Introduction: Documenting caesarean indications can support clinical audit and appropriate delivery planning. Objective: To describe selected indications among women undergoing caesarean section at Lady Reading Hospital, Peshawar. Methods: This cross-sectional study enrolled 121 women through consecutive non-probability sampling from 22 September 2022 to 21 March 2023. Indications were stratified by age, parity, gestational age, and socioeconomic status using SPSS version 25. Results: Repeat caesarean section was the most frequent listed indication (27.3%), followed by oligohydramnios (21.5%), post-date pregnancy (18.2%), prolonged labour (16.5%), and fetal distress (9.9%). Fetal distress was more frequent at parity 4–6 than at parity 1–3 (22.7% versus 7.1%; p = 0.026). Gestational age was associated with prolonged labour and oligohydramnios (p = 0.002 each). The five indication counts totalled 113 rather than 121 and require clarification. Conclusion: The findings describe the enrolled caesarean population and exploratory subgroup associations. They cannot establish the overall caesarean rate or identify avoidable operations.

Background: Reduced amniotic fluid at term commonly prompts obstetric intervention, yet the degree of reduction that meaningfully raises neonatal risk remains unclear. This study aimed to describe neonatal outcomes in term oligohydramnios and compare severe (AFI ≤2.0 cm) with moderate (AFI 2.1–5.0 cm) reduction. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Moulvi Ameer Shah Memorial Hospital, Peshawar. Of 208 records with an amniotic fluid index (AFI) ≤5 cm, 188 singleton pregnancies at 37–40 weeks were analyzed using Welch’s t test, Fisher’s exact test, Haldane-corrected odds ratios (OR) and correlation analysis (p<0.05 significant). Results: Mean maternal age was 29.96 ± 3.59 years and mean AFI 3.24 ± 1.14 cm; 49 women (26.1%) had severe oligohydramnios. Overall, 68 (36.2%) had cesarean delivery, 77 (41.0%) neonates required NICU admission, 9 (4.8%) were stillborn and 8 (4.3%) died neonatally. Severe oligohydramnios was associated with lower birth weight (2.24 vs 2.85 kg, p<0.001), lower 5-minute Apgar score (6.51 vs 8.74, p<0.001) and more NICU admission (100% vs 20.1%; OR 387.3, 95% CI 23.2–6472.2). All stillbirths and neonatal deaths occurred in the severe group (p<0.001). Conclusion: In term pregnancies with oligohydramnios, an AFI of 2 cm or less identified the neonates at greatest risk. Women with severe reduction need growth and Doppler assessment and careful delivery planning.

Introduction: Acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) represents a frequent urological emergency among elderly men and requires prompt bladder decompression through urethral catheterization. Although Trial Without Catheter (TWOC) is widely accepted as the initial conservative management strategy following catheter drainage, the optimal duration of catheterization before attempting catheter removal remains controversial. Early catheter removal may reduce catheter-related morbidity and improve patient comfort; however, delayed catheterization may allow recovery of detrusor function and improve the likelihood of successful voiding. OBJECTIVE: To compare the outcomes of TWOC performed after 24 hours versus after 5 days of catheterization in patients with AUR secondary to BPH. METHODS: A quasi-experimental design was adopted for this study, which was conducted at the Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, from 1st February 2026 to 31st July 2026. A total of 76 male patients presenting with first-episode acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) were enrolled. Participants were allocated into two intervention groups based on different trial-of-voiding-without-catheter (TWOC) timing protocols: Group A underwent TWOC after 24 hours (n=38), whereas Group B underwent TWOC after 5 days (n=38). The primary outcome measure was successful TWOC, defined as spontaneous urination without the need for re-catheterization. Secondary outcomes included the rate of re-catheterization, post-void residual urine volume, and catheter-related complications. Data were analyzed using independent-samples t-test for continuous variables, Chi-square/Fisher’s exact test for categorical variables, and multivariable logistic regression to identify factors associated with successful TWOC. A two-sided p value <0.05 was considered statistically significant. RESULTS: The baseline demographic and clinical characteristics were comparable between both groups. Successful TWOC was achieved significantly more frequently in the delayed TWOC group compared with the early TWOC group (78.9% vs. 52.6%, p=0.015). The requirement for re-catheterization was significantly lower among patients undergoing TWOC after 5 days (21.1% vs. 47.4%, p=0.015). Catheter-related complications were lower in the delayed TWOC group; however, the difference was not statistically significant (21.1% vs. 31.6%, p=0.306). Multivariable logistic regression demonstrated that smaller prostate volume and alpha-blocker therapy were independent predictors of successful TWOC. CONCLUSION: Delayed TWOC after five days of catheterization significantly improves the probability of successful spontaneous voiding and reduces the need for re-catheterization compared with TWOC performed after 24 hours in patients with AUR secondary to BPH. These findings support delayed catheter removal as an effective conservative management approach, particularly in appropriately selected patients receiving alpha-blocker therapy.

Introduction: Treatment discontinuation occurs in approximately 70% of elderly cancer patients receiving chemotherapy, yet predictive models incorporating early treatment response remain limited. We developed a toxicity-based prognostic model to identify patients at risk for premature chemotherapy discontinuation. Methods: Retrospective analysis of 106 elderly patients (≥60 years) with solid tumors receiving chemotherapy. Hematologic malignancies were excluded to enhance cohort homogeneity. Sequential logistic regression models incorporated baseline variables (Model A), cycle 2 toxicity (Model B), and cumulative toxicity trajectory (Model C) to predict treatment discontinuation. Results: Overall, 78 patients (73.6%) discontinued chemotherapy prematurely. Mean age was 66.7 years (SD 6.1); 47.2% were female. Model A (baseline only) achieved AUC 0.62. Model B (+ cycle 2 toxicity) improved to AUC 0.70. Model C (+ cumulative toxicity) achieved AUC 0.75 (95% CI 0.65-0.83) with excellent calibration (Hosmer-Lemeshow p=0.81). Cumulative Grade 3-4 toxicity events independently predicted discontinuation (OR 1.28 per event, 95% CI 1.06-1.55, p=0.009). Worsening toxicity trajectory (≥2-grade increase between cycles) predicted discontinuation (OR 2.58, 95% CI 1.09-6.13, p=0.031). Risk stratification identified three groups with observed discontinuation rates of 37.5% (low-risk), 60.6% (intermediate), and 82.1% (high-risk), representing an absolute risk difference of 44.1 percentage points (p<0.001). Performance remained robust across treatment intent (adjuvant AUC 0.71, palliative AUC 0.74) and disease stage (early I-II AUC 0.68, advanced III-IV AUC 0.76) subgroups. Conclusions: Early toxicity monitoring during chemotherapy cycles 2-3 effectively predicts treatment discontinuation in elderly patients with solid tumors. Dynamic risk stratification enables clinician-patient discussions regarding realistic treatment completion expectations and supportive care modifications. Prospective validation is warranted.

