences.

Conclusions: The Nissen-Rossetti technique offers shorter operative times but is associated with higher rates of dysphagia and oesophagal dilation. The Floppy Nissen procedure, although requiring longer operative times, demonstrated better postoperative outcomes with fewer complications and shorter hospital stays. These findings support the Floppy Nissen as the preferred surgical approach for GERD. Future randomised controlled trials are needed to confirm these results and strengthen clinical recommendations.

Safety and Efficacy of Hydroxyurea and Interferon in Myeloproliferative Neoplasms: A Systematic Review

Roha Daneyal, Mahnoor — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Myeloproliferative neoplasms (MPNs), including polycythemia vera (PV) and essential thrombocythemia (ET), are characterized by excessive proliferation of myeloid cells. Hydroxyurea (HU) results in lowering blood counts, whereas pegylated interferon (PEG-IFN) offers disease modification.

Objective: This systematic review focuses on evaluating the relative benefits and risks of HU and IFN in MPN management.

Methodology: Following PRISMA guidelines, randomized controlled trials, non-randomized clinical trials, and observational studies, including MPN-112, PROUD-PV, CONTINUATION-PV, and others, were systematically reviewed. All the patients included in these studies had either PV or ET and were treated with either HU or PEG-IFN. Protocol is registered on PROSPERO (Registration no: CRD42023399263). Data extraction and Quality assessment were done according to the Cochrane handbook of systematic reviews and meta-analysis.

Results: Six studies with a total of 1,012 patients with MPNs were included, of which 552 were treated with HU and 460 were given PEG-IFN. The median age ranged from 50 to 63 years for the HU group, and from 50 to 61.8 years for the PEG-IFN group, and treatment duration ranged from 12 to 36 months. The mean hematologic response rate was 65% for both HU (359/552) and PEG-IFN (299/460) groups at 12 to 24 months; however, at 36 months, a better response was seen with PEG-IFN. Hematocrit control was obtained in 65% of patients in each group. PEG-IFN resulted in larger decreases in JAK2V617F allele burden, with a mean of about 25% vs a mean of 15% with HU. Spleen response was assessed in 604 patients, of which 49.4% (179/362) responded to PEG-IFN, and 42.6% (141/331) responded to HU. Hematologic toxicities occurred in 25% (138/552) of HU-treated patients. In the HU group, leukemic or fibrotic transformation was seen in 2% (9/552). PEG-IFN caused immune-related adverse events in 15% (69/460) of patients, common being transaminitis (4.3%), followed by thyroid toxicities (2.4%).

Conclusions: HU and Peg IFN are both associated with hematologic response in MPN; however, Peg IFN is associated with greater long-term molecular response.

Keywords: myeloproliferative neoplasm, polycythemia vera, essential thrombocythemia, hydroxycarbamide, pegylated interferon

Psychological Dynamics of Respectful Maternity Care: Provider–Patient Interactions in Rural Pakistan

Mushaim Gillani, Ijaz Battol, Amna Inayat — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Verbal and physical abuse, non-consented actions, ineffective communication, and emotional neglect are components of the disrespectful intrapartum care in Rural Pakistan. Such experiences not only increase psychological distress but also erode the trust in health care providers, compromising both mental health and service utilization.

Objectives: The objectives are to examine the dynamics of provider and patient during childbirth in rural Pakistan, to qualify the frequency of treatment and its psychological impact on mothers, and to explore how treatment and psychological intervention contribute to respectful, emotionally supportive care.

Material and Methods: This review includes the articles between 2020 and 2025; the search engines used were Google Scholar and PubMed.

Results: Providing the intervention reduced the overall mistreatment by 50 percent and notably reduced verbal abuse and ineffective communication. S-RMC intervention reduced childbirth-related anxiety and depressive symptoms. After training, the staff reported an increase in empathy, communication, psychosocial awareness, and team coordination. In Karachi, postpartum anxiety was linked to sociocultural stress, lack of psychosocial support, and domestic responsibilities.

Conclusion: Implementing theory-driven S‑RMC interventions in rural PHCUs effectively reduced mistreatment and promoted psychosocially supportive care. Provider empathy training and systemic accountability developed trust and psychological safety, significantly lowering the maternal anxiety and depressive symptoms. For sustainable progress, future strategies should integrate culturally sensitive, trauma-informed development, evaluation of long-term mental health impacts, and trauma-informed provider development.

Keywords: Respectful Maternity Care, Psychosocial Support, Patient-Provider Relation, Postpartum Anxiety

Niservimab for RSV Prevention in Infants & Children: A Systematic Review & Meta-Analysis

Abdul Karim Shahbaz, Aamna Mujtaba — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Respiratory Syncytial Virus (RSV) is one of the most common and severe causes of lower respiratory tract infections in infants, with the leading cause of paediatric hospitalization globally, especially in resource-constrained countries. Currently, there are not many preventive strategies available: one of the newest drugs is Nirsevimab with moderate effectiveness; however, it has a high price and limited availability. To assess its effectiveness, conducting a meta-analysis of available data is critical to make recommendations on clinical management of the RSV disease and public health policies to reduce the burden of the disease in the affected population.

Methods: A systematic search was conducted in PubMed, Cochrane Central, Scopus, and Google Scholar for studies published from 2022 onward. Eligible studies included randomized controlled trials (RCTs) and observational cohorts assessing the impact of Nirsevimab on RSV outcomes. Risk of bias was evaluated using the Newcastle-Ottawa Scale for observational studies and the Cochrane RoB 2.0 tool for RCTs. Meta-analyses were conducted to estimate pooled relative risks (RRs) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and meta-regression was examined through bubble plot analysis.

