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Intra-dialytic serum potassium changes among patients on maintenance hemodialysis thrice weekly
Objective: To determine the mean change in serum potassium levels before and after the maintenance haemodialysis session. Methodology: A Quasi experimental study. Department of Nephrology,Sir Ganga Ram Hospital Lahore from 23-01-2025 to 22-04-2025. Total 110 patients were selected according to inclusion criteria. Age, gender, height, weight and comorbids were documented Serum potassium levels of MHD patients were checked before and just after the end of haemodialysis. The duration of dialysis was documented. Results: Mean duration of dialysis was 3.93 hours. Mean change in the potassium levels was 1.54±0.23 mmol/L. Mean change in potassium was compared between the groups based on age, BMI, gender and comorbs stratification, however, no statistically significant difference was observed (p>0.05). Paired t-test was applied for pre- and post-dialysis and the change was statistically significant (p<0.001). Conclusion: Maintenance hemodialysis session of 4 hours can significantly reduce serum potassium levels and subsequently reducing the risk of arrythmias due to hyperkalemia in ESRD patients.
Copyright (c) 2025 Umaar Azhar, Shahid Anwar, Sajad Ahmad, Hafiz Tahir Usman, Adeela Alam, Shehran Bilal https://creativecommons.org/licenses/by/4.0
A study to assess quality of life in end stage renal disease patients undergoing hemodialysis: A single center study
Objective: To assess the quality of life in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis and to identify factors influencing it. Methodology: Study was descriptive cross-sectional commenced at the Multan Institute of Kidney Diseases, Multan, from October 25, 2024, to April 24, 2025. Study included 100 patients with ESRD having age ?18 years, on hemodialysis from least three months. Main variables of study were demographics, duration of dialysis, vascular access type, co morbidities and the Kidney Disease Quality of Life Short Form (KDQOL-36) scale. Results: The mean age of participants was 49.2 ± 11.3 years, with 62% males and 38% females. Most patients (72%) received hemodialysis three times per week, and hypertension (68%) was the most common comorbidity. The mean score of physical and mental component were 43.25 ± 9.12 and 47.36 ± 8.74, respectively. Patients of young age on dialysis for ?12 months, and individuals without comorbidities had significantly higher quality of life scores (p < 0.05). Conclusion: Quality of life among ESRD patients on hemodialysis is moderately reduced, particularly in physical and psychological domains. Older age, prolonged dialysis duration, and comorbidities are key predictors of poor outcomes.
Copyright (c) 2025 Zubair Ahmed, Abdul Aziz, Muhammad Rashid Asgher, Khuram Bashir, Aimon Riaz, Nayyar Saleem https://creativecommons.org/licenses/by/4.0
Comparison of ibuprofen versus celecoxib in post-extraction pain relief
Objective: To compare mean pain score of celecoxib versus ibuprofen in post tooth extraction pain relief at a tertiary care hospital. Methodology: The study was Quasi experimental design conducted in the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, over a period of six months (July 2024 to January 2025). A total of 78 patients undergoing tooth extraction were enrolled and randomly allocated into two groups, with 39 patients in each group receiving either ibuprofen or celecoxib postoperatively. Pain intensity was assessed using the Visual Analogue Scale (VAS) at predefined intervals over a 24-hour postoperative period. Demographic data, including age, gender, and smoking status, were recorded and analyzed. Results: The mean age of participants was 34.9 ± 8.0 years, with a near-equal gender distribution (52.6% male, 47.4% female). Most participants (59.0%) were from rural areas, and 24.4% were smokers. At 24 hours postoperatively, the celecoxib group reported significantly lower mean VAS scores (2.23 ± 1.36) compared to the ibuprofen group (3.37 ± 2.14) (p < 0.05), demonstrating superior analgesic efficacy. Conclusion: Celecoxib provided significantly better pain relief than ibuprofen following tooth extraction, suggesting that selective COX-2 inhibition may offer an effective and well-tolerated alternative for postoperative analgesia in dental procedures.
Copyright (c) 2025 Sundas Iqbal Aslam, Jehan Alam, Neha Joel, Ammara Siddiqui https://creativecommons.org/licenses/by/4.0
Incidence of common nerve injuries in patients with oral and maxillofacial trauma present at tertiary care hospital
Objective: To determine the frequency of common nerve injuries among patients presented with maxillofacial trauma. Methodology: The study was designed as a cross-sectional study and conductedin the Department of Oral and Maxillofacial Surgery at Jinnah Postgraduate Medical Centre, Karachi, from November 2023 to May 2024. A detailed history was obtained from each patient, followed by a clinical examination to identify any nerve involvement due to maxillofacial trauma. Radiological evaluation in the form of Orthopantomogram (OPG) and Paranasal Sinus (PNS) views was carried out to assess the presence of fractures and any associated nerve injuries. The type of nerve injury was confirmed through a comprehensive clinical assessment and history to detect involvement of the olfactory, infraorbital, inferior alveolar, and facial nerves. Results: Mean age was 32.4 ± 11.7 years. The majority of patients were male (70.0%), with females comprising 30.0% of the study population. In terms of type of nerve injury, the inferior dental nerve (IDN) was most commonly affected (44.6%), followed by the infraorbital nerve (ION) (28.5%), the facial nerve (18.5%), and the olfactory nerve (8.5%). Conclusion: This study's findings align with global trends in oral and maxillofacial nerve injuries, showing male predominance and high RTA-related trauma incidence, though assaults are more common in developed nations, reinforcing known trauma-nerve injury associations.
