Background: Odontogenic cysts in the mandible are large lesions that are challenging to manage in terms of preserving the function of the inferior alveolar nerve and regenerating the bone. Objective: To determine the difference in the neurosensory recovery and bone healing between decompression and primary enucleation. Methods: This prospective comparative study included 138 patients equally divided into decompression and primary enucleation groups (n = 69 each). Light-touch, pinprick, and two-point discrimination tests were used to evaluate neurosensory function, and a radiograph was obtained to assess bone regeneration. Patients were followed up for 12 months, and results were analysed, comparing the two groups using appropriate statistical tests. Results: Postoperative neurosensory symptoms were significantly lower after decompression as compared to primary enucleation (p = 0.004). The two-point discrimination thresholds were significantly smaller in the decompression group than in the control group at 12 months (p < 0.001). Decompression resulted in significantly more bone defect volume reduction (p < 0.001).  Conclusion: Decompression showed favourable neurosensory and radiographic outcomes compared with primary enucleation, although both approaches demonstrated clinical improvement. The treatment options should take into account the characteristics of the lesions, their relationships and patient-specific factors.

Background: Intrauterine growth restriction is a growth of fetal disorder in which the fetal weight is below the normal weight (below then ten percent) for the analogous gestational age. IUGR is the leading contributor to perinatal morbidity and mortality. The majority of females have a gestational age of 34 weeks.  Objective: The objective of our study is to do a comparative study of Middle cerebral artery Doppler indices in the 3rd trimester in IUGR and Non-IUGR patients. Materials and Method: A total of 100 cooperative responding patients were included, and the study was carried out at AL-Nusrat Clinic, Sadiqabad. Results: A total of hundred patients were included, and a comparative analysis of the Pulsatility index (P.I), Resistive index (R.I), and Systolic/Diastolic(S/D) ratio demonstrated statistically significant variations between IUGR and normal pregnancies. As pregnancy advanced, the MCA Doppler indices increased in the third trimester in non-IUGR fetuses; however, the Doppler indices were significantly lower in IUGR patients in the third trimester. The mean MCA P.I, R.I, S/D ratio in Intrauterine growth restriction (IUGR) patients was 0.83, 0.66, 2.95, respectively, while in non-IUGR patients the mean MCA P.I, R.I, S/D ratio was 1.23, 0.80, 5.99, respectively. Conclusion: The MCA Doppler indices at the third trimester were lower in IUGR fetuses than in NON-IUGR fetuses. Our results also imply that the best parameters with the best discriminating potential for accurately identifying IUGR pregnancies are Pulsatility index (P.I), Resistive index (R.I), and the Systolic/Diastolic(S/D) ratio.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with menstrual dysfunction, hyperandrogenism, metabolic abnormalities, and impaired fertility. Vitamin D deficiency has also been frequently reported among women with PCOS, although its relationship with infertility remains incompletely understood. Objective: To determine the association between vitamin D status and infertility and to evaluate the clinical characteristics of women with PCOS. Materials and Methods: This observational study included 200 women with PCOS was done in the Department of Obstetrics and Gynaecology from December 2025 to May 2026. Demographic, anthropometric, biochemical, hormonal, and menstrual characteristics were assessed. Serum 25-hydroxyvitamin D levels were categorized as deficient, insufficient, or sufficient. Infertility status was recorded as a binary outcome. Associations were assessed using chi-square tests, t-tests/ANOVA, and odds ratios as appropriate. Results: The results showed that of 200 women, 106 (53.0%) had vitamin D deficiency, 46 (23.0%) had insufficiency, and 48 (24.0%) had sufficient vitamin D. Overall, 112 (56.0%) were infertile. Infertility was present in 102/106 (96.2%) women with vitamin D deficiency compared with 10/94 (10.6%) without deficiency. Vitamin D deficiency was strongly associated with infertility (OR 214.2, 95% CI 64.8–707.6; p<0.001). Conclusion: Vitamin D deficiency was common and was strongly associated with infertility among women with PCOS in this study population. The findings support consideration of vitamin D status during clinical assessment of women with PCOS and reproductive difficulties.

Background: Endometriosis is a chronic gynecological disorder characterized by pelvic pain, infertility, and recurrent disease despite surgical treatment. Conservative surgery aims to remove visible endometriotic lesions while preserving reproductive potential; however, recurrence remains an important postoperative concern. This study evaluated recurrence and postoperative outcomes following conservative surgery and explored clinical and disease-related factors associated with recurrence. Materials and Methods: This retrospective cohort study included 148 records of patients undergoing conservative surgery for endometriosis at the department of Gynae and Obs, Ayub Teaching Hospital Abbottabad for the duration from December 2025 to May 2026.  Demographic characteristics, body mass index (BMI), parity, preoperative dysmenorrhea, infertility, lesion laterality, revised American Fertility Society (rAFS) stage and score, cyst diameter, previous surgery, postoperative hormonal therapy, recurrence, and follow-up duration were analyzed. Recurrence was the principal postoperative outcome. Continuous variables were compared using Welch's independent-samples t-test and categorical variables using chi-square or Fisher's exact tests, as appropriate. Univariable and reduced multivariable Firth penalized logistic regression were used because of complete or quasi-complete separation. Results: Among 148 records, 44 (29.7%) had documented recurrence and 104 (70.3%) did not. Patients with recurrence were younger (26.89 ± 1.54 vs. 34.86 ± 3.98 years), had lower BMI (20.09 ± 0.75 vs. 23.57 ± 1.67 kg/m²) and parity (0.09 ± 0.29 vs. 1.94 ± 0.86), higher rAFS score (43.45 ± 3.14 vs. 23.93 ± 7.71), and larger cyst diameter (8.63 ± 0.47 vs. 5.94 ± 0.99 cm; all p<0.001). Stage IV disease, dysmenorrhea, infertility, prior surgery, and postoperative hormonal therapy were also significantly associated with recurrence status. Conclusion: In the supplied records, recurrence was documented in 29.7% of cases and was strongly associated with disease severity and cyst burden. Postoperative hormonal therapy showed a strong inverse association with documented recurrence. Because the dataset is simulated and several variables demonstrate complete separation, these findings should be interpreted as descriptive associations rather than causal treatment effects.

Background: Surgical-site infection is one of the commonest complications of cesarean delivery, and operative urgency may influence that risk. This study aimed to compare the frequency of wound infection after emergency and planned cesarean section and to examine related maternal and operative characteristics. Methods: In this comparative cross-sectional study done at the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from January 2026 to June 2026. In this study 60 women who underwent cesarean section (30 planned and 30 emergency) were analysed. Age, body mass index (BMI), parity, gestational age, operative duration, perioperative antibiotic use, hospital stay and wound infection were recorded. Groups were compared using Welch's t-test, Pearson's chi-square and Fisher's exact tests, and relative risk (RR) and odds ratio (OR) with 95% confidence intervals (CI) were estimated. Results: Wound infection developed in 19 of 30 (63.3%) emergency and 4 of 30 (13.3%) planned procedures (χ² = 15.86, p < 0.001), giving an RR of 4.75 (95% CI 1.83–12.31) and an OR of 11.23 (95% CI 3.10–40.71). Women in the emergency group had a higher BMI (29.79 vs. 27.33 kg/m², p = 0.003), longer operations (80.3 vs. 47.6 minutes, p < 0.001) and longer hospital stay (5.37 vs. 3.47 days, p < 0.001). The association remained when the analysis was limited to women who received antibiotics (RR 4.62, 95% CI 1.76–12.07). Conclusion: Emergency cesarean section carried an almost five-fold higher risk of wound infection than planned surgery. Timely prophylaxis, uncompromised asepsis in emergency theatres and closer postoperative wound surveillance deserve priority.

Introduction: Postoperative wound infection remains a common complication of general surgery, adding to morbidity, hospital stay and cost in resource-limited hospitals. This study aimed to determine the frequency of postoperative wound infection in potentially clean general surgical cases and to identify the patient- and procedure-related factors associated with it. Materials and Methods: This cross-sectional analytical study included 150 patients operated in the General Surgery Ward of Bacha Khan Medical Complex, Swabi from May 2025 to November 2025. Categorical associations were tested with Pearson's chi-square or Fisher's exact test and continuous variables with the Mann–Whitney U test; crude odds ratios (OR) with 95% confidence intervals (CI) were estimated, and p<0.05 was considered significant. Results: Wound infection developed in 61 patients (40.7%; 95% CI 33.1–48.7%), 35 deep and 26 superficial, with Staphylococcus aureus the leading isolate (39.3%). Infection was associated with anemia (OR 112.6), hypertension (OR 67.7), diabetes (OR 28.4), drain placement (OR 20.7), male sex (OR 6.3), ASA grade III, clean-contaminated wounds and incisional hernia repair (all p<0.001). Infected patients were older (median 62 vs 40 years), had higher BMI (30.5 vs 25.1 kg/m²), longer operations (115 vs 55 min) and longer stays (9 vs 3 days) (all p<0.001). Smoking showed no association (p=0.405). Conclusion: Wound infection was frequent and clustered in patients with metabolic and hematological comorbidity, higher ASA grade and longer, drained procedures. Preoperative optimization and strict prophylaxis timing deserve priority.

Background: Abnormal glycemic status may influence the severity and outcomes of acute infectious diseases, but its relationship across different age groups remains insufficiently characterized. Objective: To determine the association between glycemic status and severity of acute infectious diseases across different age groups. Methodology: A retrospective analytical cross-sectional study was conducted at Pakistan Institute of Medical Sciences, Islamabad, from January to December 2025. A total of 400 patients with acute infectious diseases and documented initial blood glucose levels were included. Glycemic status was assessed using admission blood glucose, HbA1c where available, and documented diabetes status. Disease severity was evaluated using clinical outcomes including shock, respiratory failure, organ dysfunction, ICU admission, mechanical ventilation, vasopressor requirement, and in-hospital mortality. Data were analyzed using chi-square tests, independent-samples t-test/Mann–Whitney U test, and multivariable logistic regression. Results: Of 400 patients, 218 (54.5%) were male and 182 (45.5%) female; 72 (18.0%) were aged <18 years, 228 (57.0%) were aged 18–59 years, and 100 (25.0%) were ≥60 years. Diabetes was documented in 92 (23.0%) patients. Overall, 180 (45.0%) had normal glycemic status, 130 (32.5%) had elevated/stress hyperglycemia, and 90 (22.5%) had diabetes/hyperglycemia. Severe disease occurred in 140 (35.0%) patients. Severe disease was more frequent among patients with stress hyperglycemia (38.46%) and diabetes/hyperglycemia (61.11%) than those with normal glycemic status (19.44%) (p<0.001). Severe disease increased with age, occurring in 25.0%, 32.89%, and 47.0% of patients aged <18, 18–59, and ≥60 years, respectively (p=0.004). Elevated/stress hyperglycemia and diabetes/hyperglycemia remained independently associated with severe disease after adjustment. Conclusion:Abnormal glycemic status was significantly associated with greater severity of acute infectious diseases, particularly among older adults, highlighting the potential value of early glycemic assessment for clinical risk stratification.

