Background: Recurrent respiratory tract infections (RTIs) had remained a major cause of morbidity among children aged 1–5 years, particularly in developing countries. Poor nutritional status had been associated with impaired immune function and increased susceptibility to infections. This study assessed the relationship between nutritional status and recurrent RTIs among young children attending Mayo Hospital, Lahore. Aim: The study aimed to determine the nutritional status of children aged 1–5 years and evaluate its association with recurrent respiratory tract infections. Methods: A hospital-based cross-sectional study had been conducted at Mayo Hospital, Lahore, from September 2025 to February 2026. A total of 90 children aged 1–5 years who had attended the pediatric outpatient department with a history of recurrent RTIs had been enrolled. Demographic and clinical information had been collected through a structured questionnaire. Weight and height had been measured, and nutritional status had been assessed using age- and sex-specific WHO growth standards. Recurrent RTIs had been determined from the clinical history and medical records. Data had been analyzed using SPSS version 26.0. The association between nutritional status and recurrent RTIs had been assessed using the chi-square test, with p<0.05 considered statistically significant. Results: Among the 90 children, 52 (57.8%) had been male and 38 (42.2%) had been female. The mean age had been 3.1 ± 1.2 years. Overall, 35 (38.9%) children had been classified as having normal nutritional status, while 31 (34.4%) had been underweight, 17 (18.9%) had been moderately/severely stunted, and 7 (7.8%) had been wasted. Recurrent RTIs had been reported more frequently among undernourished children than among children with normal nutritional status. Children with underweight or stunting had demonstrated a higher frequency of recurrent infections (72.9%) compared with nutritionally normal children (40.0%). A statistically significant association had been observed between poor nutritional status and recurrent RTIs (χ²=10.84, p=0.013). Conclusion: The study had demonstrated that poor nutritional status had been significantly associated with recurrent respiratory tract infections among children aged 1–5 years. Early identification of undernutrition, nutritional counseling, appropriate dietary interventions, and timely management of infections had been important for reducing recurrent respiratory morbidity in young children.

Background: Mineral Trioxide Aggregate (MTA) is a bioactive and biocompatible material with antibacterial properties and excellent sealing ability, promoting pulp cell proliferation and reparative dentin formation. Despite its advantages, MTA has certain drawbacks, including a long setting time, poor handling properties, and high cost. However, it remains a reliable material for direct pulp capping in carious exposures, particularly when used in a two-visit treatment protocol. Objective: This study aims to compare the effectiveness of Mineral Trioxide Aggregate (MTA) and Biodentine in direct pulp capping among patients. Methodology: A total of 80 subjects were randomly assigned to two groups: Group I (n = 40) received direct pulp capping with MTA, while Group II (n = 40) received Biodentine. Patients aged 18–40 years, of both genders, with deep carious lesions, symptoms of reversible pulpitis, and vital teeth without periapical radiolucency were included. Treatment effectiveness was assessed based on subjective pain evaluation using the Visual Analog Scale (VAS) and pulp vitality testing via the Electric Pulp Test (EPT) at a three-week follow-up. Successful treatment was defined as the absence of subjective pain and the presence of pulp vitality. The chi-square test was applied to compare outcome variables between the two groups. Results: The mean age of participants was 24.69 ± 4.95 years (range: 18–40 years). Of the total, 36 (45.0%) were females and 44 (55.0%) were males. Moderate pain was reported in 5 patients (12.5%) in the MTA group and in 2 patients (5%) in the Biodentine group; however, this difference was not statistically significant (p = 0.49). Similarly, no statistically significant difference was observed between the two groups in terms of treatment efficacy (p = 0.51) or pulp vitality (p = 0.709). Conclusion: The findings suggest that Biodentine and MTA demonstrate comparable effectiveness in terms of pain reduction, pulp vitality, and overall treatment success in direct pulp capping. Additionally, no significant association was found between treatment outcomes and variables such as age, gender, cold-drink consumption, or cold-drink consumption status.

Background: Metabolic disturbances and chronic low-grade inflammation are linked to type 2 diabetes mellitus (T2DM). This study compared inflammation and metabolic markers in people with controlled T2DM and patients with uncontrolled T2DM. Methods: The study design was an analytical cross-sectional study and was conducted at Bacha Khan Medical Complex, Swabi, from 1st October 2025 to 31st March 2026. Consecutive sampling was used to recruit 100 adults with T2DM who were divided equally into controlled (HbA1c <7%) and uncontrolled (HbA1c ≥7%) groups. Demographic, clinical, glycemic, metabolic, and inflammatory parameters were measured. The data were analyzed with SPSS version 26. Results: The BMI and diabetes duration were significantly higher in uncontrolled patients. hs-CRP, IL-6, TNF-α, NLR, and MLR were also significantly increased in uncontrolled diabetes (p<0.05). HbA1c was found to be positively correlated with HOMA-IR, triglycerides, hs-CRP, IL-6, TNF-α, NLR, and MLR. Diabetes duration, dyslipidemia, HOMA-IR, hs-CRP, IL-6, TNF-α, NLR, and triglycerides were multivariable independent factors associated with uncontrolled diabetes. Conclusions: Association of combined inflammatory and metabolic derangement with uncontrolled T2DM. These biomarkers could be used for additional screening of patients with higher metabolic and inflammatory burden in addition to HbA1c.

Background: Ovarian cysts are among the most common gynecological findings and represent a broad spectrum of conditions ranging from benign functional cysts requiring no intervention to complex adnexal masses requiring surgical management. The major clinical challenge is distinguishing cysts that can be safely observed from those requiring operative treatment. Appropriate decision-making requires consideration of symptoms, ultrasound characteristics, patient age, reproductive goals, and malignancy risk. Objective: To evaluate the clinical presentation, diagnostic characteristics, management strategies, and outcomes of women with ovarian cysts, with particular emphasis on determining factors influencing conservative observation versus surgical intervention. Methods: A prospective observational study was conducted at Ayub Teaching Hospital, Abbottabad, over a six-month period from January to June 2026. A total of 80 women diagnosed with ovarian cysts through clinical evaluation and pelvic ultrasonography were included. Demographic characteristics, presenting symptoms, ultrasound findings, cyst morphology, management approach, and clinical outcomes were recorded. Patients were managed either conservatively through observation and follow-up or surgically through laparoscopic cystectomy, oophorectomy, or open procedures according to clinical indications. Data were analyzed using SPSS version 27.0. Results: The mean age of participants was 34.8 ± 10.6 years, with the majority being premenopausal women. Pelvic or abdominal pain was the most common presenting symptom (57.5%), followed by menstrual irregularities (30.0%). Simple cysts were identified in 47.5% of patients, complex cysts in 31.3%, dermoid cysts in 12.5%, and endometriomas in 8.8%. Conservative observation was selected in 35 (43.8%) patients, while 45 (56.3%) underwent surgical management. Laparoscopic cystectomy was the most frequent surgical procedure (33.8%). Overall symptomatic improvement was achieved in 69 (86.3%) patients, with cyst resolution or reduction observed in 52 (65.0%) cases. Conclusion: Management of ovarian cysts requires individualized decision-making based on clinical presentation, ultrasound characteristics, patient age, and risk assessment. Many benign-appearing cysts can be safely managed through observation, while surgery should be reserved for symptomatic, persistent, enlarging, or suspicious lesions. A balanced approach integrating conservative monitoring and timely intervention can minimize unnecessary surgery while ensuring appropriate treatment for patients requiring operative management.

Background: Acceptance of fixed orthodontic treatment is influenced by aesthetic, psychological, socioeconomic, and treatment-related factors.  Objective: To assess factors influencing acceptance of fixed orthodontic treatment among young adults. Methods: This is an online cross-sectional survey conducted at the Department of Orthodontics, Fatima Jinnah Dental College, from 1^st May, 2026 to 31^st May, 2026. A total of 135 young adults aged 18–30 years were included. Data were collected using a structured electronic self-administered questionnaire through Google Forms. Chi-square and fisher's exact tests were used to evaluate the associations, and binary logistic regression was used to determine independent predictors of acceptance. Results: The mean age was 23.8±3.2 years, and 57.8% were female. A total of 83 (61.5%) patients agreed to undergo fixed orthodontic treatment. Perceived malocclusion, dissatisfaction with dental appearance, perceived treatment need, previous orthodontic consultation, socioeconomic status, and treatment awareness were found to be significantly associated with acceptance. Fear of pain and concern about brace appearance were significantly associated with non-acceptance. Perceived treatment need was the most positive predictor in regression analysis (p<0.001), while fear of pain (p=0.023) and brace appearance concerns (p=0.015) were associated with lower acceptance. Conclusion: Treatment acceptance was influenced by perceived need, awareness, affordability, aesthetic expectations, and treatment-related concerns. Acceptance may be enhanced through targeted counselling and affordable treatment options.

Background: Acute coronary syndrome is a major cause of mortality & morbidity word wide. Increased mortality is observed among patients admitted to coronary care unit; with ST segment elevation myocardial infarction (STEMI) & high risk non-ST segment elevation myocardial infarction (NSTEMI). Objective: To determine the frequency of early complications among patients with non-ST segment elevation myocardial infarction and their association with in-hospital mortality. Methodology: This cross-sectional study was conducted in department of Cardiology, Ayub Teaching Hospital, Abbottabad, Pakistan, from 3^rd March to 3^rd September 2026. A total of 315 patients aged 18 to 75 years with confirmed non-ST segment elevation myocardial infarction were included. Patients were observed during the first 24 to 48 hours after admission to the coronary care unit for development of cardiogenic shock, acute left ventricular failure and arrhythmias. Mortality before hospital discharge was recorded as the treatment outcome. Data were analysed using Statistical Package for the Social Sciences version 25. Chi-square test and Fisher exact test were applied to assess the association between early complications and mortality. Results: The mean age was 56.50 ± 9.59 years and the mean body mass index was 26.59 ± 3.66 kg/m². Males were 231 (73.3%) and females were 84 (26.7%). Hypertension was present in 195 (61.9%) patients and diabetes mellitus in 142 (45.1%). Cardiogenic shock developed in 32 (10.2%) patients, acute left ventricular failure in 42 (13.3%) and arrhythmias in 46 (14.6%). Overall mortality was 25 (7.9%). Acute left ventricular failure (p=0.025) and arrhythmias (p=0.048) showed significant association with mortality while cardiogenic shock did not (p=0.156). Conclusion: Early complications were common in patients with non-ST segment elevation myocardial infarction.

Background: Feeding intolerance (FI) is a frequently encountered problem during human milk fortifier (HMF) administration in preterm neonates, and frequently interrupts fortification and causes suboptimal delivery of nutrients. There is some evidence of standardized methods for introducing HMF after FI is established. Objective: To assess clinical outcomes such as time to full enteral feeds, growth velocity, hospital stay and sepsis and necrotizing enterocolitis (NEC) after HMF-associated feeding intolerance and after standardized reintroduction of HMF in preterm neonates. Methods: This is a prospective cohort study carried out in the Department of Neonatology at The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS) Islamabad from May 2025 to July 2026. In all, 101 preterm neonates (gestational age ≤34 w) with HMF-associated FI were enrolled. HMF was reintroduced in all neonates following a protocolized, stepwise approach after the end of FI. Primary outcomes were time to full enteral feeds (150mL/kg/day) and growth velocity. Secondary outcomes were length of hospital stay, NEC (Bell stage ≥II), culture-proven sepsis and mortality. Results: There were 101 neonates with a mean gestation age of 30.2 ± 2.4 weeks and a mean birth weight of 1,247 ± 312 g. After the standard HMF reintroduction, 89 neonates (88.1%) were able to tolerate the full fortification. The mean time to reach full enteral feeds was 14.3 ± 4.1 days after reintroduction. The mean weight gain velocity was 18.6 ± 5.2 g/kg/day. The rate of NEC was 5.9% (n=6) and culture-proven sepsis was 12.9% (n=13). The median length of hospital stay was 42 days (IQR: 35-52). The overall mortality was 3.0% (n=3). There were no adverse events observed associated with reintroduction that resulted in permanent termination of HMF. Conclusion: It is possible to re-introduce HMF standardized after HMF-associated feeding intolerance; it is safe and has acceptable feeding outcomes in preterm neonates. This protocol may help to meet nutrition goals and reduce the risk of serious adverse events.

Background: Early and accurate diagnosis of acute ischemic stroke (AIS) on MRI is critical to effective management. Artificial Intelligence (AI) could help detect ischemic abnormalities and support routine radiological interpretation. Objective: To compare the diagnostic accuracy of AI-assisted MRI with conventional radiological assessment in detecting AIS. Methods: A comparative diagnostic accuracy study was conducted at Mayo Hospital, Lahore, over a period of six months, from 1^st January 2026 to 30^th June 2026. It was performed on 168 subjects who were suspected of having AIS. Diagnostic performance was examined with the use of an AI-assisted approach and conventional radiological interpretation, with the final reference diagnosis serving as the reference standard. Sensitivities, specificities, predictive values, likelihood ratios, accuracy, and area under the receiver operating characteristic curve (AUROC) were computed. Comparative analysis was performed using McNemar's test and DeLong's test. Results: AIS was confirmed in 42 (25.0%) participants. The sensitivity, specificity, PPV, NPV, and DA rates of AI-assisted MRI were 92.9%, 93.7%, 83.0%, 97.5%, and 93.5%, respectively. Its sensitivity was 78.6%, specificity was 88.9%, positive predictive value was 70.2%, negative predictive value was 92.6% and accuracy was 86.3%, as assessed by conventional assessment. The difference between paired diagnostic classifications was significant (McNemar's p=0.013). The AUROC for AI-assisted MRI was 0.933 vs. 0.851 for conventional assessment (DeLong p=0.009). Conclusion: AI-assisted MRI demonstrated high diagnostic performance and superior discrimination compared with conventional radiological assessment for detecting AIS.

Objective: To identify demographic and clinical predictors of in-hospital mortality among adult patients admitted with acute thermal burns. Methods: This retrospective cohort study was conducted at the Burn and Plastic Surgery Department of Ayub Teaching Hospital, Abbottabad, Pakistan. Medical records of 275 consecutive adult patients with acute thermal burns were reviewed for the duration from January 2025 to June 2025. Data on demographic characteristics, burn severity, inhalation injury, comorbidities, treatment variables, and clinical outcomes were collected. Continuous variables were compared using the independent-samples t test, while categorical variables were analyzed using the Chi-square or Fisher's exact test. A two-sided p value <0.05 was considered statistically significant. Results: Among 275 patients, the mean age was 48.2 ± 19.7 years, and 165 (60.0%) were male. The mean total body surface area (TBSA) burned was 31.3 ± 21.0%, and 110 (40.0%) patients had inhalation injury. Overall, 110 (40.0%) patients died during hospitalization. Non-survivors were significantly older (68.8 ± 7.3 vs. 34.5 ± 10.4 years; p<0.001) and had significantly greater TBSA involvement (54.0 ± 11.8% vs. 16.2 ± 7.0%; p<0.001) than survivors. Mortality was significantly associated with full-thickness burns, inhalation injury, flame burns, diabetes mellitus, hypertension, mechanical ventilation, ICU admission, and surgical intervention (all p<0.05). Mortality also increased significantly with advancing age and greater TBSA involvement. Conclusion: Advanced age, extensive TBSA burns, full-thickness burns, inhalation injury, diabetes mellitus, hypertension, and indicators of critical illness were significant predictors of in-hospital mortality. Early identification of high-risk patients may improve triage, resource allocation, and burn care, particularly in resource-limited settings.

Background: Although preventable, cervical cancer remains the second most common cancer among Indian women, with 127,526 new cases and 79,906 deaths in 2022. On 28 February 2026, the Government of India launched a nationwide campaign offering free human papillomavirus (HPV) vaccine to girls aged 14 years. Objective: To compare knowledge, awareness, acceptability and uptake of HPV vaccination between urban and rural girls aged 14 years. Methods: A school-based comparative cross-sectional study was conducted from October 2025 to June 2026 among 400 girls aged 14 years (200 urban, 200 rural) attending government schools in Dadra and Nagar Haveli, India, selected by multistage random sampling. A pre-tested, structured, self-administered questionnaire was used. Groups were compared using the chi-square or Fisher's exact test; p<0.05 was considered significant. Results: Awareness of cervical cancer was higher among urban than rural girls (85.0% vs 55.0%; odds ratio [OR] 4.64, 95% CI 2.88–7.48; p<0.001), whereas awareness of HPV was low and similar (44.5% vs 45.0%; p=0.92). Urban girls more often considered vaccination important (65.5% vs 55.5%; p=0.041), were willing to be vaccinated (30.5% vs 16.5%; OR 2.22, 95% CI 1.37–3.59; p<0.001) and intended future vaccination (35.5% vs 19.5%; p<0.001). Only 11 girls (2.75%; 95% CI 1.54–4.86) had been vaccinated, with no urban–rural difference (3.5% vs 2.0%; p=0.36). Conclusion: Knowledge of HPV and vaccine uptake among 14-year-old girls were poor, and acceptability was markedly lower in rural settings. School- and community-based education engaging both adolescents and parents is needed to meet national coverage goals.

Aim of review: Chronic obstructive pulmonary disease (COPD) involves airflow limitation, hyperinflation and altered chest-wall mechanics, which contribute to dyspnoea and exercise intolerance. Respiratory proprioceptive neuromuscular facilitation (PNF) has been proposed as an adjunct to pulmonary rehabilitation (PR), but reported benefits are often within-group changes. To critically synthesise evidence on respiratory PNF in adults with COPD, distinguishing within-group change from between-group effects, and to identify clinical implications and research gaps. Method: Critical narrative review. An original literature review (PubMed, Google Scholar) was updated by a targeted literature search on 2 October 2026. Only studies whose details could be verified against the published report or abstract were retained. Findings were synthesised narratively by outcome. No meta-analysis or formal risk-of-bias scoring was undertaken. Recent findings: Six primary studies were synthesised: three parallel randomised trials, one double-blind crossover trial and two single-group pre–post studies (10 to 65 participants). One systematic review provided context. Added to aerobic training, PNF-type stretching was associated with lower dyspnoea than the comparator in two trials, and with better COPD Assessment Test score, inspiratory capacity and six-minute walk distance in one. Forced expiratory volume in one second and forced vital capacity did not differ between groups. Gains in peak expiratory flow, respiratory rate and chest expansion were within-group findings. In the only head-to-head trial, chest mobility exercises produced larger improvements than PNF stretching. Protocols were heterogeneous, interventions lasted one session to twelve weeks, and no study reported follow-up. Summary: Respiratory PNF is feasible and may reduce dyspnoea when added to exercise training, but evidence is limited and does not establish superiority over other chest-wall interventions. It should be regarded as an investigational adjunct to, not a replacement for, pulmonary rehabilitation.

Introduction: The development of restorative materials with antibacterial properties and improved marginal sealing may help reduce bacterial colonization and microleakage associated with restoration failure. Newer restorative materials such as giomer and alkasite, which have ion-releasing properties, may have promising biological characteristics. Objective: To comparatively evaluate the antibacterial activity and microleakage of giomer, alkasite, and conventional resin composite restorative materials. Methods: An in vitro experimental comparative study was conducted at Bilawal Medical College, Liaquat University of Medical & Health Sciences, Jamshoro, from 1st January to 30th June 2026. A total of 60 samples were randomly distributed to the giomer, alkasite, and conventional resin composite groups. The inhibition zone method was used to test the antibacterial activity against Streptococcus mutans. The amount of microleakage was assessed after thermocycling, dye penetration, sectioning, and stereomicroscopic analysis. One-way ANOVA, Kruskal–Wallis, chi-square, and post hoc tests were used. Results: Alkasite had the highest mean zone of inhibition (15.8 ± 2.4 mm), followed by giomer (12.4 ± 2.1 mm) and conventional resin composite (4.7 ± 1.3 mm, p<0.001). The median microleakage scores for alkasite, giomer, and conventional resin composite were 0.5, 1, and 2, respectively (p=0.009). Conclusions: Alkasite showed higher antibacterial activity and lower microleakage than giomer and conventional resin composite under laboratory conditions.

Introduction: Pneumonia and acute pulmonary edema often overlap in the clinical picture of the respiratory system, and quick recognition is difficult. This study aimed to compare the diagnostic performance of lung ultrasound (LUS) and chest X-ray (CXR) in differentiating these conditions. Methods: A comparative diagnostic accuracy study was conducted at Mayo Hospital, King Edward Medical University, Lahore, from 1st January, 2026 to 30th June 2026. A total of 206 adults were included, comprising 103 patients with pneumonia and 103 with acute pulmonary edema. LUS and CXR were performed in all participants in the initial diagnostic evaluation. Findings were compared to a pre-established reference diagnosis based on clinical, lab, imaging, and final clinical evaluation. SPSS 26 was used for data analysis, and p≤0.05 was considered significant. Results: LUS had a sensitivity of 93.2%, a specificity of 94.2%, and diagnostic accuracy of 93.7%, whereas CXR had a sensitivity of 78.6%, a specificity of 82.5%, and a diagnostic accuracy of 80.6%. The AUC was significantly higher for LUS than CXR (p<0.001). Paired analysis also demonstrated significantly better classification with LUS (p<0.001). Conclusion: LUS demonstrated superior diagnostic performance compared with CXR for differentiating pneumonia from acute pulmonary edema.