Copyright (c) 2024 Sarfraz Ali, Jehan Alam, Ruqayah Shah, Ahmad Sohail https://creativecommons.org/licenses/by/4.0
Comparison between the efficacy of in-plane vs out-of-plane needle technique for ultrasound guided intravascular access
Objective: To compare the efficacy in terms of first pass success rate of in-plane vs out-of-plane needle technique for ultrasound guided central venous catheterization. Methodology: Randomized controlled trial was conducted at the Anesthesia Department, Shaikh Zayed Hospital Lahore, for a duration of 6 months i.e. from Jan 16, 2025 till June 15, 2025. After obtaining written informed consent, 280 patients who met the selection criteria were enrolled and were split into two equal-number groups using the lottery technique.i.e. 140 in each group. Patients in Group A underwent internal jugular vein catheterization via in-plane approach and Group B underwent out-of-plane approach. Outcomes were assessed and were statistically analyzed. Results: The mean age of the patients in Group A was 5211.49 years and in Group B was 5111.32 years. The mean time take for CVC in Group A was 557.71 seconds and in Group B was 427.29 seconds (p<0.001). The mean number of needle passes in Group A were 21.21 and in Group B were 10.55 (p=0.02). In Group A, the in-plane approach was efficacious in 87% patients compared to out-of-plane approach which was efficacious in 84.3% patients (p=0.495) Conclusion: There was no discernible difference in the effectiveness of the in-plane and out-of-plane approaches for CVC in patients undergoing heart surgery.
Copyright (c) 2025 Hira Khalil, Riffat Zahid , Unais Ahmed, Syed Mehmood Ali , Tayyaba Mumtaz, Hafsa Hafeez https://creativecommons.org/licenses/by/4.0
Efficacy of adjunctive corticosteroid therapy in severe community acquired pneumonia (SCAP) at a tertiary care hospital in Pakistan
Objective: To determine the adjunctive corticosteroid therapy in severe community acquired pneumonia (SCAP) at a tertiary care hospital in Pakistan. Methods: A randomized controlled trial was conducted at department of Pulmonology, Gujranwala Medical College / DHQ Gujranwala from 07-11-2024 to 06-05-2025. Sixty patients admitted in the department of pulmonologywere selected and divided into two groups. Group-A received only antimicrobial therapy and group-S received antimicrobial and 40?mg/day prednisone for 7 days as adjunctive therapy. Baseline data was recorded. Duration of antibiotics and hospital stay were also documented. Re-evaluation was done at seventh day of treatment and efficacy was assessed.Data was analyzed through SPSS version 25. Student t-test, chi square test or Fisher’s Exact test were applied. P ?0.05 was taken as statistically significant. Results: Duration of antibiotics therapy and hospitalization were significantly shorter in the steroid group (10.60±1.59 vs. 14.83±3.79 days, p<0.001; 11.43±2.03 days vs. 13.93±3.77 days, p=0.003, respectively). The outcome was better in the steroids group as compared to the antibiotics alone group (70% vs. 43.3%, p= 0.037). Conclusion: The use of corticosteroids has a beneficial role in improving the outcome and reducing the hospital stay among the elderly patients of severe community acquired pneumonia.
Copyright (c) 2025 Asad Iqbal Khan, Muhammad Younus, Asim Saleem Sheikh, Abdullah Khalid, Ali Raza, Hanzala https://creativecommons.org/licenses/by/4.0
Effect of Paracetamol (Acetaminophen) on functional outcome in acute stroke patients in neurology department of a Tertiary Hospital of Sialkot
Objective: To compare meanfunctional outcome (mRS score), and incidence of complications and mortality rate in acute stroke patients with and without acetaminophen. Methods: A randomized controlled trial was conducted department of Neurology, Khawaja Muhammad Safdar Medical College, Sialkot from 11-04-2025 to 10-07-2025. A total of 200 patients were randomly divided into two equal groups. Group A was given paracetamol 1g every 6 hours, while Group B was not given paracetamol. Patients were called for follow-up, and mRS was calculated at 4 weeks and 8 weeks. During the 8-week period, the development of fever, pneumonia, UTI, sepsis, or death was recorded. mRS was compared using t-test, and mortality and complications were compared using chi-square test, taking p-value of ?0.05 as statistically significant. Results: At both 4 and 8 weeks, Group A demonstrated significantly better functional outcomes, with lower mean mRS scores (2.87 vs. 3.81, p=0.001; 2.15 vs. 3.44, p<0.001). Complications were less frequent in Group A, as pneumonia occurred in 20% compared to 33% in Group B (p=0.037), and sepsis in 13% vs. 24% (p=0.045). UTI was slightly higher in Group A (36% vs. 30%), though not statistically significant (p=0.367). Mortality was also significantly reduced in Group A (20%) compared to Group B (34%, p=0.026). Conclusion: Acetaminophen use in acute stroke improved functional outcomes, reduced mortality, and lowered complication rates, supporting its potential as a simple and cost-effective adjunct therapy.
Copyright (c) 2025 Hanzala, Sajjad Ali, Ahmed Jamshaid, Abdullah Khalid, Asad Iqbal Khan, Zarka Zahid https://creativecommons.org/licenses/by/4.0
Pattern of dentoalveolar injuries in trauma patients presenting in maxillofacial department of tertiary care hospital
Objective: To determine the patterns of dentoalveolar injuries in patients presenting to the Maxillofacial Surgery Department of a tertiary care hospital. Methodology: The study employed a cross-sectional design and was conducted in the Department of Oral and Maxillofacial Surgery at Jinnah Postgraduate Medical Centre, Karachi, from December 2023 to June 2024. A detailed history and clinical examination, including extra-oral and intra-oral assessments, were conducted. Radiographic evaluations such as periapical, panoramic, and cone-beam CT scans were performed as needed. Injuries were classified according to Andreasen’s criteria. Results: Regarding the causes of nerve injury, road traffic accidents were the most common etiology, accounting for nearly half of the cases 49.7%, followed by assault 22.7%, falls 14.9%, epileptic seizures 9.4%, and firearm injuries 3.3%.The pattern of dentoalveolar injuries showed that enamel fractures were the most prevalent 24.9%, followed by root fractures 16.6%, subluxation and concussion 14.4%, dentine fractures 12.6%, extrusion 8.3%, crown fractures 6.6%, and intrusion 2.2%. Conclusion: Young males were predominantly affected by dentoalveolar trauma, with road traffic accidents and falls as the leading causes. Avulsion, subluxation, and luxation were the most common injury patterns.
