Journal of Peoples University of Medical & Health Sciences Nawabshah. (JPUMHS)

CHALLENGING THE INCREASING HEALTH DANGER OF HEAT WAVES IN PAKISTAN.

2025-07-02T12:26:48+05:00

By way of Pakistan deals with additional
challenging summer, the power & rate of
high temperature waves had turn out to be a
terrible community healthiness worry.

ANALYZING MENTAL HEALTH DISORDER RATES AMONG PRIVATE SECTOR MEDICAL STUDENTS: TACKLING GENDER DISPARITIES.

2025-07-02T12:49:01+05:00

ABSTRACT
BACKGROUND: This study investigates the frequency of Mental Health Disorders among
students at Private sector medical college and university with a specific focus on the mental
health challenges faced by undergraduate students. OBJECTIVE: This study aims to explore
the prevalence of these mental health disorders between university students and to identify
key risk factors, providing insights for targeted interventions to support student well-being.
METHODOLOGY: A total of 247 students (166 females and 81 male) from different
programs, including MBBS (132 participants), BDS (44 participants), and other medical
disciplines (71 participants), participated in this cross-sectional study. Random sampling was
used to choose participants according to their educational attainment, gender, and field of
study. Students who had used on-campus wellness and counseling services met the inclusion
criterion, whereas those who had never used these services were not included. This study
employed six established instruments to evaluate mental health conditions, including the
GAD-7 (generalized anxiety disorder-7) to screen for generalized anxiety disorder, the PHQ
9 (patient health questionnaire-9) to gauge the severity of depression, and the PHQ-15 to
measure somatic symptoms. Obsessive-compulsive disorder symptoms were evaluated using
the OCI-R (obsessive-compulsive inventory-n revised). SPIN was used for social anxiety, and
the severity measures for specific phobia and panic disorder, both showing strong validity and
reliability. The DAST-10 (drug abuse screening test) was used to assess substance use.
RESULTS: Results indicated a high prevalence of mental health disorders: 58.9% for somatic
symptom disorder, 39.9% for depression, 22.3% for generalized anxiety disorder, and 48%
for obsessive-compulsive disorder and 4.1% in substance-use disorder. Notably, female
students exhibited significantly higher scores in depression and anxiety disorders compared
to their male counterparts. Significant comorbidities were observed, with depression
frequently co-occurring with somatic symptom disorder and anxiety disorders.
CONCLUSION: Enhancing mental health resources and support systems within university
settings is crucial to promote student well-being and academic success. Further research is recommended to explore the underlying causes of these gender disparities in mental health.

THE IMPACT OF VITAMIN D3 LEVELS ON INFERTILITY.

2025-07-02T12:52:43+05:00

ABSTRACT
BACKGROUND: Infertility is the fifth most serious global physical or mental health
condition. It may have detrimental effects on both partners' social, psychological,
physical, and financial well-being. The literature reveals positive relationship between
infertility and vitamin D3 level but data on their complex interaction is relatively scarce
in Pakistan, highlighting the need for further research. OBJECTIVE: To examine the
impact of vitamin D3 levels on infertility. METHODOLOGY: A cross-sectional
investigation was conducted on 132 infertile and 132 fertile women selected through
convenience sampling at the Gynecology and Obstetrics ward of the PMC hospital,
Nawabshah, Pakistan. Data were collected through a questionnaire and entered and
analyzed in computer software Statistical Package for Social Sciences (SPSS)
version 25.0. The link between infertility and qualitative variables was examined using
the chi-square test, and the mean difference in vitamin D3 across research groups was
evaluated using the independent sample t test. A confidence interval of 95% was used for
the study. RESULTS: Vitamin D3 deficiency and insufficiency were significantly higher
in infertile women (53%, 18.9%) compared to fertile women (22%, 11.3%). Infertility
significantly increases with the age of participants increased ranging from 3.8% in 20-25
years to 34.8% in 36-40 years. Infertility was higher in the middle class (81.1%) compared
to the poor class (18.9%) and significantly higher in illiterates 43.2% followed by primary
(30.3%) and low in graduation (3.8%). CONCLUSION: Infertile women had
significantly greater levels of vitamin D3 inadequacy and insufficiency than fertile
women. Besides Vitamin D3, Infertility was found to be associated with age and
education of women. Initiatives such as vitamin D3 supplementation, improving women’s
education and social status and health interventions should be implemented to address
this issue.

THE ROLE OF RESILIENCE AS A MEDIATOR AND ITS IMPACT ON NURSES AND HEALTHCARE PROFESSIONAL’S PSYCHOLOGICAL WELL-BEING AND MENTAL DISTRESS.