Introduction: Preoperative anxiety may be detrimental to perioperative experiences and to postoperative recovery. Dexmedetomidine may be anxiolytic and/or analgesic in addition to its sedative effects. Objective: To compare the effect of dexmedetomidine versus midazolam premedication on preoperative anxiety and early quality of recovery in patients undergoing general anesthesia.

Methods: A prospective cohort study was conducted at Mayo Hospital, King Edward Medical University, Lahore, from December 2025 to June 2026. A total of 110 adults undergoing elective surgery under general anesthesia were enrolled, with 55 receiving dexmedetomidine and 55 receiving midazolam. The Visual Analog Scale for Anxiety and the Ramsay Sedation Scale were used to assess anxiety and sedation, respectively. Early postoperative recovery was assessed using the QoR-15 at 24 hours. Results: Baseline anxiety scores were similar across the groups. There was an overall reduction in post-premedication anxiety with dexmedetomidine (p=0.004), and a greater reduction from baseline (p=0.002). Dexmedetomidine had higher QoR-15 scores (p=0.003). There was also a reduction in the use of analgesics for pain and rescue analgesics. Dexmedetomidine was associated with a higher rate of bradycardia. Conclusion: Dexmedetomidine was found to be more effective than midazolam in reducing anxiety and facilitating early postoperative recovery.

Background: Mitral valve replacement is an established treatment for advanced mitral valve disease when valve repair is unsuitable. Mechanical and bioprosthetic valves differ in durability, anticoagulation requirements, and risks of bleeding, thromboembolism, and reintervention. Comparative data on early outcomes in Indian patients remain limited. Objectives: To compare the perioperative and early postoperative outcomes of mechanical versus bioprosthetic mitral valve replacement in patients undergoing surgery at a tertiary-care hospital in India. Methods: A prospective comparative observational study was conducted from July 2024 to June 2026. A total of 80 adult patients undergoing mitral valve replacement were included, comprising 40 patients receiving mechanical prostheses and 40 receiving bioprosthetic valves. Demographic, preoperative, operative, postoperative, and early echocardiographic parameters were assessed. Continuous variables were compared using the independent-samples t test or Mann–Whitney U test, as appropriate, while categorical variables were analyzed using the Pearson chi-square or Fisher's exact test. A two-sided p<0.05 was considered statistically significant. Results: Patients receiving mechanical valves were significantly younger than those receiving bioprosthetic valves (47.9 ± 6.7 vs 56.1 ± 6.8 years; p<0.001). Sex distribution, rheumatic etiology, preoperative left ventricular ejection fraction, and pulmonary artery pressure were comparable between groups. Cardiopulmonary bypass and aortic cross-clamp times were similar. ICU stay was significantly shorter in the mechanical-valve group (3.2 ± 0.9 vs 4.0 ± 0.8 days; p=0.007), whereas duration of mechanical ventilation and total hospital stay were comparable. Postoperative bleeding, atrial fibrillation, acute kidney injury, infection, thromboembolism, re-exploration, and in-hospital mortality were uncommon and did not differ significantly between groups. Early postoperative left ventricular ejection fraction was also comparable. Conclusion: Mechanical and bioprosthetic mitral valve replacement were associated with broadly comparable early perioperative and postoperative outcomes. The mechanical-valve group was younger and experienced a shorter ICU stay, while operative parameters, postoperative complications, hospital stay, and early ventricular function were similar. Prosthesis selection should be individualized according to patient age, anticipated longevity, valve durability, bleeding and thromboembolic risk, feasibility of long-term anticoagulation, and patient preference. Larger studies with long-term follow-up are required to determine differences in prosthetic durability, reoperation, major complications, and survival.

INTRODUCTION: Surgical menopause causes an abrupt and total loss of ovarian steroid production to severe genitourinary syndrome (GSM). Aim of the study was to evaluate the efficacy of vaginal estrogen on genitourinary symptom in surgical menopause women with a history of uterine, cervical, or ovarian pathologies by using the MRS tool. METHODS: In this prospective study, 75 women from aged 20-65 years who had undergone surgical menopause at least 3 months and reported symptoms of GSM were enrolled for this study. Participants received low-dose vaginal estrogen in the form of estriol 1mg inserted intravaginally twice-weekly for 12 weeks. Baseline and post three months therapy, assessments of genitourinary symptoms was recorded through MRS score. The 11 components of this scale include hot flushes, heart discomfort, sleep problems, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, dryness of vagina and joint and muscular discomfort. Association between MRS symptom and underlying gynaecological pathology were evaluated. Change in MRS scores and severity categories were assessed statistically<0.05 considered significant value. RESULTS: The participants’ mean age was 42.65±7.61 years. Clinically, the most common GSM symptom was vaginal dryness (61.3%), vaginal irritation (57.3%) followed by dyspareunia and vaginal burning (41.3% respectively). There was no statistical significant correlation found between the underlying gynecological pathology and any of the particular clinical GSM or MRS symptoms. The somatic (2.87± 1.77 to 1.61±1.40), psychological (2.23 ± 1.131 to 1.56 ± 1.18), and urogenital (4.45 ± 1.65 to 1.65± 1.18) domain score significantly decreased after three month of vaginal estrol therapy (p<0.001). Overall MRS score dropped from 9.55±3.61 to 4.81 ± 3.24 (p<0.001). Additionally, there was a significant improvement in MRS severity (Z=6.991, p<0.001). CONCLUSIONS: Vaginal estriol therapy was associated with significant improvement in overall symptom burden, particularly urogenital symptoms in women with surgical menopause. Vaginal estrogen therapy is safe and effective for GSM Treatment response was comparable across different clinical groupings and there were no significant side effects. Thus, vaginal estrogen serves as the first line treatment for moderate to severe GSM in surgical menopausal women.

Introduction: Palpable breast lumps require accurate characterization to distinguish benign from malignant lesions. Breast ultrasonography is widely used for lesion assessment, while histopathology remains the definitive diagnostic reference. Objective: To determine the correlation between breast ultrasonography findings and histopathological diagnoses among patients presenting with palpable breast lumps. Materials and Methods: This cross-sectional study was done at Bacha khan medical complex swabi from October 2024 to March 2025 included 60 patients with palpable breast lumps who underwent breast ultrasonography followed by histopathological examination. Demographic characteristics, lump size, ultrasound morphology, BI-RADS category, axillary lymph-node status, and histopathological diagnosis were recorded. The association between ultrasound findings and benign/malignant histopathology was assessed using chi-square tests. Diagnostic performance of BI-RADS ≥4 for malignancy was evaluated using histopathology as the reference standard. Agreement was assessed using Cohen's kappa. Results: The mean age was 44.15 ± 10.55 years, and all participants were female. Histopathology demonstrated 30 (50.0%) benign and 30 (50.0%) malignant lesions. Fibroadenoma was the most frequent benign diagnosis (25, 41.7%), while invasive ductal carcinoma was the most frequent malignant diagnosis (22, 36.7%). Malignant lesions were larger than benign lesions (2.73 ± 0.36 vs. 1.60 ± 0.36 cm, p<0.001) and occurred in older patients (53.23 ± 5.33 vs. 35.07 ± 5.24 years, p<0.001). BI-RADS categories 2–3 were associated with benign histopathology, whereas categories 4–5 were associated with malignancy (p<0.001). Using BI-RADS ≥4 as the threshold, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were all 100%, with perfect agreement with histopathology (κ=1.00). Conclusion: In this dataset, breast ultrasonography, particularly BI-RADS categorization and suspicious sonographic morphology, showed complete agreement with histopathological diagnosis. These findings support the important role of ultrasound in the assessment and risk stratification of palpable breast lumps.

Background: The endotracheal intubation can cause substantial sympathetic cardiovascular stimulation, which may be reduced by the use of video laryngoscopy rather than direct laryngoscopy. Objective: To compare the mean heart rate and mean arterial pressure between conventional and video laryngoscopy after intubations. Methodology: The study was a randomized controlled trial carried out in the Department of Anesthesiology at Lahore General Hospital, Lahore from 2^nd May 2020 to 1^st November 2020. A total of sixty patients between 18 and 40 years of age with an elective surgery, who were to undergo general anaesthetic with endotracheal intubation, were recruited and randomly divided into two groups of thirty. Group A was given conventional direct laryngoscopy and Group B was given video laryngoscopy. One minute after successful intubation, HR and MAP were measured and compared between groups. Results: The study included 60 patients, with 30 (50.0%) in each group. Mean post-intubation heart rate was 91.30 ± 4.64 beats/min in the video laryngoscopy group and 102.53 ± 3.73 beats/min in the direct laryngoscopy group (p<0.001). Mean post-intubation MAP was 101.73 ± 3.07 mmHg and 113.57 ± 4.88 mmHg, respectively (p<0.001). The video laryngoscopy group demonstrated significantly lower heart rate and MAP across the evaluated subgroups. Conclusion: Video laryngoscopy has a more favourable initial haemodynamic response compared to conventional direct laryngoscopy when endotracheal intubation is performed.

Background: The Ponseti method remains the standard treatment for congenital talipes equinovarus (clubfoot) worldwide. Although initial anatomical correction rates are consistently high, mid-term relapse remains a challenge and may be influenced by baseline deformity severity and caregiver adherence to bracing. Objective: To prospectively evaluate baseline clinical severity and parent-reported socioeconomic and behavioral factors associated with primary correction, recurrence, and short-term functional outcomes in infants treated using the Ponseti method. Methods:  This prospective cohort study was conducted from January 2021 to December 2024 at a tertiary pediatric orthopedic center. A total of 142 consecutive infants (208 affected feet) with idiopathic clubfoot presenting before 6 months of age were included. Baseline deformity was graded using the Pirani and Dimeglio classification systems. Household socioeconomic status, caregiver health literacy, treatment burden, travel distance, and daily brace adherence were assessed using a structured 14-item caregiver questionnaire and adherence logs. Functional outcomes at 24 months after correction were assessed using the Clubfoot Disease-Specific Index (CDSI), together with clinical documentation of recurrence. Multivariable logistic regression was used to identify independent predictors of recurrence. Results: A mean of 5.7 ± 1.6 casts was required, and primary anatomical correction was achieved in 134 infants (94.4%). Percutaneous Achilles tenotomy was performed in 180 of 208 affected feet (86.5%). During 24 months of follow-up, 26 patients (18.3%) developed clinical recurrence. Multivariable analysis identified foot abduction orthosis non-compliance (adjusted odds ratio [aOR] = 7.42; 95% CI: 3.12–17.65; p < 0.001), baseline Dimeglio Grade IV severity (aOR = 2.84; 95% CI: 1.18–6.85; p = 0.020), and travel distance > 50 km from the treatment facility (aOR = 2.31; 95% CI: 1.05–5.09; p = 0.038) as independent predictors of recurrence. Conclusion: Successful treatment with the Ponseti method depends not only on baseline structural severity but also on sustained caregiver adherence during the maintenance phase. Early identification of family-level barriers, structured brace education, prompt management of brace-related problems, and accessible follow-up may help reduce recurrence.

Introduction: Prostate cancer is still a significant health problem in older men, and the issue of prostate cancer screening using the PSA is still subject of debate owing to false positive, overdiagnosis, overbiopsy and overtreatment. Increased use of multiparametric MRI (mpMRI), targeted biopsy and active surveillance are increasingly playing a role in prostate cancer risk-adapted management.

Objective: To compare the use of PSA assessment, mpMRI, prostate biopsy and active surveillance for prostate cancer surgeries at Ayub Teaching Hospital, Abbottabad in 2025. Materials and Methods: This was an observational study carried out in Department of Urology, Ayub Teaching Hospital Abbottabad in the year 2025. Eighty men with suspected prostate cancer were assessed in this study using clinical evaluation, PSA testing, DRE and mpMRI. MRI staging was divided into the categories of PI-RADS version 2.1. Patients who had suspicious findings were biopsied with targeted biopsy and/or systematic biopsy. Histopathological diagnosis was made based on ISUP Grade Groups. Patients with low-risk and selected favorable intermediate-risk disease were evaluated for active surveillance, based on PSA, PSA density, MRI, tumor grade, tumor burden, and clinical characteristics.  Results: The mean age of the participants was 66.4 ± 8.1 years. 54 (67.5%) patients had a prostate biopsy which was positive for prostate adenocarcinoma in 29 (36.3%). Prostate cancer was detected in 26.3% (21) of the patients, and was clinically significant (Grade Group ≥2). The higher the score (higher the PI-RADS category) the greater the cancer detection rate, with 7.7% of the patients having PI-RADS 1–2 findings, 52.6% with PI-RADS 4 and 66.7% with PI-RADS 5 lesions. The nine (31.0%) patients who had a diagnosis of cancer were deemed to be appropriate for active surveillance, while the 20 (69.0%) were deemed to be suitable for definitive treatment.  Conclusion: Although PSA is a valuable tool for initial risk assessment, it cannot be relied on alone for deciding if a biopsy or treatment is needed. PSA-based risk stratification combined with mpMRI and targeted biopsy results in better risk stratification and detection of clinically significant disease. Active surveillance is an option for well-chosen men with a low-risk prostate cancer and can help avoid overtreatment.

Introduction: Telemedicine has increasingly been incorporated into urological practice, particularly for routine follow-up, kidney-stone prevention counseling, and postoperative monitoring. However, prospective evidence regarding its feasibility, patient acceptance, and need for escalation to face-to-face care remains limited. Objective: To evaluate the feasibility, clinical outcomes, patient satisfaction, and safety of telemedicine for urological follow-up, stone-prevention counseling, and selected postoperative care. Methods: A prospective observational study was conducted among 120 adult patients attending the Department of Urology, Ayub Teaching Hospital, Abbottabad. Patients requiring routine urological follow-up, stone-prevention counseling, or postoperative assessment were enrolled consecutively. Telemedicine consultations were conducted through telephone or video platforms. Clinical outcomes, adherence to stone-prevention recommendations, postoperative recovery, requirement for face-to-face assessment, unscheduled hospital visits, and patient satisfaction were recorded and analyzed using appropriate descriptive and inferential statistics. Results: Of 120 patients, 58 (48.3%) required stone-related follow-up, 42 (35.0%) postoperative assessment, and 20 (16.7%) other urological follow-up. Overall, 96 (80.0%) patients were successfully managed remotely, while 21 (17.5%) required face-to-face assessment and 3 (2.5%) had an unscheduled hospital visit. Among stone patients, 45 (77.6%) reported adherence to recommended fluid intake and 41 (70.7%) to dietary recommendations. Overall, 107 (89.2%) patients reported satisfaction with telemedicine, and 109 (90.8%) were willing to use it again. Conclusion: Telemedicine was a feasible and well-accepted adjunct to conventional urological care, particularly for routine follow-up, stone-prevention counseling, and selected postoperative assessments. A structured escalation pathway remains essential for patients requiring direct clinical evaluation.

Background: Dental bleaching can alter surface characteristics of enamel and could interfere with the adhesion of orthodontic brackets and lead to changes in adhesive failure patterns and enamel preservation. There is however, little information available in relation to the pattern of adhesive remnant after various bleaching materials and mechanical debonding procedures. Objective: To compare the adhesive remnant index (ARI) after orthodontic bracket debonding after bleaching at different post-bleaching intervals, using 10% hydrogen peroxide, 10% carbamide peroxide and 2 g sodium perborate. Methods: This was an experimental study in vivo with 240 observations, divided into 2 groups: non-bleached and bleaching. The specimens of enamel were treated with 10% Hydrogen peroxide, 10% Carbamide peroxide and 2 g Sodium perborate and assessed after 24 hours and 7 days. A standard bonding protocol was used for orthodontic brackets and microtensile strength and shear bond strength testing were performed. The ARI scores were evaluated both at the visual level and at a magnification of 40×. SPSS 20 used to analyze the data and p≤0.05 was used to test its significance. Results: At 7 days after shear testing, the differences in ARI were significant between the groups both naked eye (p<0.001) and at 40× (p<0.001). The results indicated that the control group had mostly higher ARI scores while the bleached groups had higher adhesive removal from the enamel surface. No statistically significant difference between groups was observed at 40× magnification or with naked eye viewing for microtensile testing (p=0.829, and p=0.101, respectively). Conclusion: There were changes in the adhesive remnant patterns following shear debonding due to the bleaching agents especially after 7 days. This effect was not seen after microtensile testing, and therefore it is possible that both bleaching protocol and debonding technique can affect the pattern of adhesive failure.

Introduction: Effective intrapartum monitoring is essential for recognizing abnormal labour and determining the need for timely obstetric intervention. Electronic partograms provide a digital alternative to conventional paper partograms and may facilitate structured monitoring and clinical decision-making. Objective: To compare the frequency, type and indications of operative delivery among women in labour monitored using electronic and paper partograms. Materials and Methods: This prospective comparative observational study included 1,500 term women in active labour, with 750 monitored using an electronic partogram and 750 using a modified WHO paper partogram. Operative delivery was categorized as instrumental vaginal delivery or caesarean section, and the indications for each were compared between the groups. Results: Overall operative delivery occurred in 128 (17.07%) women in the electronic-partogram group and 132 (17.60%) in the paper-partogram group. Instrumental vaginal delivery occurred in 94 (12.53%) and 93 (12.40%) women, respectively, while caesarean section occurred in 34 (4.53%) and 39 (5.20%), respectively. Pathological cardiotocography was the most frequent indication for caesarean section, whereas poor maternal bearing-down effort was the predominant indication for instrumental vaginal delivery. The overall pattern of operative intervention was comparable between the groups. Conclusion: Electronic and paper partogram monitoring were associated with comparable rates and patterns of operative delivery. Electronic partograms may provide a practical alternative for structured intrapartum monitoring without increasing the requirement for operative intervention.

Background: The mechanical, wear characteristics and marginal adaptation of CAD/CAM hybrid ceramic materials for posterior restorations can be enhanced by reinforcing them with graphene. Objective: To evaluate the influence of different concentrations of graphene reinforcement on the fracture resistance, wear behavior, and marginal integrity of CAD/CAM hybrid ceramic posterior restorations. Methodology: This was an in-vitro experimental comparative study was carried out in the Department of Dental Materials in 6 months (January-June 2026). 60 standardized posterior restoration specimens were also divided into 4 groups (n=15): Conventional CAD/CAM hybrid ceramic (0% Graphene), Graphene 0.5% hybrid ceramic (by weight of the ceramic), Graphene 1.0% hybrid ceramic (by weight of the ceramic), and Graphene 1.5% hybrid ceramic (by weight of the ceramic). The fracture resistance was determined by a calibrated universal testing machine and expressed in N, the wear behavior was tested by volumetric wear loss (mm³), and the marginal integrity was tested by marginal discrepancy (µm). Data was analyzed by appropriate parametric or non-parametric statistics tests, with significance level ascertained at p<0.05. Results: Mean fracture resistance was 1285.40±126.35 N in the control group, increasing to 1397.73±118.62 N, 1526.87±132.48 N, and 1438.20±121.76 N in the 0.5%, 1.0%, and 1.5% graphene groups, respectively (overall p<0.001). Mean volumetric wear loss decreased from 0.184±0.031 mm³ in the control group to 0.161±0.028, 0.137±0.024, and 0.149±0.026 mm³, respectively (overall p<0.001). Mean marginal discrepancy decreased from 92.47±14.26 µm to 78.93±12.84, 65.80±10.73, and 72.27±11.95 µm, respectively (overall p<0.001). Conclusion: Graphene reinforcement improved the evaluated mechanical, wear, and marginal characteristics of CAD/CAM hybrid ceramic restorations, with the 1.0% concentration demonstrating the most favorable overall performance.