Copyright (c) 2024 Ahmad Sohail, Jehan Alam, Ruqayah Shah, Sarfraz Ali https://creativecommons.org/licenses/by/4.0
Congenital cytomegalovirus infection as a cause of paediatric sensorineural hearing loss
Objective: To determine the association between sensorineural hearing loss (SNHL) and congenital cytomegalovirus (CMV) infection diagnosis with pediatric patients. Methodology: This cross-sectional investigation encompassed a cohort of 60 children (ages 1–16 years) diagnosed with sensorineural hearing loss (SNHL), who were recruited from the Audiology Department of Children’s Hospital Lahore during the period from September 2017 to February 2018, subsequent to receiving Institutional Review Board (IRB) authorization. The severity of SNHL was categorized utilizing pure-tone audiometry (according to AAO criteria), while the diagnosis of CMV infection was established through serum antibody assessment employing the chemiluminescence method (Access 2 system). Demographic and clinical information were gathered via a structured questionnaire after obtaining informed consent. Automated serological testing estimated CMV IgG and IgM antibodies in blood samples. Results: out of 60 cases, (56.67%) patients were females and (43.33%) patients were male while 44(73.33%) patients observed with CMV IgG reactive and only 16(26.67%) patients observed with CMV IgG nonreactive. and out of 60 cases 14(23.3%) patients observed with CMV IgM reactive and 46(76.67%)CMV IgM nonreactive. Predictors of paediatric sensorineural hearing loss identified by logistic regression were male (OR:2.12,CI 95%:0.205-5.58; P value = 0.93), age (OR:1.00,CI 95%:0.954-1.05; P value = 0.961), weight (OR:3.82,CI 95%:0.795-18.3;P-value 0.094), positive reaction of CMV IgG (OR:1.88, CI 95%: 0.43-1.78; P value = 0.45) and positive reaction of CMV IgM level (OR:1.89, CI 95%: 0.92-3.98; P value = 0.092) Conclusion: In conclusion, congenital CMV infection plays a major role as a cause of bilateral and unilateral SNHL in children that was hospitalized in Children Hospital Lahore.
Copyright (c) 2025 Bushra, Madiha Iqbal , Neelam Majeed https://creativecommons.org/licenses/by/4.0
Prevalence of secondary and tertiary hyperthyroidism in end stage renal disease patients - a single centre study
Objective: to determine the prevalence of secondary and tertiary hyperthyroidism among patients with end-stage renal disease (ESRD) undergoing management at a single tertiary care center. Methodology: cross-sectional observational single-center study was carried out in the Dialysis Center from 25-10-2024- 24-06-2025. One hundred twenty-three subjects were enrolled in this study. All patients were on chronic hemodialysis treatment with different primary causes of renal failure, with a mean duration of hemodialysis therapy 5.6 ± 4.89 years. A complete clinical and biochemical profile was obtained for each patient. Conventional B-mode thyroid ultrasound was performed in all cases on Aixplorer Mach 30 (SuperSonic Imagine, France).The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis). Results: We evaluated 123 patients with end stage renal disease, with renal replacement therapy, with hemodialysis three times a week, mean age 62.2 ± 11.01 years. The mean duration of hemodialysis therapy was 5.6 ± 4.89 years. According to laboratory results we have found that 74.5% of patients from our study group were euthyroid, 24.4% percent were hypothyroid (16 females and 14 males),and 4 patients (3.3%) had subclinical hyperthyroidism. According to ultrasound results, 48.7% of patients have a normal thyroid appearance, 51.2% have a nodular goiter, defined as the presence of minimum one node in any thyroid lobe and 17.8% had autoimmune thyroiditis, with positive antibodies. The mean diameter of the nodules was 4.7 ± 11.1 mm, the maximum size found on ultrasound was 24.6 mm and the minimum dimension was 2 mm. Thyroid disease was more prevalent among female patients, who present a 3.4 fold higher risk. We have also found that an increase of BMI with one unit raises the risk of developing thyroid disease with 1.083 times (P = 0.018). Conclusion: Chronic kidney disease and hemodialysis therapy have an impact on thyroid echo texture and morphology of thyroid gland. We have found that thyroid disease has a prevalence of 61.3% among patients with ESRD on hemodialysis, with a higher chance of developing thyroid disease for female gender, and the increase of body mass index raises the risk of developing thyroid disease by 1.083 times.
The Frequency and Histological Type of Oral and Maxillofacial Malignancies Presenting at Tertiary Care Hospital
Objective: to determine the frequency of common types of oral and maxillofacial malignancies in patients presenting with malignant tumors at tertiary care hospital. Methodology: The study employed a descriptive cross-sectional design and was conducted in the Department of Oral and Maxillofacial Surgery at Jinnah Postgraduate Medical Centre, Karachi, from November 2023 to May 2024. The study focused on the histological types of oral and maxillofacial malignancies, which were classified based on cellular and tissue characteristics identified through microscopic examination. Data were collected using a customized proforma, recording biographical details and study variables such as frequency and histological typing based on histopathology reports. Results: The study included 175 patients, majority of the patients 85.1% aged >40 years. Tobacco use was prevalent among the study patients i.e. smoking 35.4%, pan 27.4%, and ghutka 22.9%. It was seen that squamous cell carcinoma 54.9% dominated carcinomas, followed by mucoepidermoid 24.6% and adenoid cystic 13.7%. Among sarcomas, Burkitt’s lymphoma 58.3% was most frequent, followed by osteosarcoma 34.9%. Conclusion: This study highlights the predominance of squamous cell carcinoma among carcinomas and Burkitt’s lymphoma among sarcomas, with significant age-related differences in sarcoma subtypes. The high prevalence of tobacco use underscores the need for targeted public health interventions to reduce modifiable cancer risk factors.
Copyright (c) 2024 Sarfraz Ali https://creativecommons.org/licenses/by/4.0
Pattern of Mandibular Fractures Presenting in Maxillofacial Department of Tertiary Care Hospital.