2025-07-02T12:56:05+05:00

ABSTRACT
BACKGROUND: Professional healthcare providers and nurses' jobs are classified as
stressful and demanding. The possibility of emotional distress is high. OBJECTIVE: The
study aims to investigate the role of resilience as a mediator and its impact on nurses and
healthcare professional’s psychological well-being and mental distress. METHODS: A
questionnaire survey was employed though random sampling strategy. The study involved
120 certified professional healthcare practitioners and nurses who were working in different
hospitals and clinics. Data were collected via a demographic questionnaire, The Kessler
Psychological Distress Scale (K-10) for measurement of emotional distress, The Satisfaction
with Life Scale (SWLS) for assessment of psychosocial well-being, and the brief resilience
scale (BRS) for analysis of resilience among nurses and healthcare provider. Descriptive
statistics and graphs as numbers, frequencies, and percentages was applied. RESULTS: The
result indicated major participants (35.8%) belong to age group 20-30 YARS. 55%
participants were females. 48.3% were in nursing profession. 78% participants were in 12hour
working shift. On K-10 scale, Majority of the participants the participants showed emotional
stress on K10 scale. The result of satisfaction with life scale in our findings showed that lower
number of participants were satisfied (4.16%, 10% and 12%) while major population was
dissatisfied. 42% participants showed high resilience levels on BRS scale. CONCLUSION:
The mediation analysis found that resilience protected against direct correlations between
stress and emotional/psychological suffering. In conclusion, our results confirmed the
hypothesis that resilience moderated the link between emotional distress and psychosocial
well-being

SYNERGISTIC EFFECTS OF ESCITALOPRAM COMBINED WITH LEVOSULPRIDE AND ANTIOXIDANT VITAMINS ON ANTIOXIDANT ENZYME ACTIVITY IN PATIENTS WITH DEPRESSION: A COMPARATIVE CLINICAL STUDY.

2025-07-02T12:58:46+05:00

ABSTRACT
BACKGROUND: Depression has been increasingly linked to oxidative stress, yet the
therapeutic role of antioxidants in conjunction with antidepressants remains underexplored. This
study investigates the effects of escitalopram alone and in combination with ascorbic acid,
vitamin E, and levosulpride on the activity of key antioxidant enzymes in patients diagnosed
with Major Depressive Disorder (MDD). METHODS: A total of 380 patients with MDD, aged
20–70, were recruited from the Baluchistan Institute of Psychiatry and Behavioural Sciences,
Quetta. Participants were randomized into four treatment groups: (1) Escitalopram only, (2)
Escitalopram + Vitamin C, (3) Escitalopram + Vitamin E, and (4) Escitalopram + Levosulpride.
After two months of treatment, serum levels of Superoxide Dismutase (SOD) and Glutathione
Peroxidase (GPx) were measured using colorimetric methods. RESULTS: The combination of
Escitalopram and Levosulpride significantly increased both SOD and GPx levels compared to
control (p < 0.05), suggesting a synergistic antioxidant effect. While vitamin C and E
combinations showed mild increases in enzyme levels, they were not statistically significant.
CONCLUSION: Escitalopram combined with Levosulpride may offer enhanced antioxidant
benefits in the management of depression by modulating oxidative stress pathways. These
findings support further exploration of combination therapies for personalized treatment
approaches in depressive disorders.

FROM KNOWLEDGE TO ACTION: BARRIERS TO ADOPT HEALTH LIFESTYLE TO PREVENT HYPERTENSION.

2025-07-02T13:00:56+05:00

ABSTRACT
BACKGROUND: Our study documented the specific barriers to adopting a healthy
lifestyle in Pakistan, particularly regarding hypertension. Despite extensive research,
counselling and health education programs, we aim to uncover why residents of our
country struggle with self-care practices for preventing hypertension. OBJCTIVE: To
investigate the barriers Pakistani citizens face in adopting a healthy lifestyle for the
prevention of hypertension, this research employed a descriptive cross-sectional study
design. METHODS: A cross-sectional descriptive statistical analysis was done
among the general population. RESULTS: According to our study, infrastructure,
social, employment and stress related factors significantly influence the adoption of
regular walk or exercise. Economic barriers are most commonly faced by the
participants that further lead to stress and anxiety related barriers. CONCLUSION:
Barriers, such as lack of awareness (75.25%), prevent positive lifestyle choices. Stress,
influenced by employment and financial issues, affects the way of living. Economic
stability is linked to a healthier lifestyle. Raising awareness and providing guidance on
mental health and stress management is crucial.