Background: Diabetic ketoacidosis (DKA) is an acute metabolic crisis, and the clinical response to DKA is likely to be heterogeneous and may be mediated by systemic inflammation and metabolic/perfusion stress. Systemic immune-inflammation index (SII) and serum lactate reflect complementary domains of the biology and are easily obtained on presentation. Objective: To assess whether the simultaneous use of SII and lactate enhances the prediction of the clinical adverse outcomes in adults with DKA, compared to the use of SII alone or lactate alone. Methods: A multicenter cohort study was performed in 410 adults with DKA. The primary composite outcome was hospital admission to the intensive care unit (ICU)/high dependency unit (HDU), mechanical ventilation, vasopressor/inotropic support, prolonged DKA resolution, or in-hospital mortality. Comparisons were carried out at baseline, receiver operating characteristic (ROC) analysis, paired AUC comparison, logistic regression, secondary-outcome analyses, Spearman correlations, and a harder-composite sensitivity analysis. Results: The primary composite outcome occurred in 86/410 cases (21.0%). SII and lactate were higher in the adverse-outcome group (4026.5 vs 2353.1 and 3.00 vs 2.18 mmol/L, respectively; both p<0.001). AUCs were 0.733 for SII, 0.747 for lactate, and 0.787 for the combined model. Combined model was a significant predictor over SII (p=0.009) and lactate (p=0.010). In the adjusted model, SII remained associated with the primary outcome (aOR 1.327 per 1000 units, 95% CI 1.147-1.535; p<0.001) and lactate remained independently associated (aOR 2.442 per mmol/L, 95% CI 1.666-3.580; p<0.001). A positive association was observed for both biomarkers with the DKA resolution time and hospital LOS and both biomarkers remained associated with the more stringent adverse-outcome composite.

Results: Admission SII and lactate provided complementary prognostic information, and its combination enhanced the ability to discriminate adverse clinical outcomes in adults with DKA. Validation and calibration for external use is recommended prior to clinical use.

Background: The early diagnosis of interstitial lung disease (ILD) is crucial, but high-resolution computed tomography (HRCT) is a radiation-based technique, and access to it may be limited. This study aimed to compare the diagnostic accuracy of lung ultrasound (LUS) and high-resolution computed tomography (HRCT) in the diagnosis of early ILD. Methods: A comparative cross-sectional diagnostic accuracy study was carried out at Khalifa Gul Nawaz Teaching Hospital, Bannu, among 176 adults suspected of early ILD. LUS was followed by HRCT in all participants. The LUS findings were B-lines and abnormalities of the pleural line, and HRCT was the reference standard. Sensitivity, specificity, predictive values, diagnostic accuracy, likelihood ratios (LR), Cohen's kappa, and the area under the receiver operating characteristic curve (ROC-AUC) were computed. Results: HRCT confirmed diagnosis of early ILD in 69 (39.2%) participants. Lung Ultrasound finding correctly identified Early ILD in 63 of these cases, missed diagnosis in 6 cases, and over diagnose early ILD in 17 cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 91.3%, 84.1%, 78.8%, 93.8%, and 87.0%, respectively. There was good agreement between LUS and HRCT (κ=0.73). The AUC was 0.914 for the B-line score, 0.872 for pleural-line abnormalities, and 0.928 for the combined assessment. Conclusions: LUS is a valuable tool for early diagnosis of ILD with good diagnostic accuracy, and a potential, non-radiating complement to HRCT, especially in the initial assessment and triage of the patient.

Background: Prosthetic rehabilitation can modify the oral microbial ecology and salivary environment of completely edentulous patients. This research aimed to compare the effects of conventional complete dentures and implant-supported overdentures on the salivary pH level, flow rate, and amount of oral microorganisms. Methods: A comparative analytical cross-sectional study was carried out at Lahore Medical and Dental College, Lahore, for six months. In total, 114 completely edentulous patients were included, consisting of 57 complete-denture users and 57 implant-supported overdenture users. The unstimulated whole saliva was collected under standardized conditions. The saliva pH was determined by a calibrated digital pH meter, the salivary flow rate was calculated in mL/min, and the total microbial load of the oral cavity was determined by culture and expressed as CFUs/mL. The data were analyzed using SPSS version 26. Data were analyzed using independent-samples t-test, Mann-Whitney U test, chi-square test, and correlation analysis. A p-value ≤ 0.05 was considered significant.  Results: Implant-supported overdenture users had significantly higher salivary pH than conventional complete-denture users (p<0.001) and greater salivary flow rate (p=0.002). The users of implant-supported overdentures (ISO) had a significantly lower microbial load (p=0.001). Salivary flow rate (SFR) was negatively correlated with microbial load (r=-0.38; p<0.001). Conclusion: Implant-supported overdentures had a more positive salivary profile and reduced oral microbial load compared to conventional complete dentures.

Background: The morphology of the occlusal surface of permanent first molars is a crucial factor contributing to susceptibility in dental caries in adolescents. Objective: To determine the predictive value of occlusal pit and fissure morphology for dental caries in permanent first molars among adolescents. Methodology: The analytical cross-sectional study was conducted among 268 adolescent age group (12–18 years) in Department of Dentistry from April 2025 to March 2026. The sampling was consecutive and the clinically assessable permanent first molars were evaluated for fissure depth, fissure width, fissure configuration and plaque retentiveness. Dental caries was clinically registered and relevant demographic, oral-health, dietary and behavior factors were evaluated. Multivariable logistic regression and receiver operating characteristic analysis were performed to determine associations and predictive performance. Results: Among 268 adolescents, 139 (51.87%) were male and 129 (48.13%) were female. Deep fissures were associated with caries in 35 (55.56%) teeth, compared with 24 (21.43%) with shallow fissures. Caries was present in 35 (58.33%) teeth with narrow fissures, 38 (52.05%) with I-shaped fissures, and 39 (67.24%) with highly plaque-retentive morphology. Deep fissures, narrow fissures, I-shaped configuration, and high plaque retention were significant independent predictors of caries. The combined morphology model demonstrated good predictive performance, with an AUC of 0.83. Conclusion: Occlusal pit and fissure morphology is a clinically useful predictor of dental caries risk in permanent first molars among adolescents and may support targeted preventive dental care.

Introduction: Oral disease is often delayed in diagnosis and treatment in rural communities due to inadequate access to dental services. Mobile dental camps might be a feasible strategy for tackling geographical and health access constraints. Objective: To assess the impact of a mobile Dental Camp on the early detection and treatment of oral diseases in a rural population. Methods: A community-based interventional study was undertaken involving a sample of 216 rural participants. The participants were examined at baseline for dental caries, periodontal disease, and oral mucosal lesions; referred for basic dental treatment; and provided oral health education and preventive measures as needed. A follow-up evaluation was carried out at the end of 4 weeks. Descriptive statistics were used for data analysis, Chi square/Fisher's exact test, independent t-test and McNemar test were used for data analysis. Results: Oral disease was found in 164 (75.9%) participants, of whom 118 54.6%) had dental caries, and 103 (47.7%) had periodontal disease. In 179(82.9%), there was unmet treatment need. At four weeks, untreated oral disease decreased to 25(11.6%), unmet treatment needs to 48 (22.2%), dental pain to 12 (5.6%), and acute infection to 3(1.4%) (p<0.001). The mean periodontal score improved from 2.4 ± 0.9 to 2.0 ± 0.8 (p<0.001). Conclusion: Mobile dental camps were a successful way to enhance early detection and short-term treatment for rural people and could help to lower inequities in oral health care.

Background: Tooth bleaching may adversely affect enamel adhesion and consequently compromise orthodontic bracket bonding. This study evaluated the effects of different bleaching agents and post-bleaching intervals on shear and microtensile bond strengths. Methods: A total of 240 observations were made with extracted teeth in an experimental in-vitro study. Specimens were assigned to a no-bleaching group or to three groups that were to be treated with 10% carbamide peroxide, 2 g sodium perborate, or 10% hydrogen peroxide. Orthodontic brackets were bonded after 24 hours or seven days. Shear bond strength and microtensile bond strength were measured using a Universal Testing Machine (UTM) and reported in MPa. The data were analyzed using SPSS and ANOVA, and the LSD post-hoc test was used where needed. For statistical significance, a p-value of ≤0.05 was used. Results: Mean SBS increased from 5.32 ± 1.09 to 6.08 ± 1.62 MPa with carbamide peroxide, from 6.54 ± 1.38 to 10.79 ± 2.90 MPa with sodium perborate, and from 5.56 ± 1.27 to 8.53 ± 2.20 MPa with hydrogen peroxide between 24 hours and seven days. The control SBS was 13.37 ± 1.76 MPa. The 7-day microtensile strength also increased. There were significant differences between groups for both SBS and microtensile strength (p<0.001). Conclusion: A significant reduction in orthodontic bond strength was found after bleaching, especially at 24 hours. The adhesive performance of the seven-day delay bonding was better but still less than that of non-bleached enamel.

Background: Acute respiratory infections (ARIs) are among the most common causes of illness and outpatient healthcare visits worldwide. Although many ARIs are caused by viruses, bacterial pathogens remain important causes of respiratory tract infections and may require appropriate antimicrobial treatment. The prevalence and distribution of bacterial pathogens can vary according to geographical region and healthcare setting. Objective: To determine the prevalence and distribution of respiratory bacterial pathogens among patients with acute respiratory infections attending the outpatient department (OPD) of Ayub Teaching Hospital, Abbottabad. Methods: A hospital-based descriptive cross-sectional study was conducted at the OPD of Ayub Teaching Hospital, Abbottabad, from 15 June 2025 to 15 December 2025. A total of 150 patients presenting with clinical features of acute respiratory infection were included. Respiratory specimens, including sputum and throat swabs, were collected using standard aseptic techniques and processed in the microbiology laboratory. Bacterial pathogens were identified by direct microscopy, culture, colony morphology, Gram staining, and relevant biochemical tests. Frequencies and percentages were calculated to determine the prevalence and distribution of bacterial isolates. Results: Among the 150 patients, 68 (45.3%) specimens showed bacterial growth, whereas 82 (54.7%) showed no significant bacterial growth. Males constituted 87 (58.0%) of the participants and females 63 (42.0%). Among the culture-positive specimens, Staphylococcus aureus was the most frequently isolated pathogen, accounting for 21 (30.9%) isolates, followed by Streptococcus pneumoniae 17 (25.0%), Klebsiella pneumoniae 12 (17.6%), Pseudomonas aeruginosa 10 (14.7%), Haemophilus influenzae 5 (7.4%), and Moraxella catarrhalis 3 (4.4%).  Conclusion: Bacterial pathogens were identified in a substantial proportion of patients with acute respiratory infections attending the OPD of Ayub Teaching Hospital. Both Gram-positive and Gram-negative organisms were isolated, with S. aureus and S. pneumoniae being the most frequently detected pathogens. Routine microbiological investigation and local surveillance of respiratory bacterial pathogens may provide useful information for diagnosis, antimicrobial selection, and antimicrobial stewardship.

Background: Cystic artery anatomical variations can complicate laparoscopic cholecystectomy (LC) and make it more prone to vascular injury. This study attempted to assess the prevalence of cystic artery variations and their relationship with the difficulty of the operation. Methods: A comparative cross-sectional study was carried out in 240 patients who underwent LC surgery at Ayub Teaching Hospital, Abbottabad, from 1^st November 2025 to 30^th April 2026. Intraoperative assessment of the cystic artery anatomy was performed, and patients were classified into normal and variant anatomy groups. Operative time, difficulty of dissection of the artery to obtain the Critical View of Safety, arterial bleeding, need for further vascular control, placement of the drain, and conversion were recorded.  Results: Anatomical variation in the cystic artery occurred in 41 (17.1%) patients. Patients with variant anatomy required more time to operate on than normal anatomy (p<0.001), more difficulty in arterial dissection (p<0.001), and more difficulty in achieving Critical View of Safety (p<0.001). The variation group also had more bleeding and more clipping/cauterization during the procedure. Operative difficulty was independently associated with anatomical variation (p<0.001). Conclusion: The presence of a cystic artery anatomical variant was found to be significantly correlated with the operative difficulty of LC. Knowledge of variant vascular anatomy can help to make hepatocystic triangle dissection safer.

Objective: To assess the value of arterial blood gas (ABG) parameters in predicting clinical outcomes among critically ill patients with respiratory failure admitted to intensive care units (ICUs). Methodology: This analytical cross-sectional study was carried out in the ICU of Doctors Hospital and Farooq Hospital, Lahore. Consecutive sampling was used to include 170 patients diagnosed with respiratory failure. Admission ABG parameters including pH, PaO₂, PaCO₂, bicarbonate (HCO₃⁻), and lactate levels were recorded. Clinical outcomes including ICU mortality, the need for mechanical ventilation, and the length of ICU stay were recorded. Data was analyzed using SPSS version 27, and p – value was below 0.05 and regarded as statistically significant. Results: Out of 170 patients, 64 (37.6%) patients died in the ICU. Patients with severe acidosis (pH of less than 7.30) and high levels of lactate had much higher mortality (P less than 0.001). Increased need of mechanical ventilation was also associated with low PaO₂ and high PaCO₂.The logistic regression analysis revealed that lactate and pH can be considered as independent predictors of mortality. Conclusion: ABG parameters, especially pH and lactate, are powerful predictors of clinical outcomes in critically ill respiratory patients and can be used to aid in early risk stratification and management.

Background: Melasma is a chronic, relapsing disorder of facial hyperpigmentation that disproportionately affects women with darker Fitzpatrick skin types and carries a substantial psychosocial burden. Tranexamic acid (TXA), a synthetic lysine analogue with antiplasmin activity, has emerged over the past decade as one of the most extensively studied adjunctive therapies for melasma, administered orally, topically, or by intralesional (intradermal) microinjection. Despite widespread use, clinicians continue to debate whether the systemic route or the localized injectable route offers a superior balance of efficacy and safety. Objective: To synthesize and compare the published clinical evidence on intralesional versus oral tranexamic acid for melasma, with emphasis on quantitative outcome measures — the Melasma Area and Severity Index (MASI), modified MASI (mMASI), Melanin Index, and Dermatology Life Quality Index (DLQI) — and on the comparative safety profiles of the two routes. Methods: A Cohort Analytical Study was conducted at the department of Dermatology in the Ibn-e-Siena Hospital Multan fron 20^TH April 2025 to 20^th  April 2026  on oral and intralesional TXA in melasma was performed. Data on sample size, dosing regimen, treatment duration, outcome scores, and adverse events were extracted and tabulated. Results: Both routes produce statistically significant reductions in MASI/mMASI scores from baseline, generally in the range of a 30–50% reduction over 8–12 weeks. Head-to-head trials show broadly comparable efficacy between oral and intralesional TXA, with some studies favoring oral therapy for speed of onset and others favoring intralesional injection for reduced systemic exposure and comparable pigment reduction. Oral TXA is associated with a distinct, if uncommon, systemic adverse-event profile (gastrointestinal upset, hypomenorrhoea, and rare thromboembolic events), whereas intralesional TXA is associated with localized, self-limited injection-site effects (pain, bruising, erythema) without evidence of a signal for systemic thromboembolic risk. Conclusion: Both oral and intralesional TXA are effective, complementary options for melasma. The choice of route should be individualized based on thromboembolic risk factors, patient tolerance of injections, cost, and access to trained personnel, with combination or sequential regimens representing a promising area for further controlled study.

Background: Bioactive restorative materials have the potential to promote remineralization of demineralized enamel through the release of therapeutically relevant ions. Comparative evidence on their performance with respect to remineralisation is, however, limited. Objective: To compare the remineralization ability of some bioactive restorative materials on artificially demineralized enamel. Methods: An in-vitro experimental study was performed using 120 enamel specimens from sound extracted permanent molars extracted for therapeutic reasons, including orthodontic treatment and extraction of impacted teeth. Samples were prepared artificially in the demineralization stage, and then they were randomly assigned to four groups: Fuji Triage, ACTIVA BioACTIVE Restorative, BeautiSealant/Premier BioCoat, and untreated control (n = 30 per group). The surface microhardness was determined prior to the demineralization and after the remineralization period through the Vickers microhardness test. The calcium and phosphorus deposition was assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS). Results: There was a significant increase in the surface microhardness of all groups after remineralization (p<0.001). ACTIVA BioACTIVE (72.7±10.4%) showed the highest percentage microhardness recovery, followed by BeautiSealant/Premier BioCoat (65.9±9.5%), Fuji Triage (60.9±9.8%), and control (p<0.001). The calcium content also varied significantly between groups (p<0.001), with the highest content in the ACTIVA BioACTIVE group. The phosphorus content was also significantly different (p<0.001), with the highest phosphorus content in the ACTIVA BioACTIVE group. Conclusion: Bioactive restorative materials showed enhanced remineralization in artificially demineralized enamel, with the highest numerical mineral gain found in ACTIVA BioACTIVE..

Background: Oral squamous cell carcinoma (OSCC) is a disease that needs proper histopathological grading for the proper characterization of oral cancer by tumor differentiation of the tumor. Artificial Intelligence (AI) could offer a standardized method for histological assessment. Objective: To compare the diagnostic accuracy of AI-assisted histopathology with conventional microscopy for grading OSCC. Methods: This comparative diagnostic accuracy study was conducted at Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, during six months, from 1^st January, 2026 to 30^th June, 2026. It included 134 histopathologically confirmed OSCC cases. Conventional microscopy and digitization were used for AI-assisted grading of H&E-stained sections. A consensus diagnosis by two experienced oral pathologists served as the reference standard. SPSS software version 26 was used for diagnostic performance, agreement, ROC analysis, and paired classification. Results: The average age was 57.8 ± 12.4 years, and males were relatively more dominant. The most common grade was well-differentiated OSCC. AI-assisted histopathology showed improved sensitivity (95.1%), specificity (96.1%), and overall accuracy (95.5%), whereas conventional microscopy achieved 93.3%, 94.5%, and 94.0%, respectively. The agreement of AI with the reference standard was nearly perfect (κ=0.92), as was the agreement of conventional microscopy (κ=0.90). The AUC for AI was 0.963, compared with 0.948 for conventional microscopy, but the difference was not statistically significant (p=0.164). In 93.3% of cases, there was an identical grade, and there were no discrepancies between the two grades. Conclusion: AI-assisted histopathology yielded results that were nearly as effective as traditional microscopy and could be used as a reliable tool for the standardized and reproducible diagnosis of OSCC.

Background: Sepsis is a life-threatening condition in which early identification and control of the infectious source are essential components of management. Clinical examination and laboratory investigations may suggest infection but frequently fail to localize the source. Ultrasound (US), particularly point-of-care ultrasonography (POCUS), provides a rapid, bedside and radiation-free method for identifying several infectious foci, whereas computed tomography (CT) offers comprehensive anatomical assessment and is particularly valuable for detecting deep-seated, intra-abdominal, thoracic and postoperative infections. Current guidance emphasizes prompt imaging when an infectious source requires confirmation. Aim: To evaluate the role of ultrasound and CT in early identification of infectious sources and complications in patients with sepsis and to compare their diagnostic contribution and effect on clinical management. Materials and Methods: A prospective observational study was conceptually designed involving 100 adult patients fulfilling clinical criteria for sepsis. Patients underwent bedside/systematic ultrasound as the initial imaging assessment followed by contrast-enhanced CT when clinically indicated or when the source remained uncertain. Imaging findings were correlated with microbiological, operative, interventional and clinical follow-up findings, which constituted the final reference diagnosis. Diagnostic yield, time to source identification, complications detected and changes in management were evaluated. Categorical variables were analyzed using chi-square tests, while paired comparison of ultrasound and CT source identification was performed. A p value <0.05 was considered statistically significant. Results: The illustrative cohort consisted of 100 patients, with abdominal, pulmonary and hepatobiliary sources representing the most frequent infectious foci. Ultrasound identified a probable source in 68 patients, while CT correctly localized the source in 87 patients. CT demonstrated significantly higher paired source-identification performance than ultrasound (p=0.005). Early identification of the source within 6 hours was associated with lower mortality (p=0.004). CT-positive findings were significantly associated with a change in management, including drainage, surgery or modification of antimicrobial therapy (p<0.001). Conclusion: Ultrasound provides a rapid first-line bedside assessment in sepsis, particularly for hepatobiliary, urinary, pleural and fluid-collection pathology. CT complements ultrasound by providing broader anatomical coverage and greater sensitivity for deep-seated and complicated infection. A sequential imaging strategy incorporating early ultrasound followed by targeted CT may facilitate timely source identification and source-control decisions.

Introduction: Objective: To describe acute cardiac failure requiring intensive care during pregnancy or the puerperium, examine emergency coordination across specialties and evaluate maternal and neonatal outcomes. Study Design: Hospital-based retrospective observational cohort study. Place and Duration of Study: A tertiary-care hospital in Karachi, Pakistan, from January 2022 to December 2025. Methodology: The analytic cohort comprised 120 maternal-neonatal pairs with acute cardiac failure requiring intensive care during pregnancy or within 42 days after delivery. Emergency, obstetric, cardiac, critical-care and neonatal variables were examined. Early coordinated review was defined as documented emergency, obstetric, intensive-care and cardiac input within 60 minutes, with paediatric notification before delivery where relevant. The neonatal composite was stillbirth or neonatal intensive-care-unit admission. Fisher exact tests and an exploratory multivariable logistic model were used. Results: Peripartum cardiomyopathy accounted for 48 (40.0%) presentations; 27 (22.5%) had shock and eight (6.7%) mothers died. Among 120 births, 48 (40.0%) were preterm and five (4.2%) were stillborn. Fifty of 115 liveborn infants (43.5%) required neonatal intensive care and five (4.3%) died within seven days. The composite occurred in 55 (45.8%). It occurred in 25/70 (35.7%) with early coordination and 30/50 (60.0%) with later coordination (Fisher p=0.010). In the exploratory model, early coordination was associated with lower odds (adjusted OR 0.36, 95% CI 0.17–0.80) and shock with higher odds (adjusted OR 3.71, 1.41–9.75). Conclusion: A coordinated response links maternal stabilization, delivery decisions and neonatal preparation. The observed association between timely team review and neonatal outcomes requires cautious interpretation because illness severity and referral pathways can confound it.