Objective: This study will be conducted to evaluate the pattern of mandibular fractures presenting in maxillofacial department of tertiary care hospital. Methodology: The study was conducted in the Department of Oral and Maxillofacial Surgery at Jinnah Postgraduate Medical Centre, Karachi, over a period of six months from December 2023 to June 2024, after the synopsis was approved. A validated questionnaire was used to collect demographic data, including age, gender, and residential status, as well as details regarding the etiology of the fracture (e.g., road traffic accidents, falls, assaults, sports injuries) and fracture characteristics (location, type, and complexity). Results: Unilateral fractures 55.5% were more common than bilateral fractures 44.5%, with the angle 32.0% and body 26.5% being the most frequent fracture sites. Gender analysis showed no significant differences in fracture type (unilateral fractures: 53.5% in males vs. 60.7% in females, p=0.355) or fracture location (p=0.602), though males had a higher incidence of para-symphysis fractures 7.6% vs. 1.8%. Similarly, age stratification (18–40 years vs. 41–60 years) revealed no significant associations with fracture type or location. Conclusion: Mandibular fractures are a fairly common injury in severe trauma, primarily affecting young males. The most frequent sites of fracture are the mandibular angle, followed by the body and the condyle, while symphyseal, parasymphyseal and ramus fractures are relatively rare.
Copyright (c) 2024 Ahmad Sohail, Jehan Alam https://creativecommons.org/licenses/by/4.0
Prevalence of eczema in breast feed versus bottled feed
Objective: To compare the prevalence of eczema in infants who are exclusively breastfed versus those who are bottle-fed during the first six months of life. Methods: This cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, Pakistan from 8 July 2023 to 7 January 2024 among infants aged 6 months to 2 years attending pediatric outpatient clinics. Feeding practices were recorded based on caregiver interviews, categorizing infants as either exclusively breastfed or bottle-fed. The diagnosis of eczema was made clinically by a pediatrician using standard diagnostic criteria. Statistical analysis was performed to compare the prevalence between the two groups. Results: In a study of 200 infants aged 1 month to 2 years, eczema prevalence was significantly higher in bottle-fed (28%) than breastfed (12%) children (p = 0.004). Among males, 28.6% of bottle-fed and 11.1% of breastfed had eczema (p = 0.016), while in females, rates were 27.3% and 13.0%, respectively (p = 0.046). Eczema was more common in bottle-fed infants across both normal BMI (17.2% vs. 7.3%, p = 0.047) and overweight categories (42.9% vs. 33.3%, p = 0.001). Conclusion: This study demonstrates a significantly higher prevalence of eczema among bottle-fed children compared to breastfed children aged 1 month to 2 years, highlighting the protective role of breastfeeding against early childhood eczema.
Copyright (c) 2024 Ushna Fatima, Shaheen Masood, Syed Zaidan Shuja , Taimoor Naeem Faridi, Shafaq shahid, Amber Naseer https://creativecommons.org/licenses/by/4.0
Comparison of outcome with 50% salicylic acid versus cryotherapy in the treatment of plantar warts
Objective: “To compare the outcome of 50% salicylic acid versus cryotherapy in treating plantar warts.” Methodology: An RCT was conducted at the dermatology department of Nishtar Hospital, Multan, from August 1st, 2024, to January 31st, 2025. A total of 656 patients with plantar warts were randomly allocated to Group A (cryotherapy) and Group B (50% salicylic acid). All patients were evaluated at the conclusion of week 12 following the commencement of therapy. The outcome was classified as complete response (absence of warts), partial response (decreased number of warts), and no response after 12 weeks of treatment. The outcome was compared using a 5% significance level chi-square test, and a p-value of ? 0.05 was considered significant. Results: Both groups were comparable in terms of mean age, gender, duration of warts, and the number of warts. Group A had a higher complete response rate than Group B (30.8% vs. 24.7%; p = 0.134). No significant associations were found between patient response and study groups for age (p = 0.180), gender (p = 0.120), duration of warts (p = 0.249), or number of warts (p = 0.458). Conclusion: Our study concludes that cryotherapy had a better complete response rate than 50% salicylic acid at 12 weeks of therapy. Key Words: Cold Therapy; Cryotherapy; Human Papillomavirus; Salicylic Acid; Plantar Warts; Verruca; Warts;
Copyright (c) 2025 Shoaib Iqbal, Aliya Akhtar, Raheel Tahir, Sidra Tahir, Amra Batool, Asma Batool https://creativecommons.org/licenses/by/4.0
Growth Assessment and Nutritional Profiling of School-Aged Children: A Cross-Sectional Study
Introduction: Childhood malnutrition, encompassing both undernutrition and overnutrition, is a major public health issue. Regular growth monitoring using anthropometric indices is vital to evaluate the nutritional status of school-aged children and to guide intervention strategies. Material & Methods: A cross-sectional study was carried out on a sample of 1300 school children. Data collected included age, height, weight, and BMI. Nutritional status was assessed using WHO growth standards for Weight-for-Height (WFH) and Height-for-Age (HFA). Children were categorized into Severe, Moderate, and Mild Malnutrition, Normal, Overweight, Obese+, and Obese++. Results: Of the 1300 children examined, 14.3% were identified with severe wasting, 25.1% with moderate wasting, and 30.5% with mild malnutrition. Only 20.2% of children fell within the normal range. Overweight and obesity were found in 7.0%, 2.5%, and 0.4% of the children respectively. Conclusion: A significant proportion of the study population exhibited malnutrition, with a majority falling into various categories of undernutrition and a considerable portion affected by overnutrition. These findings underscore the need for regular nutritional surveillance and targeted health programs to address the dual burden of malnutrition in school-aged children.