Results: Seven studies (four cohort and three RCTs), comprising 82,446 infants, met the inclusion criteria. Nirsevimab significantly reduced the risk of RSV-related hospitalization (RR: 0.14; 95% CI: 0.09–0.20; I² = 67%) and ICU admission (RR: 0.11; 95% CI: 0.06–0.18; I² = 23%). It also lowered the need for primary (RR: 0.40) and emergency care (RR: 0.28), and showed efficacy in preventing RSV A (RR: 0.25) and RSV B infections (RR: 0.24). No significant increase in adverse events was observed. Subgroup and sensitivity analyses confirmed robustness of findings, though heterogeneity was noted.

Conclusion: Nirsevimab provides a high efficacy in the prevention of RSV-associated hospitalizations and severe infection in infants with an acceptable safety profile. It has potential as a preventive intervention and could go a long way to reduce the burden caused by RSV on this group of patients. More research is necessary to assess long-term results and the effectiveness of Nirvesimab in the population.

Selective Renal Artery Branch vs. Conventional Main Artery Denervation in Treatment-Resistant Hypertension: A Systematic Review and Meta-Analysis

Sara Sharif, Allah Dad, Muhammad Arham, Atif Nawaz Malik, Iman Ali, Arbaz Hassan — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Treatment-resistant hypertension affects over 500 million people globally, yet only 23% of hypertensive individuals achieve adequate control. Renal nerve denervation (RDN) has emerged as a promising adjunctive therapy. This systematic review and meta-analysis compares the efficacy of selective renal artery branch RDN versus conventional main renal artery RDN in lowering blood pressure.

Objectives: To compare selective renal artery branch denervation versus conventional main renal artery denervation in achieving optimal blood pressure control.

Material and Methods: In accordance with PRISMA guidelines, a systematic search of four databases—PubMed, EMBASE, Scopus, and ClinicalTrials.gov —was conducted to identify randomized controlled trials and observational studies comparing selective renal artery branch denervation with main renal artery denervation. The primary outcomes included office systolic blood pressure (SBP) at the 6-month primary endpoint and daytime and nighttime ambulatory blood pressure parameters. Statistical analyses were performed using R (version 2025.05.0+496), with statistical significance defined as a two-tailed p-value < 0.05.

Results: Among four studies enrolling 488 patients, 204 were in the selective renal artery RDN group and 376 in the conventional main renal artery RDN group. Selective renal artery RDN significantly reduced office systolic blood pressure (SBP) compared to conventional RDN (MD −4.04 mmHg; 95% CI: −6.59 to −1.49; p = 0.0019). Significant reductions were also observed in daytime ambulatory SBP (MD −7.96 mmHg; 95% CI: −13.35 to −2.56; p = 0.0039), daytime diastolic BP (DBP) (MD −4.09 mmHg; 95% CI: −7.32 to −0.87; p = 0.0126), and nighttime SBP (MD −9.82 mmHg; 95% CI: −12.88 to −6.77; p < 0.0001), all favoring the selective renal artery RDN group. Heterogeneity was substantial for office SBP (I² = 82.1%) but minimal for all ambulatory BP outcomes (I² ≤ 8.5%).

Conclusion: Selective renal artery branch RDN is more effective in reducing office and ambulatory blood pressure than conventional main renal artery RDN. These findings highlight selective RDN as a promising treatment option for patients with resistant hypertension, offering better blood pressure control, in light of recent RDN FDA approval. Head-to-head RCTs with extended follow-ups are warranted to validate these results further.

Keywords: Renal Denervation; Hypertension; Ambulatory Blood Pressure Monitoring; Catheter Ablation; Treatment-Resistant Hypertension

Prevalence of Post-Partum Haemorrhage Amongst the Users of Calcium Channel Blockers

Minal Sarfraz Abbasi — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Postpartum haemorrhage (PPH) is a common cause of maternal death worldwide, but data on PPH incidence and the possible causes are scarce. Erythrocyte suspension transfusion before birth, placenta Previa, birth canal avulsion, administration of general anaesthesia before delivery, and maternal anemia are major factors influencing PPH in nulliparous and multiparous women. It has been noticed that a vast majority of these incidences are reported amongst hypertensive patients who have been prescribed Calcium Channel blockers like Amlodipine and diltiazem. Calcium channel blockers work by inhibiting the uptake of Calcium ions by cardiac and smooth muscle cells and thus lead to vasodilation and decreased contractility of cardiac muscles. It has been noted that uterine involution, i.e. a process of endometrial contraction after birth, is essential to prevent PPH in women after delivery. These contractions rely heavily on the influx of Calcium ions into the smooth muscle cytosol, and by inhibiting this influx of Calcium ions, Calcium channel blockers may lead to an atonic uterus. A study claims that 12.6% of women with pre-existing or gestational hypertension were prescribed CCBs, and 2.7% of them experienced PPH.

Objectives: The objectives of this study were to determine the incidence of postpartum hemorrhage among users of calcium channel blockers, to assess the level of public awareness regarding postpartum hemorrhage, and to identify the most commonly used calcium channel blockers in current medical practice.