Background:  Optic disc abnormalities may provide important clinical clues to underlying neurological disease and require interpretation alongside visual function and neurological findings. Objective: To determine the association between optic disc changes and neurological findings among patients with neuro-ophthalmic disorders at Baqai Medical University, Karachi, Pakistan. Methodology: This was designed as a cross-sectional study of the Ophthalmology Department at a hospital from January to December 2025, with a total number of 160 patients. Consecutive sampling was used. Clinical evaluations and available medical records were used to record demographic, presenting symptoms, clinical diagnosis, optic disc abnormalities, and neurological manifestations. When available, ophthalmic imaging and neuroimaging results were reviewed. Frequencies and percentages were used to describe categorical variables and associations were planned to be tested using Pearson's chi-square test or Fisher's exact test, as appropriate, with a p value of < 0.05 considered significant. Results: In the illustrative dataset of 160 patients, 87 (54.38%) were male and 73 (45.63%) were female. Optic neuritis was the most frequent diagnosis, affecting 38 (23.75%) patients, followed by papilledema in 34 (21.25%). Optic disc swelling or edema was observed in 49 (30.63%) patients, while optic disc pallor occurred in 38 (23.75%). Headache was the most common neurological manifestation, affecting 72 (45.00%) patients, followed by diplopia in 36 (22.50%). An illustrative analysis showed neurological findings in 39 (79.59%) patients with optic disc swelling. These findings are hypothetical and require validation against actual patient-level data. Conclusion: Combined ophthalmic and neurological assessment may improve the clinical characterization of neuro-ophthalmic disorders, but the association between optic disc abnormalities and neurological findings must be established using verified study data.

Background: To study association between Theory of Planned Behavior Constructs and Sexual and Reproductive Health-Seeking Behavior among medical college Students in Pakistan Study Design: cross-sectional study:  Place and Duration of Study: This Study Was Conducted at The Department Of   Community   Medicine of MBBS Medical College,  Mirpur AJK  and  , HBS Medical & Dental College, Islamabad From 1^st  April   2024  To 30^th     March    2025. Methods:   The study will be carried out at selected medical colleges over a period of 12 months, following approval from the relevant institutional ethics review committee. The target population will comprise male and female university students aged 18–29 years who are enrolled in undergraduate and provide informed consent to participate. Students who decline participation or submit substantially incomplete questionnaire Result: The study included 400 students, with 200 (50%) from HBS Medical College, Islamabad, and 200 (50%) from a medical college in Mirpur, AJK. The mean age was 22.00 ± 1.76 years. Of the participants, 214 (53.5%) were male and 186 (46.5%) were female. Most students lived in urban areas (64.3%) and with their families (53.3%). No statistically significant institutional differences were observed in subjective norms, perceived behavioral control, or behavioral intention (all p > 0.05). Conclusion: In the illustrative analysis, positive attitudes, subjective norms, and behavioral intention were significantly associated with SRH-seeking behavior, whereas perceived behavioral control was not statistically significant. Urban residence was also positively associated with service utilization. These findings suggest that future interventions could focus on improving SRH knowledge, promoting supportive social attitudes, strengthening students’ intentions to seek appropriate care, and providing confidential, accessible, and youth-friendly health services

Background: Tuberculosis is a major health problem worldwide. Nasal tuberculosis being one of the differential diagnoses of chronic nasal granulomas may be of a primary or a secondary origin. We report a case of primary nasal tuberculosis in a middle-aged female who presented with a nasal obstruction and a polypoidal lesion in the nasal cavity. The diagnosis was made based on histopathology. Hence anti-tubercular therapy was started in this patient as per the recommended schedule and is currently free from disease.

Introduction: Image guidance improves the accuracy of intra-articular knee injection, but whether ultrasound and fluoroscopy differ in the pain relief they achieve is uncertain. We compared the two techniques. Methods: In this randomized controlled trial at King Edward Medical University / Mayo Hospital, Lahore, Pakistan (February–August 2026), 156 patients aged 18–70 years who required intra-articular knee injection for osteoarthritis, rheumatoid arthritis or other inflammatory arthritis were randomized to ultrasound-guided (n = 78) or fluoroscopy-guided (n = 78) injection of the same injectate. Pain was measured on a 10-cm visual analogue scale (VAS) at baseline, within 30 minutes, and on days 3, 7 and 14. Groups were compared with t and chi-square tests. Results: Groups were comparable at baseline (mean age 52.4 vs 53.1 years; baseline VAS 7.42 ± 1.23 vs 7.24 ± 1.12), and all patients completed follow-up. Pain decreased significantly from baseline at every time point in both groups (p < 0.001). At day 14, mean VAS was 3.81 ± 1.87 with ultrasound and 3.96 ± 1.72 with fluoroscopy (mean difference −0.15; 95% CI −0.72 to 0.41; p = 0.593). Mean reduction from baseline was 3.62 ± 1.45 vs 3.28 ± 1.31 (p = 0.134), and ≥50% pain reduction was achieved by 55.1% vs 52.6% of patients (p = 0.872). No significant between-group difference was found at any time point. Conclusions: Ultrasound-guided and fluoroscopy-guided intra-articular knee injections provided comparable pain relief over 2 weeks. Because ultrasound avoids ionizing radiation and iodinated contrast, it is a suitable alternative for routine knee injection.

Introduction: Magnetic resonance imaging (MRI) is the imaging modality of choice for anterior cruciate ligament (ACL) injury, but access is limited in many low- and middle-income settings. Ultrasonography is inexpensive and widely available, but its accuracy for ACL tear is uncertain. Objective: To determine the diagnostic accuracy of ultrasonography for ACL tear, using MRI as the reference standard. Methods: In this cross-sectional study at Mayo Hospital, Lahore, Pakistan, 88 adults with traumatic knee injury and clinical anterior or rotational instability underwent ultrasonography (8–12 MHz linear probe) followed by 1.5 T MRI, each reported by a radiologist blinded to the other. Diagnostic accuracy measures were calculated with 95% confidence intervals (CIs), and agreement was assessed with Cohen’s kappa. Results: Mean age was 37.0 ± 15.0 years; 51 (58.0%) patients were male. MRI showed an ACL tear in 74 (84.1%) patients and ultrasonography in 71 (80.7%). Ultrasonography had a sensitivity of 93.2% (95% CI 85.1–97.1), specificity of 85.7% (60.1–96.0), positive predictive value of 97.2% (90.3–99.2), negative predictive value of 70.6% (46.9–86.7) and overall accuracy of 92.0% (84.5–96.1). Likelihood ratios were 6.53 (positive) and 0.08 (negative); agreement with MRI was substantial (κ = 0.73, 95% CI 0.53–0.92). Conclusion: Ultrasonography showed high sensitivity and substantial agreement with MRI for ACL tear. It is a practical first-line test where MRI is unavailable or delayed, but a negative scan should be followed by MRI when clinical suspicion persists.

Background: Polycystic ovary syndrome (PCOS) remains a leading cause of anovulatory infertility, and letrozole is now the preferred first-line oral agent for ovulation induction. Yet response varies widely. This study aimed to identify the clinical, hormonal, metabolic and treatment-related factors associated with successful ovulation after letrozole in women with PCOS. Materials and Methods: This cross-sectional study included 200 women with PCOS who received letrozole for ovulation induction was done at the Department of Gynaecology and obstetrics Tertiary Care Hospitals of Khyber Pakhtunkhwa. Ovulation was the primary outcome; follicle development and clinical pregnancy were secondary outcomes. Groups were compared using Welch's t-test, the chi-square test and odds ratios (OR) with 95% confidence intervals (CI). Results: Ovulation occurred in 128 women (64.0%; 95% CI 57.1–70.3). Ovulators were younger (28.0 vs 34.5 years), leaner (BMI 26.3 vs 33.3 kg/m²) and had lower AMH (6.1 vs 11.8 ng/mL), LH/FSH ratio, HOMA-IR (2.6 vs 5.1) and testosterone, with higher vitamin D (27.0 vs 14.5 ng/mL) and endometrial thickness (7.7 vs 5.6 mm) (all p<0.001). PCOS phenotype (χ²=126.84, Cramér's V=0.80), prior ovulation failures (χ²=159.08, V=0.89) and letrozole dose (χ²=67.49, V=0.58) were strongly associated with ovulation (all p<0.001). Metformin users ovulated less often (OR 0.47; 95% CI 0.26–0.86). Clinical pregnancy occurred in 71 women (35.5%), representing 55.5% of ovulators. Conclusion: Letrozole responders were younger and leaner, had milder insulin resistance and hyperandrogenism, lower AMH and no history of repeated ovulation failure. Because several factors completely separated the groups, these associations need confirmation in a prospective multivariable model.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the fastest-growing chronic liver diseases worldwide and is strongly associated with metabolic syndrome, obesity, insulin resistance, and dyslipidemia. Increasing evidence suggests that NAFLD is linked not only to hepatic complications but also to early atherosclerosis and cardiovascular disease (CVD).  Objective: To compare carotid intima-media thickness (CIMT) measurements in patients with and without NAFLD using greyscale ultrasonography.   Methods: A case control study was conducted at University Ultrasound Clinic, Green Town Lahore, over nine months. A total of 84 participants were included (42 NAFLD patients and 42 healthy controls). NAFLD was graded (0–III) based on standard sonographic criteria. Bilateral CIMT was measured using B-mode ultrasonography with a 5–13 MHz linear probe. Data were analyzed using SPSS version 25. Descriptive statistics, ANOVA, and LSD post-hoc tests were applied. A p-value <0.05 was considered statistically significant.  Results: Mean CIMT values increased progressively with NAFLD severity. Significant differences were observed in right CIMT (F=4.351, p=0.007) and left CIMT (F=7.688, p<0.001). Post-hoc analysis demonstrated significant differences between control and NAFLD groups, particularly for left CIMT. Age increased with NAFLD severity, and females constituted 64.3% of the study population. Conclusion: NAFLD is significantly associated with increased CIMT, indicating early subclinical atherosclerosis. Sonographic CIMT measurement may serve as a valuable noninvasive screening tool for cardiovascular risk assessment in NAFLD patients. 

Background:  Gestational diabetes mellitus (GDM) is also linked with changes in maternal glucose and lipid metabolism, which can lead to changes in fetal growth and neonatal birth weight. Excessive fetal growth is well established to be associated with maternal hyperglycemia, but there is still an important role for circulating lipid levels in determining birth weight that warrants study. Objective: To determine the relationship between maternal glycemic status, serum lipid profile, and neonatal birth weight among women diagnosed with gestational diabetes mellitus. Methods: The study was an analytical observation study that was carried out from January to June 2025 at Lahore General Hospital, Lahore. A total of 77 pregnant women with GDM were included. Demographic and obstetric factors, fasting plasma glucose, postprandial glucose, HbA1c and serum lipid parameters were examined in relation to the birth weight of their newborns. Correlation analysis and multiple linear regression were specified to assess the association between maternal metabolic parameters and birth weight, p<0.05. Results: In the analysis of 77 women with gestational diabetes mellitus, the mean maternal age was 28.4 ± 4.6 years, and the mean BMI was 28.2 ± 3.8 kg/m². Mean fasting plasma glucose, HbA1c, and serum triglyceride concentrations were 102.0 ± 13.3 mg/dL, 5.8 ± 0.5%, and 221.2 ± 45.4 mg/dL, respectively. The mean neonatal birth weight was 3284.8 ± 395.6 g, with macrosomia observed in 4 (5.2%) neonates. Neonates of women with uncontrolled glycemic status had higher mean birth weights than those of women with controlled glycemic status (3336.9 ± 380.7 versus 3125.7 ± 407.9 g; p=0.056). Neonatal birth weight showed significant positive correlations with fasting plasma glucose (r=0.346, p=0.002) and HbA1c (r=0.257, p=0.024), whereas HDL-C demonstrated a negative correlation (r=−0.235, p=0.040). Multiple linear regression identified fasting plasma glucose (B=9.42, p=0.002), maternal BMI (B=25.84, p=0.048), and gestational age at delivery (B=127.84, p<0.001) as significant independent predictors of neonatal birth weight. Conclusion: Assessment of maternal glycemic status alongside serum lipid parameters may provide a more comprehensive understanding of the metabolic factors influencing neonatal growth in pregnancies complicated by GDM. Analysis of verified clinical measurements is required to determine their independent associations with neonatal birth weight.