Copyright (c) 2025 Muhammad Naveed Mazhar, Syed Hassan Danish, Muhammad Zeeshan Khalid, Muhammad Karina Naveed, Farah Ahmad, Asghar Latif Shamsi https://creativecommons.org/licenses/by/4.0
Pudendal nerve block for post-opertive pain following per-anal surgeries in non-suppurative conditions
Objective: To compare patient outcomes of pain scores, time to first mobilization, need for intravenous opioids and mean hospital stay in patients receiving bilateral pudendal nerve block versus those receiving intravenous analgesia undergoing hemorrhoidectomy Methodology: This Quasi-experimental study was conducted at department of surgery, Combined Military Hospital, Multan from February 2024-December 2024. The patients were randomized into two groups of 80 patients each. Group A (n=80) to receive bilateral pudendal nerve block and Group-B (n=80) to receive intravenous analgesia in the form of opioids. Primary variables studied were median pain scores on the Visual Analog scale assessed at 6, 12, 24 and 36 hours. Secondary variables of study were need for rescue opioid analgesia and mean hospital stay. Mean total dose of IV Nalbuphine used till discharge was 13.44±5.87 mg versus 38.94±6.34 mg (p<0.001). Mean hospital stay was 2.35±0.48 days versus 3.76±0.55 days (p<0.001) Results: Median pain scores assessed post-operatively after spinal effect wore off showed that pain scores between both groups were 2.00 (1.00) versus 4.00 (2.00) at 6 hours (p<0.001), scores were 3.00 (1.00) versus 3.00 (1.00) at 12 hours (p=0.415), scores were 4.0 (1.00) versus 5.00 (1.00) at 24 hours (p<0.001) and scores were 4.00 (1.00) versus 4.00 (2.00) at 36 hours (p=0.081). Conclusion: The study concludes that PNB is associated with lesser pain scores, lesser duration of admission and lower need of opioids as rescue analgesia in patients undergoing hemorrhoidectomies.
Copyright (c) 2025 Afsa Nayyar https://creativecommons.org/licenses/by/4.0
Effect of letrozole on shrinking the size of uterine fibroids in symptomatic patients of the reproductive age group
Objective: To compare the mean fibroid size (cm) before and after treatment with letrozole and the frequency of symptom improvement in symptomatic patients of the reproductive age group. Methodology: Quasi-experimental study was conducted between November 1st, 2024, and April 30th, 2025, at the Obstetrics and Gynaecology Department of Nishtar Hospital in Multan. Thirty women aged 25-45 who presented to the outpatient department were enrolled in this study. Throughout the trial, married women were encouraged to use barrier methods of contraception. Symptoms were graded according to the operational definition. Every woman took 5mg of the tablet Letrozole daily for three months. The myoma size before and after treatment, and the improvement of symptoms, were recorded. Results: The mean age of the study population was 34.70 ± 5.31 years. Most patients were married (76.7%, n=23), had 0–2 children (66.7%, n=20), and were non-obese (73.3%, n=22). Leiomyomas were primarily single in 63.3% (n=19) patients, with a mean size of 4.63 ± 1.22 cm, and 60.0% (n=18) exceeded 5 cm. Letrozole therapy significantly reduced uterine fibroid size from 5.37 ± 0.88 cm (pre-treatment) to 4.64 ± 0.70 cm (post-treatment), with a mean reduction of 0.73 cm (p=0.003). Among 30 patients, 66.7% (n=20) reported symptom improvement after letrozole therapy. Conclusion: Reduced uterus-leiomyoma size, improved control of related symptoms, and fewer adverse effects were observed after treatment with Letrozole. Key Words: Aromatase Inhibitors; Fibroid; Leiomyoma; Letrozole; Uterine fibroids;
Copyright (c) 2025 Amara Malik, Saima Ashraf, Moiz Hassan Azdee https://creativecommons.org/licenses/by/4.0
Comparison of effect of Fentanyl versus Esmolol on attenuation of hemodynamic response to laryngoscopy and endotracheal intubation
Abstract Objective: This study aimed to compare the efficacy of esmolol and fentanyl in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation. Methodology: A randomized controlled trial was conducted at CPEIC Multan, involving 194 patients undergoing elective surgery under general anesthesia. Patients were divided into two groups: Group A received 0.5 mg/kg of intravenous esmolol, and Group B received 1 mcg/kg of intravenous fentanyl, administered three minutes before intubation. Hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were recorded at baseline and five minutes post-intubation. Results: Both groups had comparable demographic and baseline hemodynamic characteristics. Post-intubation, Group A exhibited significantly lower HR (84.18±6.33 bpm) than Group B (96.72±5.39 bpm, p<0.001). Although SBP and DBP differences between the groups were not statistically significant (p=0.112 and p=0.229, respectively), MAP was significantly lower in Group B (92.48±8.44 mmHg) compared to Group A (96.14±6.89 mmHg, p=0.001). Conclusion: Esmolol was more effective in attenuating the tachycardic response to laryngoscopy and intubation, whereas fentanyl showed a greater effect on MAP reduction. These findings suggest esmolol may be preferable for controlling heart rate, while fentanyl may better manage blood pressure surges. Tailored dosing or adjunct therapies might be necessary for comprehensive hemodynamic control.
Copyright (c) 2025 Salwa Sheeraz, Kaneez Umme Farwa https://creativecommons.org/licenses/by/4.0
Comparing rubberband ligation vs sclerobanding for second degree hemorrhoids: A prospective comparative study
Objective: To analyze the findings related to rubber band ligation versus sclerobanding in patients presenting with second degree hemorrhoids. Methodology: Quasi experimental study was conducted at surgery Department, Combined Military Hospital Multan from April 2024 to March 2025. A total of 260 patients belonging to both genders with second degree hemorrhoids were divided into two groups of 130 patients each. Patients in Group A underwent rubber band ligation while patients in Group received sclerobanding. The operative time was documented in both groups. Patients were followed up at 2, 4 and 8 weeks intervals for resolution of symptoms and any complications. SPSS version 25 was employed for data analysis, and a p-value below 0.05 was regarded as indicative of statistical significance. Results: The average age of participants in the study was 43.6 ± 11.4 years. The mean duration of surgery in the RBL group was 5.9 ± 2.0 minutes, compared to 9.4 ± 2.2 minutes in the sclerobanding group a difference that was statistically significant (p < 0.001). At 8 weeks follow up, complete resolution of symptoms was reported in 110 patients in Group A (84.6%) versus 121 patients (93.1%) in Group B. There was a statistically significant difference between the two groups (p = 0.030). At the 8-week follow-up, recurrence was observed in 7.7% of patients (10 individuals) in Group A, compared to 2.3% (3 individuals) in Group B—a difference that reached statistical significance (p = 0.046). Conclusion: Sclerobanding was found to be better than rubber band ligation alone in patients presenting with second degree hemorrhoids.