Background:  Pesticide poisoning is an important preventable cause of morbidity and mortality, particularly in agricultural communities where toxic compounds may be readily accessible. Fatal pesticide self-poisoning remains a major public-health and medico-legal concern in low- and middle-income countries. Objective: To describe the epidemiological profile of fatal pesticide poisoning cases undergoing medico-legal autopsy, with particular reference to age, sex, occupation, locality, manner of death and period of survival. Materials and Methods: An autopsy-based descriptive observational study was conducted in the Department of Forensic Medicine, Government Medical College, Latur, from 1 January 2017 to 31 May 2018. A total of 156 fatal pesticide poisoning cases were included. Information was obtained from autopsy findings, available clinical records, police inquest papers and accompanying history. Data were summarized as frequencies and percentages. Results: During the study period, 1,950 medico-legal autopsies were conducted, including 250 poisoning deaths. Fatal pesticide poisoning accounted for 156 cases, representing 62.4% of poisoning deaths and 8.0% of all medico-legal autopsies. Males constituted 129 (82.7%) cases and females 27 (17.3%). The 20-29-year age group contributed 134 (85.9%) cases. Agricultural workers accounted for 138 (88.5%) cases and 144 (92.3%) victims were from rural areas. Suicide was the commonest manner of death (120; 76.9%), followed by accidental poisoning (30; 19.2%) and homicide (6; 3.8%). Fifty-five victims (35.3%) survived for 6-12 hours, while 52 (33.3%) were brought dead. Conclusion: Fatal pesticide poisoning in this autopsy series predominantly involved young adult males, agricultural workers and rural residents, with suicidal ingestion forming the largest group. Prevention requires safer pesticide access and storage, effective regulation of highly hazardous pesticides, community awareness and timely emergency care.

Background:  Surgical site infection (SSI) is a significant complication that occurs after surgery, and it increases morbidity, time to healing, length of hospital stay and healthcare costs. Body mass index (BMI) is an easily-determined measure of nutrition and obesity which can affect wound healing and infection following abdominal surgery. Objective:  To investigate the association between BMI and the occurrence of surgical site infection among patients undergoing elective abdominal surgery. Methodology: A hospital-based observational cohort design was considered for 77 adult patients undergoing elective abdominal surgical procedures at the Department of General Surgery, Khalifa Gul Nawaz Hospital Bannu, Bannu Medical College, from June to December 2025. BMI was divided into four groups and the main outcome was SSI within 30 days of surgery. Data analysis was designed to be performed with SPSS version 26 and the following tests were used: chi-square test, Fisher's exact test, and odds ratio (OR) with 95% confidence interval (CI).  Results: In the dataset, 14 of 77 patients (18.2%) developed SSI. Infection occurred in 1/20 (5.0%) patients with BMI below 25 kg/m², 3/27 (11.1%) overweight patients, 5/20 (25.0%) patients with class I obesity, and 5/10 (50.0%) patients with BMI ≥35 kg/m². The overall association between BMI category and SSI was statistically significant using the Pearson chi-square test (p=0.014), although sparse expected cell counts warrant an exact-test analysis. Compared with patients with BMI below 35 kg/m², those with BMI ≥35 kg/m² had higher odds of SSI (OR=6.44, 95% CI: 1.55–26.79; Fisher's exact p=0.015).  Conclusion: The analysis demonstrates how increasing BMI may be associated with a higher postoperative SSI risk. Confirmation using the actual 77-patient dataset is essential before conclusions about the study population can be established. Preoperative BMI assessment may contribute to individualized surgical risk evaluation.

Background: Emergency midline laparotomy can cause postoperative complications such as surgical site infection, incisional hernia, and wound dehiscence. It is important to obtain optimal fascial closure to minimize postoperative morbidity. Objective: To compare the frequency of surgical site infection and incisional hernia following primary fascial closure versus primary closure supplemented with retention sutures after emergency midline laparotomy. Methods: This was a comparative observational study of 250 patients at Abbottabad International Medical College and Teaching Hospital, Abbottabad. It was conducted for 1 year from 1st June 2025 to 31st May 2026. The patients were randomly allocated into two groups of 125 subjects each based on closure technique. Patients were randomly divided into two groups of 125 patients each, based on closure technique. SPSS 26 was used for data analysis, and p ≤0.01 was considered significant. Conclusion: Surgical site infection (SSI) was found in 18.4% of the patients who underwent primary fascial closure, while it was seen in 9.6% of patients receiving additional retention sutures, which is statistically significant (p=0.045). Incisional hernia was observed in 15.2% and 6.4%, respectively (p=0.025). The group that had the sutures retained also had fewer cases of wound dehiscence (p=0.020). Conclusion: Primary fascial closure with retention sutures appeared to have fewer surgical site infections, incisional hernias, and wound dehiscence compared to conventional primary closure of the fascial layer after emergency midline laparotomy.