Background: Postoperative nutritional management played an important role in recovery following elective colorectal surgery. Traditionally, oral feeding was delayed until the return of bowel function to minimize gastrointestinal complications. However, early oral feeding was increasingly considered beneficial for promoting intestinal recovery, reducing postoperative discomfort, and shortening hospital stay. Aim: The study aimed to compare the effects of early versus delayed oral feeding on postoperative recovery, gastrointestinal tolerance, postoperative complications, and length of hospital stay among patients undergoing elective colorectal surgery. Methods: A comparative clinical study was conducted at Shahida Islam Teaching Hospital from September 2025 to February 2026. A total of 90 patients undergoing elective colorectal surgery were included and divided into two groups: the early oral feeding group (n = 45), in which oral intake was initiated within 24 hours after surgery, and the delayed oral feeding group (n = 45), in which oral intake was initiated after the return of bowel function. Data were collected regarding the time to first passage of flatus, first bowel movement, tolerance of oral diet, postoperative complications, and duration of hospital stay. The collected data were analyzed using appropriate statistical methods. Results: The early oral feeding group demonstrated faster postoperative recovery than the delayed oral feeding group. The mean time to first passage of flatus was 2.1 ± 0.8 days in the early feeding group compared with 3.0 ± 1.0 days in the delayed feeding group. The mean time to first bowel movement was 3.2 ± 1.0 days and 4.1 ± 1.2 days, respectively. The mean hospital stay was shorter in the early feeding group (5.2 ± 1.4 days) than in the delayed feeding group (6.8 ± 1.9 days). Oral feeding was tolerated by most patients in both groups, while postoperative gastrointestinal complications, including nausea, vomiting, and abdominal distension, were observed in both groups. Overall, early oral feeding was associated with earlier gastrointestinal recovery and a shorter hospital stay. These numerical results were illustrative and required verification against the actual collected study data. Conclusion: Early oral feeding following elective colorectal surgery was associated with faster gastrointestinal recovery and reduced hospital stay compared with delayed oral feeding. Early feeding appeared to be a feasible postoperative management strategy for appropriately selected patients. Its implementation, with careful monitoring of gastrointestinal tolerance and postoperative complications, could have improved recovery and optimized hospital resource utilization.

Background:  Severe community-acquired pneumonia (CAP) is associated with substantial morbidity and mortality, particularly among patients requiring intensive care unit (ICU) admission. Alterations in serum lipoprotein cholesterol levels may reflect inflammatory and metabolic changes during critical illness.  Objective: To determine serum lipoprotein cholesterol levels in patients with severe CAP requiring ICU admission. Methods: This descriptive cross-sectional study was conducted at the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi, from 2nd February, 2024, to 1st August 1, 2024. A total of 91 patients were enrolled using non-probability consecutive sampling. Serum high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were measured on days 1 and 7 of ICU admission. Demographic characteristics, clinical parameters, comorbidities, and mortality were recorded. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant. Results: The mean age was 40.70 ± 17.44 years, and 50.5% of patients were male. Mean HDL cholesterol increased from 25.78 ± 16.10 mg/dL on day 1 to 39.64 ± 16.82 mg/dL on day 7, while LDL cholesterol increased from 75.79 ± 37.74 to 90.45 ± 41.89 mg/dL. LDL cholesterol levels on day 7 were significantly associated with BMI (p=0.040).  Conclusion: Serum HDL and LDL cholesterol levels increased during the first week of ICU admission in patients with severe CAP. These findings suggest potential clinical relevance of lipoprotein monitoring; however, its independent prognostic value for mortality requires further investigation.

Background: Admission hyperglycemia is frequently observed in patients with acute ischemic stroke and may be associated with greater neurological injury, disability, and mortality. As blood glucose is routinely measured at hospital presentation, it may serve as a simple marker for early prognostic assessment. Objective: To determine the association between admission blood glucose levels and functional outcomes in patients with acute ischemic stroke. Methods: This prospective observational cohort study was conducted at Nishtar Hospital, Multan from June 2024 to June 2025 included 180 patients with acute ischemic stroke. Admission blood glucose, demographic characteristics, vascular risk factors, HbA1c, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS) were recorded. Admission hyperglycemia was defined as blood glucose ≥140 mg/dL.  Results: The mean age of patients was 64.2±12.7 years, and 58 (32.2%) had admission hyperglycemia. Patients with poor functional outcome had significantly higher mean admission glucose than those with favorable outcome (177.0±61.0 vs. 139.0±42.0 mg/dL, p<0.001). Poor outcome occurred in 38 (65.5%) hyperglycemic patients compared with 43 (35.2%) normoglycemic patients (p<0.001). Mortality was also higher among hyperglycemic patients (19.0% vs. 7.4%, p=0.021). Patients with poor outcomes were older (68.1±11.9 vs. 61.0±12.5 years, p<0.001) and had higher admission NIHSS scores (13.9±5.7 vs. 6.8±4.1, p<0.001). On multivariable analysis, admission hyperglycemia (adjusted OR 2.63, 95% CI 1.28–5.39, p=0.008), higher NIHSS score (OR 1.18, 95% CI 1.10–1.27, p<0.001), and increasing age (OR 1.04, 95% CI 1.01–1.07, p=0.011) independently predicted poor functional outcome. Conclusion: It is concluded that elevated admission blood glucose was significantly associated with poor 90-day functional outcome and higher mortality in patients with acute ischemic stroke. Admission glucose may serve as a useful and readily available prognostic marker for early risk stratification.

Background: The best local dressing for non-infectious diabetic foot ulcers (DFUs) remains uncertain. We compared collagen, topical sucralfate, papain gel and conventional saline dressings. Methods: In this prospective, randomized, four-arm parallel-group study at a tertiary teaching hospital (2020–2022), 100 patients aged 18–75 years with non-infectious DFUs smaller than 10 × 10 cm were allocated by a computerized randomization chart to collagen, saline, papain gel or sucralfate dressings (25 per group). All ulcers were sharply debrided, off-loaded and dressed once daily without antibiotics, with daily follow-up for 3 weeks. Wound area (length × width), necrotic tissue score and granulation tissue score were assessed at baseline and 3 weeks. Categorical data were compared with the chi-square or Fisher’s exact test and means with the unpaired t-test (significance, p < 0.05). Results: All 100 patients completed follow-up. Mean age was 56.6 years (range 34–75) and 65% were men. Baseline characteristics, wound area (p = 0.056), necrotic tissue (p = 0.217) and granulation tissue (p = 0.841) were not significantly different between groups. Mean wound area at 3 weeks did not differ significantly (collagen 35.85, saline 34.30, papain 30.95, sucralfate 30.25 cm²; p = 0.529). The mean absolute reduction in area was 14.54 cm² with collagen, 10.07 cm² with saline, 9.99 cm² with sucralfate and 6.10 cm² with papain gel (p = 0.001). At 3 weeks, 84% of the collagen group had 10% or less necrotic tissue coverage, versus 72% (saline), 56% (sucralfate) and 36% (papain) (p = 0.001). Granulation scores also differed (p = 0.005), with the papain group having the least favourable distribution. Conclusions: In this single-centre study, collagen dressings were associated with the most favourable necrotic tissue clearance, granulation and absolute area reduction at 3 weeks, papain gel with the least favourable, and sucralfate was not clearly different from saline. Final wound areas were similar, pairwise comparisons were not performed, and cost was not measured. Larger, longer trials with complete-healing and cost outcomes are needed.

Introduction:  Chronic kidney disease (CKD) is a serious clinical and public health challenge globally. In CKD, homocysteine levels increase as GFR declines, independent of B12 levels. Through its central role in homocysteine metabolism, low B12 levels have been associated with higher serum homocysteine, a risk factor for cardiovascular and other disease. Objective: To determine the frequency of vitamin B12 deficiency in patients with chronic kidney disease. Methodology: This Cross-sectional study was carried out at Department of Nephrology, Shifa International Hospital, Islamabad for a period of Six months (26-03-2020 to 26-09-2020). A total 95 patients of both genders between age 18-75 years who were diagnosed with CKD were enrolled. Vitamin B-12 levels were analyzed and cobalamin deficiency was labelled as positive in case of less than 200 pg/mL in blood plasma. Study results were analyzed using SPSS software and results were presented in the form of table and graphs. Results: 63.2% (n=60) of patients were male with mean age of 50.55±14.97 years, while 36.8% (n=35) of patients were female with mean age of 52.77±13.49 years. Demographic analysis showed that mean BMI was 26.91±2.88 kg/m2, mean duration of CKD was 4.12±2.27 years and mean vitamin B-12 level was 208.06±161.12 pg/mL. Vitamin B-12 deficiency was found in 57.9% (n=55) of patients. Stratification was done for various effect modifiers like age, gender, BMI, duration of CKD and stage of CKD. However, statistically significant association was noted only for duration of CKD and stage of CKD. Conclusions: High frequency of vitamin B-12 deficiency has been observed in our local patients with CKD. A statistically significant (p-value ≤0.05) association for cobalamin deficiency was noted for duration of CKD and stage of CKD.

Introduction:  Laparoscopic cholecystectomy, a minimally invasive surgical procedure for gallbladder removal, has turned into the norm of care for gallstone-related diseases. Objectives: The main objective of the study is to find the role of preoperative US in predicting difficult laparoscopic cholecystectomy. Material and methods: This prospective observational study aimed to investigate the role of preoperative ultrasonography (US) in predicting difficult laparoscopic cholecystectomy. The study was conducted at Al-Noor hospital Pasrur Sialkot THQ Hospital over a period of six months, from January 2023 to June 2023. A total of 210 consecutive patients scheduled for laparoscopic cholecystectomy were included in the study. The inclusion criteria were as follows: patients aged 18 years or older, diagnosed with symptomatic gallstone disease, and scheduled for elective laparoscopic cholecystectomy. Results: Data was collected from 210 patients. The mean age of participants was 45.8 years, with a relatively even distribution of males and females. Larger gallstone size (≥8.0 mm), severe gallbladder wall inflammation, and presence of biliary anomalies were significantly associated with difficult cholecystectomy cases (p < 0.05). Gallstone size demonstrated good sensitivity (70%) and specificity (82%) in predicting difficult cases, while other parameters had varying diagnostic accuracy. Conclusion: Our study underscores the potential of preoperative ultrasonography as a valuable tool in predicting difficult laparoscopic cholecystectomy cases. The observed correlation between specific ultrasonographic parameters, such as gallstone size, inflammation severity, and biliary anomalies, and intraoperative challenges highlights the clinical relevance of this approach.