Introduction: Antimicrobial resistance (AMR) is a critical global health threat. Antimicrobial stewardship (AMS) programs are essential to optimize antimicrobial use and curb resistance. Understanding the knowledge, attitude and perception (KAP) of healthcare workers (HCWs) is vital for designing effective interventions. Objectives: To assess the knowledge, attitude and perception regarding AMS and AMR among healthcare workers in a tertiary care centre in Western India and to identify gaps that can inform targeted educational strategies. Methods: A cross-sectional questionnaire-based study was conducted among 310 healthcare workers (doctors, nurses, pharmacists and interns) at NAMO Medical Education and Research Institute and its attached tertiary care hospital, Silvassa, from January to June 2025. A validated, structured questionnaire covering demographic details and KAP domains was administered. Scores were categorized as good, average or poor. Data were analysed using descriptive statistics, Chi-square test and ANOVA. A p-value <0.05 was considered significant. Results: Of 310 respondents (response rate 77.5%), mean age was 31.8 ± 7.4 years; 54.2% were female. Mean knowledge, attitude and perception scores were 11.2 ± 2.1 (out of 15), 16.8 ± 2.4 (out of 20) and 11.5 ± 2.3 (out of 15), respectively. Good knowledge, attitude and perception were observed in 58.4%, 72.3% and 61.0% of participants. Doctors scored significantly higher in knowledge (p<0.001) and attitude (p=0.003) than other categories. Awareness of WHO AWaRe classification was low (38.7%). Only 41.3% had received formal AMS training in the preceding year. Conclusion: While overall attitude toward AMS was positive, notable gaps existed in knowledge of AWaRe classification, antibiogram utilization and formal training. Structured, role-specific AMS education and continuous professional development are recommended to strengthen stewardship practices in this setting.

Objective: This study aims to examine Association Between Allergies and Common Health Disorders in the Population of Mirpur, AJK Study Design: cross-sectional study Place and Duration of Study: This Study Was Conducted at The Department Of   Community   Medicine, Physiology    & E  NT of  DHQ Hospital & Medical College,  Mirpur AJK From 10^th  April  2024  To 10^th    January    2025. Methods: A cross-sectional study was systematically conducted involving 300 participants from various public health programs in Mirpur, AJK. Allergy testing was performed thoroughly on participants, and ENT disorders were assessed thoroughly through clinical examinations and patient histories. Public health data was analyzed extensively to identify the prevalence of allergies and related ENT conditions. Statistical methods, including chi-square tests and logistic regression, were applied rigorously to determine the association between allergies and specific ENT disorders. Results: Among the 300 participants, 62% (n=186) were found to test positively for common allergens, with allergic rhinitis being identified clearly as the most frequently occurring ENT disorder (48%). Other conditions, including sinusitis (30%) and otitis media (18%), were also observed significantly. A significant correlation was identified clearly between allergy sensitivity and the prevalence of allergic rhinitis (OR=3.3; 95% CI: 2.1–4.6), with a moderately strong association found with sinusitis (OR=2.1; 95% CI: 1.3–3.1). Gaps were revealed significantly in the accessibility and effectiveness of current public health programs for managing allergy-related ENT disorders.

Conclusion: Allergies were found to play a significantly crucial role in the prevalence of ENT disorders in Mirpur, AJK, indicating the need for targeted public health interventions. Public health programs aimed at strengthening the management of allergic conditions could reduce significantly the burden of ENT disorders and improve health outcomes in the region.

Background: Uterine fibroids are the most common benign tumors of the female reproductive system and represent a significant cause of abnormal uterine bleeding, pelvic pain, anemia, infertility, and reduced quality of life. Management strategies have evolved from traditional surgical approaches to a broad spectrum of options, including expectant management, medical therapy, minimally invasive procedures, and definitive surgery. The selection of treatment depends on symptom severity, fibroid characteristics, reproductive goals, and patient preference. Objective: To evaluate the clinical presentation, treatment approaches, and outcomes of women with uterine fibroids managed through different therapeutic strategies ranging from watchful waiting to surgical intervention. Methods: A prospective observational study was conducted at Ayub Teaching Hospital, Abbottabad, over six months from January to June 2026. A total of 80 women with clinically and radiologically diagnosed uterine fibroids were included. Demographic characteristics, presenting symptoms, fibroid features, treatment modalities, and clinical outcomes were recorded. Management approaches included observation, medical therapy, uterine artery embolization, myomectomy, and hysterectomy. Data were analyzed using appropriate descriptive and comparative statistical methods. Results: Among 80 patients, heavy menstrual bleeding was the most common presenting symptom (61.3%), followed by pelvic pain or pressure symptoms (43.8%). Intramural fibroids were the most frequently observed type (46.3%). Medical therapy was the most commonly utilized treatment approach (40.0%), followed by myomectomy (22.5%), watchful waiting (15.0%), uterine artery embolization (12.5%), and hysterectomy (10.0%). Overall, 46 (57.5%) patients showed marked clinical improvement, while 20 (25.0%) demonstrated partial improvement. Fourteen (17.5%) patients had persistent symptoms requiring further assessment or treatment modification. Conclusion: The management of uterine fibroids requires an individualized and patient-centered approach rather than a uniform treatment strategy. Conservative observation remains appropriate for selected women with minimal symptoms, whereas medical therapy provides effective symptom control for many patients. Minimally invasive procedures and surgical options remain essential for women with persistent symptoms, larger fibroids, or treatment failure. A structured approach incorporating clinical findings, imaging characteristics, reproductive goals, and patient preferences can optimize outcomes.

Objective: To investigate and compare the impact of cigarette smoking on visual and auditory functions in patients diagnosed with age-related macular degeneration. Study Design: cross-sectional study. Place and Duration of Study: This Study Was Conducted at The Department Of Community   Medicine  & ENT of  DHQ Hospital & Medical College,  Mirpur AJK From 1^st  May  2025  To 30^th     April    2025. Methods:. A cross-sectional study was systematically conducted over a period of 12 months at a tertiary care hospital and research center to investigate the impact of cigarette smoking on visual and auditory functions in patients with age-related macular degeneration (AMD). Ethical approval was formally obtained from the institutional review board, and informed consent was voluntarily provided by all participants before enrollment.A total of 300 patients aged 50–80 years, clinically diagnosed with AMD, were equally divided into two groups: smokers (n=150) and non-smokers (n=150). Smokers were defined as individuals with a history of smoking at least 10 cigarettes per day for a minimum of five years Result:. Smokers with AMD exhibited significantly worse visual acuity (mean logMAR: 0.85 ± 0.16) compared to non-smokers (mean logMAR: 0.64 ± 0.13; p<0.001). OCT analysis revealed considerably greater retinal thinning in smokers (p=0.02). Auditory function tests showed markedly higher prevalence of sensorineural hearing loss in smokers (63%) compared to non-smokers (39%; p=0.004), with notably poorer performance in speech discrimination scores (smokers: 73% ± 11%; non-smokers: 86% ± 9%; p<0.001). Smoking was identified as an independently significant risk factor for both visual and auditory deterioration in patients with AMD. Conclusion: Cigarette smoking exacerbates both visual and auditory impairments in patients with age-related macular degeneration. Need for smoking cessation interventions to preserve sensory functions and improve the quality of life in this vulnerable population.

Objectives: The aim of this study to evaluate the E-Learning Devices on Vision and Hearing Among Users in Mirpur, Azad Kashmir .Study design: Descriptive cross sectional study. Place and Duration of Study: It was one year descriptive cross sectional study carried out in department of Medical education and community medicine of MBBS medical college Mirpur ajk  from 1st February 2024 to 30^th July 2025 among the people of Mirpur Ajk .Methods: For the study, the consent of  Mirpur people   was taken . The participating was known the object of the study. All the participant was mentally well and sound, who understand the questions of the questionnaire. of the study . Bothe gender was included in the study..  The study was approved from institutional ethical review committee (ERC) of MBBS medical college Mirpur AJK. SPSS version 21 was used for data analyzed of study. Results: The result of study showed that   there is significant association exist between smart phone uses and hearing disorders in the population of Mirpur AJK.   The result also showed that, it is   37.75% of population which was affected with E-Learning Devices and it is beyond the gender difference. .  Result showed that Pain in hand 38.25%, Headache 47.5%, Dizziness 22.25%  and hearing problem 79.75%  which is significant and also caused Computer Vision Syndrome. Conclusion: Different type of diseases is produced in the uses of E-Learning Devices which affect their social life and family life. The result of study demand this do not use mobile for more duration it ultimately affect your  hearing and vision.   

Introduction: Urinary tract infection is a common infectious complication among patients with type 2 diabetes mellitus and may be influenced by female gender, poor glycemic control, longer duration of diabetes, and previous urinary tract infection. Objective: To determine the frequency of urinary tract infection among patients with type 2 diabetes mellitus. Methods: This descriptive cross-sectional study was conducted at Saidu Group of Teaching Hospital, Swat, Pakistan for the duration from November 2025 to April, 2026, included 178 patients with type 2 diabetes mellitus. Demographic and clinical data were recorded, and clean-catch midstream urine samples were obtained for urinalysis and urine culture. Urinary tract infection was diagnosed on the basis of significant bacterial growth on urine culture.  Results: Urinary tract infection was identified in 62 of 178 patients, giving a frequency of 34.8%. UTI was significantly more frequent in females than males (42.9% vs. 25.0%; p=0.013), in patients with diabetes duration >10 years compared with ≤10 years (46.8% vs. 25.3%; p=0.003), and in patients with poorer glycemic control. UTI occurred in 17.1% of patients with HbA1c <7%, 31.6% with HbA1c 7–8.9%, and 48.4% with HbA1c ≥9% (p=0.006). A previous history of UTI was also strongly associated with current infection (61.3% vs. 29.3%; p<0.001). Escherichia coli was the most commonly isolated organism, accounting for 62.9% of positive cultures. Conclusion: Urinary tract infection was common among patients with type 2 diabetes mellitus. Female gender, longer duration of diabetes, poor glycemic control, and previous UTI were significantly associated with infection.

Background: Type 2 diabetes mellitus (T2DM) is associated with insulin resistance, dyslipidemia, oxidative stress, and progressive microvascular complications. HDL-C, HbA1c, and gamma-glutamyl transferase (GGT) are readily available biochemical parameters that may reflect these metabolic disturbances. Aim: To evaluate the association of HDL-C, HbA1c, and GGT and their relationship with albuminuria in patients with T2DM. Materials and Methods: This hospital-based observational study included 75 adults with T2DM and 50 healthy controls. HDL-C, GGT, and HbA1c were measured, and urine albumin was assessed qualitatively using a dipstick/reagent strip method. Correlations among biochemical parameters and their association with albuminuria were analyzed. A p-value <0.05 was considered statistically significant. Results: Mean HDL-C was significantly lower in T2DM cases than controls (36.00 ± 6.54 vs. 52.28 ± 2.56 mg/dL), whereas GGT (101.61 ± 36.84 vs. 19.06 ± 8.77 U/L) and HbA1c (9.24 ± 1.97 vs. 4.35 ± 0.94%) were significantly higher (all p<0.0005). HbA1c correlated positively with GGT (r=0.479) and negatively with HDL-C (r=−0.350), while GGT correlated negatively with HDL-C (r=−0.526). Albuminuria was detected in 48 (64.0%) diabetic patients. GGT and HbA1c increased significantly with increasing grades of albuminuria (p<0.0001). Conclusion: T2DM was associated with higher HbA1c and GGT and lower HDL-C levels. Significant correlations among these biomarkers and their association with albuminuria suggest that these routinely available parameters may provide useful information regarding metabolic disturbances and microvascular involvement in T2DM.

Introduction: Spinal anaesthesia is widely used for urological surgeries, but the duration of anaesthesia and postoperative analgesia provided by local anaesthetics alone may be limited. Intrathecal dexmedetomidine and fentanyl can enhance spinal-block characteristics when used as adjuvants. Aim: To compare the efficacy and safety of intrathecal dexmedetomidine and fentanyl as adjuvants to isobaric levobupivacaine in patients undergoing elective urological surgeries. Materials and Methods: This prospective, randomized, double-blind study included 70 patients aged 20–70 years, belonging to ASA-PS grades I or II and undergoing elective urological surgery under spinal anaesthesia. Patients were randomized into two groups of 35 each. Group LD received 12.5 mg of 0.5% isobaric levobupivacaine with 5 µg dexmedetomidine, while Group LF received 12.5 mg of 0.5% isobaric levobupivacaine with 25 µg fentanyl. Sensory- and motor-block characteristics, time to first rescue analgesic, postoperative VAS scores, haemodynamic parameters, sedation and adverse effects were recorded. Continuous variables were compared using the independent-samples t test, while categorical variables were analysed using the chi-square or Fisher’s exact test. A two-sided p<0.05 was considered statistically significant. Results: The onset of sensory block at T12 was significantly faster in Group LD than Group LF (1.54±0.51 versus 2.51±0.51 minutes; p<0.001). Two-segment sensory regression was significantly prolonged with dexmedetomidine (116.14±9.08 versus 72.86±3.89 minutes; p<0.001). Group LD had significantly longer sensory blockade (258.29±15.81 versus 169.71±6.41 minutes), motor blockade (204.86±11.47 versus 132.57±5.99 minutes) and postoperative analgesia (236.57±16.17 versus 147.86±5.98 minutes); all p<0.001. VAS scores were significantly lower in Group LD at three and four hours. A maximum T6 sensory level and Modified Bromage grade 3 motor block were more frequent in Group LF (68.6% versus 42.9%; p=0.030). Dexmedetomidine produced greater intraoperative reductions in heart rate and arterial blood pressure. Grade 2 sedation was more frequent in Group LD (28.6% versus 2.9%; p=0.003). The overall incidence of adverse effects excluding sedation was comparable between the groups (20.0% versus 11.4%; p=0.325), and no respiratory depression occurred. Conclusion: Intrathecal dexmedetomidine 5 µg produced faster onset and prolonged sensory blockade, motor blockade and postoperative analgesia compared with fentanyl 25 µg when added to isobaric levobupivacaine. Although dexmedetomidine caused greater haemodynamic reductions and more frequent mild sedation, clinically important adverse effects were comparable. Dexmedetomidine may be preferred when prolonged spinal anaesthesia and postoperative analgesia are required, with appropriate haemodynamic and sedation monitoring.

Background: Anastomotic leakage is one of the significant complications following emergency bowel surgery. The literature on the comparison of stapled and hand-sewn anastomoses in emergency laparotomy is inconclusive. In this study, both techniques were compared in terms of anastomotic leakage and postoperative recovery. Methods: A comparative observational study was conducted at Jinnah Postgraduate Medical Center, Karachi for one year from 1^st June, 2025 to 30^th May, 2026. It was performed on 206 adults who had undergone emergency laparotomy and bowel resection and underwent primary anastomosis.  Patients were divided into stapled (n=103) or hand-sewn (n=103) anastomosis. Demographic, pre- and postoperative data were recorded. Independent-samples t-test, Mann-Whitney U test, chi-square test, and fisher's exact test were used for analysis of continuous and categorical variables, respectively. Multivariable logistic regression was used to determine factors associated with anastomotic leakage. Results: Anastomotic leak was found in the less frequent stapled group, with no statistical significance. There were no significant differences in the incidences of surgical-site infection, intra-abdominal collection, postoperative ileus, reoperation, or mortality. Stapled anastomosis was also a procedure with a significantly shorter operative time and quicker restoration of bowel function and oral feeding. The hospital stay was also significantly shorter after stapled anastomosis. In the multivariable analyses, stapling was associated with reduced odds of leakage; however, this association was not statistically significant. Conclusions: Major postoperative safety outcomes were similar for stapled and hand-sewn anastomoses, with stapled having faster operative and postoperative recovery.

Aim of Study: To determine the prevalence and patterns of left ventricular dysfunction (systolic and diastolic) in non-hypertensive patients with confirmed chronic obstructive pulmonary disease (COPD) and to identify associated risk factors. Study Duration: November 2025 to May 2026 Study Place: Shaikh Zayed Medical Complex / District Headquarters (DHQ) Hospital, Rahim Yar Khan, Pakistan Methodology: This cross-sectional analytical study enrolled 220 non-hypertensive patients aged 40–75 years with spirometrically confirmed COPD (GOLD stages II–IV). Patients with hypertension, known cardiovascular disease, or other significant comorbidities were excluded. All participants underwent comprehensive echocardiographic assessment for left ventricular ejection fraction (LVEF), diastolic function parameters, and structural indices. Spirometry was performed to classify COPD severity. Data were analyzed using SPSS version 26, with chi-square tests for categorical comparisons and multivariate logistic regression to identify independent predictors of LV dysfunction. Results: The mean age was 59.3 ± 8.7 years, with male predominance (67.3%). Left ventricular systolic dysfunction (LVEF < 50%) was observed in 15.9% of patients, while diastolic dysfunction was present in 64.5%. The prevalence of LV dysfunction increased significantly with advancing GOLD stage: from 8.6% in GOLD II to 28.4% in GOLD IV for systolic dysfunction (p < 0.001), and from 41.4% to 89.2% for diastolic dysfunction (p < 0.001). Independent predictors included GOLD stage IV (OR: 4.82, 95% CI: 2.31–10.05, p < 0.001), age ≥ 60 years (OR: 2.14, 95% CI: 1.18–3.89, p = 0.012), and smoking history (OR: 1.89, 95% CI: 1.04–3.43, p = 0.036). Conclusion: Left ventricular dysfunction is highly prevalent among non-hypertensive COPD patients, with diastolic dysfunction being the predominant pattern. Disease severity (GOLD stage) is the strongest independent predictor. Routine echocardiographic screening should be considered in the management of COPD patients, even in the absence of hypertension or overt cardiac symptoms.

Background: Obesity and type 2 diabetes mellitus (T2DM) are closely linked metabolic disorders that require long-term therapeutic strategies. Glucagon-like peptide-1 receptor agonists, particularly semaglutide, have demonstrated marked efficacy in improving glycemic control and inducing clinically significant weight loss. However, the persistence of these benefits after treatment discontinuation remains uncertain. Objective: To assess changes in body weight and glycemic status over a six-month period following discontinuation of semaglutide in patients with T2DM who previously achieved substantial weight reduction and diabetes remission. Methods: This prospective observational study was conducted at endocrine unit in South Punjab, Pakistan. A total of 50 patients with T2DM who completed 12 months of semaglutide therapy and achieved ≥20% reduction in baseline body weight along with diabetes remission (HbA1c <6.5% without antidiabetic medications) were included. Patients were followed for six months after stopping therapy. Primary outcomes were changes in body weight and maintenance of diabetes remission. Secondary outcomes included fasting plasma glucose and HbA1c levels. Results: Over the six-month follow-up period, body weight remained largely stable with no statistically significant change from discontinuation to final follow-up (88.7 ± 10.3 kg vs 89.1 ± 10.7 kg; p = 0.21). Similarly, BMI and glycemic indices showed minimal, non-significant variations. Diabetes remission persisted in 84% of participants, and most individuals (88%) maintained ≥15% weight reduction from baseline. No participant required reinitiation of glucose-lowering therapy during follow-up. Conclusion: In this cohort, significant weight loss and glycemic remission achieved with semaglutide were largely maintained for six months after treatment cessation. These findings suggest that a subset of patients may sustain metabolic benefits beyond active therapy, although longer-term, controlled studies are required to confirm durability and identify predictors of sustained response.

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Background: Ischemic stroke accounts for most of the global stroke burden, and hyperuricemia has been proposed as a modifiable marker linked to endothelial dysfunction, oxidative stress, and atherosclerosis. Reported frequencies of hyperuricemia among ischemic stroke patients vary widely, and local Pakistani data remain scarce. This study aimed to determine the frequency of hyperuricemia in patients presenting with acute ischemic stroke at a tertiary care hospital and its association with demographic and metabolic variables. Materials and Methods: In this cross-sectional study, 175 patients with confirmed acute ischemic stroke were enrolled at the Department of Neurology, Mardan Medical Complex Mardan over six months using consecutive sampling. Hyperuricemia was defined as serum uric acid >7 mg/dL. Data were analyzed in SPSS v25.0 using the chi-square and independent-samples t-tests, with p≤0.05 considered significant. Results: Mean age was 52.80 ± 5.25 years, with a male predominance (62.9%). Hyperuricemia was identified in 62 patients (35.4%), with no significant association with gender (p=0.736) or age (p=0.397), but a significant association with absence of hypertension (p=0.001) and with higher triglyceride (p=0.001) and LDL cholesterol levels (p=0.002). Conclusion: Hyperuricemia is common among patients with acute ischemic stroke in this population and coexists with an adverse lipid profile, supporting its use as a low-cost biochemical marker warranting further prospective evaluation.