PREVALENCE OF MUSCULOSKELETAL DISORDERS AND ITS CORRELATION TO PHYSICAL ACTIVITY AMONG UNDERGRADUATE HEALTHCARE STUDENTS.

2025-07-14T06:14:46+05:00

BACKGROUND: Musculoskeletal disorders (MSDs), characterized by self-reported musculoskeletal strain, are among the conditions that physical activity (PA) can help prevent. Conversely, insufficient PA increases the risk of developing MSDs. In Malaysia, studies have shown that musculoskeletal pain is prevalent among medical undergraduates, influenced by factors such as a family history of trauma and academic-related stressors. This study aims to determine the prevalence of MSDs and assess how these disorders affect levels of physical activity in undergraduate medical students. OBJECTIVE: study was planned to explore the prevalence of MSDs and its correlation to PA in undergraduate healthcare students. METHODS: The cross sectional study was carried out among the medical students of various subjects for the time period of 06 months. Total 403 sample were selected through convenience sampling technique. Standardized Nordic Musculoskeletal Questionnaire (NMQ) and Physical activity measured through IPAQ questionnaires were used to assess the sensitivity and severity of musculoskeletal pain. RESULTS: From the collected data, it was observed that 32.5% (131) were involved in less physical activity during their routine work whereas 23.1% had maintained their life with routine exercise. The severity of pain was different among medical students as low back pain was observed among 59.3%, followed by neck pain 55.3%, shoulder pain 54.6%, upper back 43.9%, wrists/hands 40.4%, and ankles/feet 36.5%. There was a significant association between the musculoskeletal disorders in elbow, knee and ankles/feet region with the level of PA. CONCLUSION: The present study revealed a high prevalence of musculoskeletal disorders among undergraduate medical students, with pain most frequently reported in the lower back (59.3 %), neck (55.3 %), and shoulder (54.6 %). A subset of participants maintained sufficient levels of physical activity to permit analysis of the relationship between musculoskeletal complaints in the elbow, knee, and ankle/foot regions and overall activity level.

EFFECT OF STEROID SPRAY ON ADENOIDS AND THE CORRELATION OF RADIOGRAPHIC AND ENDOSCOPIC FINDINGS IN ASSESSING THE PEDIATRIC PATIENTS.

2025-07-02T13:06:33+05:00

OBJECTIVE: To determine the effect of steroid spray on adenoids and the correlation of
radiographic and endoscopic findings in assessing the pediatric patients during a one-year
period STUDY DESIGN: Cross sectional study. PLACE AND DURATION OF STUDY:
Department of Pediatric surgery of Peoples University of Medical & Health Sciences for
Women, Shaheed Benazir Abad, Sindh (June 25, 2022 to June 24, 2023). SUBJECTS AND
METHOD: 83 patients of age bracket of 2 years to 19 years with nasal obstruction, discharge,
mouth breathing, sleep apnea, ear complaints, with adenoid tissue on x-ray imaging and with
clinical symptoms of adenoid hypertrophy lasting consistently for 6 months were included.
Patients were assessed clinically along with endoscopic and radiographic assessment followed
by pharmacological management with corticosteroid nasal spray. Mean + SD deviation was
determined for quantitative variables, whereas frequency and percentages were derived for
qualitative variables. Pearson’s Correlation was used to determine the correletion between
A/N ratio and Endoscopic results. Statistical package for social science (SPSS) software
version 26. RESULTS: The most of the children 36 (43%) were found in age group between
6-10. Male Female ratio was 2.4:1. A significant improvement has been found in clinical
symptoms after steroid nasal spray usage. The A/N ratio and endoscopic adenoid size were
found significantly positively correlated (r=+0.46, p=0.01). CONCLUSION: A significant
correlation between the A/N ratio and endoscopic adenoid assessment. Furthermore, the use
of steroid nasal spray as a treatment technique for the conservative management of adenoid
hypertrophy is also very beneficial.

BONE HEALTH ASSESSMENT AND PROFILING IN CHILDREN WITH SEVERE ACUTE MALNUTRITION STUDY FROM LARKANA.