Background: Emergency midline laparotomy can cause postoperative complications such as surgical site infection, incisional hernia, and wound dehiscence. It is important to obtain optimal fascial closure to minimize postoperative morbidity. Objective: To compare the frequency of surgical site infection and incisional hernia following primary fascial closure versus primary closure supplemented with retention sutures after emergency midline laparotomy. Methods: This was a comparative observational study of 250 patients at Abbottabad International Medical College and Teaching Hospital, Abbottabad. It was conducted for 1 year from 1st June 2025 to 31st May 2026. The patients were randomly allocated into two groups of 125 subjects each based on closure technique. Patients were randomly divided into two groups of 125 patients each, based on closure technique. SPSS 26 was used for data analysis, and p ≤0.01 was considered significant. Conclusion: Surgical site infection (SSI) was found in 18.4% of the patients who underwent primary fascial closure, while it was seen in 9.6% of patients receiving additional retention sutures, which is statistically significant (p=0.045). Incisional hernia was observed in 15.2% and 6.4%, respectively (p=0.025). The group that had the sutures retained also had fewer cases of wound dehiscence (p=0.020). Conclusion: Primary fascial closure with retention sutures appeared to have fewer surgical site infections, incisional hernias, and wound dehiscence compared to conventional primary closure of the fascial layer after emergency midline laparotomy.

Background: Maintaining analytical accuracy in high-throughput clinical chemistry laboratories is essential for reliable patient care. Analytical deviations between scheduled control measurements may not be picked up by conventional internal quality-control procedures. In addition to patient-based real-time quality control (PBRTQC), error detection using artificial intelligence (AI) provides alternative means of ongoing monitoring of laboratory performance. Objective: To explore the application of real-time patient data quality control and AI-driven error detection in high-throughput chemistry analyzers and compare their potential performance with conventional quality-control methods. Methods: A laboratory-based analytical comparative study was proposed at Armed Forces Institute of Pathology (AFIP), Rawalpindi, from 22 August 2022 to 24 August 2024. The analysis, with 72 independent quality-control evaluation episodes included. The sensitivity, specificity, predictive values, overall accuracy, error-detection time and false positive rates of conventional QC and AI-assisted monitoring were compared. Exact McNemar tests were used to compare paired categorical outcomes. Results: Of the 72 evaluation episodes, 24 (33.3%) were classified as containing laboratory errors. AI-assisted QC detected 21 of 24 confirmed errors compared with 14 detected through conventional QC. Sensitivity was higher with AI-assisted QC than with conventional QC (87.5% versus 58.3%, p=0.039). Overall accuracy was 87.5% and 80.6%, respectively (p=0.302). Specificity was 87.5% for AI-assisted QC and 91.7% for conventional QC (p=0.688). median error-detection times were 12 and 29 minutes, respectively; statistical significance could not be determined from the available aggregate figures. Conclusion: AI-assisted real-time quality monitoring has the potential to improve the identification of laboratory errors and strengthen analytical surveillance in high-throughput chemistry laboratories. However, increased alert sensitivity may be accompanied by more false-positive results. Validation using actual laboratory data is essential before conclusions can be drawn regarding implementation effectiveness.

Background:  Serum ammonia measurements are sensitive to preanalytical conditions, including storage temperature, light exposure, and duration of storage.  Objective:  To evaluate the effects of light exposure, temperature, and storage duration on measured serum ammonia concentrations under controlled laboratory conditions. Methodology: There were 30 independent serum specimens subjected to a laboratory-based factorial experimental design. Ammonia levels were measured at 0, 1, 2, 4, 8 and 24 hours, where the light-exposed and light-protected conditions were 1000 lux and 4 ± 1°C and 25 ± 2°C respectively. Absolute change from baseline and percentage change from baseline were used to express changes. The main effects and interactions were reported using a linear mixed-effects model with multiple comparisons using the Holm procedure   Results:  The baseline mean ammonia concentration was 28.64 ± 6.83 µmol/L. After 24 hours, concentrations increased by 33.55% under room-temperature, light-protected conditions and by 38.62% under room-temperature, light-exposed conditions. Under refrigeration, concentrations decreased by 5.38% and 6.39%, respectively. Storage temperature (+8.45 µmol/L, p < 0.001), storage time (+0.38 µmol/L/hour, p < 0.001), and the temperature-by-time interaction (p < 0.001) were statistically significant. The overall light effect was not significant (p = 0.142), although the exposed-versus-protected difference at 25°C was +1.45 µmol/L (p = 0.002). Conclusion: Storage temperature and duration may substantially influence measured serum ammonia concentrations, but the reported findings require validation against the original experimental dataset.

Background: Hyperemesis gravidarum (HG) is the severe end of pregnancy nausea and vomiting and a leading cause of admission in early pregnancy. Women with limited nutritional reserve may tolerate prolonged vomiting poorly, yet Pakistani data are scarce. This study aimed to determine whether low pre-pregnancy body mass index (BMI) is associated with severe HG among women admitted with HG in Peshawar. Materials and Methods: This hospital-based cross-sectional study analysed records of 146 women admitted with HG to the Department of Obstetrics and Gynecology, Moulvi Ameer Shah Memorial Hospital, Peshawar. BMI was classified using WHO cut-offs, and severity was grouped as severe or non-severe (mild or moderate). Fisher's exact test, prevalence ratio (PR), Pearson and Monte Carlo exact chi-square tests, the linear-by-linear association test and Kendall's tau-b were applied. Results: Underweight was present in 66 women (45.2%) and severe HG in 86 (58.9%). Every underweight woman had severe Hyperemesis gravidarum, compared with 20 of 80 (25.0%) women who were not underweight (PR 4.00, 95% CI 2.74–5.85; p<0.001). Severity declined steadily across BMI categories (linear-by-linear χ²=112.73, p<0.001; tau-b −0.82). Reclassifying two women with a BMI of exactly 18.5 kg/m² did not alter the result (PR 3.73, 95% CI 2.61–5.33). Conclusion: Low pre-pregnancy BMI was strongly associated with severe HG in this cohort. Severity declined steadily as BMI increased. Early recording of weight and height may help identify women at risk, and larger prospective studies should confirm this.