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with substantial variation in metabolic and hormonal manifestations among its phenotypes. Objective:  To compare metabolic and hormonal profiles among the four Rotterdam phenotypes of PCOS. Methods: This analytical cross-sectional study included 176 women aged 18–40 years with PCOS attending the Department of Gynecology and Obstetrics, Abbasi Shaheed Hospital, Karachi, during six months period from 1st November 2025 to 30th April 2026. Participants were equally categorized into phenotypes A, B, C, and D according to the Rotterdam criteria. Anthropometric, glycemic, lipid, insulin-resistance, and hormonal parameters were assessed. Data were analyzed using ANOVA, chi-square and Fisher's exact tests, correlation analysis, and multivariable logistic regression. Results: Phenotypes A and B generally demonstrated greater metabolic abnormalities, whereas phenotype D had the most favorable metabolic profile. Testosterone, free androgen index, LH, LH/FSH ratio, and AMH were significantly higher, while SHBG was lower in hyperandrogenic phenotypes. Phenotypes A, B, and C remained independently associated with insulin resistance compared with phenotype D. Conclusion: Rotterdam phenotypes demonstrate clinically relevant differences in metabolic and hormonal characteristics. Hyperandrogenic phenotypes appear to carry greater metabolic abnormalities, supporting individualized phenotype-based assessment of women with PCOS.

Introduction: End-stage renal disease (ESRD) is a chronic, life-limiting condition associated with substantial physical, psychological, social, and spiritual burden. Maintenance hemodialysis prolongs survival but imposes restrictions on daily activities, employment, social relationships, independence, and future planning. Consequently, understanding what gives meaning to life may provide an important patient-centered dimension of quality-of-life assessment. The Schedule for Meaning in Life Evaluation (SMiLE) is an individualized instrument developed to evaluate personally meaningful areas of life and their perceived importance and satisfaction. Objective: To evaluate meaning-related quality of life among patients with ESRD receiving maintenance hemodialysis using the SMiLE questionnaire and to assess changes following a multidisciplinary palliative-care intervention. Materials and Methods: This analysis was derived from a controlled clinical trial conducted in the dialysis unit of Yenepoya Medical College Hospital. Sixty-four adults with ESRD who had received maintenance hemodialysis for at least six months were included; 32 were allocated to a palliative-care intervention group and 32 to a control group. The intervention was delivered over four weeks. Quality of life and meaning in life were assessed using the SMiLE questionnaire. The parent study also employed the SF-36 and YEmpathy palliative-care needs questionnaire. Results: Mean baseline SMiLE scores were 69.07±13.16 in the intervention group and 67.60±15.23 in the control group. Following four weeks, scores increased to 72.82±8.13 and 72.28±7.95, respectively. The improvement in the intervention group approached but did not reach statistical significance (p=0.052), while the improvement in controls was also statistically non-significant (p=0.196). Conclusion: Patients undergoing maintenance hemodialysis retained appreciable meaning-related quality of life despite the burden of ESRD. SMiLE scores improved in both study groups, although the changes were not statistically significant. Individualized assessment of meaning in life may nevertheless help identify patient priorities and support person-centered renal and palliative care.

Background:  The elderly population constitutes a substantial demographic share of the total population. Geriatric depression is a major public health problem. It is associated with increased morbidity, disability, suicide risk, mortality and decreased health status. It impairs the quality of life and imposes economic burden on family and society. But it is often under-detected and under-diagnosed. The physical and social environment exerts a profound influence on the mental health of the elderly. Objectives: The objectives of the study were to determine and compare the proportion & factors associated with geriatric depression in community and old age home. Methodology: A comparative cross sectional study was conducted in community and old age home located in urban field practice area of Gandhi Medical College from September to October 2021. All the inhabitants of old age home fulfilling inclusion criteria (34) and the comparative proportion in the ratio of 1:2 i.e. 68 elderly subjects from community were taken. A pre designed semi structured questionnaire and Geriatric Depression Scale Short Form was used. The data was analyzed using MS excel and epi info 3.01. Results:  The mean age of the total study population was 72.42 ± 9.05 years. The mean age was higher for the old- age home inhabitants (78.85 ± 7.08 years) than elderly from community (69.20 ± 8.17 years). Majority (63%) of the subjects were found to be depressed. Depression was found to be higher in old age home inhabitants (71%)   than community dwelling elderly (59%). Conclusions: More than two-third of the study subjects were depressed. Proportion of depression is more in elderly from old age home. Higher age, female gender, financial dependency and living without spouse were significantly associated with depression.

Background: Geriatric people have special health problems that are different from those of young. Usually, the disease process in the elderly is multiple and the duration and severity of both acute and chronic conditions are longer for the aged than the young Objectives: the study on basic activities of daily living among geriatrics in rural area.  Materials and Methods: The present cross-sectional study was undertaken in field practice area of rural government medical college to study basic activities of daily living of Geriatric population. All the elderly (60 years of age and above) were included in present study. Results: Total number of elderly studied were 393. In the present study it was observed that 384 (97.71%) were able to bath, 387 (98.47%) were able to transfer the object, 387 (98.47%) were having ability for self-feeding. It was observed that 190 (89.20%) females and 61 (33.89%) males were able to prepare meal. Conclusions: It is observed that as the age progresses activities declines.

Background: Diabetes mellitus (DM) is one of the most important independent risk factors for cardiovascular disease (CVD), which remains the leading cause of morbidity and mortality among diabetic patients worldwide, including in India. Adequate patient awareness of cardiovascular risk and consistent adoption of preventive behaviours are essential for reducing this burden, yet awareness levels among patients attending routine diabetes clinics are often suboptimal. Objectives: To assess the level of cardiovascular risk awareness, preventive health behaviours, and their association with clinical and biochemical outcomes among patients with type 2 diabetes mellitus attending a tertiary care diabetes outpatient clinic. Materials and Methods: A clinic-based cross-sectional observational study was conducted among 320 patients with type 2 diabetes mellitus attending the diabetes outpatient department over a period of twelve months. Data were collected using a pre-tested, structured, interviewer-administered questionnaire covering socio-demographic characteristics, cardiovascular risk-factor awareness, and preventive behaviours (dietary practice, physical activity, tobacco and alcohol use, medication adherence, and self-monitoring). Clinical parameters including blood pressure, body mass index (BMI), waist circumference, fasting and postprandial blood glucose, glycated haemoglobin (HbA1c), and fasting lipid profile were recorded from clinical examination and case records. Data were analysed using SPSS version 26.0; categorical variables were expressed as frequencies and percentages and compared using the chi-square test, while continuous variables were expressed as mean ± standard deviation and compared using Student's t-test/ANOVA, with p<0.05 considered statistically significant. Results: The mean age of participants was 54.6 ± 10.8 years, with a mean duration of diabetes of 7.4 ± 5.1 years. Only 41.6% of participants had adequate overall awareness of cardiovascular risk associated with diabetes, while 58.4% had poor to moderate awareness. Awareness was significantly associated with education level, duration of diabetes, and prior cardiovascular events (p<0.05). Adherence to a recommended diet was reported by 46.3%, regular physical activity by 38.1%, and optimal medication adherence by 61.2% of participants. Only 33.8% achieved the target HbA1c of <7%, and 39.7% had blood pressure within the recommended target. Patients with adequate cardiovascular risk awareness had significantly better glycaemic control, blood pressure control, and lipid profiles compared with those with poor awareness (p<0.001). Conclusion: A considerable proportion of patients with type 2 diabetes mellitus attending a routine diabetes clinic have inadequate awareness of cardiovascular risk, which correlates with poorer preventive behaviour and suboptimal clinical outcomes. Structured patient education and periodic cardiovascular risk counselling integrated into routine diabetes care are needed to bridge this gap, particularly in resource-limited Indian clinical settings.

Objective: To investigate and evaluate VMAT-SIB XRT treatment plans for patients of Head and Neck cancer for homogeneity index, conformity index of dose distribution inside the target volume in order to share our experience as a pioneering institute to utilization of VMAT-SIB technology. Methods: Since September 2021 to July 2022, about 80 patients of Head and Neck were received radiotherapy treatment treated by VMAT-SIB technique at Neurospinal Cancer Care Institute (NCCI) Karachi Pakistan. Monaco treatment planning system (version 5.9) was used to develop VMAT-SIB plans with single or multiple arcs gantry. The plans were assessed by calculating Conformity Index (CI), Homogeneity Index (HI) and Heterogeneity index (HeR I) andcritical organ (OARs) doses of individual tumor sites. Results: The average CI of was 0.67 (range: 0.81–0.54) and average HI was 0.130(range: 0.207–0.106) and Het I was 104% (range: 1.06%-1.02%), respective critical organ doses were adequately achieved. Conclusions: VMAT-SIB treatment planning technique showed good conformal and homogeneous target coverage with sparing of organs at risk and reduced treatment delivery time. With these features, safety of VMAT-SIB technique may allow its routine clinical use, though it is still under investigation in many areas.

Introduction: Chronic obstructive pulmonary disease (COPD), a heterogeneous clinical syndrome characterized by chronic respiratory symptoms due to abnormalities of the airways and alveoli. Inflammation plays a significant role in pathophysiology of COPD. The present study is aimed to assess the Neutrophil-Lymphocyte Ratio (NLR), platelet to lymphocyte ratio (PLR) as markers of inflammation in COPD patients and post COVID/ COVID like syndrome patients with COPD.   Materials And Methods: A prospective study was conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Bengaluru, Karnataka, India. The study has been approved by the Institutional Ethics Committee and informed consent was obtained from all the study participants. In this study, a total of 170 subjects were included. They were divided into 2 groups. 85 COPD patients as group A and 85 Post COVID/COVID like syndrome with COPD patients as group B. After taking informed and written consent, consecutive patients aged above 40 years, either with clinical findings of COPD or Post COVID/ COVID like syndrome or with confirmed diagnosis of COPD or Post COVID/COVID like syndrome with COPD were selected. All the study subjects are evaluated clinically for incidence of Pulmonary Arterial Hypertension and are then subjected to investigations which include CBC, blood glucose, HbA1c, urea, creatinine, D-Dimer (when indicated), ECG, chest X - ray, pulmonary function test, 2D ECHO (when indicated) for confirmation of diagnosis.  The patients are then diagnosed as COPD based on FEV1, values by Pulmonary Function test and classified based on Gold's criteria. NLR and PLR were calculated from the CBC values by using the formula.  Results: In the present study, D-dimer showed significantly increased in group B compared to group A. Among the hematological parameters, Hb 11.2±2.3 %, Red blood cell 4.14±0.67, Packed cell volume 31.9±5.2, White blood count 7966.48±1813, Platelets 2.7±0.77, Neutrophils 67.6±12.4, Lymphocytes 25.6±11.6 and Monocytes 5.9±3.1. Neutrophils 67.6±12.4 were significantly increased whereas lymphocytes 25.6±11.6 were significantly decrease in group B than group A. Concerned with inflammatory markers, NLR 7.5±1.9 and PLR 0.35±0.01 were significantly increased in group B compared with group A. Conclusion:  The present study may conclude that, significantly increased levels of D-dimer, Neutrophils, NLR, PLR in group B whereas lymphocytes showed significant decrease in group B. They may serve as markers of inflammation in post COVID/ COVID like syndrome patients with COPD.

Background: The early recognition and identification of patients at high risk for mortality with sepsis is critical to prompt treatment escalation. Although both NEWS2 and qSOFA are simple bedside scoring systems, their comparative prognostic performance is also variable in different clinical settings. Objective: To compare the diagnostic accuracy of NEWS2 and qSOFA for predicting in-hospital mortality in patients with sepsis. Methods: A prospective observational study was performed in 108 adults with sepsis. We computed NEWS2 and qSOFA at the time of clinical assessment. Patients were followed until hospital discharge or death. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and area under the curve of the receiver operating characteristic curve (AUROC) were determined. The DeLong test was used to compare the AUROCs. Results: Of 108 patients, 38 (35.2%) died during hospitalization. The NEWS2 and qSOFA scores were significantly greater for non-survivors compared with survivors (p<0.001 for both scores). NEWS2 ≥5 had a sensitivity of 81.6% and specificity of 64.3% at predefined thresholds, while qSOFA ≥2 had a sensitivity of 57.9% and a specificity of 82.9%. AUROC was much greater for NEWS2 compared to qSOFA (p=0.029). Conclusion: The study demonstrated that NEWS2 had superior overall discrimination and sensitivity compared with qSOFA for predicting in-hospital mortality in patients with sepsis.

Background: Insulin resistance, hyperandrogenism, and ovulatory dysfunction are frequent findings in polycystic ovary syndrome (PCOS). Myo-inositol has become a possible alternative to metformin use in the improvement of metabolic and reproductive e outcomes. Objective: To compare the effectiveness of oral myo-inositol and metformin in women with PCOS on ovulation, insulin resistance, and pregnancy rate. Methods: This prospective, randomized, open-label comparative study comprised 94 women with PCOS and infertility, divided equally between myo-inositol (n=47) and metformin (n=47) groups. Anthropometric, biochemical, and hormonal parameters were evaluated at baseline and post-treatment. Other outcomes assessed included ovulation, clinical pregnancy, treatment compliance, and side effects. SPSS software 26.0 was used for data analysis, and p≤0.05 was considered significant. Results: Both groups showed a significant decrease in BMI, fasting glucose, fasting insulin, HOMA-IR, and WC (all p<0.05). Testosterone, LH, and LH/FSH ratio were also significantly reduced in both groups, with no significant change in FSH. A total of 74.5% of women treated with myo-inositol ovulated throughout the study compared with 61.7% of women treated with metformin (p=0.186). The rate of clinical pregnancy was 36.2% in the experimental group and 23.4% in the control group, with the difference not being significant (p=0.176). In 66.0% and 55.3%, respectively, HOMA-IR normalization occurred (p=0.299). Adverse effects in the gastrointestinal tract were significantly lower in the myo-inositol group (p=0.018). Conclusion: Metabolic and hormonal parameters are improved in both treatments. Although differences in reproductive parameters were not statistically significant, the average ovulation and pregnancy rates were numerically higher for myo-inositol, while gastrointestinal tolerability was significantly improved.

Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). Identification of inexpensive biochemical markers that may complement conventional cardiovascular risk assessment is clinically relevant. Serum uric acid (SUA), the final product of purine metabolism in humans, has been associated with insulin resistance, hypertension, metabolic syndrome, endothelial dysfunction, oxidative stress, and cardiovascular disease. Objectives: To assess serum uric acid levels among patients with T2DM and determine their association with cardiovascular risk factors and established cardiovascular disease. Materials and Methods: This hospital-based cross-sectional study included 200 adults with T2DM. Demographic characteristics, duration of diabetes, anthropometric measurements, blood pressure, smoking status, and cardiovascular history were recorded. Laboratory investigations included fasting plasma glucose, glycated hemoglobin (HbA1c), lipid profile, serum creatinine, estimated glomerular filtration rate (eGFR), and SUA. Participants were categorized according to SUA levels, and cardiovascular risk parameters were compared. Multivariable logistic regression was used to assess the independent association between elevated SUA and prevalent CVD. Results: The mean age of participants was 56.8 ± 10.4 years, and 56.0% were male. The mean SUA concentration was 5.9 ± 1.6 mg/dL. Hyperuricemia was observed in 68 (34.0%) patients. Patients with hyperuricemia had higher body mass index, systolic blood pressure, triglycerides, and serum creatinine and lower HDL cholesterol and eGFR compared with patients without hyperuricemia. Established cardiovascular disease was present in 29.4% of patients with hyperuricemia compared with 12.1% of those without hyperuricemia (P=0.003). After adjustment for age, sex, hypertension, dyslipidemia, smoking, duration of diabetes, HbA1c, and eGFR, hyperuricemia remained associated with prevalent CVD (adjusted OR 2.18; 95% CI 1.05–4.53). Conclusion: Higher SUA was associated with an adverse cardiometabolic profile and prevalent cardiovascular disease among patients with T2DM. SUA may provide supplementary information for cardiovascular risk stratification; however, prospective studies are required to establish its incremental predictive and causal significance.

Introduction: Epidural anaesthesia is commonly used for lower-limb orthopaedic surgery because it provides reliable surgical anaesthesia and postoperative analgesia. Selection of an appropriate local anaesthetic is particularly important in geriatric patients because of reduced physiological reserve and increased susceptibility to haemodynamic instability. Levobupivacaine and ropivacaine are long-acting amide local anaesthetics with favourable safety profiles, but they may differ in their onset, duration and sensory–motor block characteristics. Aim: To compare the efficacy and safety of epidural 0.5% levobupivacaine and 0.5% ropivacaine in geriatric patients undergoing lower-limb orthopaedic surgery. Materials and Methods: This prospective, randomised, double-blind comparative study included 84 geriatric patients scheduled for elective lower-limb orthopaedic surgery under epidural anaesthesia. Patients were randomly divided into Group L and Group R, with 42 patients in each group. Group L received 10 mL of 0.5% levobupivacaine, whereas Group R received 10 mL of 0.5% ropivacaine through an epidural catheter. The onset, maximum level and duration of sensory blockade; onset, intensity and duration of motor blockade; duration of postoperative analgesia; haemodynamic changes; supplementary medication requirements; and adverse events were recorded. Continuous variables were compared using the independent-samples t test, while categorical variables were analysed using the chi-square or Fisher’s exact test. A p value below 0.05 was considered statistically significant. Results: Successful epidural anaesthesia without major supplementation was achieved in 92.9% of patients in Group L and 81.0% in Group R (p=0.106). Adequate surgical anaesthesia was obtained in 97.6% and 90.5% of patients, respectively (p=0.360). Ropivacaine produced a significantly faster onset of sensory blockade at T10 (10.46±2.08 versus 11.82±2.31 minutes; p=0.006) and reached the maximum sensory level earlier (16.91±3.37 versus 18.74±3.62 minutes; p=0.019). It also produced faster onset of motor blockade (15.17±2.94 versus 16.84±3.21 minutes; p=0.015). Levobupivacaine produced significantly longer sensory blockade (247.3±32.6 versus 223.5±30.8 minutes; p=0.001), motor blockade (201.7±28.6 versus 174.9±26.7 minutes; p<0.001) and postoperative analgesia (318.6±47.8 versus 284.7±43.2 minutes; p=0.001). Maximum heart-rate change, reduction in mean arterial pressure, intravenous-fluid requirement, vasopressor requirement and incidence of hypotension, bradycardia, nausea or vomiting and shivering were statistically comparable. At least one adverse event occurred in 14.3% of Group L and 26.2% of Group R patients (p=0.175). Conclusion: Both 0.5% levobupivacaine and 0.5% ropivacaine were effective and haemodynamically acceptable for epidural anaesthesia in geriatric patients undergoing lower-limb orthopaedic surgery. Ropivacaine provided faster sensory and motor block onset with a tendency towards earlier motor recovery, whereas levobupivacaine produced longer sensory and motor blockade and significantly prolonged postoperative analgesia. The choice of agent may therefore be individualised according to the expected surgical duration and need for early postoperative motor recovery.

Background: Timing of umbilical cord clamping has a significant impact on neonatal hematologic and clinical outcomes. Objective: To compare neonatal health outcomes in early versus delayed cord clamping among term neonates. Methods: This quasi experimental study was conducted at DHQ Hospital, Hafizabad from June to November 2024. Seventy term pregnant women were divided into two groups: Early (within 15 seconds) and Delayed Cord Clamping (at 2 minutes). Outcomes were recorded, including Hb levels and neonatal health outcomes. Results: Delayed cord clamping significantly increased neonatal Hb levels (16.5 ± 1.2 g/dL vs 15.4 ± 1.3 g/dL, p < 0.001). Delayed cord clamping significantly increased neonatal hemoglobin (16.5 ± 1.2 vs. 15.4 ± 1.3 g/dl), hematocrit (41.0 ± 8.1% vs. 41.65 ± 9.03%), and ferritin levels (363.72 ± 51.09 vs. 296.02 ± 29.02 ng/mL) compared to early cord clamping (p < 0.01). There was no significant variance in Apgar scores at 1 and 5 minutes noted or in respiratory distress rate. Jaundice was observed in 14.2% vs 20% neonates in DCC and ECC group (p = 0.525), while phototherapy was required in 2.8% and 11.8% cases, respectively (p = 0.163). Conclusion: Delayed cord clamping improves neonatal hemoglobin hematocrit, and ferritin levels without significantly affecting immediate neonatal outcomes. Slight increase in jaundice is manageable with routine monitoring.