Hemorrhoids, postoperative pain, rubber band ligation, sclerobanding.
Copyright (c) 2025 Dr. Hamza Ali Malik, Dr. Muhammad Ali Khan, Dr. Rizwan Shabbir, Dr. Muhammad Ibtisam Raza, Dr. Abdullah Sher Kakar, Dr. Hassan Shabbir https://creativecommons.org/licenses/by/4.0
Increase in vessel luminal diameter after rotational atherectomy: a study from multan institute of cardiology, pakistan
Objective: To determine the increase in vessel luminal diameter in patients undergoing rotational atherectomy at Multan Institute of Cardiology, Pakistan. Material and Methods: A descriptive study enrolled 100 patients undergoing rotational atherectomy at Multan Institute of Cardiology, Pakistan. After baseline characteristics, the pre- and post-procedural minimal luminal diameter and reference vessel diameter were recorded. The change in luminal diameter was recorded in terms of mean and standard deviation. We stratified the data, applied a post-stratification t-test, and considered a p-value of less than 0.05 as significant. Results: The mean age was 52.20 ± 11.19 years, with more male (76.0%) patients. Risk factors included hypertension (45.0%), smoking (40.0%), diabetes (34.0%), and hyperlipidemia (32.0%). Lesions most frequently involved was the left anterior descending artery (LAD: 55.0%), with mid-distal location (65.0%) and severe calcification (71.0%). The minimal lumen diameter (MLD) significantly increased from pre-procedure and post-procedure 0.75?±?0.14?mm to 1.88?±?0.22?mm (p?<?0.001). At the same time, the mean luminal gain was 1.13±0.026?mm. The luminal gain with relation to reference diameter was 46%. Conclusion: Rotational atherectomy can lead to significant luminal gain with remarkable procedural success.
Copyright (c) 2025 Momin Rasheed, Badar Ul Ahad Gill, M. Ikram Farid, Mubashir Sherwani, Muhammad Shahzad Fareed, Masood Ahmad Khan https://creativecommons.org/licenses/by/4.0
Comparison of small versus large intracoronary thrombus burden on angiographic and short-term outcomes in patients undergoing primary PCI
Objective: To compare the angiographic and short-term clinical outcomes of small vs. large intracoronary thrombus in patients undergoing Primary PCI. Methodology: A prospective comparative study was conducted at the CPEIC, Multan, from 10-04-2024 to 31-04-2025. Three hundred thirty patients with STEMI were enrolled, and the thrombus burden was analysed. Patients with thrombus grades of 0-2 were labelled as small thrombus burden (STB), and those with ?3 were considered large (LTB). The primary outcome variables were TIMI III flow (procedural success), 30-day mortality and 30-day re-infarction. Qualitative data was compared using the Chi-square test, and quantitative data with an independent t-test. Results: Out of 330 patients, there were 160 (48.5%) with STB and 170 (51.5%) with Large TB. No significant differences were observed in STEMI types (anterior wall: 58.1% vs. 60.0%, p=0.809; inferior wall: 32.5% vs. 29.4%) or culprit vessels (left anterior descending: 61.9% vs. 64.7%, p=0.765; right coronary artery: 32.5% vs. 31.2%). Mortality was higher in the STB group (11.9% vs. 5.9%, p=0.05), while re-infarction rates were comparable (8.8% vs. 7.1%, p=0.569). Procedural success (TIMI III flow) was significantly higher in STB (95.6% vs. 88.8%; p=0.022). Conclusion: Although the angiographic differences for thrombus burden were insignificant, small thrombus burden was associated with relatively more procedural success, 30-day mortality and 30-day reinfarction.
Copyright (c) 2025 Muhammad Shahzad Fareed, Muhammad Ikram Farid, Badar Ul Ahad Gill, Mubashir Sherwani, Momin Rasheed, Masood Ahmad Khan https://creativecommons.org/licenses/by/4.0
The Role of Magnetic Resonance Imaging in the Intra-Operative Evaluation of Fistula in Ano
Abstract: Objective: assessing the role of magnetic resonance (MRI) imaging in intraoperative evaluation of fistula in ano. Study Type: Cross Sectional Analytical Study Study Place and Duration: Department of Radiology, Combined Military Hospital Gujranwala, from September 1, 2023 to August 30, 2024. Material and methods: Sixty patients were referred to the hospital's Radiology Department. Subsequently, these patients were referred for MRI scans in the Radiology Department. The MRI scanner used was equipped with a 16 channel body coil and a surface-coil. The data of all 60 patients who underwent surgical intervention were included in the study. The interval between MRI and surgery was from one week to two months. The gold standard was considered to be surgical findings, which were recorded independently by the surgeon. The researcher personally collected the data for the study and analyzed using SPSS version24. Continuous variables (age) were examined using descriptive statistics, namely; standard and mean deviation while categorical variables (gender) were using frequency and percentage. Results: Diagnostic performance indicated sensitivity (94.9%) and specificity (100.0%). The PPV was 100.0%, and the NPV was 25.0%, with an overall diagnostic accuracy of 95.0%. Conclusion: MRI offers precise anatomical and pathological information essential for directing pre-surgical decisions and planning in the management of perianal fistulas. Keywords: Magnetic Resonance Imaging (MRI), Intra-operative, Evaluation, Fistula in Ano, Accuracy, Sensitivity, Specificity.