Background: Erythropoietin-resistant anemia remains a challenging complication in patients receiving maintenance hemodialysis.  Objective: To evaluate the efficacy and safety of full-dose erythropoietin combined with low-dose roxadustat in hemodialysis patients with erythropoietin-resistant anemia.

Methods: This retrospective observational study was conducted at the Department of Nephrology, HBS Medical and Dental College Islamabad from July 2025 to July 2026 included 185 adult patients with end-stage kidney disease receiving maintenance hemodialysis who had persistent anemia despite adequate erythropoietin therapy.  Results: Mean hemoglobin increased from 8.1±0.8 g/dL at baseline to 10.4±1.1 g/dL at 12 weeks (p<0.001), while hematocrit increased from 25.2±3.1% to 32.3±3.9% (p<0.001). Overall, 134 (72.4%) patients achieved treatment response, while 139 (75.1%) had a hemoglobin increase of ≥1.0 g/dL and 131 (70.8%) achieved hemoglobin ≥10.0 g/dL. Mean erythropoietin requirement decreased from 12,480±2,960 to 9,420±2,610 IU/week (p<0.001). Adverse events occurred in 29 (15.7%) patients, with hypertension being the most common.  Conclusion: It is concluded that low-dose roxadustat combined with ongoing full-dose erythropoietin was associated with significant improvement in hemoglobin levels and reduced erythropoietin requirements in patients with erythropoietin-resistant anemia undergoing hemodialysis.

Background: Anastomotic leakage is one of the most serious complications following colorectal surgery and may lead to sepsis, reoperation, prolonged hospitalization, and increased morbidity. Protective ileostomy is commonly used to divert fecal flow following selected lower colorectal and colonic anastomoses and may reduce the clinical consequences of anastomotic failure. However, ileostomy itself can be associated with dehydration, electrolyte disturbances, and other stoma-related complications. Objective: To evaluate the role of protective ileostomy in patients undergoing lower colorectal and colonic anastomosis, with particular emphasis on anastomotic leakage, postoperative complications, reoperation, and hospital stay. Methods: A hospital-based observational study was conducted at Abbottabad International Medical College, Abbottabad, Pakistan, from January 2024 to December 2025. A total of 50 patients undergoing lower colorectal or colonic anastomosis were included. Patients were evaluated according to demographic characteristics, type of anastomosis, use of protective ileostomy, anastomotic leakage, postoperative complications, reoperation, and duration of hospitalization. Patients were categorized according to whether protective ileostomy was performed. Results: Of the 50 patients, 22 (44.0%) underwent protective ileostomy, while 28 (56.0%) underwent anastomosis without diversion. Anastomotic leakage occurred in 2 (9.1%) patients in the protective ileostomy group compared with 4 (14.3%) patients in the non-ileostomy group. Reoperation was required in 1 (4.5%) patient with ileostomy and 3 (10.7%) patients without ileostomy. Stoma-related complications included high-output stoma, dehydration, electrolyte imbalance, and peristomal skin irritation. Conclusion: Protective ileostomy was associated with lower observed rates of anastomotic leakage and reoperation in this study. However, stoma-related complications remain important considerations. Protective ileostomy should therefore be considered selectively according to patient characteristics, anastomotic level, surgical risk, and intraoperative findings. Larger prospective studies with longer follow-up are required to establish its benefits and risks more conclusively.

Introduction: Interstitial lung disease (ILD) comprises a heterogeneous group of pulmonary disorders characterized by inflammation and fibrosis of the lung interstitium, leading to progressive respiratory impairment.  Objective: This study aimed to evaluate the clinical profile and radiological patterns of interstitial lung disease among patients presenting at a tertiary care center. Methods: This analytical cross-sectional study was conducted among 180 patients diagnosed with interstitial lung disease at Al Aleem medical college Lahore from May 2025 to May 2026. Patients of either gender who were diagnosed with ILD based on clinical evaluation, pulmonary function testing, and radiological assessment were eligible for inclusion. Patients with incomplete clinical records, inadequate radiological imaging, previously diagnosed pulmonary malignancy, active pulmonary infection, or other conditions causing secondary interstitial changes without confirmed ILD were excluded.  Results: The mean age of patients was 58.6 ± 14.2 years, with 95 (52.8%) patients aged ≥60 years. Males constituted 108 (60.0%) cases. Progressive dyspnea was the most common presenting symptom (165, 91.7%), followed by dry cough (139, 77.2%). Fine inspiratory crackles were observed in 152 (84.4%) patients, and a restrictive pulmonary function pattern was present in 137 (76.1%) cases. Idiopathic pulmonary fibrosis was the most frequent ILD subtype (62, 34.4%), followed by connective tissue disease-associated ILD (38, 21.1%) and hypersensitivity pneumonitis (27, 15.0%). On HRCT, the usual interstitial pneumonia pattern was predominant (69, 38.3%), followed by nonspecific interstitial pneumonia (41, 22.8%).  Conclusion: It is concluded that interstitial lung disease commonly presents in older individuals with progressive respiratory symptoms and restrictive lung impairment. HRCT plays a central role in identifying characteristic radiological patterns, particularly UIP and NSIP.

Background: Knee osteoarthritis is a common degenerative joint disorder associated with pain, stiffness, and progressive functional limitation. Platelet-rich plasma has emerged as a biological treatment option because of its potential anti-inflammatory and regenerative effects. Objective: To evaluate the efficacy of platelet-rich plasma therapy in improving pain and functional outcomes in patients with knee osteoarthritis. Methods: This prospective interventional study was conducted at Ayub Medical College MTI Abbottabad from June 2025 to June 2026 included 300 patients aged 40–75 years with symptomatic Kellgren–Lawrence grade I–III knee osteoarthritis. Results: Mean VAS score decreased from 7.2±1.1 at baseline to 5.1±1.2 at one month, 3.7±1.3 at three months, and 4.0±1.4 at six months (p<0.001). Mean WOMAC total score improved from 58.4±10.8 at baseline to 37.1±10.7 at six months (p<0.001). Overall, 212 (70.7%) patients were treatment responders, while 192 (64.0%) achieved ≥50% reduction in VAS score and 218 (72.7%) achieved ≥30% improvement in WOMAC score. Adverse events occurred in 41 (13.7%) patients and were predominantly mild. Conclusion: It is concluded that platelet-rich plasma therapy was associated with significant improvement in pain and functional status among patients with knee osteoarthritis, with benefits sustained for up to six months and an acceptable safety profile.