Materials and Methods: This cross-sectional study was conducted at Holy Family Hospital and included all women admitted with postpartum hemorrhage who had been prescribed calcium channel blockers prior to admission. A total sample of 310 patients was calculated using the WHO sample size calculator with a 95% confidence interval and a 5% margin of error. Participants were selected through random sampling, and only those who provided informed consent and had a history of CCB use were included, while patients unwilling to participate were excluded. Data were collected using a self-administered English-language questionnaire that gathered demographic information and explored the relationship between CCB use and postpartum hemorrhage. After explaining the study objectives and obtaining written consent, printed questionnaires were distributed to eligible patients over a four-week period. Data were analyzed using descriptive and inferential statistical methods, with Microsoft Excel and SPSS version 27 employed to ensure accuracy.

Results: It has been noted that almost 34% of the Pakistani women suffer from post partum haemorrhage. PPH has also been accounted for 27.1% of maternal deaths with 90% of those deaths occurring within 24 hours of delivery. Amongst the causes of PPH, atonicity of the uterus is the most significant and is related to the use of Calcium channel blockers in almost 3.2 percent of cases.

Conclusions: Postpartum haemorrhage (PPH) is an obstetric emergency complicating 1–10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. Similarly, in Pakistan alone, the use of CCBs is seen in 13 percent of the Pakistani population. 46.2% of the Pakistani population suffers from hypertension, with the majority of patients, i.e., 16.6% being women. The knowledge of postpartum haemorrhage in Pakistan is extremely scarce. Similarly, research is being conducted presently to improve our knowledge regarding the interrelationship between the use of CCBs and PPH.

Keywords: Postpartum haemorrhage, Calcium channel blockers, Hypertension, Atrophy of the Uterus

Tirofiban Saves Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Hira Arshad — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality globally. Standard antiplatelet therapies, while partially effective, do not fully inhibit all pathways of platelet aggregation, leaving patients at risk of recurrent thrombotic events. Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has shown promise as an adjunctive treatment in AIS.

Methods: A comprehensive search was conducted in PubMed, ClinicalTrials.gov, and Cochrane Library from inception to July 2024, following PRISMA guidelines. Inclusion criteria comprised randomized controlled trials (RCTs) and comparative observational studies where tirofiban was used as an adjunct to standard antiplatelet therapy. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and favorable modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes included National Institute of Health Stroke Scale (NIHSS) scores and all-cause mortality. Data was analyzed using Review Manager v5.4.1, with random-effects models employed for all outcomes.

Results: Fifteen studies, comprising 4,457 patients, were included. Tirofiban significantly improved the likelihood of achieving favorable mRS scores (OR 1.65, 95% CI [1.29, 2.11], p= 0.0001), with moderate heterogeneity (I²=57%, p=0.006). Tirofiban also significantly reduced NIHSS scores (MD -2.08, 95% CI [-2.77, -1.39], p<0.00001). There was no significant difference in the incidence of sICH between the tirofiban and control groups.

Conclusion: Tirofiban as an adjunct to standard antiplatelet therapy in AIS patients significantly improves functional outcomes and reduces neurological impairment without increasing the risk of sICH.

Keywords: Tirofiban, Antiplatelet Therapy, Acute Ischemic Stroke, Stroke, Neurology, Dual antiplatelet therapy

Statins in Hepatitis B and C Patients is Associated with Reduced Hepatocellular Carcinoma Risk

Ume Rooman, Sehrish Shahani, Fiza Shaikh, Sadna, Raj Patel — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and represents a major global health burden. Chronic infection with the hepatitis B virus (HBV) and hepatitis C virus (HCV) is a well-established etiological factor for HCC, contributing to more than 75% of global cases. Given the increasing burden of HCC and the need for effective preventive strategies beyond antiviral therapy, a comprehensive synthesis of available evidence regarding the chemopreventive role of statins in HBV or HCV-infected individuals is warranted. This systematic review aims to evaluate and quantify the association between statin use and HCC risk among patients with hepatitis B or C.

Objective: To determine whether statin therapy reduces the risk of HCC in this high-risk population.

Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines and included studies retrieved from PubMed, Google Scholar, the Cochrane Library, and the Directory of Open Access Journals (DOAJ). Eligible studies involved patients with HBV or HCV, evaluated the use of statins as the intervention, and compared outcomes with non-statin users, specifically focusing on the risk of developing hepatocellular carcinoma. Only original research articles published in English between January 2019 and April 2025 were included. The quality of all included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool.

Results: Among the 15 studies included in our review, 14 studies found that statins were associated with a lower risk of HCC in patients infected with Hepatitis B or C. Only one study did not report statistically significant results for viral hepatitis. In our pool of included studies, 3 studies found a dose-dependent protective effect against HCC. Although statins are primarily lipid-lowering drugs, some studies report a greater effect of lipophilic statins in reducing HCC risk.

Conclusion: We found an overall positive association between the use of statins and a reduced risk of HCC in HBV and HCV patients, with evidence supporting a dose-dependent relationship. Lipophilic statins were found to be more efficacious. However, further research is needed to establish the optimal doses and statin types, as well as their use in patients with multiple comorbidities, before physicians can empirically prescribe statins to HBV and HCV patients.

Keywords: Hepatitis B, Hepatitis C, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hepatocellular Carcinoma, Antineoplastic Agents

Natriuresis-Guided Diuretic Therapy in Acute Heart Failure: A Meta-Analysis of Diuretic Efficacy

Syed Wajihullah Shah, Abuzar Khan — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Acute Heart Failure (AHF) is a major cause of hospitalisation and mortality. While loop diuretics are the mainstay of treatment, relying solely on clinical signs for dose adjustments can delay effective therapy. Natriuresis offers an objective marker for diuretic response. This meta-analysis evaluates the effectiveness and safety of natriuresis-guided diuretic therapy compared to standard care.