2025-07-02T13:09:40+05:00

INTRODUCTION: Malnutrition in children is a significant public health and growth issue
in Pakistan. Children who suffer from malnutrition are much more likely to die and suffer
from illnesses. OBJECTIVE: A prospective study was conducted in a PEDS ward of
Nutrition Shaikh Zaid Hospital Larkana, to determine the status of Bone Profile and associated
risk factors in severe acute malnutrition in children up to 5 years of age. METHODS: A total
of 105 patients with severe acute malnutrition (SAM) who were admitted to our PAEDS
nutrition ward and met the inclusion criteria were included in the study, which lasted six
months. Following a thorough history and examination, the patients' calcium, phosphorus,
alkaline phosphatase, and vitamin D levels were assessed. RESULTS: The study examined
105 patients, mainly females, with a higher mean age and majority living in cities. Symptoms
included fever, weight loss, cough, and diarrhea. Laboratory tests revealed significant
biochemical imbalances, including low vitamin D levels, calcium, ALP, and phosphorus
levels. These imbalances could impact health outcomes and require additional therapeutic
care. The case group's vitamin D levels were significantly lower than the control group.
CONCLUSION: The study found that the patient group had serious health imbalances, such
as low levels of calcium, phosphorus, vitamin D, and ALP, which called for therapeutic care
and focused interventions.

INVESTIGATING THE ANTIOXIDANT EFFECT OF VITAMIN E AGAINST MSG INDUCED OXIDATIVE STRESS ON OVARIES OF WISTAR ALBINO RATS.

2025-07-02T13:16:42+05:00

BACKGROUND: MSG, a flavoring agent is well known for its toxic effects on reproductive
system due to its oxidative stress which may leads to infertility. Antioxidants like Vit E helps
to overcome this issue. OBJECTIVE: To evaluate the toxic effects of MSG on the ovaries of
Albino Wistar rats and the possible protective effects of vitamin E on damaged ovarian tissues.
STUDY DESIGN: Experimental study. PLACE OF STUDY: The study was performed at
the Animal House department, Sindh Agriculture University Tandojam and, the department
of Anatomy and Postgraduate laboratory of Isra University Hyderabad. DURATION OF
STUDY: 6 months. MATERIALS AND METHODS: 40 Albino Wistar rats were divided
into 4 groups. Among them first was controlled group, second was treated with 0.08mg/g of
MSG daily, third and fourth were treated with Vit E in the dosage of 0.4mg/g for 30 and 15
days respectively. After a month the animals were sacrificed and slides of 4-6 µm of thickness
were made for examination. Spss version 21. and MS Excel was used, chi-square test was
applied at the P value of <0.05. RESULTS: The results show that Group A shows no sign of
damage, Group B shows hemorrhage, atretic follicles, vacuolation, distorted basement
membrane, hypertrophied theca cells, and less mature follicles while Group C shows a marked
reduction in all of this damage whereas Group D shows improved results on all of these toxic
effects other than vacuolation and atretic follicles. CONCLUSION: MSG causes damage to
ovarian tissue and contrary to this Vit E shows a protective effect against this damage.

SOCIAL AND PSYCHOLOGICAL EFFECTS ON DAILY WAGERS DUE TO INFLATION IN HYDERABAD.

2025-07-02T13:18:57+05:00

BACKGROUND: Inflation has effected deeply all walks of life of people but the most
acutely effects daily wagers, who depend on everyday wage, experience social and financial
distress as their incomes lose their worth, causes them to experience greater stress, anxiety,
and depression. This research aims to offer a thorough evaluation of the difficulties
encountered by daily wagers during inflation by exploring the underlying financial variables,
societal contexts, and psychological wellness. OBJECTIVE: To identify the social and
psychological effects on daily wagers due to inflation. ETHODOLOGY: The descriptive
cross sectional study was conducted among 422 daily wagers both male and female aged 19
60 years old in Hyderabad city, using 11-self-administered questionnaires for social effects
and 21-items depression, anxiety and stress scale for psychological effects. The outcome
variables were effects on earning, paying for basic necessities, family’s lifestyle, social life,
saving money and depression, anxiety, stress. Statistical analyses were conducted to analyze
the data. RESULTS: Depression, anxiety and stress were found 43.4%, 76.3% and 83.9%
among daily wagers respectively. The study participants were reported to be effected on daily
earning 84.6%, effected on paying basic necessities 88.4%, effected on social lives 83.2% and
effected on saving money 84.6% respectively. CONCLUSION: This study has brought into
light that inflation is one of the sticking points in the current situation that having an impact
on individuals' daily earnings, paying necessities, social lives, saving money and their level
of depression, anxiety, and stress.