Background: Conventional transvaginal ultrasonography is widely used to evaluate endometrial abnormalities but may have limited ability to differentiate benign and clinically significant lesions. Ultrasound elastography provides additional information on tissue stiffness, which could enhance diagnostic performance. Objective: To compare the diagnostic accuracy of transvaginal ultrasound elastography and conventional ultrasonography for detecting endometrial pathology using histopathology as the reference standard. Methods: This comparative cross-sectional diagnostic accuracy study included 207 women at DHQ Hospital Landikotal, Khyber District, over six months. The participants were subjected to conventional transvaginal ultrasonography and ultrasound elastography, and then histopathologic examination was performed. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and receiver operating characteristic curves were evaluated. Results: Transvaginal ultrasound elastography showed a higher sensitivity than conventional ultrasonography (91.5% vs. 83.8%) and a higher specificity (81.5% vs. 73.8%). Elastography had an overall diagnostic accuracy of 88.4%, which was higher than conventional ultrasonography at 80.7%. The areas under the receiver operating characteristic curve were 0.884 and 0.788, respectively. Conclusion: In addition to conventional imaging, elastography may be helpful for providing complementary information regarding tissue stiffness and enhancing lesion characterization.

This retrospective cohort study was conducted at Gomal University using patient medical records. Patients with prostatic enlargement and urinary stone disease who had undergone either endourological or open surgical procedures were included. Patients were grouped based on the procedure they had received during routine clinical care.

Clinical and perioperative data were retrieved from existing records. Outcomes were compared between the two groups to evaluate differences in effectiveness and postoperative results.

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: Empyema thoracis can cause significant illness and even death in children if treatment is delayed or inadequate. Despite this, there is still no clear consensus on the best management approach. As the disease progression, fibrinous adhesions and multiloculated collections develop, making simple pleural drainage increasingly difficult and in some cases, ineffective.  Aims and Objectives: In this study, we aimed to evaluate the safety, effectiveness, operative findings and outcomes of thoracotomy and decortication for stage II – III empyema thoracis in children. Methods: This was a retrospective observational study, who underwent thoracotomy and decortication for stage II - III empyema thoracis in children during the study period from January 2013 to December 2024 in our institution. Demographic data, operative findings and outcomes were analyzed. Results: Total 50 patients (age 1 year to 12 years) (40 male and 10 female) were underwent thoracotomy and decortication. Patients were presented after 3 weeks of the onset of disease. Tube thoracostomy was done in all patients after confirmation of pus by needle thoracocentesis.  A pathogen was isolated from 10 patients. Computed tomography of chest revealed multiloculated pus, debris, thick pleural peel and encasement of lung. Thoracotomy and complete formal decortication of lung was done in all patients. The variable operative findings were multilocuiated pus, debris and thickened visceral peel. The operative findings correlated directly with the computed tomography of chest. Apyrexia after thoracotomy was 1 day and drain removal was after 3 days. Postoperative hospital stay was 7 days. There was no mortality. The patients were followed up for 1 month to 1 year. At follow up, all children were doing well and had satisfactory chest radiographs.  Conclusions: Thoracotomy and decortication is a safe, effective, and well tolerated in children for Stage II and Stage III empyema thoracis and remains procedure of choice. Timely and early operation reduces morbidity, rapid resolution symptoms and a short hospital stay.

Background: Major orthopaedic trauma may coexist with ocular and orbital injuries that are clinically subtle during early resuscitation. This study evaluated the frequency and spectrum of ophthalmic manifestations in patients with long-bone and pelvic fractures and examined factors associated with ocular abnormalities. Methods: This prospective observational study was conducted jointly by the Departments of Orthopaedics and Ophthalmology at Malati Medical College and Hospital, Turkhed, Murtizapur. Consecutive adults with acute radiologically confirmed long-bone and/or pelvic fractures underwent standardized ophthalmic assessment after stabilization, preferably within 24–48 hours. Demographic, injury-related, ocular, fundus, and imaging findings were recorded. Results: In the cohort of 100 patients, the mean age was 38.6 ± 15.2 years and 73% were male. Road traffic accidents accounted for 64% of injuries. Fifteen patients had at least one ophthalmic abnormality. Subconjunctival haemorrhage was observed in 6%, retinal haemorrhage in 4%, cotton-wool spots in 3%, Purtscher-type retinal changes in 2%, traumatic optic neuropathy in 2%, and orbital fractures in 5%. Ocular abnormalities were more frequent among patients with multiple fractures and those with associated head or facial trauma. Conclusion: Ocular abnormalities may accompany major long-bone and pelvic trauma, particularly in patients with multiple injuries or craniofacial involvement. Early structured ocular screening after stabilization may facilitate detection of occult retinal, orbital, and optic nerve injury.