Objective: To assess whether natriuresis-guided diuretic therapy improves clinical outcomes in patients recovering from acute heart failure.

Materials and Methods: A systematic review and meta-analysis were conducted per PRISMA and Cochrane guidelines. PubMed, Embase, and Web of Science were searched for relevant trials up to February 2025. Studies included randomised or non-randomised trials comparing natriuresis-guided diuretic therapy to standard care in AHF patients. Primary outcomes included natriuresis (mmol at 24 and 48 hours) and diuresis (L at 48 hours); secondary outcomes were weight loss (kg at 48 hours), length of stay (days), hypotension (systolic BP < 90 mmHg), and hypokalemia (serum K⁺ < 3.5 mmol/L). Data was analysed using RevMan 5.4. Results were presented as mean difference (MD) or risk ratio (RR) with 95% confidence intervals, and heterogeneity was assessed using the I² statistic.

Results: Four trials with 831 patients were included. Natriuresis-guided therapy significantly improved natriuresis at 24 hours (MD: 83.66 mmol, P < 0.00001) and 48 hours (MD: 132.27 mmol, P = 0.0003). Diuresis at 48 hours also increased (MD: 1.35 L, P < 0.00001). Weight loss showed a non-significant increase (MD: 0.49 kg, P = 0.11). Hospital stay was reduced (MD: -0.80 days, P = 0.005). No significant differences were observed for incidence of hypotension (RR: 0.80, P = 0.60) or hypokalemia (RR: 1.03, P = 0.92).

Conclusion: Natriuresis-guided diuretic therapy improves natriuresis, diuresis and shortens hospital stay in AHF patients, with a safety profile comparable to standard care.

Keywords: Acute Heart Failure, Natriuresis, Diuretics, Hypokalemia, Hypotension

Comparative Efficacy and Safety of Self-Expanding Versus Balloon-Expandable TAVR in Patients with Aortic Stenosis: A Systematic Review and Meta-Analysis

Warda Zaheer, Manahil Asghar — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Patients with aortic stenosis have a high mortality risk. New self-expanding valves (SEV) and balloon expandable valves (BEV) are used in trans catheter aortic valve replacement (TAVR). We performed a systematic review and meta-analysis to compare the clinical outcomes of efficacy and safety of these two valves in patients with aortic stenosis.

Methods: A systematic search of PubMed, Embase, and Cochrane was conducted from inception to June 2024. Randomized controlled trials that included adult human patients with aortic stenosis undergoing TAVR, comparing clinical outcomes of efficacy and safety between SEV and BEV, were eligible. Random effects meta-analysis using the inverse variance method was employed. Quality appraisal was done using the Cochrane Risk of Bias 2 Tool. This review was registered with PROSPERO, CRD42024563628.

Results: We identified 8 RCTs, and data from 2779 patients were analyzed. Random effects analysis showed that SEV, when compared to BEV, significantly increased risk of all-cause mortality RR = 1.84, 95% CI: 1.11-3.04), cardiovascular mortality RR 2.00 (95% CI: 1.05-3.83), and permanent pacemaker implantation RR = 1.67 (95% CI: 1.22-2.28) at 30 days. However, these outcomes were not statistically significant for 1 year. Other assessed outcomes, like stroke, acute kidney injury, and myocardial infarction, also did not have statistically significant results.

Conclusion: BEV had improved mortality outcomes compared to SEV in the short term. However, future clinical trials with larger sample sizes are needed for a comprehensive understanding.

Keywords: transcatheter aortic valve replacement; self-expanding valve; balloon expandable valve; aortic stenosis; meta-analysis

Impact of Bariatric Surgery on Cardiovascular Outcomes in Obese Patients: A Systematic Review and Meta-Analysis

Tue, 25 Nov 2025 00:00:00 +0000

Background: Obesity is a major risk factor for cardiovascular diseases (CVDs), which remain the leading cause of global morbidity and mortality. Bariatric surgery offers sustained weight loss and potential cardiovascular benefits beyond conventional treatments.

Objective: To evaluate the effect of bariatric surgery on cardiovascular outcomes in obese patients through a systematic review and meta-analysis.

Methods: A systematic literature search was conducted across PubMed and Google Scholar for studies published up to July 2025. Screening was performed using Rayyan software, and eligible randomized controlled trials and cohort studies comparing cardiovascular outcomes in bariatric surgery versus non-surgical obese patients were included. Data from 14 studies encompassing over 759,000 participants were extracted and analyzed. Meta-analyses were performed using RevMan software with random-effects models to calculate pooled risk ratios and assess heterogeneity.

Results: Bariatric surgery significantly reduced risks of ischemic heart disease (RR=0.58), heart failure (RR=0.62), MACCE (RR=0.66), revascularization (RR=0.44), cerebrovascular events (RR=0.73), and all-cause mortality (RR=0.36). Non-significant trends were seen for myocardial infarction and cardiac death.

Conclusions: Bariatric surgery significantly lowers several major cardiovascular risks and mortality in obese patients, supporting its role in cardiovascular risk management.

Keywords: Bariatric Surgery; Cardiovascular Diseases; Obesity; Meta-Analysis; Treatment Outcome

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. — Tue, 14 Oct 2025 00:00:00 +0000

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.