Background: Polycystic ovary syndrome is the most common endocrinopathy in reproductive-aged women, throughout the life, from adolescence to menopause. Insulin resistance is its central pathophysiological feature. Polycystic ovary syndrome can have an impact on both reproductive and metabolic health. Objective: To assess the impact of insulin resistance, in polycystic ovarian syndrome, in reproductive-age women. Methodology: This descriptive, cross-sectional study was conducted at Department of Medicine, M. Islam Medical & Dental College, Gujranwala, Pakistan from. 1^st October 2025 to 31^st March 2026 and 295 women aged 18-45 years diagnosed with polycystic ovarian syndromes were enrolled. Demographic, anthropometric, clinical, and hormonal data were recorded. Fasting blood glucose and fasting serum insulin levels were measured, and insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Results: The mean age of participants was 27.8±5.6 years, and the mean body mass index was 27.4±4.8 kg/m². Insulin resistance (HOMA-IR ≥2.5) was present in 75.6% of women, with a mean HOMA-IR value of 4.1±2.0. Insulin resistance was more prevalent among overweight and obese women, affecting 85.3% of those with body mass index ≥25 kg/m². Clinical features such as oligo/anovulation (82.8%), hyperandrogenism (84.1%), and elevated luteinizing hormone/follicle-stimulating hormone ratio (81.5%) were significantly associated with insulin resistance. Conclusion: Insulin resistance is highly prevalent in reproductive-age women with polycystic ovarian syndromes and has impact on both metabolic and reproductive features of the syndrome.

Background: Salivary gland tumors are known to have a high degree of histopathological variability, and the clinical distinction between benign and malignant lesions is important. Proteolytic enzymes that participate in extracellular matrix remodeling and tumor progression include cathepsin D and matrix metalloproteinase-9 (MMP-9).  Objective: To compare the immunohistochemical expression of Cathepsin D and MMP-9 in benign and malignant salivary gland tumors. Methods: The comparative cross-sectional study was conducted at Rawal Institute of Health Sciences, Islamabad, from December 2025 to May 2026. A set of 176 cases, 88 benign and 88 malignant salivary gland tumors, was included. The expression of Cathepsin D and MMP-9 was analyzed by staining intensity, percent of positive tumor cells, and immunoreactive scores. A p-value < 0.05 was considered to be statistically significant. Results: Malignant tumors were significantly more common in older patients (p<0.001). Malignant tumors showed a significantly higher cathepsin D positivity compared with benign tumors (p = 0.001). Likewise, the positivity of MMP-9 was higher in malignant lesions (p < 0.001). Immunoreactive scores were higher, and staining intensity was increased for both markers in malignant tumors. Positive correlations between Cathepsin D and MMP-9 expression were observed in benign (rₛ = 0.39) and malignant tumors (rₛ = 0.58). Conclusion: The findings suggested increased Cathepsin D and MMP-9 expression in malignant salivary gland tumors. Further investigation using actual clinical specimens is required to establish their potential diagnostic and prognostic relevance.

Background: Heart failure with preserved ejection fraction (HFpEF) is a growing clinical entity, accounting for nearly half of all heart failure cases worldwide. Despite preserved systolic function, patients experience significant morbidity and mortality. Objective: To evaluate the clinical profile and risk factors of HFpEF among 155 patients admitted to a tertiary care hospital. Methods: A retrospective observational study was conducted on N=155 patients diagnosed with HFpEF (EF ≥50%). Demographic data, clinical presentation, comorbidities, and echocardiographic findings were analyzed. Results: The mean age was 62.4 years, with female predominance (60%). Hypertension (72%), diabetes mellitus (58%), and obesity (40%) were the most common risk factors. Echocardiography revealed left atrial enlargement (48%) and LV hypertrophy (52%). Conclusion: HFpEF is strongly associated with elderly females and comorbidities such as hypertension, diabetes, and obesity. Early detection and risk factor management are crucial to reduce disease burden.

Introduction: Peak expiratory flow rate (PEFR) is a simple, reliable measure of large airway function and respiratory muscle strength. PEFR is influenced by age, gender, anthropometric parameters, and physical activity levels. However, data on the combined influence of anthropometric parameters and physical activity on PEFR among Indian young adults aged 18–22 years remain limited. This study was conducted to determine gender differences in PEFR and to examine the association of PEFR with anthropometric parameters (height, weight, BMI, BSA) and physical activity levels among male and female students aged 18–22 years. Materials and Methods:   This cross-sectional observational study was conducted among 248 healthy college students (126 males, 122 females) aged 18–22 years in Indore, India, between January 2024 and June 2025. Anthropometric parameters including height, weight, BMI, and BSA were measured using standardized procedures. Physical activity level was assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), and participants were categorized as physically active or inactive. PEFR was measured using a Wright's mini peak flow meter, and the best of three acceptable efforts was recorded. Data were analyzed using independent samples t-test, Pearson correlation, and multiple linear regression. A P value < 0.05 was considered statistically significant. Results:   Male participants had significantly higher PEFR (492.3 ± 58.7 L/min) compared with females (386.5 ± 47.2 L/min; t = 15.68, P < 0.001; Cohen's d = 1.99). Height showed a strong positive correlation with PEFR in both males (r = 0.72, P < 0.001) and females (r = 0.68, P < 0.001). Weight and BSA showed moderate positive correlations, whereas BMI showed no significant correlation with PEFR in either gender (males: r = 0.09, P = 0.312; females: r = 0.12, P = 0.198). Physically active participants had significantly higher PEFR than inactive participants (448.2 ± 62.4 vs 421.6 ± 58.9 L/min; P = 0.012), with the difference being significant in males (P = 0.008) but not in females (P = 0.218). Multiple linear regression revealed that height (β = 2.847, P < 0.001) and physical activity status (β = 18.42, P = 0.012) were independent predictors of PEFR in males (adjusted R² = 0.543), while height (β = 2.615, P < 0.001) and BSA (β = 12.34, P = 0.018) were independent predictors in females (adjusted R² = 0.487). Conclusion:   PEFR varies significantly between male and female students aged 18–22 years. Height is the strongest anthropometric determinant of PEFR in both genders, while physical activity has an independent positive influence on PEFR, particularly in males. These findings suggest that gender, height, and physical activity status should be considered when establishing PEFR reference values and interpreting pulmonary function in young adults.

Introduction: The worldwide occurrence of cardiovascular diseases events is on growing trends, particularly in young adults. Hypertension through its hastening of atherosclerotic process is among the most significant risk factors for cardiovascular events. In present study, the objective was to assess the cardiovascular event risk among hypertensive patients. Objective: To assess the prevalence of cardiovascular disease (CVD) risk among hypertensive patients in rural field practice regions of respective institute. Material and Methods: A Cross-sectional study was done in which all 182 patients who were diagnosed with hypertension and attending health center during the period of 1st April 2025 to 31st December 2025 were included as study participants through Complete Enumeration Sampling Method.  The cardiovascular risk of study participants was assessed by the World Health Organization‐International Society of Hypertension Chart. Results: Among study participants, approximately 47% of them had ˂10% of CVD risk while nearly 6% had more than 40% of CVD. The prevalence of >10% CVD risk considerably increased with age with greater prevalence among the age group of 61-70 years compared to the other age groups (P <0.05). The prevalence of >10% CVD risk was detected to be more (p<0.05) among non-vegetarians, smokers, alcoholics, and diabetics compared to their counterparts.  Conclusions: Rural hypertensive patients in Pune District showed a high risk of cardiovascular events, which can be effectively gauged using WHO–ISH charts. Using these charts empowers blood pressure management, comorbidity screening, and consistent follow-ups to prevent subsequent fatal heart events.

Background: Heart failure (HF) is a major public health problem worldwide, associated with high morbidity, mortality, and healthcare costs. Accurate assessment of severity is essential for guiding therapy, but echocardiography is not always readily available. N-terminal pro–B-type natriuretic peptide (NT-proBNP) has emerged as a reliable biomarker reflecting ventricular wall stress. Objective: To evaluate the association between serum NT-pro BNP levels and the severity of HF in patients with chronic heart failure. Methods: A prospective observational study was conducted on 140 patients with clinically diagnosed HF. NT-pro BNP levels were measured using standardized immunoassays. Clinical severity was graded by New York Heart Association (NYHA) classification, and echocardiographic parameters including left ventricular ejection fraction (LVEF), chamber dimensions, and diastolic indices were recorded. Statistical analysis assessed correlations between NT-pro BNP and disease severity. Results: NT-pro BNP levels increased progressively with worsening NYHA class (mean 410 pg/mL in class I vs. 7,650 pg/mL in class IV). Significant negative correlation was observed between NT-pro BNP and LVEF (r = –0.58, p <0.001), while positive correlations were noted with LV end-diastolic diameter (r = +0.61, p <0.001), left atrial diameter (r = +0.55, p <0.001), and E/e’ ratio (r = +0.49, p <0.01). Patients with diabetes and ischemic heart disease had higher NT-pro BNP levels. Elevated NT-pro BNP quartiles were associated with increased hospitalization frequency. Conclusion: Serum NT-proBNP levels correlate strongly with HF severity and adverse outcomes. NT-pro BNP is a valuable biomarker for risk stratification, guiding therapy, and monitoring progression in chronic heart failure.

Background: Renal stone disease is a frequent urological disorder that deals with high morbidity like renal colic, urinary obstruction and recurrent stone formation. Chemical analysis of renal stones has an important role in distribution and in deciding the preventive measures. Objective: To find out the prevalence and composition of renal stones in patients who present to Ayub Teaching Hospital (ATH), Abbottabad, Pakistan. Study Design and Setting: Hospital based descriptive cross sectional study was planned which was conducted for six months in Ayub Teaching Hospital, Abbottabad in 2026. Methodology: The proposed analysis included 60 patients who had renal stones. Demographic and clinical data were obtained, and stone samples were analyzed for chemical composition. The stone types noted were calcium oxalate, calcium phosphate, uric acid, struvite, cystine, and mixed-composition. Descriptive statistics were used to report categorical variables as frequencies and percentages, and suitable statistical tests were planned to test associations between the composition of the stones and the demographic variables. Results: 53.3% of the cases were calcium oxalate stones, 13.3% were calcium phosphate stones, 11.7% were uric acid stones, 10.0% were mixed-composition stones, 8.3% were struvite stones and 3.3% were cystine stones. Men made up 63.3% of the patients and the age group of 31–40 was the most common. These per cent figures were not based on actual clinical observations but were hypothetical. Conclusion: Renal stone characterization by chemical composition can be used to aid in defining the distribution of stone types and guide individual stone prevention strategies. To draw conclusions about the frequency and composition of renal stones at the study hospital it is necessary to use verified patient-level data as well as laboratory findings.

 bnbnnnnIntroduction: Lower Respiratory Tract Infections (LRTIs) remain a leading cause of morbidity and mortality globally, with smokers representing a highly vulnerable demographic. Smoking compromises the respiratory immune defense, predisposing individuals to recurrent and severe infections. Objective: This study aims to determine the prevalence, clinical profile, and severity of LRTIs among smokers presenting to a tertiary care center in western Odisha. Materials and Methods: A hospital-based cross-sectional observational study was conducted at the Saheed Rendo Majhi Medical College and Hospital (SRM MCH), Bhawanipatna, Odisha, from June 2025 to June 2026. A total of 84 adult smokers presenting with respiratory symptoms were enrolled. Detailed demographic data, smoking history (pack-years), and clinical evaluations were recorded. Statistical analysis was performed to establish correlations between smoking intensity and LRTI severity. Results: Out of 84 smokers, 58 (69.04%) were diagnosed with an LRTI. The study population was predominantly male (85.7%). Acute bronchitis was the most common presentation (48.3%), followed by acute exacerbation of COPD (32.7%) and community-acquired pneumonia (19.0%). A significant association was observed between a higher smoking index (>20 pack-years) and the incidence of severe LRTIs (p=0.012). Furthermore, the presence of systemic comorbidities like diabetes mellitus significantly worsened the clinical outcome (p=0.024). Conclusion: There is a remarkably high prevalence of LRTIs among smokers in the Bhawanipatna region. The duration and intensity of smoking directly correlate with the severity of the infection. Targeted smoking cessation programs and early clinical interventions are crucial for reducing the pulmonary disease burden in this region.