Introduction: The smile line, which represents the relationship between the upper lip and the exposed maxillary anterior teeth and gingiva during smiling, is an important factor to consider in smile esthetics and plays a role in diagnosis and treatment planning in restorative dentistry, prosthodontics, periodontology, and orthodontics. It is geographically distributed in a way that is related to demographic variables. Objective: To evaluate the association of smile line type in the maxillary anterior dentition with age, gender, and ethnicity among dental outpatients. Methods: An analytical cross-sectional study was carried out in the Dental Outpatient Departments of Dow University of Health Sciences, Karachi, for one year. The subjects were 420 young adults (210 males, 210 females), aged 18–30 years, who were recruited by non-probability convenience sampling, under the following inclusion and exclusion criteria. The participants were photographed in a standardized way with a digital single-lens reflex camera, and the images were analyzed using Adobe Photoshop 7.0. Frontal photographs of the participants were taken using a digital single-lens reflex camera and analyzed in Adobe Photoshop 7.0 software, in which the participants were asked to smile. The smile line was categorized as low, average, or high based on the classification by Tjan et al., and interrater reliability was evaluated using ICC. The data were analyzed using SPSS version 25, and the chi-square test was used at the level of significance (p<0.05). Results: The average smile line was the most common type (n=283; 67.4%), followed by the low (n=100; 23.8%) and high (n=37; 8.8%) smile lines. A low smile line was more frequent in males (28.6% vs. 19.0%) and a high smile line in females (13.3% vs. 4.3%). The high smile line was found to be less frequent with age, being 13.7% in the age group 18–21 years, 7.7% in the age group 22–25 years, and 2.4% in the age group 26–30 years. Smile line type was significantly correlated with age group (p=0.004), gender (p=0.001), and ethnicity (p=0.027). Conclusion: In this sample of young adults, the predominant smile line was the average smile line, and there was a significant relationship between smile line type and age, gender, and ethnicity. Therefore, the smile line assessment should be included in the esthetic assessment, and the treatment planning should be personalized based on the demographic and dentofacial features of the patient.

Background: Occupational heat exposure may lead to dehydration and negatively impact salivary function, although there is limited evidence exploring the link between occupational heat exposure and xerostomia in outdoor workers. The aim of this study was to evaluate the correlation between occupational HS and XS among outdoor workers. Methods: An analytical cross-sectional study was conducted among 164 outdoor workers at Bahria University Health Sciences, Karachi, from 1^st February to 31^st July 2026. The demographic characteristics, occupational exposure, hydration, heat-related symptoms, and xerostomia were obtained through a structured questionnaire. Wet-bulb globe temperature (WBGT), urine specific gravity, and unstimulated salivary flow were assessed. Associations were evaluated using Chi-square tests and logistic regression. Results: Xerostomia was observed in 73 (44.5%) participants. The prevalence was higher in workers exposed to moderate and high heat compared to those exposed to low heat (p<0.001). There was a significant association between xerostomia and longer outdoor working hours, dehydration, and lower fluid consumption. The mean unstimulated salivary flow was reduced in the workers with xerostomia compared to the non-xerostomia workers (p<0.001). High heat exposure (AOR=4.91; 95% CI: 1.87-12.90), working >6 hours/day (AOR=2.36; 95% CI: 1.12-4.97), moderate/severe dehydration (AOR=3.74; 95% CI: 1.56-8.96), and fluid intake <3 L/day (AOR=2.21; 95% CI: 1.04-4.69) were independently associated with xerostomia. Conclusion: Working in conditions of occupational heat stress, long hours spent outdoors, dehydration, and lack of fluid consumption were separately associated with xerostomia. Oral dryness can be reduced in outdoor workers by implementing workplace heat-mitigation and hydration strategies.

Background: Preeclampsia is a leading cause of morbidity and mortality among pregnancies, especially in high-risk pregnancies. This study compared low-dose aspirin alone with aspirin combined with calcium supplementation for the prevention of preeclampsia. Methods: This was a prospective comparative interventional study of 182 high-risk pregnant women who were admitted to a tertiary-care hospital from 1^st December 2025 to 31^st May 2026. Participants were randomly assigned to aspirin 150 mg or aspirin 150 mg together with calcium 1.5- 2 g per day. The primary outcome was the development of preeclampsia. Assessment of maternal and neonatal outcomes was also conducted. All analyses were performed using SPSS Version 26. Results: Preeclampsia occurred in 34 (37.4%) women who took aspirin alone and 22 (24.2%) women who took aspirin and calcium (p=0.048). The combination group had a significantly higher mean gestational age at delivery. Combined supplementation was also associated with higher mean birth weight (p=0.049). The combination of aspirin and calcium was associated with lower odds of preeclampsia in multivariable analysis (p=0.043). Conclusions: High-risk women who received calcium supplementation plus low-dose aspirin had better outcomes for selected pregnancy outcomes and a decreased risk for preeclampsia.

Introduction: Traditional metrics like radiological alignment and surgeon-assessed range of motion often fail to capture a patient’s true recovery experience following total knee arthroplasty (TKA). Patient-reported outcome measures (PROMs) provide a vital, patient-centric perspective on surgical success. However, longitudinal data utilizing PROMs in Eastern India remains sparse. This study evaluates the trajectory and clinical significance of patient-reported recovery following primary TKA at a tertiary government hospital in this region.

Methods: We conducted a prospective longitudinal observational cohort study tracking 73 patients who underwent primary unilateral TKA for primary knee osteoarthritis over 12 months. Patients were evaluated using four validated instruments: the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and Short Form-36 (SF-36). Assessments occurred pre-operatively and at 1, 3, 6, and 12 months post-surgery. We analyzed score trends, examined outcome predictors using binary logistic regression, evaluated inter-PROM relationships, and calculated the achievement of the minimal clinically important difference (MCID) for each metric. Results: The cohort (mean age 62.8 ± 4.3 years; 67.1% female) demonstrated highly significant improvements across all four PROMs during the follow-up period (p < 0.001 for all). The most dramatic recoveries occurred within the first three months, with continued stabilization up to one year. By 12 months, mean VAS dropped from 7.4 to 1.0, WOMAC improved from 63.7 to 22.0, OKS rose from 19.8 to 35.5, and SF-36 increased from 37.7 to 71.6. MCID thresholds were met by 100% of patients for VAS, 94.5% for WOMAC, 93.2% for SF-36, and 84.9% for OKS. While increasing age, prolonged symptom duration, and early complications showed a trend toward poorer outcomes, they did not reach independent statistical significance. Furthermore, baseline body mass index (BMI), deformity pattern, and Kellgren-Lawrence radiological severity did not meaningfully impact PROM improvements. Inter-instrument correlations at 12 months were notably strong. Conclusions: Total knee arthroplasty delivers robust, clinically meaningful improvements in pain, functional mobility, and overall quality of life for patients in Eastern India. Our findings closely align with international registry data, underscoring that radiological severity does not dictate recovery quality. These results strongly advocate for the routine integration of PROMs alongside standard clinical assessments in regional orthopaedic practice to truly measure surgical success from the patient's perspective.