The Effect of Quetiapine versus Haloperidol on Delirium Severity in Hospitalized adults; A Systematic Review and Meta Analysis

Shiza Zainab, Nawal Zahra — Tue, 25 Nov 2025 00:00:00 +0000

Background: Delirium is a neuropsychiatric disorder associated with many adverse outcomes. Although both quetiapine and haloperidol have been individually studied for delirium management, there is a lack of direct comparison between the two. We addressed this gap in our analysis.

Objectives: To compare the effects of quetiapine and haloperidol on delirium severity, response rates, mortality, hospital and ICU length of stay (LOS), and adverse events in hospitalized adults.

Methods: In accordance with PRISMA guidelines, we conducted a systematic search of PubMed, Cochrane, Embase, and Google Scholar. Three RCTs with 215 patients met the inclusion criteria after review of 60 relevant articles. Delirium severity was compared as the primary outcome, and mortality, adverse events, and length of stay as secondary outcomes. Data analysis was conducted using the Random-effects model in Review Manager (RevMan 5.4.1). This review is registered with PROSPERO (CRD420251040521).

Results: There were no statistically significant differences in mortality (Risk Ratio: 0.60, 95% CI: [0.29, 1.27], P = 0.18), sleep time (Mean Difference: 1.59, 95% CI: [-0.45, 3.63], P = 0.13) and response rate (Risk Ratio: 0.89, 95% CI: [0.51, 1.56], P = 0.69) between the two groups due to high heterogeneity. Furthermore, for delirium severity (Mean Difference: -0.80, 95% CI: [-2.05, 0.44], P = 0.21) and cognitive function (Standardized Mean Difference: -0.09, 95% CI: [-0.45, 0.28], P = 0.65), the heterogeneity was low, but the results remained statistically insignificant.

Conclusion: While both quetiapine and haloperidol offer distinct benefits, there is a need for additional, comprehensive and high-quality RCTs to determine optimal pharmacological interventions for delirium management.

Conflict of Interest and Funding: We declare no conflict of interest. No funding was received.

Keywords: Quetiapine, Haloperidol, Delirium

Efficacy of Dihydroartemisinin-piperaquine compared to Artesunate-Mefloquine in treating uncomplicated falciparum malaria in adults and children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nabahat Shafi, Maryam Abdul Rab, Syed Ibad Ali, Muhaddisa Batool. — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Malaria is a vector-borne disease. Artemisinin-based combination therapies (ACTs) are used in the treatment of malaria. Among ACTs, DHAP and AM are two widely used regimens. Currently, no credible literature has been presented in the past five years that compares them.

Objective: To evaluate the efficacy of Dihydroartemisinin-piperaquine (DHAP) compared to Artesunate-Mefloquine (AM) in treating uncomplicated falciparum malaria in adults and children.

Materials and Methods: Our study evaluates the efficacy of DHAP versus AM for treating uncomplicated falciparum malaria in children and adults. Only randomized controlled trials (RCTs) were included. A comprehensive search of PubMed, Cochrane Central, and ClinicalTrials.gov was conducted, and data were screened using Rayyan. Primary outcome (efficacy); secondary outcomes (dizziness, abdominal discomfort, sleep disturbances) were included. Risk of bias was assessed via the Cochrane tool (low risk). Data were analyzed using Review Manager with a random effects model.

Results: Out of 196 RCTs, 5 were included. No statistically significant difference in efficacy regarding symptom improvement was found between DHAP and AM [RR 1.00 (95% CI: 0.98-1.01, p=0.67)]. Adverse effects varied, with dizziness [RR 0.25 (95% CI: 0.17-0.38, p=<0.00001) and sleep disturbances [RR 0.53 (95% CI: 0.28-1.01, p=0.05] more common in the AM group, while abdominal discomfort [RR 0.84 (95% CI: 0.56-1.25, p=0.78)] was similar. Studies showed a low risk of bias.

Conclusion: DHAP is as effective as AM. Study limitations include only 5 RCTs and some level of heterogeneity. Future studies with larger patient populations are necessary.

Keywords: Dihydroartemisinin-piperaquine, Artesunate-Mefloquine, Malaria treatment, Efficacy, Adults and children.

Unveiling Fahr’s Syndrome in a Young Female: A Case of Seizures and Metabolic Imbalance That Challenges Established Diagnostic Criteria

Syed Hammad Ali — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Fahr’s syndrome is a rare neurological disorder characterized by idiopathic basal ganglia calcification, often associated with metabolic disturbances like hypoparathyroidism. This report presents the case of a 14-year-old female who exhibited a combination of neurological symptoms and metabolic abnormalities.

Methods: A 14-year-old female presented with fever, productive cough, and subsequent generalized tonic-clonic seizures. Initial empirical treatment included sodium valproate, ceftriaxone, vancomycin, and dexamethasone. Investigations included cerebrospinal fluid (CSF) analysis, CT brain scan, EEG, and serum electrolyte measurements.

Results: The patient’s CT scan revealed extensive bilateral symmetrical calcifications in the basal ganglia, periventricular deep white matter, and cerebellar hemispheres, indicative of Fahr’s syndrome. Laboratory tests confirmed hypoparathyroidism, with hypocalcemia, hypomagnesemia, and hyperphosphatemia. The treatment regimen was adjusted to include intravenous calcium gluconate, vitamin D, and magnesium sulphate. Upon discharge, the patient was asymptomatic, and a follow-up two weeks later showed improved serum calcium levels and no recurrence of symptoms.