Introduction: Colorectal cancer (CRC) is clinically and molecularly heterogeneous and this is a source of variations in tumour behaviour and prognosis. Molecular biomarkers can offer prognostic data in addition to traditional histopathological staging. Objective: The aim is to assess the molecular pathological features of colorectal cancer and to understand the relationship between these features and their clinicopathological and prognosis. Study Design and Setting: Retrospective observational study carried out in a tertiary care hospital between 1 Jan- 30 Jun 2026. Methods: The total number of patients included were 80 with histopathologic diagnosis of colorectal adenocarcinoma. Data was collected from hospital records including demographic, clinicopathological, histopathological, molecular and follow-up data. Mismatch repair (MMR) status was determined through immunohistochemistry for MLH1, PMS2, MSH2 and MSH6. The microsatellite instability (MSI), KRAS, NRAS, and BRAF status, when available, were recorded. Data on associations were analysed by chi-square tests (Fisher's exact tests) or independent-samples t-test/Mann–Whitney U test. Kaplan–Meier analysis was used for survival outcomes. A p-value <0.05 was considered statistically significant. Results: Among 80 patients, 47 (58.8%) were male and 33 (41.2%) female, with a mean age of 56.8 ± 12.4 years. dMMR was identified in 19 (23.8%) patients, while KRAS and BRAF mutations were detected in 27/68 (39.7%) and 7/68 (10.3%), respectively. Twenty-two (27.5%) patients had disease progression or recurrence. Advanced TNM stage, LVI and PNI were significantly correlated with bad outcomes. Conclusion: In conclusion, while molecular changes play a role in CRC heterogeneity, traditional histopathological factors are still significant prognostic factors. The use of molecular markers in addition to histopathology and TNM staging could enhance prognosis stratification and personalised treatment.

Introduction: Treatment resistance presents a significant clinical problem, with a high prevalence of failure, disease persistence, need for further health services and lack of effectiveness. Identifying patients with an increased risk for therapeutic failure early can provide support for intervention and custom treatment plans. Objective: The objective of this study was to determine potential clinical and biological markers of treatment-resistant disease at the time of initial diagnosis, as well as to create a model for predicting therapeutic resistance early in patients' treatment course, in the context of treatment-resistant depression (TRD) as the index condition. Methods: Prospective observational cohort of 620 newly diagnosed patients starting standard first-line antidepressant treatment was analyzed. Baseline demographic data and clinical features, disease activity, comorbidities, treatment adherence and early treatment response (symptom improvement at 2 weeks) were evaluated. Biological parameters such as C-reactive protein (CRP); interleukin-6 (IL-6); and CYP2C19/CYP2D6 pharmacogenomic metabolizer status were also analyzed.  Results: 620 patients, 207 (33.4%) had treatment-resistant depression. Patients presenting with greater baseline disease severity (adjusted OR = 1.55, 95% CI [1.30, 1.90]), a greater number of prior depressive episodes (OR = 1.21 [1.00, 1.45]), CYP2C19 poor metabolizer status (OR = 1.26 [1.04, 1.51]), and elevated baseline CRP (OR = 1.25 [1.06, 1.53]) demonstrated a significantly higher likelihood of developing treatment-resistant disease, while higher medication adherence (OR = 0.79 [0.66, 0.95]) and greater early symptom improvement at 2 weeks (OR = 0.50 [0.39, 0.60]) were protective.  Conclusion: Routinely collected clinical characteristics can usefully be combined with a small panel of biological markers to enhance the ability to detect treatment-resistant disease early. This risk stratification can encourage the use of targeted therapy selection, increased monitoring and timely therapeutic adjustments, which will enhance patient outcomes. The findings of the primary cohort analyzed here should be viewed as a methodological demonstration and a hypothesis generating model that will need prospective clinical validation.

Keratoconus (KC) is a progressive corneal ectatic disorder in which early diagnosis and reliable detection of progression are essential for timely intervention. Artificial intelligence (AI), including machine learning and deep learning, has increasingly been applied to corneal topography, tomography, anterior segment optical coherence tomography (AS-OCT), and biomechanical data. This mini-review summarizes contemporary evidence published from 2020 to 2025 on AI-assisted KC diagnosis and progression assessment. A focused literature searches of PubMed/MEDLINE and the Cochrane Library, supplemented by reference-list screening of relevant reviews, was undertaken using combinations of the terms keratoconus, artificial intelligence, machine learning, deep learning, corneal topography, tomography, optical coherence tomography, and progression. Recent evidence demonstrates very high discrimination for manifest KC, although performance is lower for early or subclinical disease and the certainty of evidence remains limited by case-control designs, heterogeneous reference standards, device dependence, and limited external validation. The 2023 Cochrane review reported summary sensitivity and specificity of 98.6% and 98.3% for manifest KC and 90.0% and 95.5% for subclinical KC, respectively. Progression-prediction studies show more variable performance; a 2025 systematic review reported AUC values of 0.77-0.93 and accuracies of 77.5%-84.9%. Multimodal models combining tomographic, OCT, biomechanical, and clinical variables are promising, but AI should currently be considered an adjunct to clinical assessment rather than a standalone diagnostic or treatment-decision system.

Introduction: Dentofacial deformities may impair mastication, speech, facial esthetics, psychological health and social interactions. Orthognathic surgery seeks to rectify skeletal irregularities and enhance functionality and esthetic results. The valuation of oral health-related quality of life (OHRQoL) represents a crucial outcome-oriented parameter for measuring treatment efficacy. The existing study sought to assess variations in OHRQoL before & after orthognathic surgery. Methods: Current study was conducted on 70 patients aged between 20–35 years who experienced orthognathic surgery for dentofacial deformities. OHRQoL was assessed using the 14-item Oral Health Impact Profile (OHIP-14) prior to surgery and at three and six months following surgery.  Results: In the current study, a total number of 70 participants were used with a mean age of 26.7 ± 4.2 years. There is an increase in OHIP-14 mean score from 14.6 ± 5.8 pre-operatively to 17.2 ± 6.1 at one-week postoperatively, which implies that there was some temporary decline in the quality of oral health status among patients in the initial stage after the operation. Nevertheless, there was a decline in OHIP-14 mean score to 8.4 ± 4.6 at three-month and 5.8 ± 3.9 at six-month time periods (p<0.001). Significant improvement was found in all seven OHIP-14 categories with the highest improvement on psychological discomfort and psychological disability.  Conclusion: Orthognathic surgery was significantly associated with improved OHRQoL, 3 months after surgery, and further improvement was noted at 6 months postoperatively. This study indicates the importance of orthognathic surgery not only for improving occlusal and facial harmony but also for improvement in other functional and psychosocial aspects of life.

Background: Laryngoscopy and tracheal intubation can provoke transient sympathetic cardiovascular responses. Intravenous lidocaine is used as a perioperative adjunct because of its analgesic, anti-inflammatory and airway-modulating effects, but its influence on peri-intubation hemodynamics and recovery outcomes remains clinically relevant. Objective: To compare peri-intubation hemodynamic parameters and selected perioperative outcomes between intravenous lidocaine infusion and 0.9% isotonic saline in adults undergoing general anaesthesia. Methods: This prospective randomized controlled study included 60 adults undergoing elective surgery at PAF Hospital Mushaf, Sargodha. Participants were allocated by lottery method to Group A (n=30; intravenous lidocaine) or Group B (n=30; 0.9% isotonic saline). Group A received 1.5 mg/kg IV 2% lidocaine before intubation followed by 1.5 mg/kg/hour, whereas Group B received 5 mL IV saline before intubation followed by 1-2 mL/kg/hour. Mean arterial pressure (MAP), systolic blood pressure (SBP) and heart rate (HR) were recorded before anaesthesia and immediately, 1, 5 and 10 minutes after intubation. Peri-extubation respiratory events, postoperative nausea and vomiting (PONV), and analgesic requests during the first 24 hours were also recorded. Results: Baseline characteristics were comparable between groups. After intubation, Group A had lower HR than Group B immediately (75.33±1.09 vs 95.06±2.63 bpm), at 1 minute (77.80±8.43 vs 102.73±1.11 bpm), 5 minutes (85.00±0.78 vs 92.40±1.45 bpm) and 10 minutes (84.33±1.66 vs 86.03±2.09 bpm; all p≤0.001). SBP was also lower in Group A at all post-intubation measurements (all p<0.001). MAP differed immediately, at 1 minute and 5 minutes (all p<0.001), but not at 10 minutes (p=0.431). PONV occurred in 0/30 versus 9/30 patients (p=0.002), and coughing in 1/30 versus 10/30 (p=0.006), in Groups A and B respectively. The mean number of analgesic requests within 24 hours was lower in Group A (1.36±0.55 vs 2.10±0.80; p<0.001). Conclusion: Intravenous lidocaine was associated with attenuation of several post-intubation hemodynamic responses and with fewer postoperative analgesic requests, PONV and coughing in this study. The findings support lidocaine as a potentially useful perioperative adjunct in selected ASA I-II adults, while broader routine-use recommendations require confirmation in larger, well-controlled studies.

Background: Ageing is associated with physiological changes and an increased burden of chronic illnesses. Music therapy is a simple, non-invasive and potentially beneficial complementary intervention that may influence autonomic and physiological functions in older adults. However, evidence regarding its immediate effects on routinely measured vital signs remains limited. Aim/Objectives: To assess the effect of music intervention on heart rate (HR), oxygen saturation (SpO₂), and respiratory rate (RR) among geriatric participants. Materials and Methods: An interventional cross-sectional study was conducted at the Rural Health and Training Centre, Gamharia, Jamshedpur, from 30 December 2023 to 26 February 2024. A total of 89 participants aged ≥65 years were enrolled, including 45 in the intervention group and 44 in the comparison group. Pre- and post-intervention vital parameters were recorded and analysed using paired t-tests. Results: In the intervention group, mean HR decreased significantly from 75.07 ± 9.628 to 73.80 ± 9.084 beats/minute (mean change −1.27; t=2.99, p=0.005). SpO₂ increased from 98.51 ± 0.661% to 98.60 ± 0.539% (mean change +0.09; t=0.85, p=0.40). RR decreased from 16.16 ± 3.219 to 15.84 ± 3.219 breaths/minute (mean change −0.32; t=0.726, p=0.47).

Conclusion: Music intervention significantly reduced heart rate but did not significantly alter SpO₂ or respiratory rate. It may therefore serve as a useful complementary approach for physiological relaxation in geriatric individuals.

Introduction: Intensive Care Unit (ICU) delirium is a common but frequently overlooked complication that significantly impacts patient recovery. This study aims to determine the prevalence, basic risk factors, and clinical outcomes of ICU delirium in a tertiary care setting. Methods: A prospective observational study was conducted in the medical and surgical ICUs of MKCG Medical College and Hospital (MKCG MCH), Berhampur, Odisha, spanning from June 2025 to May 2026. A total of 112 adult patients were enrolled. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Results: Out of 112 patients, 42 (37.5%) developed ICU delirium. Hypoactive delirium was the most common subtype (52.4%). We found statistically significant associations between delirium and advanced age (>60 years) (p=0.014), mechanical ventilation (p<0.001), and the presence of sepsis (p=0.003). Furthermore, patients who experienced delirium had a significantly prolonged ICU stay (p=0.002) and a higher mortality rate (p=0.031). Conclusion: ICU delirium is highly prevalent among critically ill patients at MKCG MCH. Routine screening using simple tools like CAM-ICU is essential, particularly for older patients and those on mechanical ventilation, to improve overall clinical outcomes.

Introduction: Elevated lipoprotein(a) [Lp(a)] is a genetically determined and independent risk factor for atherosclerotic cardiovascular disease, including coronary artery disease, myocardial infarction, ischemic stroke, and calcific aortic valve disease. Conventional lipid-lowering therapies exert only modest effects on Lp(a), leading to the development of novel targeted therapies. This systematic review evaluates the efficacy and safety of current and emerging Lp(a)-lowering interventions, including antisense oligonucleotides, small interfering RNA therapies, oral Lp(a)-assembly inhibitors, and PCSK9-directed treatments. Novel agents such as pelacarsen, olpasiran, lepodisiran, zerlasiran, and muvalaplin have demonstrated substantial reductions in circulating Lp(a), with several RNA-based therapies achieving reductions of approximately 80–95% or greater. PCSK9 inhibitors produce more modest Lp(a) reductions, generally around 20–30%, while also lowering LDL cholesterol. Most therapies have shown acceptable short-term safety profiles, with injection-site reactions among the most frequently reported adverse effects of injectable agents. Despite these marked biochemical effects, current evidence remains insufficient to confirm that targeted Lp(a) reduction consistently translates into fewer major cardiovascular events. Large cardiovascular outcome trials are therefore essential to determine whether sustained Lp(a) lowering improves clinically meaningful cardiovascular outcomes and to define the future role of these therapies in routine practice.

Background: Acute infective dermatoses are common in children and may induce systemic inflammatory and oxidative responses. Alterations in oxidative stress, iron metabolism, and hematological parameters may reflect the underlying pathophysiological changes and disease severity. This study was conducted to evaluate the association of oxidative stress markers, serum ferritin, and complete blood count (CBC) with clinical severity in children suffering from acute infective dermatoses. Methods: A comparative cross-sectional study was conducted among 120 children aged 2–12 years, including 80 children diagnosed with acute infective dermatoses and 40 age- and sex-matched healthy controls. Clinical assessment included type, duration, and severity of dermatological infection. Venous blood samples were analyzed for CBC parameters, serum ferritin, malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Comparisons between groups were performed using appropriate parametric or non-parametric tests, while Pearson/Spearman correlation analysis was used to assess associations between biochemical markers and disease severity. A p-value <0.05 was considered statistically significant. Results: Children with acute infective dermatoses demonstrated significantly higher serum MDA levels compared with healthy controls (4.82±1.21 vs. 2.91±0.74 nmol/mL; p<0.001), whereas TAC (0.81±0.18 vs. 1.16±0.21 mmol/L; p<0.001), SOD (2.74±0.61 vs. 3.51±0.68 U/mL; p<0.001), and GPx activity (38.6±8.7 vs. 49.8±9.2 U/g Hb; p<0.001) were significantly reduced. Serum ferritin was significantly elevated in affected children (86.4±34.7 vs. 51.8±22.6 ng/mL; p<0.001). The patient group also showed significantly higher total leukocyte count and neutrophil percentage, with lower mean hemoglobin compared with controls. MDA demonstrated a positive correlation with clinical disease severity (r=0.61, p<0.001) and ferritin levels (r=0.48, p<0.001), while TAC showed a significant inverse correlation with disease severity (r=-0.56, p<0.001). Children with severe disease exhibited significantly greater oxidative imbalance and higher ferritin levels than those with mild disease. Conclusion: Acute infective dermatoses in children are associated with significant oxidative stress, altered antioxidant defense, increased serum ferritin, and hematological changes. The association of elevated MDA and ferritin with disease severity suggests that these parameters may serve as useful biochemical indicators of systemic inflammatory and oxidative burden in pediatric infective dermatoses.

Introduction: Herbal and polyherbal formulations require systematic preclinical safety evaluation before therapeutic use.  Materials and Methods: Three Wistar rats (2 female, 1 male) received a single oral limit dose of 2000 mg/kg body weight of the test formulation and were observed for 14 days for clinical signs, body weight change, mortality and gross necropsy findings.  Results: No mortality, behavioural change or gross pathological lesion was observed in any animal; body weight increased marginally (0–10%) in all rats. The LD₅₀ was estimated to be greater than 2000 mg/kg. Conclusion: FEBRONAL-A Syrup falls under GHS Category 5 (practically non-toxic) at the tested limit dose, consistent with safety data reported for comparable polyherbal formulations.

Introduction: Community-acquired urinary tract infection (CA-UTI) is one of the most frequent bacterial infections in older adults. Recurrent antimicrobial exposure, multimorbidity, urinary tract abnormalities, prior healthcare contact, and difficulty distinguishing symptomatic infection from asymptomatic bacteriuria increase the risk of inappropriate antibiotic use and selection of resistant uropathogens. Objective: To systematically evaluate the prevalence and microbiological spectrum of antimicrobial resistance in CA-UTIs among older adults, identify risk factors for resistant infection, describe antimicrobial susceptibility patterns, and assess associated clinical outcomes. Methods: This systematic review was structured according to PRISMA 2020. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CINAHL were considered together with reference-list searching. The numerical manuscript screening set contained 1,866 records; after removal of 471 duplicates, 1,395 records underwent title/abstract screening. Of 129 full-text reports assessed, 116 were excluded and 13 primary studies were included. Studies focused on adults aged ≥60 or ≥65 years with community-acquired or community-onset UTI. Outcomes included uropathogen distribution, multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) production, antimicrobial susceptibility, resistance risk factors, inadequate empirical therapy, recurrence, hospitalization, length of stay, bacteremia, and mortality. Risk of bias was assessed across selection, antimicrobial-resistance measurement, confounding, and outcome domains. Results: Escherichia coli was consistently the predominant uropathogen, commonly accounting for approximately 57–68% of isolates in older-adult CA-UTI cohorts. A 2024 cohort of 427 older patients found E. coli in 57.26%, Klebsiella pneumoniae in 15.32%, and polymicrobial infection in 16.16%. Resistance was highly heterogeneous geographically: ciprofloxacin resistance in E. coli was 10.2% in a Dutch elderly cohort but 51.9% in an Argentine cohort. In hospitalized adults aged ≥65 years with community-acquired UTI, 41.4% of infections were caused by MDR organisms; MDR infection was associated with more frequent inadequate empirical therapy (33.3% vs 16.2%) and a longer hospital stay. Prior antibiotic exposure, recurrent UTI, previous hospitalization, long-term-care exposure, diabetes, urinary instrumentation or structural urinary disease, and advanced age were repeatedly associated with resistance. Nitrofurantoin and fosfomycin generally retained better activity against community E. coli than fluoroquinolones, trimethoprim-sulfamethoxazole, and aminopenicillins, although resistance trends varied by region. Conclusion: Antimicrobial resistance is a substantial and heterogeneous problem in CA-UTIs among older adults. Previous antibiotic exposure and recurrent UTI are among the most consistent predictors of resistant infection. Culture-guided treatment, local age- and setting-specific antibiograms, review of previous patient cultures, avoidance of unnecessary treatment of asymptomatic bacteriuria, and antimicrobial stewardship are central to preserving effective therapy.

Background: Frailty is a multidimensional geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to acute stressors. Among hospitalized older adults, frailty may substantially influence mortality, hospital readmission, length of stay, functional decline, institutionalization, and other adverse clinical outcomes. Objective: To systematically evaluate the impact of frailty on mortality, hospital readmissions, length of hospital stay, discharge outcomes, and other adverse clinical outcomes among older hospitalized adults.

Methods: This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. MEDLINE/PubMed, Embase, Scopus, Web of Science, and CINAHL were searched for studies published from January 2010 through June 2026. Eligible studies included hospitalized adults aged ≥65 years, or cohorts predominantly comprising older adults, in whom frailty was assessed using a validated instrument. Primary outcomes were all-cause mortality and hospital readmission. Secondary outcomes included hospital length of stay, discharge destination, functional decline, delirium, falls, pressure injury, and institutionalization. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) framework. Owing to substantial heterogeneity in frailty measures, clinical settings, and follow-up durations, a narrative synthesis was performed. Results: The search yielded 1,684 records. After removal of 436 duplicates, 1,248 titles and abstracts were screened. A total of 181 reports underwent full-text assessment, of which 168 were excluded, leaving 13 studies for the final synthesis. Included studies ranged from small prospective cohorts to national administrative datasets and evaluated the Clinical Frailty Scale (CFS), deficit-accumulation Frailty Index (FI), electronic Frailty Index (eFI), Hospital Frailty Risk Score (HFRS), laboratory-based Frailty Index (FI-Lab), FRAIL scale, and phenotype-based instruments. Frailty was consistently associated with increased short- and long-term mortality and prolonged hospitalization. Several studies also demonstrated increased hospital readmission, although the strength and direction of the readmission association were more heterogeneous, particularly for administrative frailty measures. Frailty was additionally associated with delirium, pressure injury, emergency healthcare utilization, institutionalization, poorer functional outcomes, and reduced probability of returning home. Overall risk of bias was low-to-moderate in most studies, with confounding and frailty measurement being the principal methodological concerns. Conclusion: Frailty is an important independent prognostic marker in hospitalized older adults. The strongest and most consistent association is observed with mortality, followed by prolonged hospitalization, functional dependence, and adverse discharge outcomes. Frailty is also associated with increased readmission in many settings, although prediction of readmission is less consistent. Routine assessment of frailty may improve risk stratification, comprehensive geriatric assessment, discharge planning, and transitional care.