Objective: To compare the clinical and radiographic outcomes of dental implants subjected to early loading and delayed loading. Methods: A multicenter comparative study was conducted from 18 June 2025 to 18 June 2026. A total of 47 patients receiving 61 dental implants were included. Patients were assessed according to early or delayed prosthetic loading. Clinical outcomes included implant survival and implant related complications. Radiographic assessment was performed through evaluation of marginal bone level changes. Statistical comparisons were performed between the two loading groups. Results: Twenty-four patients received early loading and 23 patients received delayed loading. Implant survival was 95.8% in the early loading group and 95.7% in the delayed loading group. Mean marginal bone loss was 0.62 ± 0.24 mm with early loading and 0.71 ± 0.27 mm with delayed loading. The difference in marginal bone loss was not statistically significant. Peri implant inflammation was observed in 12.5% and 8.7% of patients respectively. Prosthetic complications occurred in 8.3% and 13.0% respectively. No significant difference was identified for the principal clinical or radiographic outcomes. Conclusion: Early loading demonstrated clinical and radiographic outcomes comparable with delayed loading. Favorable implant survival and limited marginal bone changes were observed with both protocols.

Background: Obesity may affect knee osteoarthritis (KOA) in a few ways: mechanical loading and metabolic-inflammatory pathways. This study compared metabolic, inflammatory, and adipokine profiles between obese and non-obese patients with KOA. Methods: This is an analytical cross-sectional study conducted at the Independent Medical College between 1^st November 2025 and 30^th April 2026. A consecutive sampling process was used to enroll 36 patients with primary KOA, comprising 18 obese and 18 non-obese patients. Demographic, clinical, anthropometric, metabolic, inflammatory, and adipokine parameters were examined. WOMAC and Kellgren-Lawrence grading were used to evaluate disease severity. SPSS version 26 was used for data analysis. Independent-samples t-test, Mann-Whitney U test, chi-square/Fisher's exact test, correlation analysis, and multivariable linear regression were applied. Results: Obese patients had significantly higher BMI, waist circumference, WOMAC scores, and advanced radiographic grades. They also had higher fasting glucose, HbA1c, triglycerides, LDL-C, insulin, HOMA-IR, hs-CRP, IL-6, TNF-α, leptin, and resistin, while HDL-C and adiponectin were significantly lower. BMI positively correlated with HOMA-IR, hs-CRP, leptin, WOMAC score, and Kellgren-Lawrence grade. Obesity remained independently associated with higher hs-CRP, HOMA-IR, leptin, and WOMAC scores and lower adiponectin. Conclusion: KOA patients with obesity had metabolic dysfunction, inflammatory activation, imbalance in adipokines, and higher disease severity level. These findings support an obesity-associated metabolic-inflammatory phenotype of KOA.

Objective: To compare cardiovascular outcomes and renal safety of intravascular imaging-guided versus angiography-guided percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Study Design: Systematic review with aggregate-data meta-analysis of randomized controlled trials and separately extractable randomized ACS subgroups. Place and Duration of Study: Global published evidence searched through 6 October 2026. Methodology: A reproducible PubMed search and targeted citation retrieval identified ACS-specific trial evidence. Compatible target-vessel failure (TVF) hazard ratios were pooled using inverse-variance random-effects analysis. Broader composite outcomes and differently defined kidney-injury events were examined separately. Conservative modified Hartung–Knapp intervals tested small-study uncertainty.

Results: Ten trial cohorts comprised 7,229 randomized ACS participants. Two compatible TVF cohorts included 4,337 participants: pooled HR 0.61 (95% CI 0.46–0.80; p=0.00046; I²=17.8%). The conservative interval was 0.10–3.67. Adding the broader OCCUPI ACS composite gave HR 0.59 (95% CI 0.47–0.73; I²=0%). Exploratory pooling of two differently defined renal endpoints in 1,072 participants gave RR 0.80 (95% CI 0.35–1.87; p=0.611). Conclusion: Imaging guidance supported lower cardiovascular event risk in selected ACS patients. Renal benefit remained uncertain. Sparse compatible trials and subgroup evidence require cautious interpretation.

Background: Anemia is one of the commonest health problem and it is caused due to various nutritional, chronic disease and blood loss related factors. So, this study was undertaken to assess the pattern of etiology, risk factors and severity of anemia among patients admitted to district hospital, Palakkad Kerala. Methods: A hospital based cross-sectional study was carried out among 384 patients of age >13 years with Hb. <11gm/dL admitted in the Department of General Medicine, District Hospital, Palakkad from May 2021 to April 2022. Data of demographic, clinical and laboratory investigations were collected and the etiology and severity of anemia were assessed. Results: The mean age of study population was 61.8±16.4 years and 68.2% were females. Iron deficiency anemia was the commonest etiology (63.8%) followed by anemia of chronic disease (13.3%) and B12 deficiency (12.0%). About 14% had anemia due to blood loss. Microcytic anemia was the commonest morphological pattern. The mean Hb was 6.37±1.94 g/dL and 68.8% patients had severe anemia. Increasing age was Really connected to severity of anemia (p=0.008). Vegetarianism, alcohol intake, walking barefoot and poor hygiene were quite a bit connected to severity. Conclusion: Iron deficiency was a major etiology in anemia and patients are seen to be presenting severely ill. The data highlight the importance of screening at an early stage, nutritional evaluation, detection of any underlying chronic illnesses and ongoing blood loss as well as early etiological treatment to minimize the severity.