Intra-operative evaluation of fistula in ano
Copyright (c) 2025 Iqra Aslam https://creativecommons.org/licenses/by/4.0
Comparison of solifenacin versus mirabegron for the treatment of double j stent related lower urinary tract symptoms
Objective: Overactive bladder is mostly treated with a combination of behavioural interventions and commonly prescribed anti-muscarinic medication therapy, including solifenacin, which has considerable side effects and lowers the quality of life. Mirabegron relaxes the detrusor muscle and is a recently approved drug for the treatment of OAB. This study examined the effectiveness and safety of two medications, solifenacin and mirabegron. Methods: This study was a comparative cross-sectional study conducted at Sami Medical Center, Abbottabad for a period of 6 months from August 2022 to January 2023. Female patients of aged ?18 years with symptoms of OAB were enrolled. Results: Current study showed that the average age of patients was 37.47±12.48 years in Group S and 39.93±7.93 in Group M. The population consists of 60 (100%) females. After 4 weeks of follow up dizziness, dry mouth, constipation hypertension and blurred vision were found insignificant between both groups with p-values of 0.312, 0.161, 0.076, 0.076, and 0.313 respectively. OABSS score improved significantly and after therapy 4.20±1.32 in Group S and 3.43±1.13 in Group M. There was no significant difference in frequency of treatment withdrawal p-value 0.150. Conclusion:When it comes to relieving symptoms of OAB, both solifenacin and mirabegron are effective. The OABSS improved with both drugs; however, mirabegron was associated with fewer treatment-related adverse events. We advocate using mirabegron as the first-line treatment. Solifenacin can be utilized if patients are no longer getting the desired effects from Mirabegron.
Copyright (c) 2025 Ali Hussain https://creativecommons.org/licenses/by/4.0
Correlation of Serum Immunoglobulin-E Level with Relapsing Idiopathic Nephrotic Syndrome in Children
Objective: To correlate the relationship between the level of serum immunoglobulin-E in relapsing idiopathic nephrotic syndrome Methodology: We conducted this case-control study on 50 paediatric patients of both genders suffering from idiopathic nephrotic syndrome, who were aged between 2 and 12 years. Potential participants with a past history of urinary tract infections, non-nephrotic proteinuria, congenital nephrotic syndrome, secondary nephrotic syndrome, nephritic syndrome, and anatomical renal disorders were excluded. Patients were tested for serum Immunoglobulin E level. Results: Among the 50 participants, 29 (58.0%) were males, and 21 (42.0%) were females. 27 (54.0%) reported atopy in family. The mean age of the participants was 8.42 ± 2.81 years. The mean serum urea was 5.03 ± 1.33 mmol/L, and serum creatinine levels were 59.24 ± 11.47 µmol/L. The serum IgE levels were negatively correlated (r = -0.736, p<0.001). Similarly, serum IgE levels were negatively correlated (r = -0.408, p = 0.003). However, no statistically significant correlation was found among the serum IgE levels, serum urea, serum creatinine, gender, and family history. Conclusion: In children with idiopathic nephrotic syndrome, elevated serum IgE levels are linked to a higher chance of relapse later on.
Copyright (c) 2025 Syed Awais Haider Kazmi, Qudrat Ullah Malik, Bilal Akhlaq, Hafsa Arshad, Zohaib Akhter, Umair Anees https://creativecommons.org/licenses/by/4.0
Utilization of gram and oat flour cookies for diabetes
Objective: To evaluate the nutritional, glycemic, and sensory attributes of cookies formulated with gram (chickpea) and oat flour for potential dietary management in individuals with type 2 diabetes mellitus. Methodology: This was experimental, randomized controlled trial (RCT). A total of 60 participants (aged 35–65) with diagnosed type 2 diabetes were enrolled. Patients were divided into two grouos. Group A (Intervention Group): Received 50g/day of gram and oat flour cookies. Group B (Control Group): Received 50g/day of standard refined wheat flour cookies. Results: Group A’s postprandial blood glucose fell from 198 ± 15 to 160 ± 14 mg/dL. Group B’s decreased from 196 ± 14 to 182 ± 15 mg/dL. These were also significant (p < 0.01). HbA1c in Group A declined from 7.8 ± 0.4% to 6.9 ± 0.3%. In Group B, it dropped from 7.7 ± 0.5% to 7.5 ± 0.4% (p < 0.05). Group A’s BMI reduced from 27.2 ± 1.5 to 26.5 ± 1.4 kg/m². Group B’s changed slightly from 27.1 ± 1.6 to 27.0 ± 1.5 kg/m². These were not statistically significant. The Intervention Cookie scored 8.1 (appearance), 7.9 (taste), 7.5 (texture), and 8.0 (overall). The Control Cookie scored slightly higher: 8.5, 8.4, 8.0, and 8.3, respectively. Conclusion: Cookies made from gram and oat flour showed significantly better glycemic outcomes compared to conventional cookies, with favorable sensory properties. The combination of high fiber and low GI ingredients may serve as a potential dietary adjunct for individuals with type 2 diabetes.
Copyright (c) 2025 Noor-ul-Ain, Syed iqtadar Ali Rizvi, Samina Arshad https://creativecommons.org/licenses/by/4.0
Effect of Post-operative Antibiotic Prophylaxis on Surgical Site Infections in Pediatric Inguinal Surgeries: A Randomized Controlled Trial
Objective: To determine the frequency of surgical site infections in pediatric patients undergoing elective inguinal surgeries with and without post-operative antibiotic prophylaxis. Methodology: This randomized controlled trial was conducted at the Department of Pediatric Surgery, Fatima Memorial Hospital, Shadman, Lahore, over six months. A total of 88 children aged 2–7 years undergoing elective inguinal herniotomy or orchidopexy were randomized into two groups of 44 each. All patients received a single pre-operative dose of intravenous Ceftriaxone (50 mg/kg). Group A received additional post-operative oral antibiotics (Amoxicillin-Clavulanic acid for five days), while Group B received no post-operative antibiotics. Patients were followed for 30 days post-operatively, and surgical wounds were assessed for signs of infection. Data were analyzed using SPSS version 25, with a p-value < 0.05 considered statistically significant. Results: The overall incidence of SSI was 5.7% (5 out of 88). Group A had 2 cases (4.5%) of SSI, while Group B had 3 cases (6.8%), a difference that was not statistically significant (p = 0.64). All infections were superficial and managed conservatively. No significant difference was found in hospital stay or severity of infections between the two groups. Conclusion: Routine post-operative antibiotic prophylaxis does not significantly reduce the risk of surgical site infections in clean elective pediatric inguinal surgeries. Judicious use of antibiotics is recommended to reduce the risk of antimicrobial resistance without compromising patient safety.