Conclusion: This case underscores the necessity of considering Fahr’s syndrome in the differential diagnoses of seizures with metabolic disturbances. Timely diagnosis and appropriate management of the underlying metabolic abnormalities can result in significant clinical improvement and prevent recurrence of symptoms. It also nullifies previous diagnostic criteria, raising new gaps to be explored.

Triple A (Allgrove) Syndrome in a 5-Year-Old Male: A Novel Paediatric Case of Diagnostic Delay

Saba Noor, Mahad Younas — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Triple A syndrome (Allgrove syndrome) is an extremely rare inherited disease that affects multiple body systems. It is defined by three main features: absence of tears (alacrimia), adrenal gland failure that does not respond to ACTH, and difficulty in swallowing due to a tight lower esophagus (achalasia cardia). First reported in 1978, the condition affects about 1 in every 1,000,000 people and shows a wide range of symptoms. Due to its uncommon nature and the involvement of various organs, making an early diagnosis is often difficult, especially in areas with limited healthcare resources.

Objective: To present a diagnostically complex pediatric case of triple A syndrome and emphasize the significance of earlier identification and a collaborative approach in treating this serious condition.

Materials and Methods: A comprehensive retrospective examination was performed on the clinical progression of a 4.5-year-old boy who arrived at the Pediatric Surgery Department of Khyber Teaching Hospital in Peshawar. We thoroughly assessed the patient's history, examination results, biochemical analysis, imaging studies, esophageal tests (manometry and endoscopy), treatment plan, and follow-up.

Results: The patient showed signs of frequent vomiting, poor growth, difficulty swallowing, and lack of tears. He had been incorrectly diagnosed with tuberculosis before and underwent extended anti-tubercular treatment with no progress. Hormonal assessment showed reduced cortisol and increased ACTH, signaling adrenal insufficiency. Esophageal manometry and EGD verified achalasia, which was managed through Heller's myotomy. The classical triad of alacrimia, achalasia, and adrenal insufficiency resistant to ACTH culminated in the diagnosis of Triple A syndrome. Multidisciplinary management led to significant clinical enhancement.

Conclusion: This case highlights the importance of a strong suspicion for Triple A syndrome in children exhibiting unexplained gastrointestinal, ocular, or endocrine symptoms. Timely diagnosis and treatment avert significant complications and enhance results.

Complete Heart Block Associated with Hepatitis A Infection in a Female Child with Fatal Outcome

Haseena Naseer — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Hepatitis A virus (HAV), a positive-strand RNA virus of the picornaviridae family, primarily spreads through the fecal-oral route, often via contaminated food. While most children are asymptomatic, 80% of exposed adults develop clinical symptoms like fever, jaundice, and abdominal pain. Although HAV does not cause chronic liver damage and typically resolves within 2-6 months, severe cases can lead to complications like fulminant hepatitis, myocarditis, and rare extrahepatic manifestations. Treatment is supportive, and recovery usually results in lifelong immunity.

Case report: An 8-year-old female presented with a high-grade fever, jaundice, vomiting, and abdominal pain. She was admitted to the Pediatric ICU with bradycardia, abnormal lab results indicating acute viral hepatitis A, and suspected viral myocarditis. On the third day of admission (DOA), oxygen saturation dropped further to 77%. The patient was shifted to continuous positive airway pressure and was considered at risk of cardiogenic shock. Despite treatment, including a temporary pacemaker and inotropes, her condition worsened, leading to cardiogenic shock and death on the fourth day of admission.

Conclusion: Acute viral hepatitis caused by the HAV can be complicated by development of complete heart block secondary to viral myocarditis and may necessitate the installation of a TPM and can also lead to death. Specialized pediatric cardiac care is necessary to timely diagnose the condition. Close monitoring of the deteriorating cardiac condition of the child is important to prevent death. It is important to timely consider cardiac complications of symptomatic HAV infections and consider early shifting of patients to Mechanical Circulatory Support.

Keywords: Hepatitis A virus, hepatitis, myocarditis, pacemaker, pediatrics

Diagnostic Challenges and Management of Kikuchi-Fujimoto Disease: A Rare Case Report

Zukhruf fatima — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, and self-limiting condition primarily affecting young Asian females. It is characterized by fever, lymphadenopathy, and systemic symptoms, and is frequently misdiagnosed due to clinical similarity to infectious, autoimmune, or malignant disorders. Although its aetiology remains uncertain, viral and autoimmune triggers have been proposed. Diagnosis relies on histopathological evaluation of lymph node tissue.

Methods: A retrospective analysis was conducted using the patient’s clinical history, laboratory findings, and imaging results. The diagnosis was confirmed through histopathological examination following excisional lymph node biopsy. Written informed consent for publication was obtained from the patient. Ethical approval was not required, as per the institutional policy regarding case reports.

Case Presentation: A 42-year-old male with type 2 diabetes mellitus, residing in Karachi, Pakistan, presented with an 18-month history of recurrent high-grade fever, unintentional weight loss, and a progressively enlarging occipital lymph node. Multiple hospital admissions and empirical antibiotic therapies failed to achieve symptom resolution. On physical examination, the occipital lymph node was firm, mobile, and non-tender. Laboratory workup revealed mild normocytic anemia, leukopenia, and elevated inflammatory markers. Radiological imaging and autoimmune serologies were unremarkable. Excisional biopsy of the lymph node demonstrated necrotizing lymphadenitis with karyorrhectic debris and absence of neutrophilic infiltration, consistent with Kikuchi-Fujimoto disease. Significant clinical improvement was observed following initiation of corticosteroid therapy.