Introduction: E-cadherin is a calcium dependent adhesion molecule required to maintain epithelial integrity. This impaired has been attributed to its loss and some cell cohesion was disrupted and it also led to an increase. tumor invasiveness. This paper set out to assess E-cadherin expression of the urothelial carcinoma and their dependence upon tumor grade and penetrating depth.  Methodology: It consisted of a cross-sectional study carried at the department of pathology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, over a period of 24 months (August 2018 to August 2020). A total of 96 histologically confirmed cases of urothelial carcinoma were included using non-probability consecutive sampling. Immunohistochemistry was performed to assess E-cadherin expression, which was classified as preserved or reduced based on membranous staining in tumor cells. The Chi-square test was used to examine relationships between tumor grade and invasion into the muscularis propria and lamina propria. Results: E-cadherin expression was preserved in 53 cases (55.2%) and reduced in 43 cases (44.8%). Reduced expression was significantly more frequent in high-grade tumors (67.3%) compared to low-grade (18.2%) (p < 0.001). Tumors with muscularis propria invasion also showed significantly more reduced E-cadherin expression (72.7%) than those without (30.2%) (p < 0.001). Lamina propria invasion was similarly associated with reduced expression (p = 0.041). Conclusion:  Reduced E-cadherin expression correlates significantly with higher tumor grade and depth of invasion, highlighting its use as a prognostic marker in urothelial carcinoma. 

Introduction: Achieving sustained glycemic control in type 2 diabetes mellitus while maintaining acceptable tolerability is an important therapeutic goal. Vildagliptin, a dipeptidyl peptidase-4 inhibitor, augments endogenous incretin activity in a glucose-dependent manner, whereas metformin mainly lowers hepatic glucose output. This study evaluated and compared the efficacy and safety of these two agents when used as monotherapy in adults with newly diagnosed type 2 diabetes mellitus. Methods: A prospective randomized controlled study was carried out in the General Medicine outpatient department of Sri Venkateswara Ram Narayan Ruia Government General Hospital, Tirupati, between December 2023 and August 2024. Sixty adults aged 30–60 years with newly diagnosed type 2 diabetes mellitus were assigned in equal numbers to receive either vildagliptin 50 mg once daily or metformin 500 mg once daily. Fasting blood glucose, two-hour postprandial blood glucose, and HbA1c were measured at baseline, 3 months, and 6 months. Paired t-tests were used for within-group comparisons were reported, and independent-samples t-tests were used for comparisons between groups. Adverse events were documented during follow-up. Results: Both treatment groups demonstrated improvement in the measured glycemic parameters. At 6 months, mean fasting blood glucose was 118.83 ± 14.86 mg/dL in the vildagliptin group and 124.20 ± 28.75 mg/dL in the metformin group (between-group p=0.367). Mean postprandial glucose fell from 269.00 ± 90.23 to 167.53 ± 17.29 mg/dL with vildagliptin and from 294.93 ± 100.08 to 201.73 ± 45.46 mg/dL with metformin. The 6-month between-group difference in postprandial glucose was −34.20 mg/dL (95% CI −51.97 to −16.43; p=0.0003), recalculated from the reported summary statistics. HbA1c declined from 8.04 ± 0.65% to 7.03 ± 0.40% with vildagliptin and from 7.88 ± 0.81% to 7.57 ± 0.66% with metformin; the corresponding 6-month between-group difference was −0.54 percentage points (95% CI −0.82 to −0.26; p=0.0003), also recalculated from the reported summary statistics. No hypoglycemic events were observed. Allergy was reported in three participants in each group; headache occurred in four vildagliptin-treated participants and five metformin-treated participants; gastrointestinal intolerance was reported in four participants receiving vildagliptin and in none receiving metformin. Conclusion: In this small, single-center randomized study, both monotherapies were associated with improved glycemic indices. Vildagliptin showed a greater observed fall in HbA1c and a lower 6-month postprandial glucose value than metformin, while the difference in fasting glucose between groups was not statistically significant. These observations are specific to the present study population and regimen; confirmation in larger, multicenter randomized studies using participant-level analyses is required before broader conclusions are drawn.

Diabetes Mellitus is comprised of two categories: Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM). It is one of the most frequently occurring non-communicable illnesses in the world today, with a global prevalence rate of 537 million people living with diabetes worldwide among the adult population. Traditional techniques used to treat diabetes mellitus cases have been rendered insufficient as far as ensuring personalized care that provides timely regulation of the blood sugar levels is concerned. The advancements in the field of artificial intelligence technologies have brought about revolutionary methods of managing diabetes, including diagnostics, treatment, and support. This systematic review followed the PRISMA guidelines for research, including articles obtained from PubMed, Web of Science, and Scopus databases up to April 2026. There were twenty-two articles that fulfilled the criteria for selection and quality. The application of artificial intelligence technology led to statistically significant improvements in HbA1c, TIR, early identification of micro- and macrovascular complications, personalized insulin therapy, and increased engagement and empowerment of patients. Highly sophisticated algorithms such as recurrent neural networks, transformers, gradient-boosted machine ensembles, and reinforcement learning agents were shown to be very effective in predicting hypoglycemia and risk stratification. The digital health interventions helped increase the compliance rate of patients with treatment regimens by 25-35%. Nevertheless, some issues were still present such as inequities in access to advanced technologies, a lack of multicentric and multi-ethnic validation, regulatory uncertainties, and immaturity with respect to data governance. Artificial intelligence is revolutionizing diabetes care with an emphasis on prediction, prevention, personalization, and participation.

Introduction: Variant RARA rearrangements in acute promyelocytic leukemia (APL) are rare and may present with atypical morphologic and immunophenotypic features, leading to diagnostic challenges. We report a case of a 9-year-old female child presenting with clinical and morphologic features suggestive of acute myeloid leukemia (AML) with monocytic differentiation. Flow cytometry supported a diagnosis of acute myelomonocytic leukemia. However, conventional cytogenetic analysis revealed a variant t(11;17)(q23;q21) translocation involving the RARA gene. This case underscores the importance of integrated morphologic, immunophenotypic, and cytogenetic evaluation for accurate classification and therapeutic stratification.