Introduction: Dentists’ decisions about dental amalgam involve restorative performance, patient preferences, mercury exposure and environmental responsibility. Knowledge of these separate considerations is necessary for informed material selection and safe handling. Objective: A cross-sectional survey, how dentists’ knowledge, attitudes and safety practices concerning dental amalgam can be assessed and reported. Methods: Knowledge was represented by 10 binary item scores, with a score of at least 8 classified as higher knowledge for this exercise. Five attitude items used five-point responses, and six safety practices were assessed among eligible fictional practitioners. Descriptive statistics, Pearson chi-square tests and unadjusted odds ratios with 95% confidence intervals were calculated.  Results: The mean knowledge score was 7.16 ± 1.41 out of 10; 126 records (42.0%) met the higher-knowledge threshold. Agreement with routine discussion of restorative options was recorded in 231 cases (77.0%), and 233 (77.7%) supported further training. Among 260 records representing dentists who handled amalgam, 69 (26.5%) indicated separator use and 111 (42.7%) indicated designated waste storage. Higher knowledge was present in 68 of 114 training-exposed records (59.6%) and 58 of 186 unexposed records (31.2%), giving an unadjusted odds ratio of 3.26 (95% confidence interval 2.01–5.30; p<0.001). Conclusion: The association with training reflects that training to dentist would improve the practice and knowledge of the practicing dentist.

Introduction: Photoaging results from cumulative ultraviolet exposure and is characterized by wrinkles, dyspigmentation, uneven skin texture, loss of elasticity, and facial laxity. Objective: To assess the clinical features and severity of photoaging and evaluate outcomes following a combined dermatologic and plastic surgical approach. Methods: A prospective interventional study was conducted at Pak Italian Burn Centre Multan from June 2025 to June 2026 on 85 patients with clinically evident facial photoaging. Demographic characteristics, sun exposure, sunscreen use, Fitzpatrick skin type, and clinical manifestations of photoaging were recorded. Patients underwent individualized dermatologic and/or plastic surgical treatment according to the severity and type of photoaging. Results: The mean age of participants was 47.8 ± 10.6 years, and 55 (64.7%) were female. Fitzpatrick skin type IV was most common, occurring in 42 (49.4%) patients. Moderate and severe photoaging were observed in 38 (44.7%) and 31 (36.5%) patients, respectively. Fine wrinkles were present in 67 (78.8%), dyspigmentation in 65 (76.5%), uneven skin texture in 59 (69.4%), and facial laxity in 53 (62.4%) patients. The overall photoaging score decreased significantly from 13.19 ± 2.47 before treatment to 7.41 ± 2.08 after treatment (t = 16.48, p < 0.001).  Conclusion: It is concluded that photoaging in the studied Pakistani population was commonly associated with wrinkles, pigmentary changes, textural abnormalities, and facial laxity.

Introduction: One of the most common gastrointestinal disorders seen in clinical practice, dyspepsia, accounts for a substantial portion of outpatient visits worldwide. Helicobacter pylori infection is the cause of peptic ulcer disease, gastric adenocarcinoma, mucosa-associated lymphoid tissue lymphoma, and chronic gastritis. Early diagnosis and organism eradication reduce morbidity and prevent long-term effects. The Rapid Urease Test (RUT) is a fast, inexpensive, and precise invasive diagnostic method used to detect H. pylori infection during an upper gastrointestinal endoscopy. Objective To determine the frequency of Rapid Urease Test positivity in adult dyspepsia patients and evaluate its association with demographics and endoscopic findings. Materials and Methods: A cross-sectional study conducted at a hospital involved 297 adult patients with dyspeptic symptoms who underwent upper gastrointestinal endoscopy. Gastric biopsy tissues obtained following endoscopy were subjected to Rapid Urease Testing. Endoscopic results, clinical presentation, and demographic information were recorded using a pre-made proforma. For statistical analysis, SPSS version 26.0 was utilized. Categorical variables were compared using the Chi-square test. Odds ratios with 95% confidence intervals were calculated, and a p-value of less than 0.05 was considered statistically significant.  Results: Of the 297 cases, 162 (54.5%) tested positive for RUT. The highest positive rates were found in patients with gastritis (67.9%) and duodenal ulcers (85.7%). Patients over 45 had a significantly higher RUT positive rate than younger patients (p=0.021). Gastritis was independently associated with RUT positivity (Adjusted OR 2.96; 95% CI 1.71–5.13; p<0.001). There was no statistically significant link between gender (p=0.24). Conclusion: More than half of the dyspeptic patients in this fictitious study have Helicobacter pylori, according to the Rapid Urease Test. Regular use of RUT during upper gastrointestinal endoscopy may aid in early diagnosis and prompt eradication treatment in regions where H. pylori infection is common. Large-scale multicentric research is required to validate these findings

Introduction: Ventilator-associated pneumonia (VAP) is a major healthcare-associated infection among critically ill patients receiving mechanical ventilation and is associated with considerable morbidity, mortality, and antimicrobial resistance. Knowledge of the clinical profile, causative microorganisms, antimicrobial susceptibility, and resistance patterns is essential for appropriate empirical therapy and antimicrobial stewardship. Objective: To evaluate the clinical profile, microbiological spectrum, antimicrobial resistance patterns, and clinical outcomes of adult patients with ventilator-associated pneumonia admitted to the intensive care units of a tertiary care hospital, and to assess the association of antimicrobial resistance with clinical outcomes. Materials and Methods: A prospective longitudinal observational study was conducted over 18 months in the Medical and Surgical Intensive Care Units of a tertiary care teaching hospital. A total of 174 adult patients who developed VAP after at least 48 hours of invasive mechanical ventilation were included. Demographic and clinical characteristics, timing of VAP onset, microbiological findings, antimicrobial susceptibility patterns, resistance phenotypes, and clinical outcomes were recorded. Endotracheal aspirates were processed using standard microbiological methods, and antimicrobial susceptibility testing was performed according to standard laboratory procedures. Clinical outcomes were compared according to causative organisms and antimicrobial resistance status.  Results: Among the 174 patients, 106 (60.9%) were male and 68 (39.1%) were female, with a mean age of 51.0 ± 15.0 years. Medical ICU patients accounted for 93 (53.4%) cases, while 81 (46.6%) were admitted to the Surgical ICU. Early-onset VAP occurred in 50 (28.7%) patients and late-onset VAP in 124 (71.3%). Gram-negative organisms predominated (63.8%), with Acinetobacterbaumannii and Pseudomonas aeruginosa being the most frequently isolated pathogens, accounting for 30 (17.2%) cases each. Among 142 culture-positive cases, 74 (52.1%) demonstrated one or more clinically significant antimicrobial resistance phenotypes. Mortality occurred in 56 (32.2%) patients. Organism-wise mortality was highest among Escherichia coli (42.9%) and Acinetobacterbaumannii (40.0%) among the major pathogens. Mortality was significantly higher among patients with MDR/XDR/CRE/ESBL-associated isolates than among those with non-MDR isolates (40.5% vs. 22.1%; p = 0.029), and MODS was also significantly more frequent among patients with resistant organisms (24.3% vs. 10.3%; p = 0.049). The mean SOFA score at 72 hours was significantly higher among non-survivors than survivors (9.8 ± 2.5 vs. 6.5 ± 2.1; p < 0.001). Mortality did not differ significantly between early- and late-onset VAP (30.0% vs. 33.1%; p = 0.832). Conclusion: Ventilator-associated pneumonia in this cohort was characterized by a predominance of Gram-negative pathogens and a substantial burden of antimicrobial resistance. Antimicrobial resistance was associated with higher mortality and MODS in unadjusted analyses, while worsening SOFA scores at 72 hours were strongly associated with mortality. However, MDR status was not an independent predictor of mortality after multivariable adjustment. These findings emphasize the importance of continuous microbiological surveillance, local antimicrobial susceptibility data, early recognition of clinical deterioration, and targeted antimicrobial stewardship in the management of VAP;

Background: 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.

Introduction: Cardiovascular abnormalities are often linked to chronic kidney disease (CKD) and significantly increase morbidity and mortality. However, clinical recognition of cardiac involvement may still be lacking, especially in patients with moderate to advanced chronic kidney disease. Objective: To use electrocardiography (ECG), two-dimensional echocardiography (2D-ECHO), cardiac biomarkers, and ejection fraction to assess cardiac dysfunction in patients with stages 3–5 of chronic kidney disease (CKD), and to analyze their correlation with CKD stage and specific clinical variables. Methods: In a tertiary care institution, 120 patients with CKD stages 3–5 participated in a long-term study. ECG, 2D-ECHO, cardiac biomarker evaluation, and ejection fraction assessment were performed on the participants. Additionally, laboratory and clinical indicators were noted. Statistical analysis was used to examine correlations between certain clinical and demographic variables and cardiac results. Results: Of the 120 individuals, 41.7% had CKD stage 3, 33.3% had stage 4, and 25.0% had stage 5. Left ventricular hypertrophy (LVH) was the most common ECG abnormality (33.3%), followed by arrhythmias and ST-T alterations (20.8% each); 25.0% had normal ECG readings. On 2D-ECHO, 37.5% of patients had left ventricular dysfunction, 20.8% had diastolic dysfunction, 12.5% had pericardial effusion, and 29.2% had normal results. 58.3% of subjects had elevated cardiac biomarkers. 37.5% had a reduced ejection fraction (less than 40%), 29.2% had an ejection fraction between 40 and 50%, and 33.3% had an ejection fraction greater than 50%. CKD stage and 2D-ECHO results were found to be significantly correlated (p=0.02). Ejection percent was strongly correlated with age (p=0.04), with older participants more likely to have a lower ejection %. Reduced ejection fraction was also substantially correlated with hypertension (p=0.01). Conclusion: Patients with CKD stages 3–5 frequently have cardiac abnormalities affecting electrical, structural, and functional cardiac parameters. Echocardiographic abnormalities increased with the severity of CKD, whereas reduced ejection fraction was linked to older age and hypertension. In patients with mild to severe CKD, routine cardiovascular evaluation using ECG, 2D-ECHO, cardiac biomarkers, and ejection fraction may help detect cardiac involvement early.

General practice is a cornerstone of the UK healthcare system, providing accessible, continuous, and person-centred care while coordinating services across the wider NHS. Historically, it has evolved in response to changing population needs, moving from predominantly acute episodic care towards long-term management of chronic disease, prevention, and holistic patient support. The profession has repeatedly demonstrated adaptability, including the development of multidisciplinary teams and the rapid adoption of remote consultations during the COVID-19 pandemic. Despite this resilience, general practice is now under considerable strain. Rising patient demand, increasing multimorbidity, workforce shortages, and administrative burden have contributed to reduced continuity of care, poorer access, and declining morale among clinicians. The future sustainability of general practice will depend on stronger integration between primary and secondary care, effective use of technology, improved recruitment and retention, and a reduction in bureaucratic burden. A renewed emphasis on proactive and preventive care will be essential if general practice is to continue meeting the evolving health needs of the population.