Conclusion: This case underscores the diagnostic challenge posed by KFD, particularly in older male patients presenting with prolonged fever and lymphadenopathy—an atypical demographic. The condition may closely mimic tuberculosis or lymphoma, potentially leading to misdiagnosis and inappropriate management. Histopathological confirmation through excisional biopsy remains essential for diagnosis. Early recognition and corticosteroid therapy can result in favorable clinical outcomes.

Keywords: Kikuchi-Fujimoto disease, necrotizing lymphadenitis, fever of unknown origin, corticosteroid therapy, lymphadenopathy

Multifocal Brown Tumors Imitating Giant Cell Tumor: A Case of Recurrent Bone Fractures and Preventable Amputation

Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Brown tumor is a rare non-neoplastic focal lytic bone lesion occurring due to osteoclast overactivity secondary to hyperparathyroidism. Its incidence in patients with primary hyperparathyroidism is 1.5 to 1.7 %. These tumors mimic true bone neoplasms like giant cell tumors (GCT), posing significant diagnostic challenges. In addition, multiple brown tumors at diverse skeletal sites are significantly rare.

Case presentation: We report the case of a 27-year-old male who presented with a fracture of the right forearm and left tibia after a minor fall. He had a history of recurrent long bone fractures and swellings along with marked weight loss, irritability, polyuria, polydipsia, bone pain, and deformities. Notably, he had undergone an above-knee amputation for a previously diagnosed giant cell tumor of the right lower limb. Physical examination showed hard, non-tender swellings over the left maxillary region and above the left knee joint. Imaging revealed multiple osteolytic lesions, while a neck ultrasound showcased a hypoechoic mass posterior to the left thyroid lobe. Laboratory findings indicated severe hypercalcemia, high levels of PTH, ALP, and hypophosphatemia. Definitive management included IV fluids and bisphosphonates, and later parathyroidectomy was performed, which revealed a parathyroid adenoma on biopsy. The patient is currently on follow-up and has normal calcium and PTH levels with no fractures reported.

Discussion:

This case highlights the importance of considering brown tumors in the differential diagnosis of multifocal osteolytic lesions. Literature review reveals a gap in clinical guidance on when to suspect BT in an apparent GCT, poorly understood differences in their molecular biology, and no standard criterion for distinguishing them on imaging. While hypercalcemia facilitates diagnosis, BT may rarely occur in pseudohypoparathyroidism, where elevated PTH coexists with normal serum calcium levels. Genetic testing, bone densitometry, and hormonal studies may potentially facilitate early detection, prevention, and informed family choices, yet are a challenge in resource-limited settings.

Conclusion: Brown tumors should be ruled out in all cases of giant cell tumors for the avoidance of clinical misdiagnosis and improved patient outcomes. A simple routine biochemical test, including serum calcium and phosphate levels, can be the key to the prevention of harmful or unnecessary surgical interventions.

Metronidazole-Induced Encephalopathy in a Patient with Hypothyroidism and Diarrheal Disease: A Case Report

Zainab Iftikhar — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Metronidazole is a common antimicrobial agent that is active against anaerobic bacteria and protozoa. Although usually well tolerated, it has rare but severe side effects like metronidazole-induced encephalopathy (MIE), with its prolonged use.

Case presentation:

We present the case of a 40-year-old woman with a past history of hypothyroidism and chronic diarrhoea who had a 6-month history of dizziness and a 1-month history of ataxia and numbness. She had been sporadically consuming animal metronidazole for many years. Neurological examination was positive for cerebellar signs, glove-and-stocking hypoesthesia, and brisk reflexes. MRI of the brain revealed T2 hyperintense lesions in the dentate nuclei of the cerebellum. Cervical spine imaging demonstrated mild degenerative changes, and nerve conduction studies showed sensory-motor axonal polyneuropathy. Lab tests were significant for deranged liver function tests. A diagnosis of MIE was established on the basis of clinical presentation, chronic metronidazole use, and ruling out other causes. Treatment was discontinuation of metronidazole, intravenous hydration, and steroids. The patient significantly improved and was discharged with follow-up. At 2-month follow-up, she had no symptoms, and repeated MRI demonstrated radiological improvement.

Conclusion: This case illustrates the need to recognize MIE, particularly in patients exposed to metronidazole chronically. Prompt diagnosis and withdrawal of the causative agent are essential for full recovery.

Keywords: Hypothyroidism, Metronidazole toxicity, Dentate nuclei, T2 hyperintense lesions

Two Tumors, One Diagnosis: A Rare Case of Coexisting Secretory and Non-Secretory Paragangliomas

Rimsha Azhar, Mudasira Ishtiaq, Minahil Salam, Gohar Khan, Saira Bashir — Tue, 25 Nov 2025 00:00:00 +0000

Introduction: Paragangliomas (PGs) are a rare form of neuroendocrine tumors derived from neural crest cells. They are classified as parasympathetic, having symptoms of mass effect, or sympathetic, presenting with symptoms of catecholamine hypersecretion. In the majority of cases, a single benign lesion is encountered. The occurrence of multiple paragangliomas is a rare event discovered in only 1-2% of sporadic cases. Remarkably, in our case, the patient demonstrated coexisting lesions- a sympathetic paraganglioma in the para-aortic region and a parasympathetic in the para-glottic region. Only 70-85 cases of true laryngeal PGs have been reported in the literature, out of which 90% are supraglottic, making the para-glottic location exceedingly rare.