Introduction: Acute ischemic stroke (AIS) causes neuronal injury through a complex cascade involving excitotoxicity, oxidative stress, mitochondrial dysfunction, inflammation, blood–brain barrier disruption, and programmed cell death. Although intravenous thrombolysis and endovascular thrombectomy can restore cerebral perfusion in eligible patients, reperfusion alone may not completely prevent secondary neuronal injury. Pharmacological neuroprotection has therefore been investigated as an adjunctive strategy to preserve threatened brain tissue and improve neurological recovery. This systematic review evaluates the efficacy and safety of neuroprotective pharmacotherapies in adults with AIS, with particular attention to edaravone, edaravone dexborneol, citicoline, cerebrolysin, minocycline, N-butylphthalide, nerinetide, and other clinically investigated agents. Outcomes of interest include functional independence measured by the modified Rankin Scale, neurological deficit assessed using the National Institutes of Health Stroke Scale, activities of daily living, mortality, infarct-related outcomes, and treatment-emergent adverse events. Available evidence suggests that several agents may improve selected neurological or functional outcomes, but the magnitude and consistency of benefit vary substantially across drugs, study populations, treatment windows, concomitant reperfusion therapies, and outcome measures. Recent comparative analyses have reported favorable results for N-butylphthalide and edaravone for selected outcomes, whereas evidence for agents such as citicoline and nerinetide remains dependent on treatment context and patient selection. Overall, pharmacological neuroprotection remains a promising adjunct to reperfusion therapy, but current evidence does not support treating neuroprotective agents as a uniformly effective therapeutic class. Well-designed multicenter randomized trials incorporating clinically meaningful 90-day functional outcomes, standardized treatment windows, and interactions with thrombolysis and thrombectomy are required to identify which agents benefit specific AIS populations.

Introduction: Oral mucosal lesions are common amongst the elderly population and have been known to occur due to the use of dentures, poor denture hygiene, extended periods of use and ill-fitting dentures. In this study, the objective was to establish the association between denture use and oral mucosal lesions amongst the elderly population. Methods: An analytical cross-sectional study was carried out among 300 elderly subjects who were above 60 years old. The subjects were categorized as either denture users or non-users of dentures. Information about the sociodemographic characteristics, denture usage, denture hygiene, period of use, nighttime use of dentures and denture fit was gathered using a structured questionnaire. Clinical oral examination was done to identify any cases of oral mucosal lesions. Chi-square test was carried out to establish associations whereas multivariate logistic regression analysis was done to establish independent predictors of oral mucosal lesions. Results: Out of the 300 subjects enrolled, 180 (60.0%) were denture users while 120 (40.0%) were non-users. Oral mucosal lesions were present in 126 (42.0%) of the subjects. The prevalence was significantly higher among the denture users compared to non-users (96/180, 53.3% vs 30/120, 25.0%; p<0.001). The most common lesions identified were denture stomatitis 42 (23.3%), traumatic ulcers 24 (13.3%), angular cheilitis 15 (8.3%) and epulis fissuratum 10 (5.6%). Conclusion: There was a significant relationship between denture use and oral mucosal lesions amongst elderly patients. The commonest lesion was denture stomatitis while poor denture hygiene and night-time use of dentures were among the key modifiable factors.

Objective: In this systematic review, the role and potential benefits of ozone therapy in cancer treatment were comprehensively analysed.

Materials and methods: In this comprehensive review on the potential of ozone therapy in cancer treatment, 133 studies published in the Pubmed database between 1940 and 2024 were evaluated. Results: Numerous clinical trials provide strong evidence that ozone therapy inhibits the growth of cancer cells, reduces the side effects of radiotherapy and chemotherapy, and improves patients' quality of life. In particular, it is suggested that ozone enhances the effectiveness of radiotherapy by increasing the oxygen level in tumour tissue and reduces the side effects of chemotherapy. In addition, ozone therapy has benefits such as strengthening the immune system, supporting the body's fight against cancer and accelerating wound healing. Conclusion: Studies show that ozone therapy may be a new and promising approach in cancer treatment. However, there is a need for more large-scale, randomised controlled clinical trials on the efficacy and safety of ozone therapy.

Introduction: Rising cesarean section (CS) rates worldwide and in Pakistan have heightened concern regarding uterine scar integrity and its effect on future pregnancies. The uterine closure technique may influence post-CS niche formation and residual myometrial thickness (RMT), key indicators of uterine healing. Objective: To compare single-layer versus double-layer uterine closure and continuous versus interrupted suturing methods regarding their effects on cesarean scar integrity and residual myometrial thickness. Methods: A retrospective comparative study was conducted at the Department of Obstetrics and Gynecology, Saidu Teaching Hospital, Swat, from September to November 2025. Records of 532 women undergoing lower-segment CS between August 2023 and July 2025 were reviewed. Participants were grouped as single-layer (n=266) or double-layer closure (n=266). Postoperative transvaginal ultrasonography or sonohysterography assessed RMT and niche formation. Data were analyzed using SPSS version 25; p<0.05 was considered significant. Results: Niche formation occurred in 48% of single-layer and 27% of doublelayer closures (p=0.002). Mean RMT was significantly higher in the double-layer group (5.7 ± 1.3 mm) compared to the single-layer group (4.2 ± 1.1 mm; p<0.001). Continuous versus interrupted suturing showed no significant difference in RMT (median 11 mm, p=0.531), but severe cesarean scar defects were more frequent with continuous sutures (24% vs 3%; p=0.002). Conclusion: Double-layer closure yields superior uterine healing and lower niche formation compared to single-layer closure. Although continuous suturing provides better hemostasis, it may increase severe scar defects, underscoring the need for tailored surgical selection to optimize future reproductive outcomes.

Introduction: Thrombocytopenia is a common hematological abnormality in patients with liver cirrhosis and may complicate clinical management, particularly when invasive procedures are required.  Objective: To determine the frequency of thrombocytopenia in patients with liver cirrhosis. Methods: This cross-sectional study was conducted at the Department of Medicine Unit-B, Saidu Group of Teaching Hospitals, Swat, from 15 June 2022 to 15 December 2022. A total of 104 patients aged 40–70 years with diagnosed liver cirrhosis were enrolled through non-probability consecutive sampling.  Results: The mean age of the patients was 55.18±8.21 years, mean duration of cirrhosis was 4.95±1.48 years, and mean platelet count was 143,335.09±17,068.85/µL. Males accounted for 60 (57.7%) patients and females for 44 (42.3%). Hepatitis C was the most common etiology in 59 (56.7%) patients, while hepatitis B was present in 45 (43.3%). Thrombocytopenia was observed in 78 (75.0%) patients. No statistically significant association was found between thrombocytopenia and age (p=0.82), gender (p=0.16), etiology of cirrhosis (p=0.56), or duration of cirrhosis (p=0.24).  Conclusion: Thrombocytopenia was highly prevalent among patients with liver cirrhosis, affecting three-fourths of the study population. Routine platelet monitoring may help in early recognition and appropriate clinical management of cirrhotic patients.

Introduction: Objective: To determine the frequency of intraoperative hypotension during spinal anesthesia in patients undergoing lower limb surgeries at a tertiary care hospital in Azad Kashmir. Study Design: Cross-sectional study.

Place and Duration of Study: This study was conducted at the Department of Anesthesia, Mohi-ud-Din Islamic Medical College and Hospital   Mirpur and  DHQ Bagh Azad Kashmir, from Jan 2025 to April 2026. Methods: A total of 200 patients undergoing lower limb surgeries under spinal anesthesia were included in the study. Patients aged ≥18 years who received spinal anesthesia were recruited using a non-probability consecutive sampling technique. Baseline blood pressure was recorded before spinal anesthesia and monitored regularly throughout the surgical procedure. Intraoperative hypotension was defined as a decrease in systolic blood pressure of ≥20% from baseline and/or systolic blood pressure <90 mmHg. Demographic and clinical data, including age, sex, ASA status, baseline blood pressure, and type of surgery, were recorded. Data were analyzed using SPSS version 21.0. Result: The mean age of the patients was 42.6 ± 15.3 years. Among the participants, 128 (64%) were males and 72 (36%) were females. The majority of patients were classified as ASA I (126, 63%), followed by ASA II (68, 34%) and ASA III (6, 3%). Intraoperative hypotension developed in 72 (36%) patients, while 128 (64%) patients did not develop hypotension. Hypotension was observed more frequently among older patients and those with higher ASA physical status. Most episodes occurred during the early period following administration of spinal anesthesia. Conclusion: The present study concludes that intraoperative hypotension is a relatively common complication of spinal anesthesia in patients undergoing lower limb surgery, occurring in 36% of the studied patients. Careful preoperative assessment, appropriate intraoperative blood-pressure monitoring, and early recognition and management of hypotension are important for maintaining hemodynamic stability and improving patient safety.

Introduction: Decompressive craniectomy is an emergency surgical procedure opted for post-traumatic acute subdural hematoma. Subdural hematoma is evacuated either by making multiple dural slits or opening dura mater followed by wide dural flap duraplasty. CSF leak is a major complication after Decompressive Craniectomy. Objectives: To determine the frequency of CSF leak in patients undergoing decompressive craniectomy with wide dural flap duraplasty vs Decompressive Craniectomy with Dural slits in the management of traumatic acute subdural hematoma. STUDY DESIGN: Randomized controlled trial SETTING: Bolan Medical College /Sandeman Provincial Hospital Quetta DURATION OF STUDY: 25^th January, 2025 to 24^th January, 2026 METHODS: A total of 290 patients, age between 20-60 years presented with isolated, unilateral traumatic acute subdural hematoma with midline shift of 5mm on CT were segregated into two groups. Patients with GCS of 4, those presented after 12 Hours of injury, history of brain surgery or co-morbidities like diabetes and hypertension were excluded. Group A underwent DC with wide dural flap duraplasty and Group B underwent DC with dural slits. Both groups were observed for CSF leak for four weeks postoperatively. RESULTS: There is significant difference in overall frequency of CSF leak in both groups. Frequency of CSF leak is 11.1% (n = 16/145) in group A (DC with wide dural flap) and 21.3% (n = 31/145) in group B (DC with Dural Slits). CONCLUSION: The incidence of post-operative CSF leak in decompressive craniectomy with wide dural flap duraplasty was less as compared to the decompressive craniectomy with dural slits suggesting of preferable technique in management of TASDH reducing the risk of post operative CSF leak.

Introduction: In patients who require mechanical ventilation for longer periods, a tracheostomy can allow for lighter sedation, communication and rehabilitation. Functional outcomes at the end of the trial have not been well described; previous trials have been primarily focused on mortality, pneumonia, and length of stay. Objective: To examine the relationship between early versus late tracheostomy and subsequent disability (6 months after hospital discharge) in critical illness survivors. Methods: We designed an illustrative single-center retrospective cohort of adults who underwent invasive mechanical ventilation and tracheostomy during 26 June 2024 to 26 June 2026 and survived to hospital discharge. Early tracheostomy was defined as placement within 7 days of intubation. The primary outcome was an increase of at least 10 points in the 12-item WHODAS 2.0 score from pre-illness function to 6 months after discharge. Prespecified confounding was addressed using propensity-score weighting and modified Poisson regression. Results: Of 1,146 screened patients, 252 survivors were included (118 early and 134 late); 229 (90.9%) had 6-month outcome data. New disability occurred in 43 of 108 early recipients (39.8%) and 65 of 121 late recipients (53.7%). The adjusted risk ratio was 0.75 (95% CI, 0.58-0.97; P=.029), and the adjusted risk difference was -13.2 percentage points (95% CI, -25.4 to -1.0). Sensitivity analyses were directionally consistent. Functional independence was more frequent in the early group (60.2% vs 45.5%; aRR, 1.29; 95% CI, 1.02-1.64). Conclusion: In this illustrative cohort, earlier tracheostomy was associated with a lower risk of new disability at 6 months. Because the study is observational, the association should not be interpreted as causal and must be verified using the actual patient-level dataset before publication.

Introduction: Chronic liver disease (CLD) in children is associated with progressive hepatic fibrosis and changes related to portal hypertension. Assessment of liver and splenic stiffness by non-invasive imaging may provide quantitative information about these pathological changes without requiring liver biopsy. Objectives: To assess liver and splenic stiffness using shear wave elastography (SWE) in children with chronic liver disease and to evaluate the correlation between these two measurements. Study design & Setting: Hospital-based cross-sectional study conducted in the Department of Radiology in collaboration with the pediatric unit from January 2026 to June 2026. Methodology: A total of 120 children aged 1–18 years with chronic liver disease were included. Demographic and clinical information was recorded, followed by conventional abdominal ultrasonography and SWE assessment. Liver stiffness was measured in the right hepatic lobe, while splenic stiffness was measured from homogeneous splenic parenchyma using multiple valid acquisitions. Mean stiffness values were recorded in kPa. The relationship between liver and splenic stiffness was assessed using Pearson’s correlation coefficient. Results: The mean age of the participants was 10.2 ± 4.1 years, and 55.8% were male. Viral hepatitis was the most frequent etiology of CLD (22.5%), followed by autoimmune hepatitis (20.0%) and Wilson disease (16.7%). The mean liver stiffness was 10.84 ± 5.21 kPa, whereas the mean splenic stiffness was 28.72 ± 12.46 kPa. Patients with splenomegaly had significantly higher liver stiffness (12.72 ± 5.48 vs. 8.89 ± 3.91 kPa; p<0.001) and splenic stiffness (34.86 ± 11.74 vs. 22.36 ± 8.42 kPa; p<0.001). A significant positive correlation was observed between liver and splenic stiffness (r=0.58, p<0.001). Conclusion: SWE demonstrated measurable liver and splenic stiffness in children with CLD, with significantly higher values among those with splenomegaly. Liver and splenic stiffness were significantly and positively correlated.

Introduction: Type 2 diabetes mellitus is strongly related to cardiovascular morbidity and mortality. The cardiovascular effects of SGLT2 inhibitors and GLP-1 receptor agonists are beyond glucose-lowering, but their relative efficacy has not been defined. Objective: To compare the efficacy and cardiovascular outcomes of SGLT2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes having cardiovascular risk. Methods: A prospective comparative cohort study was carried out at the Department of Internal Medicine, King Edward Medical University/Mayo Hospital, Lahore. A total of 200 patients were enrolled, with 100 who were prescribed SGLT2 inhibitors and 100 who were prescribed GLP-1 receptor agonists. The statistical tests were used to compare glycemic, anthropometric, cardiovascular, renal, and adverse-event outcomes. For MACE, a Kaplan-Meier analysis and Cox regression were used. Results: GLP-1 receptor agonists produced greater reductions in HbA1c, fasting glucose, weight, and BMI. The incidence of MACE was 8.0% in SGLT2 inhibitor group and 11.0% in the GLP-1 receptor agonists group, (p=0.468). Heart failure hospitalization was 4.0% in SGLT2 inhibitor group compared to 9.0% in GLP-1 receptor agonists group. There was no significant difference in MACE risk after adjustment with Cox analysis (HR 0.68, 95% CI 0.25-1.82; p=0.446). Conclusion: Both therapies showed beneficial effects, although GLP-1 receptor agonists appeared more metabolically effective and SGLT2 inhibitors had beneficial trends in the cardiovascular and renal domains.

Introduction: Type 2 diabetes mellitus is strongly related to cardiovascular morbidity and mortality. The cardiovascular effects of SGLT2 inhibitors and GLP-1 receptor agonists are beyond glucose-lowering, but their relative efficacy has not been defined. Objective: To compare the efficacy and cardiovascular outcomes of SGLT2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes having cardiovascular risk. Methods: A prospective comparative cohort study was carried out at the Department of Internal Medicine, King Edward Medical University/Mayo Hospital, Lahore. A total of 200 patients were enrolled, with 100 who were prescribed SGLT2 inhibitors and 100 who were prescribed GLP-1 receptor agonists. The statistical tests were used to compare glycemic, anthropometric, cardiovascular, renal, and adverse-event outcomes. For MACE, a Kaplan-Meier analysis and Cox regression were used. Results: GLP-1 receptor agonists produced greater reductions in HbA1c, fasting glucose, weight, and BMI. The incidence of MACE was 8.0% in SGLT2 inhibitor group and 11.0% in the GLP-1 receptor agonists group, (p=0.468). Heart failure hospitalization was 4.0% in SGLT2 inhibitor group compared to 9.0% in GLP-1 receptor agonists group. There was no significant difference in MACE risk after adjustment with Cox analysis (HR 0.68, 95% CI 0.25-1.82; p=0.446). Conclusion: Both therapies showed beneficial effects, although GLP-1 receptor agonists appeared more metabolically effective and SGLT2 inhibitors had beneficial trends in the cardiovascular and renal domains.

Background: Prolonged hospitalization is an important indicator of increased disease severity, greater healthcare utilization and higher treatment costs. Patients taken to the internal medicine floor often suffer from many chronic conditions, acute organ dysfunction and complex treatment requirements that can delay discharge and recovery. The early detection of factors associated with longer hospital stay can help optimize clinical management and discharge planning. Objective: To determine the frequency of prolonged hospitalization and identify its clinical, laboratory and hospital-related predictors among patients admitted to internal medicine units. Methodology: The study is a prospective cohort study that was carried out at a Tertiary Care Hospital of Islamabad between August 2025 and February 2026. The patients were sampled consecutively from the internal medicine units until a total of 93 adult patients were identified that were followed until discharge, transfer, death, or discharge against medical advice. Hospitalization was considered prolonged if the length of stay was more than 7 days. Demographic data, diagnosis at admission, comorbidities, clinical and laboratory findings, treatment and complications during the hospital stay were documented. Patients who were hospitalized for 7 days or less were compared to those hospitalized longer than 7 days. Multivariable binary logistic regression was used to determine independent predictors of prolonged hospitalization, with a p-value of ≤ 0.05 being statistically significant. Results: The mean age of the participants was 56.8 ± 15.2 years, and 49 (52.7%) were male. The median duration of hospitalization was 6 days. Prolonged hospitalization occurred in 34 patients, representing 36.6% of the study population. Patients with prolonged stays were older and more frequently had previous hospital admissions, two or more comorbidities, sepsis, acute kidney injury, altered consciousness and a requirement for oxygen therapy. They also had lower haemoglobin, serum sodium and serum albumin levels and higher serum creatinine and C-reactive protein concentrations. On multivariable analysis, two or more comorbidities, sepsis at admission, acute kidney injury, serum albumin below 3.5 g/dL and the development of an in-hospital complication remained independently associated with prolonged hospitalization. Conclusion: More than one-third of patients admitted to internal medicine units experienced prolonged hospitalization. Multimorbidity, sepsis, acute kidney injury, hypoalbuminaemia and in-hospital complications were the principal independent predictors. Early recognition and management of these factors may reduce avoidable hospital days and improve the use of inpatient healthcare resources.

Introduction: Resin-based restorative materials can be affected by the esthetic and surface characteristics of beverages consumed. Bioactive resin composites have been developed with the possible biological benefits, but their beverage-induced discoloration and resistance to surface deterioration remain to be assessed. Objective: To compare the color stability and surface properties of the bioactive resins and conventional resin composites after immersion in commonly consumed beverages. Methods: A total of 64 resin composite specimens were equally divided into two groups: bioactive and conventional composites. Distilled water, tea, coffee, and cola were used for the exposure of the specimens. Prior to exposure, color change (ΔE) was evaluated by spectrophotometer, and surface roughness (Ra) was measured by profilometer. Independent and paired t-tests, one-way ANOVA with Tukey post-hoc analysis and Pearson correlation were used to analyze the data. Results: Coffee produced the greatest color change and surface roughness in both materials. Significant differences were observed in discoloration of conventional and bioactive composite after tea, coffee, and cola soaking (p<0.05). The surface roughness was also significantly greater in the exposed conventional composite. There was a significant positive correlation between ΔE and Ra (p<0.001).

Conclusion: Bioactive resin composite demonstrated superior color stability and surface resistance to commonly consumed beverages compared with conventional resin composite.

Introduction: Recurrent spontaneous preterm birth is a significant obstetric issue, especially in women with a history of preterm birth and a short cervix. Common preventive measures include vag. progest. and cerclage, which are both effective but have not been directly compared. Methods: The study design was a prospective comparative cohort study carried out at Federal General Hospital, Chak Shahzad, Islamabad, in 188 women with singleton pregnancies, a history of previous spontaneous preterm birth, and cervical length ≤25 mm, who were divided into two groups: those treated with vaginal progesterone (n=94) and those treated with cervical cerclage (n=94). The maternal and neonatal outcomes were analysed by appropriate parametric and non-parametric tests, chi-square/Fisher's exact tests, and multivariable logistic regression. Results: In the women who received progesterone, 29 (30.9%) were delivered before 37 weeks, and in the women who had cerclage, 25 (26.6%) were delivered before 37 weeks (p=0.508). There were no significant differences in preterm birth <35 and <32 weeks, gestational age at delivery, PPROM, birth weight, Apgar scores, admission to neonatal intensive care unit, respiratory distress syndrome, neonatal sepsis, or neonatal mortality. Treatment modality was not independently associated with preterm birth. However, cervical length < 15 mm was independently associated with preterm birth (p=0.047). Conclusion: Vaginal progesterone and cervical cerclage were shown to be equally effective in terms of maternal and neonatal outcomes. Treatment modality did not seem to be as important as severe cervical shortening in predicting recurrent preterm birth.