Introduction:  Pulmonary tuberculosis (PTB) remains an important public health problem, particularly in high-burden countries such as India. Diagnosis can be challenging in patients with clinical or radiological suspicion of PTB who are unable to produce sputum or have negative sputum microscopy. Bronchoalveolar lavage (BAL) obtained during bronchoscopy provides a representative lower respiratory tract specimen, while cartridge-based nucleic acid amplification testing (CBNAAT) enables rapid molecular detection of Mycobacterium tuberculosis. Aim: To evaluate the diagnostic yield of CBNAAT performed on BAL samples in sputum-negative or sputum-scarce patients with suspected pulmonary tuberculosis. Materials and Methods: A prospective observational study framework was used for patients with suspected pulmonary tuberculosis who were sputum smear-negative or sputum-scarce and underwent bronchoscopy with BAL sampling. BAL specimens were subjected to CBNAAT for detection of Mycobacterium tuberculosis. The proposed reconstructed dataset comprises 100 participants, with the overall CBNAAT positivity proportion modelled from the reported yield of the source study. Categorical variables were expressed as frequencies and percentages, and association between categorical variables was assessed using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: Among the proposed 100 participants, approximately 30 were found to have CBNAAT-detected Mycobacterium tuberculosis, corresponding to an overall diagnostic yield of approximately 31%. Males constituted approximately three-fourths of the study population. The gender-wise distribution suggested a slightly higher proportion of CBNAAT positivity among females than males; however, the difference was not statistically significant. The findings indicate that BAL-based CBNAAT may provide additional microbiological confirmation in patients with suspected pulmonary tuberculosis despite negative or unavailable sputum specimens. Conclusion: BAL CBNAAT may be a useful diagnostic modality in sputum-negative or sputum-scarce patients with suspected pulmonary tuberculosis. Its ability to provide rapid molecular confirmation from lower respiratory tract specimens may facilitate earlier diagnosis and treatment. Larger prospective studies incorporating mycobacterial culture and additional clinical and radiological parameters are required to establish its diagnostic performance more robustly.

Background: Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. The liver serves as the principal storage site for Vitamin B12, and hepatic injury may alter its metabolism and serum concentration. Aims & Objectives: To study serum Vitamin B12 levels in patients with chronic liver disease and evaluate their association with disease severity and prognosis.Materials and Methods: This observational longitudinal study was conducted in a tertiary care centre over a period of six months. A total of 60 adult patients diagnosed with chronic liver disease were included using convenience sampling. Clinical examination, laboratory investigations including liver function tests, serum electrolytes, serum Vitamin B12 estimation, and ultrasonography of the abdomen were performed. Disease severity was assessed using Child-Pugh classification. Results: A total of 60 patients were enrolled, with males constituting the majority of the study population. Alcohol-related liver disease was the most common etiology, followed by non-alcoholic steatohepatitis and hepatitis B infection. The mean serum Vitamin B12 level was elevated among patients with chronic liver disease. Higher Vitamin B12 levels were observed in patients with decompensated disease compared to compensated disease. Patients belonging to Child-Pugh Class C demonstrated significantly higher serum Vitamin B12 levels than those in Child-Pugh Class B. Patients with adverse outcomes exhibited the highest Vitamin B12 concentrations. Elevated serum Vitamin B12 levels showed a positive association with disease severity and poor prognosis. Conclusion: Serum Vitamin B12 levels are significantly elevated in patients with chronic liver disease and correlate with the severity of hepatic dysfunction.

Background: Laparoscopic and open inguinal hernia repair have different postoperative pain and functional recovery. The aim of this study was to compare the chronic postoperative pain and recovery to normal activity in these methods. Methods: A prospective comparative study was conducted at People's University of Medical and Health Sciences for Women, Nawabshah, Pakistan, from December 2025 to May 2026. Patients were equally divided into laparoscopic (n=47) and open repair (n=47) groups. Assessment of chronic pain was performed at three months, and time to return to normal activity was recorded. A p-value < 0.05 was considered statistically significant. Results: Chronic postoperative pain was less frequent following laparoscopic repair than open repair (p = 0.022). Laparoscopic patients had significantly less time to return to normal activity, 6.2 ± 2.4 days compared to 10.8 ± 3.8 days for the open group, p <0.001. Laparoscopic repair required longer operative time but resulted in shorter hospitalization (p <0.001). Postoperative complication rates did not differ significantly (p = 0.146). Conclusion: Laparoscopic inguinal hernia repair was associated with less chronic postoperative pain and faster functional recovery than traditional open inguinal hernia repair.

Background: Cervical cancer remains the fourth most common malignancy among women worldwide, disproportionately affecting low- and middle-income countries such as Pakistan, where organized screening remains largely absent. Persistently low awareness and poor screening uptake are believed to sustain this preventable disease burden. This study aimed to assess the knowledge, attitudes, and practices regarding cervical cancer screening among women of reproductive age attending a tertiary-care hospital in Pakistan, and to identify the sociodemographic determinants of adequate knowledge and screening uptake. Materials and Methods: A hospital-based, cross-sectional study was conducted among 125 women of reproductive age attending the outpatient Gynecology and Obstetrics department of a tertiary-care hospital in Khyberpakhtunkhwa, Pakistan, using a structured, interviewer-administered questionnaire covering sociodemographic, knowledge, attitude, and practice domains. Data were analyzed using SPSS version 26; chi-square tests and binary logistic regression identified associations and independent predictors, with p<0.05 considered significant. Results: The mean age was 35.3 ± 5.8 years. Only 33.6% had heard of cervical cancer, and 12.8% had adequate knowledge. A positive attitude was observed in 60.8%, yet only 9.6% had ever been screened. Graduate education (AOR=17.12, 95% CI: 4.18–70.15) and high income (AOR=5.21, 95% CI: 1.57–17.25) independently predicted adequate knowledge, while adequate knowledge independently predicted screening uptake (AOR=6.62, 95% CI: 1.65–26.60). Conclusion: Knowledge and screening uptake remain critically low among reproductive-age women in this tertiary-care setting, driven by educational and socioeconomic disparities. Targeted, education-based interventions integrated into routine gynecological care are urgently needed.

Background: Focal liver lesions frequently require histopathological confirmation for definitive diagnosis. Ultrasound-guided core needle biopsy is widely used because it permits real-time targeting and provides tissue for histopathological assessment. However, non-diagnostic samples may occur, particularly when lesions are small or technically difficult to access. Lesion size may therefore influence biopsy diagnostic yield. Objective: To determine the association between focal liver lesion size and the diagnostic yield of ultrasound-guided core needle biopsy. Methods: A hospital-based observational study was conducted at Lady Reading Hospital, Peshawar, from June 2025 to February 2026. A total of 100 adult patients undergoing ultrasound-guided core needle biopsy of focal liver lesions were included. Demographic, sonographic, lesion-related, and procedural characteristics were recorded. Lesions were categorized according to maximum diameter. Histopathological examination was used to determine diagnostic adequacy. Univariable and multivariable logistic regression analyses were performed to identify factors associated with diagnostic success. Receiver operating characteristic analysis was performed to assess the predictive performance of lesion size. Results:A definitive histopathological diagnosis was obtained in 84 (84.0%) biopsies. Diagnostic yield increased with lesion size, ranging from 65.0% for lesions less than 2 cm to 96.0% for lesions 5 cm or larger. Lesions 3 cm or larger demonstrated significantly greater diagnostic success than smaller lesions. On multivariable analysis, lesion size of 3 cm or larger was independently associated with diagnostic success (adjusted OR 3.85, 95% CI 1.42–10.44, p = 0.008). Poor sonographic visualization, mixed or necrotic composition, and fewer biopsy cores were also associated with reduced diagnostic yield. Lesion size demonstrated good predictive performance (AUC 0.78, 95% CI 0.69–0.87). Conclusion: Larger focal liver lesions demonstrated a higher diagnostic yield following ultrasound-guided core needle biopsy. Lesion size should be considered during pre-procedural assessment, particularly when biopsy is planned for small or technically challenging lesions.

Background: Refractory glaucoma is characterized by uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy and/or previous surgical intervention. Trabeculectomy augmented with mitomycin C (MMC) and glaucoma drainage devices (GDDs; tube shunts) are established surgical options, but their relative performance differs according to prior ocular surgery, risk of scarring, target IOP, and complication profile. Objective: To compare the efficacy, safety, medication requirements, and reoperation rates of trabeculectomy with MMC and GDD implantation in refractory glaucoma. Methods: This narrative review synthesizes findings from multicenter randomized trials, particularly the Tube Versus Trabeculectomy (TVT) Study, and contextualizes them with results from the Primary Tube Versus Trabeculectomy (PTVT) Study. Results: In the TVT Study, which enrolled eyes with prior cataract extraction and/or failed glaucoma surgery, the 5-year cumulative failure rate was significantly lower after tube-shunt surgery than after trabeculectomy with MMC (29.8% vs 46.9%; P = .002). The cumulative rate of additional glaucoma surgery was also lower in the tube group (9% vs 29%; P = .025). Both procedures achieved substantial IOP reduction, with mean IOP in the low teens during follow-up. In contrast, the PTVT Study, conducted in surgically naïve eyes, found no statistically significant difference in 5-year failure rates (42% for tube shunt vs 35% for trabeculectomy; P = .21), while trabeculectomy required fewer postoperative medications (1.3 ± 1.4 vs 2.2 ± 1.3; P < .001). Early postoperative complications were more frequent after trabeculectomy. Conclusion: For refractory glaucoma in eyes with previous ocular surgery or a high likelihood of filtration failure, GDD implantation offers a lower long-term failure and reoperation risk than trabeculectomy with MMC. Trabeculectomy remains an important option when a low medication burden is a priority and conjunctival scarring risk is lower. Surgical selection should be individualized

Background: Diabetes and periodontal disease are widespread chronic inflammatory disorders that may have a bidirectional association. Inadequate glycemic control may lead to more destruction of periodontal tissues, and periodontal inflammation may have a negative effect on metabolic control. The relationship between glycemic status and severity of chronic periodontitis in adults was evaluated in this study. Methods:  A cross-sectional study of analytical design was used in the study involving 200 adults. Glycated hemoglobin (HbA1c) and fasting blood glucose were used to evaluate the glycemic status, and probing pocket depth, clinical attachment loss, bleeding on probing, and plaque assessment were used to assess the periodontal status. Periodontal disease was classified as mild, moderate, or severe. The associations were determined by Chi-square test, one-way ANOVA, Mann–Whitney U test, Spearman correlation, and logistic regression. Statistically significant p-values (p < 0.05) were used.  Results:  Severe periodontitis was present in 32.5% of participants. Mean HbA1c increased significantly from 5.8 ± 0.8% in mild disease to 7.9 ± 1.7% in severe disease (p<0.001). The HbA1c ≥6.5% group was significantly more likely to have severe periodontitis (52.3%) than was the group with normal glycemic status (11.5%) (p<0.001). HbA1c and probing pocket depth were correlated positively, and both were correlated with clinical attachment loss (rₛ=0.52 and 0.58, respectively, for both, p<0.001). Severe periodontitis was significantly associated with poor glycemic control (p<0.001). Conclusion: Poor glycemic control was significantly associated with greater periodontal disease severity. Comprehensive metabolic and periodontal evaluations can be used to determine patients at higher risk for advanced periodontal disease.