Case presentation: We report the case of a 30-year-old female, initially presented with right submandibular neck swelling and symptoms of dyspnea, hoarseness of voice, snoring, daytime somnolence, sweating, and apprehension. She was diagnosed with a rare non-secretory right para-glottic paraganglioma, which was surgically excised. Months later, recurrent symptoms led to further evaluation, revealing a functionally active para-aortic paraganglioma, confirmed biochemically and histopathologically. 6 weeks post op, the symptoms regressed, and the patient is currently on follow-up.

Discussion: When a paraganglioma is identified, it is crucial to screen for additional tumors. This approach is underscored by several key considerations drawn from the literature. Advanced imaging techniques, including functional imaging with DOTA PET scans, have proven effective in detecting multifocal disease and its management. Approximately 30-40% of paragangliomas and pheochromocytomas are associated with germline mutations. Identifying these mutations can have significant implications not only for the patient but also for family members who may be at risk. In resource-limited settings, the challenges of accessing advanced diagnostic tools and genetic testing are significant. Enhancing the availability of these resources is essential to optimizing patient care. Despite these challenges, the principles of thorough screening and vigilant follow-up remain applicable.

Conclusion: Concurrent paragangliomas at abdominal and para-glottic sites are exceptionally rare. All cases of unexplained sympathetic overactivity should be screened biochemically for paraganglioma. Improved access to genetic counseling and testing is critical for optimal management and risk stratification. Long-term follow-up remains essential, even after symptom resolution.

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

Tue, 14 Oct 2025 00:00:00 +0000

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.

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

Faiz un Nisa, Eman Fatima — Sun, 14 Sep 2025 00:00:00 +0000

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

Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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

Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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 — Sun, 14 Sep 2025 00:00:00 +0000

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

Trends in Hypertensive Renal Disease with Renal Failure-Related Mortality Among Gender Ethnicity and Census Regions in the United States from 1999-2000

Faiza Ikram — Sun, 14 Sep 2025 00:00:00 +0000

Background: Hypertensive renal disease affects roughly 753 million people worldwide each year. In the United States, the age-adjusted mortality rate (AAMR) for hypertension-related end-stage renal disease (ESRD) increased from 9.7 to 43.7 per 100,000 between 1999 and 2020. This study evaluates national mortality trends in hypertensive renal disease over this period, highlighting disparities by gender, race, and urbanization to inform targeted interventions and improve outcomes.

Methods: Mortality data for hypertensive renal disease with renal-failure–related deaths from 1999 to 2020 were extracted from the CDC WONDER database. Age-adjusted mortality rates with 95% confidence intervals (CIs) were calculated to assess national and demographic trends.

Results: Men consistently demonstrated higher AAMRs than women (148.92; 95% CI: 148.37–149.48 vs. 106.11; 95% CI: 105.73–106.49). African American individuals had the highest overall AAMR at 286.29 (95% CI: 284.68–287.90), rising from 186.23 in 1999 (95% CI: 179.34–193.13) to 529.72 in 2020 (annual percent change [APC] 5.27). Metropolitan areas saw AAMRs climb from 197.57 (95% CI: 187.88–207.26) to 1,112.12 (APC 10.00), while non-metropolitan areas increased from 97.35 (95% CI: 90.63–104.08) to 643.06 (APC 11.81). State-level AAMRs ranged from 61.23 (95% CI: 59.29–63.16) in Connecticut to 225.06 (95% CI: 214.96–235.16) in the District of Columbia.

Conclusion: From 1999 to 2020, hypertensive renal disease mortality rose sharply, with the greatest burden among men, African Americans, and residents of non-metropolitan areas. These findings underscore the need for multifaceted public-health strategies emphasizing early detection, equitable access to care, and targeted interventions to reduce mortality.

Keywords: Hypertensive renal disease; Chronic kidney disease; Kidney damage; Mortality trends

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

Farwa Saleem , Eisha Jabbar — Tue, 14 Oct 2025 00:00:00 +0000

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

Tue, 14 Oct 2025 00:00:00 +0000

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 — Tue, 14 Oct 2025 00:00:00 +0000

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 — Tue, 14 Oct 2025 00:00:00 +0000

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.

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

Husna Irfan Thalib — Sun, 14 Sep 2025 00:00:00 +0000

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.

Machine Learning-Based Deconvolution of Immune Infiltrates in Cardiac Fibrosis

Husna Irfan Thalib — Sun, 14 Sep 2025 00:00:00 +0000

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.

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

Pakeezah Tabasum, Wajiha Fatima, FNU Adnan — Sat, 13 Sep 2025 00:00:00 +0000

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.

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

Sat, 13 Sep 2025 00:00:00 +0000

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

Sun, 14 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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 — Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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, Aimen Sarfaraz, Abeera Asad, Amna Zafar, Amna Asghar, Aqsa Mehfooz — Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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.

Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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, Aimen Shahbaz, Syeda Warda Zaidi, Obaid Ur Rehman — Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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, Tooba Shabbir, Hafsa Gul, Maryam Zafar, Anosha Ali, Imrana Saeed — Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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

Sat, 13 Sep 2025 00:00:00 +0000

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.

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

Rabia Mahmood, Umama Khalid, Mishal Ahmad — Sat, 13 Sep 2025 00:00:00 +0000

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)

Digital Health: Opportunity or Overload for Young Doctors

Aayet Zulfiqar — Sat, 13 Sep 2025 00:00:00 +0000