Copyright (c) 2025 Sikandar Ali Arshad, Syed Hassan Danish, Muhammad Zaeem Khalid , Khalid Maqsood, Farah Ahmad https://creativecommons.org/licenses/by/4.0
Comparison of short-term outcomes of open appendectomy and laparoscopic appendectomy in patients with acute appendicitis
Objective: To compare laparoscopic appendectomy and Open appendectomy in terms of short-term outcomes in patients with acute appendicitis. Methodology: Study was commenced at Department of Surgery at Ibn-e-Siena Hospital, Multan, as a randomized controlled trial over six months following the approval of the synopsis. A total of 60 patients, with 30 in each group, were included in the study using non-probability consecutive sampling. Patients were followed up weekly in the outpatient department for 30 days postoperatively. The occurrence of surgical site infection and seroma formation was assessed. Results: Mean duration of surgery of LA was significantly higher than OA, 63.13±3.28 minutes and 46.90±2.23 minutes, respectively (p<0.001). Mean duration of hospital stay of OA was significantly higher than OA, 3.03±0.92 days and 1.90±0.61 days, respectively (p<0.001). Surgical site infection was significantly higher in OA 12 (40.0%) than LA 3 (10.0%). (p=0.007). Whereas, seroma formation was observed in 6.7% OA and 3.3% in LA (p=0.129). Conclusion: Laparoscopic appendectomy offers advantages over open appendectomy in terms of reduced postoperative pain, shorter hospital stays, and lower wound infection rates, making it a preferred approach where feasible. However, the longer operative time and slightly higher risk of intra-abdominal abscess formation should be considered when selecting the surgical technique.
Copyright (c) 2025 Warda Iram, Humayun Amjad, Bria Qaiser https://creativecommons.org/licenses/by/4.0
Comparison of rubber band ligation and injection sclerotherapy for second degree hemorrhoids
Objective: To compare the effectiveness of rubber band ligation (RBL) and sclerotherapy injection (SI) for 2nd degree hemorrhoids. Methodology: The study was conducted in the Department of General Surgery, Ibn-e-Siena Hospital, Multan, as a randomized controlled trial. It spanned a duration of six months following the approval of the study synopsis. The patients were randomly assigned to two groups (Group A and Group B) using the lottery method with sealed opaque envelopes. Group A consisted of patients who underwent hemorrhoidectomy using rubber band ligation, while Group B included those treated with injection sclerotherapy. All procedures were performed according to institutional protocols by consultant surgeons with a minimum of five years of post-fellowship experience. Results: The mean age of rubber band ligation and Injection sclerotherapy was 49.95±5.38 years and 47.66±6.01 years, respectively. (p=0.781). There were 73.4% males and 26.6% females in Group rubber band ligation and 65.6% males and 34.4% females, in Group sclerotherapy. (p=0.337). There were 15.6% obese in Group rubber band ligation and 21.9% obese in Group sclerotherapy. The mean duration of symptoms of Group rubber band ligation and Group sclerotherapy was 5.37±1.13 months, respectively. (p=0.198). Efficacy for Group rubber band ligation and Group sclerotherapy was 65.6% and 81.3%, respectively. (p=0.035). Conclusion: Rubber band ligation has been demonstrated to be superior to injection sclerotherapy in terms of effectiveness for the treatment of second-degree hemorrhoids, offering better outcomes in symptom resolution, reduced recurrence rates, and overall patient satisfaction while maintaining a minimally invasive approach with fewer complications.
Copyright (c) 2025 Farwa Sarwar, Noman Sarwar, Mahrukh Rehman, Saman Javaid, Hassan Saeed , Huda Khalid https://creativecommons.org/licenses/by/4.0
Outcomes of closed reduction and percutaneous K wire fixation of supracondylar humerus fractures
Objective: To determine the outcomes of closed reduction and percutaneous k-wire fixation in supracondylar hummers fracture. Methodology: Retrospective study. Data included in this study was obtained from hospital record of Sligo University hospital, Ireland. Cases of supracondylar humerus fracture that were operated in the year of 2021 with closed reduction and percutaneous K wire fixation technique were taken. Study was conducted on 34 patients presented with supracondylar fractures of humerus. Main variables of study were hospital stay, k-wire removal time, duration of operation, side of fracture, mode of injury and outcomes assessed by Flynn criteria. SPSS version 23 was used for data analysis. Results: According to grading Flynn’s Criteria, (58.9%) patients had excellent result, (29.4%) had good, (8.8%) had fair and only one patient had poor result. There was no difference between functional results and gender (p=0.872), age (p=0.072), duration of operation (p=0.073) and length of hospital stay (p=0.366). Conclusion: Normal range of movements and anatomy of limb can be restored better with closed reduction percutaneous k-wire fixation.
Copyright (c) 2025 Muhammad Bilal Tahir, William Gaine https://creativecommons.org/licenses/by/4.0
Clinical outcomes of Arthroscopic Partial Mensisectomy for Chronic Mensical Tears in Early Post Operative Period
Objective: To evaluate the clinical outcome of arthroscopic partial meniscectomy in patients with chronic meniscal tears in early postoperative period. Methodology: Study was retrospective that was carried out in Orthopaedic department of Sligo university hospital from January 2020 to March 2021. Study was started after ethical approval from hospital committee. Main variables of study were discharge status, knee score preoperative, at 6 weeks and 12 weeks duration. SPSS version 23 was used for data analysis. Results: The mean preoperative knee score of the patients was 49.46±5.59. While, the mean knee score after 6 and 12 weeks of operation was gradually increase, (p=0.000). The mean knee score of male and female were almost equal, (p=0.173). Mean knee score at different age groups were also almost equal, (p=0.329). The mean knee score of lateral group was higher than medial group after 6 and 12 weeks of operation, (p<0.001). Conclusion: Arthroscopic partial meniscectomy is an effective surgical procedure for chronic or irreparable meniscal tears. Procedure improves the knee function in very short period of time after surgery as proved by improvement in WOMET knee score.
Western Ontario Meniscal Evaluation (WOMET)