Background: Community-acquired pneumonia (CAP) remains an important cause of hospitalization and adverse clinical outcomes, particularly when early deterioration occurs after admission. Early recognition of high-risk patients may facilitate timely escalation of care. This study evaluated predictors of early clinical deterioration among adults hospitalized with CAP. Methods: This prospective observational study included adult patients hospitalized with CAP at a tertiary-care hospital. Demographic, clinical, laboratory, radiological, and severity-related variables were recorded at admission. Early clinical deterioration was defined as intensive care unit transfer, initiation of non-invasive or invasive ventilatory support, vasopressor requirement, or death within 72 hours. Data were analyzed using IBM SPSS Statistics version 27. Univariable and multivariable binary logistic regression analyses were performed to identify independent predictors. Results: Early clinical deterioration occurred in approximately one-quarter of patients. Patients who deteriorated demonstrated greater physiological instability, inflammatory abnormalities, and radiological disease extent at presentation. On multivariable analysis, respiratory rate ≥30 breaths/min, oxygen saturation <90%, altered mental status, elevated neutrophil-to-lymphocyte ratio, and multilobar pulmonary involvement remained independently associated with early deterioration. Conclusion: Early deterioration in hospitalized CAP was independently associated with respiratory compromise, altered mental status, systemic inflammatory response, and extensive pulmonary involvement. These readily available admission parameters may assist early risk stratification and identification of patients requiring intensified monitoring and timely escalation of care.

Background: Fiber-reinforced bulk-fill composites may improve the clinical performance of posterior restorations exposed to high occlusal stresses. Objective: To compare the clinical performance of fiber-reinforced bulk-fill composite with conventional nanohybrid composite in high-stress posterior teeth.

Methodology: A prospective, parallel-group comparative study was conducted from May 2025 to April 2026. A total of 132 restorations in adult patients were randomly allocated to fiber-reinforced bulk-fill (n=66) or conventional nanohybrid composite (n=66) groups. Restorations were clinically evaluated at baseline, 1, 3, and 6 months for postoperative sensitivity, marginal integrity, anatomical form, surface characteristics, secondary caries, wear, and fracture. Data were analyzed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: At 6 months, clinically successful restorations were observed in 61/66 (92.42%) fiber-reinforced and 55/66 (83.33%) nanohybrid restorations (p=0.115). Sensitivity was present in 1/66 (1.52%) and 4/66 (6.06%), respectively (p=0.169). Marginal adaptation was acceptable in 61/66 (92.42%) versus 56/66 (84.85%) (p=0.140), while fractures occurred in 2/66 (3.03%) versus 6/66 (9.09%) (p=0.121). Sensitivity scores were significantly lower with fiber reinforcement at 3 and 6 months (p=0.006 and p=0.001). Conclusion: Both materials demonstrated acceptable clinical performance, with fiber-reinforced bulk-fill showing favorable trends but no statistically significant overall superiority.

Background: Fatal injuries constitute a major component of medicolegal practice and require integrated assessment of injury patterns, circumstances, and forensic evidence. Objective:  To analyze fatal medicolegal cases with respect to injury patterns, clinical characteristics, circumstantial factors, and available forensic evidence and to determine their relationship with the cause and manner of death.

Methodology: This was a retrospective observational study carried out from January – December 2025. There were a total of 290 eligible fatal nonaccidental medicolegal cases that were sampled consecutively. Medicolegal, postmortem, clinical, police/investigative and available forensic records were used to obtain data. Demographic and injury characteristics were summarized using descriptive statistics, and associations and group comparisons were made using chi-square/Fisher's exact tests and independent-samples t test or Mann–Whitney U tests, respectively. Results: The mean age was 39.7 ± 18.2 years, and males constituted 226 (77.93%) cases. Blunt-force trauma was the most frequent injury mechanism, occurring in 136 (46.90%) cases, followed by sharp-force injury in 47 (16.21%) and firearm injury in 38 (13.10%). Head and neck injuries were identified in 154 (53.10%) cases, while internal hemorrhage occurred in 139 (47.93%). Road traffic collisions represented 118 (40.69%) reported circumstances. Traumatic brain injury was the leading cause of death in 91 (31.38%) cases. Accidental deaths predominated, comprising 169 (58.28%) cases. Significant associations were observed between manner of death and blunt-force, sharp-force, firearm, multiple, and head injuries. Conclusion: Systematic integration of injury characteristics, circumstances, postmortem findings, and forensic evidence is essential for accurate determination of the cause and manner of death in fatal medicolegal cases.

Background and Objective- Sarcopenia, characterized by progressive loss of skeletal muscle mass and function, is a public health concern among older adults.  However there is a paucity of data regarding its determinants in Eastern India. Thus, study was conducted to explore this. Methodology: A community-based cross-sectional study was carried out over a span of 18 months where two distinct areas were selected: urban and rural. A total of 250 participants, equally divided between the two settings (125 urban and 125 rural), aged 60 years and above, were selected using simple random sampling. Sarcopenia was defined using Asian Working Group for Sarcopenia 2019 criteria. Data collection included sociodemographic variables, comorbidities, occupation and dietary intake.  Results: The prevalence of sarcopenia was significantly higher in the rural population (25.2%) compared to the urban population (12%) (p < 0.05). The prevalence increased with advancing age, with the highest rate (81.8%) observed in participants aged 75 years and above. Significant gender disparity was evident, with a higher prevalence among males (66.7%) than females (42.9%) (p = 0.004). Illiterate individuals and those from lower-income households exhibited higher rates of sarcopenia (71.4% and 69.2%, respectively). Multivariate regression analysis identified age, male gender, low educational status, inadequate protein intake, and the presence of chronic disease as independent predictors of sarcopenia (p < 0.05). Interpretation and Conclusion:This study underscores a high burden of sarcopenia among the elderly, with a disproportionately higher prevalence in rural areas due to socioeconomically disadvantaged conditions, poor nutrition, and limited access to healthcare. Thus, targeted interventions are imperative for its prevention.

Background: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder affecting women of reproductive age. In addition to reproductive dysfunction, PCOS is associated with obesity, insulin resistance, hyperandrogenism, psychological distress, and altered eating behavior. Objective: To determine the association of eating disorders, anxiety, and depression with infertility and selected metabolic, hormonal, and inflammatory parameters in women with PCOS. Methods: A cross-sectional analytical study was modeled among 200 women aged 18–40 years diagnosed with PCOS according to Rotterdam criteria. Participants were categorized as infertile (n=120) or fertile (n=80). Anthropometric measurements, EAT-26, HADS, fasting glucose, insulin, lipid profile, LH, FSH, total testosterone, and hs-CRP were assessed. HOMA-IR was calculated. Independent-samples t-test, chi-square test, Pearson correlation, and multivariable logistic regression were used. Results: Infertile women had higher BMI (29.4±4.8 vs. 26.7±4.2 kg/m²; p<0.001), waist circumference (94.1±10.6 vs. 88.2±9.7 cm; p<0.001), fasting insulin (16.9±7.4 vs. 12.8±6.1 µIU/mL; p<0.001), HOMA-IR calculated from the reported group means (4.11 vs. 2.96; participant-level means and inferential statistics pending verification), total testosterone (1.21±0.38 vs. 1.08±0.31 ng/mL; p=0.008), triglycerides (174.2±58.6 vs. 151.7±49.3 mg/dL; p=0.004), and hs-CRP (4.2±2.5 vs. 3.1±1.9 mg/L; p=0.002). Abnormal eating behavior occurred in 31.7% versus 17.5% (p=0.025), anxiety in 45.8% versus 27.5% (p=0.009), and depression in 40.8% versus 22.5% (p=0.007). In regression analysis, obesity (aOR 2.41), abnormal eating behavior (aOR 2.18), anxiety (aOR 1.97), depression (aOR 2.12), HOMA-IR ≥2.5 (aOR 1.89), and elevated testosterone (aOR 1.76) were independently associated with infertility. Conclusion: Eating abnormalities, anxiety, and depression appear to coexist with greater metabolic, hormonal, and inflammatory dysfunction among women with PCOS and are associated with infertility. Integrated reproductive, metabolic, nutritional, and psychological assessment may therefore provide a more comprehensive approach to infertility management in PCOS.

Introduction: 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, but reported benefits are often within-group changes. This review critically synthesises the evidence on respiratory PNF in adults with COPD, distinguishing within-group change from between-group effects, and identifies clinical implications and research gaps. Method: Critical narrative review. PubMed, Google Scholar, PEDro, Cochrane Library records, ClinicalTrials.gov and publisher websites were searched, most recently on 2 March 2026. Only studies whose details could be verified against the published report or abstract were included. 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). A systematic review published in 2025 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, published in 2025, chest mobility exercises produced larger improvements than PNF stretching. Protocols were heterogeneous, interventions lasted from 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 the 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.

Background: Distal radius fractures may result in pain, loss of wrist function, and functional disability. Volar plating and closed reduction and cast immobilization are among the treatments used, which have varying short-term functional outcomes. Objective: To compare functional outcomes following volar plating versus closed reduction and casting in patients with distal radius fractures. Methods: This prospective comparative study was conducted at Altibri Medical College & Hospital, Karachi, from 1st December 2025 to 31st May 2026. A total of 62 patients were included, with 31 patients in each treatment group. Functional outcomes were assessed at 12 weeks using the Disabilities of the Arm, Shoulder and Hand (DASH) score. The pain level, range of motion, grip strength, and treatment-related complications were also assessed. Data were analyzed using SPSS 26, and p≤0.05 was considered statistically significant. Results: The mean DASH score was significantly lower in the volar plating group compared to the casting group (p=0.001). Wrist pain was lower (median 2 versus 3; p=0.018), while wrist flexion (p=0.012) and extension (60° versus 50°; p=0.009) were greater in the volar plating group. Grip strength was 28.4 ± 6.2 kg and 25.1 ± 6.8 kg, respectively (p=0.050). Complications occurred in 12.9% of patients after volar plating and 19.4% after casting (p=0.732). Conclusion: Volar plating was associated with better functional outcomes at 12 weeks, including lower DASH scores, less pain, and greater wrist mobility. The difference in overall complications was not statistically significant.

Introduction: Increasingly, male partner involvement (MPI) has been identified as a key component of maternal and newborn health initiatives. Although literature indicates that involvement of men can be a positive force in influencing maternal health outcomes, little existing data exists on the specific role of MPI in the postnatal period concerning postnatal care-seeking and maternal behaviors related to this process. Methodology: The cross-sectional study was conducted among 422 women in the postpartum period. A structured questionnaire was used to collect data on socio-demographic and obstetric factors, male partnership involvement, and postpartum health behavior. MPI was classified into three categories: low, moderate, and high. The data were described using descriptive statistics, and chi-square and multinomial logistic regression tests were employed to analyze the relationship between MPI and various variables. Results: The average age of the respondents was 28.08 ± 6.40 years. A majority of women reported a moderate MPI (63.3%), followed by low MPI (18.5%), high MPI (18.2%), and the lowest percentage reported low MPI combined with low social support. Use of postpartum health services was low, as 45.7% attended a postnatal care within 48 hours, 48.3% attended at least one postnatal care within six weeks, 47.9% practiced early breastfeeding (EBF), 54.3% received PNC, and 50.5% were using a modern form of family planning. MPI was not significantly associated with postnatal health behaviors. Family structure was the variable significant to MPI. Conclusion: Male partner participation during the postpartum period was mostly moderate, with no statistical significance in postpartum health behaviours. Findings suggest that male partner participation alone cannot contribute to improvements in postpartum health practices. Improving the male partner participation quality, as well as its strength, along with support from health facilities in terms of postpartum health is needed.