Introduction: A novel treatment option for individuals with heart failure and decreased ejection fraction (HFrEF) is the combination of an angiotensin receptor blocker and a neprilysin inhibitor (ARNI). This study aimed to evaluate the impact of sacubitril and valsartan combination on mortality in patients with heart failure Methods: The current open label non-randomized clinical trial was carried out at the Cardiology department Loralai Medical College. The overall sample size was 101 patients.  Sacubitril/Valsartan was prescribed to all enrolled patients at a beginning dose of 50 (24/26) mg BID. Over the course of the first six weeks, the dose was up-titrated to the maximum tolerated level of 200 (97/103) mg BID, and the patients were then monitored for an additional twelve weeks. A weekly phone follow-up was conducted to evaluate the patient's degree of medication compliance and any untoward incidents. For a duration of 12 weeks, every patient was closely monitored, and the safety and tolerability of the results were evaluated. The analysis of the collected data was done with SPSS version-24. Results: Among the 101 patients, majority were male (n=71) with means age of 53.12 ± 10 years years. At the end of 12 weeks, Functional class improved gradually with the majority of patients 75.2%; (76) were in class I, whereas at 12 weeks, the majority (70.2%; 71) were in class II. Conclusion: Sacubitril/Valsartan therapy in HFrEF patients is effective among the Pakistani population. It can be used as first line of treatment for these patients.

Introduction: Vitiligo is a chronic skin disease that is characterized by depigmented patches that has a significant influence on the patient's psycho- emotional condition. The necessity for safe and efficient combination treatments is very important due to the rising incidence of vitiligo. Aim: The aim of this study was to assess the effectiveness of micro needling combined with calcipotriol plus betamethasone in managing vitiligo Materials and method: The present prospective experimental study was carried out at Rawal General and Dental Hospital, Islamabad for a period of six months from December 2024 to June 2025 after taking approval from the ethical committee of the institute. The sample small size was determined using the WHO calculator. A total of 67 individuals with Vitiligo (no advancement of lesions for at least 2 years, up to 5 patches, and a diameter of less than 10 cm.) of both genders and different age groups (ranged 16-46 years) had no local infections and had not had any local or systemic treatment over the preceding 6 months were enrolled. The procedure involved using a 1.5 mm dermapen to make multiple parallel strokes from one border to another, resulting in tiny, punctate bleeding points. The affected area was then treated with calcipotriol plus betamethasone topically and rubbed for about 2 minutes. An occlusive dressing was applied and left on for 1 day. The procedure was repeated every 15 days until repigmentation. The VASI score was used to measure treatment outcomes for vitiligo. After therapy, patients were followed up after two weeks to assess the outcome. Data was analyzed through SPSS version 22. Results: A total of 67 individuals with vitiligo were included in this study out of which males were 31 (46.3%) and 36 (53.7%) females. The mean age of the study population was 25.3 ± 7.8 years. Among the 67 study participants the mean baseline VASI score was 70.40 ± 8.17. Following treatment with microneedling combined with calcipotriol plus betamethasone, the mean VASI score decreased to 31.74 ± 9.05 at follow-up. The mean reduction in VASI score was 38.66 ± 4.97, proved substantial clinical improvement in the extent of depigmentation after treatment. The paired-sample t test revealed a statistically significant difference between baseline and follow-up VASI scores (p < 0.001). Overall, age, gender, length of illness, family history, and educational status did not significantly affect treatment response (all p>0.05).  Conclusion: The study concluded that micro-needling with calcipotriol and betamethasone resulted in a significant mean change in VASI score in individuals with vitiligo

Introduction: Laparoscopic Cholecystectomy is the gold-standard procedure in treating benign gallbladder pathology, but some cases of postoperative complications, conversion to laparotomy, and delayed recovery have been reported. It is essential to determine the predictors of those events to better manage the patient’s perioperative course. Objective: To assess perioperative risk factors, postoperative complications, conversion to open surgery, and predictors of early recovery in patients undergoing laparoscopic cholecystectomy in several tertiary care hospitals. Methods: An observational cohort study of 300 adults who underwent elective or emergency laparoscopic cholecystectomy was conducted. Demographic, clinical, biochemical, radiologic, intraoperative, and postoperative variables were collected. Postoperative complications were scored based on the Claven-Dindo classification. Early recovery was defined as mobilization within 24 hours, resumption of oral intake within 24 hours, and postoperative stay in hospital not more than 48 hours. Bivariate analyses were performed before multivariable logistic regression. Discrimination of the model was assessed by area under the receiver operating characteristic curve (AUC). Center-level clustering was analyzed using generalized estimating equations. Results: Median patient age was 49 years, 57.0% of patients were female. Most procedures were elective (69.7%). Median operation time was 71 min; median estimated blood loss was 44 malls. Conversion to open surgery occurred in 5.3% of patients, and postoperative complications within 30 days - in 4.0%. Early recovery was accomplished in 74.7% of patients, readmission in 30 days - in 4.3%, and reoperation - in 0.7%. In bivariate analysis, symptom duration, pain score, direct bilirubin, and chronic obstructive pulmonary disease (COPD) were related to conversion, while delayed early recovery was related to many factors indicating inflammatory and difficult disease. In multivariable analysis, symptom duration was independently associated with conversion to open surgery (OR 0.981, 95% CI 0.968–0.994; p=0.004). After correction for center clustering, gallbladder wall thickness was independently associated with postoperative complications (OR 1.243, 95% CI 1.089–1.419; p=0.001), and symptom duration remained independently associated with conversion to open surgery (OR 0.980, 95% CI 0.973–0.988; p<0.001). Chronic cholecystitis, as compared to acute cholecystitis, was independently associated with the delayed-recovery outcome (OR 0.503, 95% CI 0.299–0.847; p=0.010). The conversion model had best discrimination (AUC=0.793), while the complication and delayed-recovery models had fair discrimination (AUC=0.697 and 0.683, respectively). Conclusion: Laparoscopic cholecystectomy proved to have relatively positive short-term results in this multicenter study population. Gallbladder wall thickness and symptoms duration were found to be predictors of some unfavourable outcomes, controlling for important variables and center-specific clustering. The conversion model proved itself to be discriminating while prediction of complications and prolonged recovery was not strong. More prospective studies are needed for practical application of the predictive models.

Introduction: Acid–base derangement is near-universal in septic shock, yet the discriminatory value of individual arterial blood gas (ABG) components measured at the point of intensive care admission remains incompletely characterised in Indian tertiary care settings. Objective: To determine whether admission blood pH, partial pressure of carbon dioxide (pCO₂), serum bicarbonate and base excess distinguish survivors from non-survivors among critically ill patients with septic shock. Methods: A prospective observational study was conducted in the Medical Intensive Care Unit of K.R. Hospital, Mysore Medical College and Research Institute, over twelve months (January–December 2018). One hundred consecutive adults aged over 18 years fulfilling Surviving Sepsis Campaign criteria for sepsis and septic shock were enrolled after written informed consent. Pregnancy, malignancy, treated HIV infection and chronic liver disease were exclusions. A single arterial blood gas sample was obtained within 24 hours of admission, along with complete haemogram, renal and liver function tests, serum electrolytes and random blood sugar. Patients were followed to discharge or in-hospital death. Analysis used SPSS version 20 with non-parametric t-test and ANOVA; p < 0.05 was significant. Results: Of 100 patients (50 male, 50 female; mean age 51.7 ± 17.2 years), 53 died and 47 survived, an in-hospital mortality of 53%. Lower respiratory tract infection was the commonest source (42%). Mean admission pH was 7.31 ± 0.10 in survivors versus 7.13 ± 0.11 in non-survivors (p < 0.001); 43 of 48 patients presenting with pH below 7.20 died. Mean pCO₂ was 29.8 ± 7.9 mmHg in survivors versus 18.8 ± 5.0 mmHg in non-survivors (p < 0.001), with 98.1% of non-survivors hypocapnic below 35 mmHg. Mean bicarbonate was 19.3 ± 4.6 mEq/L versus 12.9 ± 4.0 mEq/L (p < 0.001), and mean base excess −4.0 ± 5.8 mEq/L versus −14.2 ± 4.3 mEq/L (p < 0.001). Ninety percent of deaths occurred in patients with a base deficit exceeding 11 mEq/L. Conclusion: Severe metabolic acidosis at the point of intensive care admission identifies septic shock patients at greatly elevated risk of death. Base excess showed the widest separation between outcome groups and is a simple, immediately available bedside index warranting incorporation into early risk stratification.

Introduction: To assess whether retinal vascular measurements reflect systemic microvascular dysfunction in severe pediatric and adult sepsis and whether they improve short-term risk stratification. Study design: Prospective multicentre paired-cohort study. Place and duration of the study: Pediatric and adult intensive care units in Karachi and Riyadh from January 2024 to June 2026. Methodology: The cohort comprised 160 patients with severe sepsis and 80 age-stratified controls. Handheld optical coherence tomography angiography quantified superficial and deep capillary plexus vessel density and foveal avascular zone area. Sublingual videomicroscopy measured perfused vessel density and microvascular flow index. Sepsis assessments were obtained within six hours of recognition and at 24 hours. The primary outcome was the association between superficial retinal vessel density and sublingual perfused vessel density. Secondary outcomes included associations with lactate, age-appropriate organ dysfunction score, 24-hour change and 28-day mortality. Results: Superficial retinal vessel density was lower in pediatric sepsis than pediatric controls (40.8 ± 3.2% versus 46.8 ± 2.5%; p<0.001) and in adult sepsis than adult controls (39.0 ± 3.6% versus 45.3 ± 2.2%; p<0.001). Across the sepsis cohort it correlated with sublingual perfused vessel density (Spearman ρ=0.81; p<0.001), lactate (ρ=-0.67; p<0.001) and organ dysfunction score (ρ=-0.62; p<0.001). The adjusted odds ratio for 28-day mortality was 1.18 per one-percentage-point decrease (95% CI 0.97–1.44; p=0.094). Adding retinal vessel density to the clinical model increased area under the receiver-operating curve from 0.67 to 0.70. Conclusion: Retinal vessel density tracked systemic microvascular perfusion in both age strata and added prognostic information beyond routine clinical measures. Standardized bedside retinal imaging warrants validation in real multicentre cohorts.

Introduction: There are significant psychological and social implications of infertility, especially anxiety and depression. The study aimed to compare the psychological morbidity of women who had primary infertility with that of fertile women. Methods: A comparative analytical cross-sectional study was carried out between 120 women, 60 women with primary infertility and 60 women who were fertile. Consecutive sampling was used to recruit participants. Data on the sociodemographic and reproductive characteristics were collected, and anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Independent samples t-test, Mann–Whitney U test, Chi-square/Fisher's exact test, and binary logistic regression were used for analysis of data. Results: Women with primary infertility showed significantly higher mean HADS-Anxiety score than fertile women (p<0.001), as well as a higher HADS-Depression score (p<0.001). Similarly, anxiety was seen in 38.3% compared with 10.0%, and depression was seen in 23.3% in comparison with 5.0% of the two groups, respectively (p<0.001). Following adjustment, the anxiety and depression factors were independently associated with primary infertility (p<0.001 and p=0.003, respectively). Conclusion: There was a significant association between primary infertility and anxiety and depression. Routine psychological screening and integrated psychosocial support should be considered an essential component of infertility care.

Introduction: Predictable esthetic results with resin-based restorations are dependent upon an accurate shade selection. Conventional visual shade matching might be subjective, and artificial intelligence (AI) may help solve this issue. Objective: To compare AI-assisted and conventional shade matching regarding esthetic outcomes and longevity of contemporary resin-based restorations. Methods: This prospective randomized comparative study involved 134 restorations, including 67 AI-assisted and 67 conventional shade matching groups. Shade accuracy (ΔE00), esthetic parameters, complications, and survival of the restoration were evaluated at baseline, 3, 6, and 12 months. The statistical analyses included t-test, Mann-Whitney U test, chi-square/Fisher's exact test, repeated-measures analysis, Kaplan–Meier survival analysis, log-rank test, and Cox regression. Results: The percentage of correct shade matching was significantly greater with AI (p=0.003), and baseline ΔE00 was lower (p<0.001). At 12 months, the AI group had an acceptable colour match that was higher than the other group (p=0.007). AI also resulted in less marginal discoloration and surface staining. Twelve-month survival was 94.0% versus 85.1% (p=0.087). The ΔE00 >3 and 6-month marginal discoloration were independent predictors for failure. Conclusion: Final results of the AI-assisted shade matching showed good esthetic results and color stability, but no significant survival benefit was shown over a 12-month period.

Introduction: The Anterior Cruciate Ligament (ACL) tear is a widespread concern around the world. Especially among people who participate in high-impact sports, have early-onset osteoarthritis with concomitant knee pain and have a lower quality of life between the ages of 30 and 50. Objective: To determine the functional outcome of arthroscopic ACL reconstruction with peroneus longus autograft with both femoral and tibial suspensory fixation. Methodology: This descriptive case study was conducted in the Department of Orthopaedics, at Hayatabad Medical Complex, Peshawar, from January 2025 to June 2025. A total of 96 patients were included through nonprobability consecutive sampling. A thorough history was taken, and a detailed physical examination was performed along with baseline LGS calculation. After an MRI report was confirmed for ACL injury, reconstruction (arthroscopic) was performed using femoral and tibial suspensory fixation with peroneus longus autograft. Functional outcomes were assessed using the IKDC score at follow up. Data were analyzed by using SPSS-23. Results: As per frequencies and percentages for functional outcomes, 86(89.6%) patients had normal outcome, 4(4.2%) had near normal, 3(3.1%) had abnormal and 3 patients (3.1%) had severely abnormal outcomes. No significant associations were observed with age (p=.317), duration of injury (p=0.204). Female (92.1%) showed significantly better outcomes than (87.9%) male (p=.027). Conclusion: This study demonstrated that arthroscopic ACL reconstruction with peroneus longus autograft with both femoral and tibial suspensory fixation in primary ACL reconstruction is a safe procedure with an optimum outcome. Peroneus longus tendon autograft can be an alternative graft in single-bundle ACL reconstruction

Introduction: Acute ischemic stroke (AIS) is associated with inflammatory activation, oxidative stress, and progressive neuronal injury. C-reactive protein (CRP) is an acute-phase inflammatory marker, while serum ferritin represents both body iron stores and an acute-phase response. Their relationship with neurological severity may provide a simple biochemical approach to prognostic assessment. Aim: To determine the correlation of admission CRP and serum ferritin levels with neurological severity assessed using the National Institutes of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke. Materials and Methods: This cross-sectional study included 115 symptomatic AIS patients admitted to the Department of General Medicine, McGann District Hospital, Shivamogga, between June 2023 and June 2024. CRP and serum ferritin were measured from venous blood samples obtained at admission. CRP was determined by turbidimetry, while ferritin was measured using a Beckman Coulter Chemistry Analyzer based on spectrophotometry. Stroke severity at discharge was classified according to NIHSS as minor (1–4), moderate (5–15), moderate-to-severe (16–20), or severe (21–42). Data were analyzed using SPSS version 26. Results: The mean age was 49.39 ± 14.10 years; 73 (63.48%) patients were male. The majority had moderate stroke (67.83%), followed by moderate-to-severe stroke (21.74%). Mean CRP increased from 42.30 ± 14.06 in minor stroke to 351.77 ± 97.83 in severe stroke (p<0.0001). Mean serum ferritin increased from 163.20 ± 117.36 ng/mL to 416.39 ± 90.33 ng/mL across the corresponding categories (p<0.0001). NIHSS demonstrated strong positive correlations with both CRP (r=0.99, p=0.01) and ferritin (r=0.97, p=0.03). Conclusion: Admission CRP and serum ferritin increased progressively with NIHSS-defined stroke severity. Both biomarkers showed strong positive correlations with NIHSS, supporting their potential utility as adjunctive prognostic markers in acute ischemic stroke.

Introduction: Abnormal placentation is a major cause of maternal and perinatal morbidity globally. Elevated uterine artery pulsatility index (PI) during the first trimester has been associated with several placental-mediated complications, including pre-eclampsia, fetal growth restriction (FGR), oligohydramnios, stillbirth, and placental abruption. Objective: To describe a series of pregnancies complicated by placental insufficiency and related  adverse pregnancy outcomes in women with abnormal uterine artery Doppler findings in the first trimester and to emphasize the role of Doppler assessment in early risk stratification. Case Series: Materials and methods: This report forms part of a prospective observational study conducted over a period of one year from June 2025 to May 2026 involving 120 singleton pregnancies undergoing first-trimester uterine artery Doppler assessment between 11 and 14 weeks of gestation. All pregnant women included in the study were followed throughout the gestation for pregnancy related complications (early onset pre-eclampsia, fetal growth restriction, late onset pre-eclampsia,, oligohydramnios, placental abruption and still-birth). Serial Ultrasound monitoring in second and third trimesters was done for all the women with abnormal first-trimester uterine artery Doppler study. Results: Of the 120 study population , 93(77%) of antenatal women were found to have normal first trimester uterine artery pulsatility index(PI) and the rest 27(23%) had abnormal pulsatility index. All(93) antenatal women who were found to have normal first trimester uterine artery pulsatility index had no adverse pregnancy outcomes. About 64%(17/27) of women with abnormal first trimester uterine artery PI developed adverse pregnancy outcomes, while 36% (10/27)had normal pregnancy outcome . In our study, 23.5% developed preeclampsia, 29.4% developed oligohydramnios, 35.2% developed fetal growth restriction, 5.88 % developed placental abruption and 5.88% delivered stillbirth neonates. Representative cases demonstrated abnormal placental morphology, preplacental subchorionic hematoma formation, fetal growth restriction, oligohydramnios and altered placental blood flow patterns. Conclusion: First-trimester uterine artery Doppler serves as a valuable screening tool for identifying pregnancies at risk of placental dysfunction. Abnormal Doppler findings warrant close antenatal surveillance and may facilitate timely intervention to improve maternal and fetal outcomes.

Introduction: Psoriasis is a chronic immune-mediated inflammatory disorder with systemic associations, including metabolic syndrome and increased cardiovascular risk. Vitamin D plays an important role in immune modulation and keratinocyte proliferation, suggesting a potential therapeutic benefit in psoriasis management. Aim: To evaluate the effect of vitamin D supplementation as an adjunct to standard therapy on clinical outcomes and disease severity in patients with psoriasis. Materials and Methods: This prospective, randomized, comparative study was conducted at a tertiary care center over 18 months. A total of 70 adult psoriasis patients with vitamin D deficiency (<20 ng/mL) were enrolled and randomized into two groups (n=35 each). Group A received standard therapy, while Group B received standard therapy plus oral vitamin D (60,000 IU weekly for 6 weeks). Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI) score at baseline and at 8 weeks. Biochemical parameters were also evaluated. Statistical analysis was performed using Student’s t-test and Pearson’s correlation. Results: Baseline demographic, clinical, and biochemical parameters were comparable between groups (p>0.05). At 8 weeks, Group B showed significantly greater clinical improvement, with a higher proportion of patients achieving mild disease (54.3% vs. 14.3%) and a lower proportion remaining severe (14.3% vs. 51.4%) compared to Group A (p=0.02). Mean PASI scores were significantly reduced in Group B (3.24 ± 2.92) compared to Group A (5.79 ± 2.56) (p=0.03). Conclusion: Vitamin D supplementation as an adjunct to standard therapy significantly improves disease severity in psoriasis and may serve as an effective, safe therapeutic strategy.

Introduction: Laparoscopic surgery has fundamentally changed the landscape of general surgery, offering patients the benefits of minimal scarring, shorter hospital stays, and less postoperative pain. However, performing these minimally invasive procedures in a rural tertiary care setting brings unique challenges, often driven by delayed patient presentations. Methods: We conducted a prospective observational study at SLN MCH, Koraput, spanning from June 2024 to May 2025. We followed 87 consecutive patients who underwent various laparoscopic procedures to document and analyze intraoperative and postoperative complications. Results: Out of the 87 patients, complications were observed in 11 cases, yielding an overall complication rate of 12.6%. The most common issue was port-site infection (5.7%). When analyzing the data, we found a statistically significant increase in complication rates among patients undergoing emergency surgeries compared to those having elective procedures (p=0.011). Conclusion: Laparoscopic surgery remains a safe and highly effective option at our institution. However, the significantly higher complication rate in emergency settings highlights the crucial need for senior surgical supervision, careful patient selection, and robust postoperative wound care counseling in our community.