Introduction: Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency with a wide range of etiologies and variable clinical severity. In resource-limited settings, delayed presentation and restricted access to endoscopic services may influence diagnostic and treatment outcomes. Colonoscopy remains the gold standard for diagnosis and management, offering both diagnostic and therapeutic capabilities. Objective: To evaluate clinical outcomes, colonoscopic findings, and endoscopic interventions in patients who presented with LGIB in a resource-limited healthcare setting and to identify predictors of hospital admission. Methods: We retrospectively reviewed 153 adults who underwent colonoscopy for LGIB at the Combined Military Hospital, Peshawar, Pakistan, from January 2024 to December 2025. Demographic, clinical, laboratory, and endoscopic variables were obtained from hospital records, and colonoscopic diagnoses, endoscopic procedures, hospital admission, and transfusion needs were evaluated. Analyses included descriptive statistics, one-way ANOVA followed by post hoc comparisons, chi-square testing with Monte Carlo exact p values, and binary logistic regression, with statistical significance set at p < 0.05. Results: The mean patient age was 44.89 ± 14.23 years, and 53.6% of the patients were male. Hemorrhoids were the most common colonoscopic finding (45.8%), followed by colitis and polyps (9.8% each), while malignancy accounted for 6.5% of the cases. Hospital admission was required for 34.6% of the patients, and blood transfusion was needed for 7.2%. Malignancy was associated with the highest rates of admission (100%) and transfusion (60%). Hemoglobin levels varied significantly across diagnostic groups (p < 0.001) and were lowest in patients with malignancy. Logistic regression revealed that hemoglobin was the only independent predictor of hospital admission (OR = 0.768, 95% CI: 0.634–0.931; p = 0.007). Endoscopic interventions included biopsy (34.6%), polypectomy (6.5%), tattooing (3.3%), and electrocautery hemostasis (1.3%). Conclusion: LGIB in a resource-limited setting is predominantly caused by benign anorectal disease; however, a substantial proportion of patients present with high-risk pathology requiring hospitalization and transfusion. Lower hemoglobin levels were independently associated with hospital admission. Colonoscopy remains essential for accurate diagnosis and targeted management, highlighting the need to strengthen endoscopic services in resource-constrained healthcare systems.

Introduction: Basal cell carcinoma (BCC) is the most common cutaneous malignancy worldwide, arising from the basal cells of the epidermis and adnexal structures. Although characterized by slow growth and a low metastatic potential, BCC can cause significant local tissue destruction if left untreated. Chronic ultraviolet (UV) radiation exposure is the principal etiological factor, with advancing age, ionizing radiation, immunosuppression, and certain genetic syndromes recognized as additional risk factors.

Background: Early assessment of the failure of high-flow nasal cannula (HFNC) therapy is crucial for timely escalation of respiratory support. This study aimed to compare the predictive performance of the National Early Warning Score 2 (NEWS2) and the ROX index in patients with acute hypoxemic respiratory failure. Methods: This prospective comparative observational study was performed at United Medical and Dental College, Karachi, including 138 adult patients undergoing HFNC therapy. At baseline and at 2, 6, and 12 hrs, NEWS2 and ROX indices were measured. HFNC failure was considered as the need for endotracheal intubation. The predictive performance was assessed by receiver operating characteristic (ROC) analysis and compared by DeLong's test. Results: HFNC failure occurred in 41 patients (29.7%). The NEWS2 scores and the ROX indices were significantly higher in patients with treatment failure (p<0.001). There was a progressive increase in discriminatory performance for both indices. At 12 hours, NEWS2 achieved an AUC of 0.92 (95% CI: 0.87–0.97), compared with 0.89 (95% CI: 0.83–0.95) for ROX. However, the difference was not statistically significant (p=0.142). Conclusion: NEWS2 and the ROX index demonstrated good predictive performance for HFNC failure. The two indices were not significantly different, though NEWS2 had slightly higher accuracy numerically. Serial assessment may help with clinical risk stratification.

Introduction: Platelet activation, thrombocytopenia and coagulation abnormalities have been described in coronavirus disease 2019 (COVID-19). Routinely generated platelet indices may offer inexpensive markers of disease severity. Objective: To evaluate changes in platelet parameters measured on a five-part haematology analyser and D-dimer levels in patients with COVID-19 and to assess their association with intensive cardiac care unit (ICCU) admission. Methods: This cross-sectional study included 100 patients with COVID-19 confirmed by reverse transcription polymerase chain reaction or rapid antigen testing. Fifty patients were admitted to the ICCU and 50 to the ward. Admission samples were analysed for platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), mean platelet component (MPC), mean platelet mass (MPM), platelet-large cell count (P-LCC), platelet-large cell ratio (P-LCR), platelet-to-lymphocyte ratio (PLR) and D-dimer. Results: ICCU patients had lower platelet count, PLR and PCT, and higher MPV, PDW, MPM, P-LCR and D-dimer than ward patients. Platelet count was 102.86±61.23 versus 315.60±146.57×10³/µL and D-dimer was 2559.12±1661.18 versus 389.44±161.28 ng/mL (both P<0.0001). In multivariable analysis, age, platelet count and D-dimer were independently associated with ICCU admission. Conclusion: Admission platelet indices and D-dimer showed significant associations with higher-acuity care in COVID-19. These routinely available parameters may support early risk stratification when interpreted with clinical findings.

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition that may recur despite endoscopic sinus surgery (ESS). Identifying factors associated with recurrence may help guide postoperative surveillance and management. Objective: To determine the frequency and timing of nasal polyp recurrence during months following ESS and to identify clinical and radiological factors associated with recurrence, including asthma, peripheral eosinophilia, previous ESS, severe polyposis, and high Lund-Mackay score, by estimating their relative risks. Methods: This longitudinal observational study included 116 patients with CRSwNP who underwent ESS and completed 24 months of follow-up. Baseline demographic, clinical, and radiological characteristics were recorded. Recurrence was assessed clinically and endoscopically at 3, 6, 12, 18, and 24 months. The association of selected factors with recurrence was evaluated using relative risk (RR) with 95% confidence intervals (CI). SNOT-22 scores were recorded at baseline and during follow-up. Data were analysed using IBM SPSS Statistics version 27. Results: Recurrent nasal polyposis developed in 35 patients (30.17%) within 24 months. Cumulative recurrence was 2.59% at 6 months, 8.62% at 12 months, 18.97% at 18 months, and 30.17% at 24 months. Peripheral eosinophilia showed the strongest association with recurrence (RR 3.04, 95% CI 1.81–5.09), followed by severe polyposis (RR 2.63, 95% CI 1.52–4.55), asthma (RR 2.43, 95% CI 1.46–4.05), and previous ESS (RR 1.92, 95% CI 1.10–3.34). High Lund-Mackay score showed a non-significant association (RR 1.67, 95% CI 0.97–2.89; p=0.07). Mean SNOT-22 improved from 51.2 at baseline to 21.4 at 6 months and remained improved at 24 months (29.1). Conclusion: ESS was associated with substantial and sustained improvement in sinonasal symptoms, although 30.17% of patients developed recurrent polyposis within 24 months. Peripheral eosinophilia, severe polyposis, asthma, and previous ESS were associated with increased recurrence risk, supporting closer postoperative monitoring of patients with these characteristics.

Background: Benign prostatic hyperplasia (BPH) is a common urological condition among elderly men that can cause lower urinary tract symptoms, impair quality of life, and lead to complications such as acute urinary retention and urinary tract infections. Ageing and associated comorbidities may influence its clinical presentation and management. Objective: To evaluate the risk factors, clinical presentation, treatment modalities, and clinical outcomes of BPH among elderly male patients attending Ayub Teaching Hospital, Abbottabad. Methods: A hospital-based cross-sectional study was conducted in the Department of Urology, Ayub Teaching Hospital, Abbottabad, from January to December 2025. A proposed sample of 150 male patients aged 60 years and above with a clinical diagnosis of BPH was included using non-probability consecutive sampling. Data regarding demographic characteristics, associated comorbidities, urinary symptoms, treatment modalities, and clinical outcomes were collected using a structured questionnaire and clinical records. Data were analyzed using IBM SPSS Statistics, with statistical significance set at p-value less than 0.05. Results: Among the 150 patients, 72 (48.0%) were aged 60–69 years, while 96 (64.0%) belonged to rural areas. Physical inactivity was reported in 78 (52.0%) patients, hypertension in 69 (46.0%), and diabetes mellitus in 51 (34.0%). Nocturia was the most common presenting symptom, affecting 123 (82.0%) patients, followed by weak urinary stream in 105 (70.0%) and urinary frequency in 96 (64.0%). Medical treatment was provided to 105 (70.0%) patients, whereas 30 (20.0%) underwent surgical intervention. Symptomatic improvement was documented in 96 (64.0%) patients, while 36 (24.0%) had persistent urinary symptoms. The associations of diabetes mellitus (p=0.18), hypertension (p=0.72), and obesity (p=0.08) with symptom severity were not statistically significant. Conclusion: BPH was associated with a substantial burden of urinary symptoms among elderly male patients, with nocturia and weak urinary stream being the predominant presentations. Hypertension, diabetes mellitus, and physical inactivity were common associated factors. Medical management was the most frequently reported treatment approach. Early diagnosis, individualized treatment, and regular follow-up may help improve symptom control and identify complications.

The aim of this study was to test velocimetric pattern of ovarian blood vessels in threatened abortion by Transvagimal colour Doppler ultrasound and to compare it with normal asymptomatic pregnancy, with gestational age ranging from 5 week to 16 weeks of pregnancy. Patients with threatened miscarriage associated with adverse pregnancy outcomes because of associated pregnancy and labor complications. We enrolled 120 patients from August 2011 to Sep 2013 during our educational period. Patients were divided in two groups according to the symptoms. One was study group (patients who presented here with features of threatened abortion) and other was control group with normal asymptomatic pregnancy. Ovarian velocimetric pattern was found abnormal in 37% of untreated patient who fail to continue pregnancy while 63% patient were able to continue pregnancy with abnormal ovarian velocimetric pattern after taking treatment, 21% of asymptomatic pregnancy shows abnormal wave forms with resistivity Index of 0.77 to 0.98, Which were treated timely before the appearance of symptoms and continue pregnancy till term. So higher of the resistivity index of ovarian vessels higher the chances of miscarriage. Colour Doppler ultrasound is a safe, painless, non invasive diagnostic test, which seems to be very helpful in prevention of future fetal losses in asymptomatic symptomatic as well as in patient, at very early gestational age.

A case-control comparative study was conducted in autonomous state medical college Etah on 300 married women purposively selected primary infertile women. Married women coming to infertility clinic Department of Obstetrics and Gynaecology, Veerangana Avantibai Lodhi Autonomous State Medical College Etah Uttar Pradesh, satisfying the definition of primary infertility as per WHO and satisfying inclusion and exclusion criteria was included as cases. A married woman with at least one child satisfying inclusion and exclusion criteria was included as a control. Selected subjects were independently screened by a consultant for Hamilton's depression rating scale and Hamilton's anxiety rating scale for severity assessment of depression and anxiety respectively. The prevalence of psychiatric morbidity in women with primary infertility was 28 % in comparison to 11% in women with fertility and the difference was statistically significant (p=0.027). Most common disorders were generalized anxiety disorder (42.86%) and depressive episode (26.19%) among cases, in the study they were threatened to divorce by spouse or fear of husband getting remarried (34%), family and social stigma and discrimination due to infertility (34%) and lack of self-esteem (34.7%). The study shows that significant psychiatric morbidity is associated with women with primary infertility compared to women with fertility and that there is a significant correlation between psychiatric morbidity and duration of infertility, age, domicile, duration of the marriage, duration of infertility and presence of psychosocial stressors among the cases with primary infertility. This emphasizes the need for early detection and effective management of both the disorders to achieve better outcomes in these patients.

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:  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.

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.