MODIFIED METABOLIC SYNDROME

2025-07-02T13:38:00+05:00

BACKGROUND: Metabolic syndrome refers to a set of clinical factors leading to a
multitude of complex multi-system complications. Derangement of phosphate homeostasis
may suggest a tendency towards metabolic syndrome. OBJECTIVE: To determine the
frequency of hypophosphatemia in patients with metabolic syndrome METHODOLOGY:
A cross-sectional study undergone from February to August 2024 upon a sample of 150
consenting adults of either gender, diagnosed with Metabolic syndrome lasting ≥ 6- weeks
duration having age 30-60 years presenting at Liaquat University Hospital, Hyderabad,
Pakistan. Data was composed on predesigned proforma and the frequency (percentage)
and mean ± SD was calculated for qualitative and quantitative variables. RESULTS:, Of
the study sample, hypophosphatemia was noted in 90 (60%) patients, from which 49
(54.4%) were males and rest were females .The statistical significance was analyzed for
hypophosphatemia in accordance with age (p=0.00), residence (p=0.00), duration of
metabolic syndrome, (p=0.03), smoking (p=0.02), obesity (p=0.03), hyperlipidemia
(p=0.02), hypomagnesemia (p=0.00), hyperuricemia (p=0.00) and uncontrolled diabetes
mellitus (p=0.00) while in context to gender it was observed as non-significant
(p=0.13).CONCLUSION: There was a significant association of hypophosphatemia
among patients with metabolic syndrome, with significant association with regards to
various patient demographic and clinical data.

ORIGINAL ARTICLECOMPARISON OF MEAN HEALING TIME WITH HONEY VERSUS 1% ACETIC ACID IN THE TREATMENT OF INFECTED WOUNDS

2025-07-02T13:42:29+05:00

BACKGROUND: Infected wounds pose a significant challenge in medical practice,
requiring effective treatment strategies to facilitate timely healing. The use of topical solutions
is a common approach for wound management. The antimicrobial properties of honey
compare with 1% acetic acid make it an attractive option for treating infected wounds. Honey
creates an acidic environment that decrease the bacterial growth of bacteria, also MRSA
Methicillin-resistant Staphylococcus aureus and commonly Pseudomonas aeruginosa, can
happen due to wound infections. OBJECTIVE: To compare mean healing time with honey
versus 1% acetic acid in the infected wound treatment. PLACE AND DURATION OF
STUDY: This is a Randomized Control Trial Study was done on patients in the Department
of general surgery, Liaquat University of Medical & Health Sciences Hospital Jamshoro, for
the period of one and half year July 2022 to March 2023. PATIENTS AND METHOD: All
patients who fulfilled the inclusion criteria and visited LUMHS, Jamshoro were included in
the study. Informed consent was taken after explaining the procedure, risks and benefits of the
study. The sample was divided into two groups (intervention and control). For the intervention
group, honey available commercially was used for cleaning and debriding the wound and
placed on the wound via soaked gauze. The dressing was done twice daily. The same was
done for the control group using obtained 1% acetic acid. All the collected data were entered
into the proforma attached at the end and used electronically for research purposes. Total 440
cases with clinical diagnosis of infected wound were admitted through outpatient department.
All the data was recorded on predesigned Performa. RESULTS: The mean ± standard
deviation of age in group A (Honey locally available) was 41.10±12.95 and group B (1%
acetic acid) was 43.65±13.62 years. In the group-wise distribution of gender, 146 (66.4%)
males and 74 (33.6%) females have included in group A while 166 (75.5%) males and 54
(24.5%) females were included in group B respectively. The mean ± SD for the duration of
healing time was noted as 5.31±3.50 and 13.68±7.64 days in group A and group B respectively
while having a highly significant P-value i.e. (0.0001) CONCLUSION: It is to be found that
the healing time of infected wounds with honey is significantly less as compared to 1% acetic
acid. More well-controlled prospective randomized trials with bigger sample size, with more
parameters in large centers in Pakistan are

BIOCHEMICAL EFFECTS OF LYCOPENE ON BLOOD GLUCOSE IN HIGH SUCROSE DIET FED MALE WISTER ALBINO RATS.

2025-07-02T16:57:52+05:00

OBJECTIVE: To evaluate the Biochemical effects of lycopene on blood glucose in high
sucrose diet fed male wister albino rats. METHODS: An experimental research, spanning six
months and carried out at LUMHS Jamshoro, utilized 60 adult male Albino Wistar rats, which
were randomly assigned to four groups. Group A received 0.9% normal saline, while Group B,
serving as the positive control, was given a sucrose-rich diet with no additional treatment.
Experimental Groups C and D were administered the same sucrose diet along with lycopene at
doses of 40 mg/kg and 60 mg/kg body weight, respectively, over a 28-day period. Lycopene was
delivered daily through intragastric intubation. After the treatment phase, blood samples were
collected via cardiac puncture, and serum was separated for biochemical testing to assess blood
glucose levels. Statistical evaluation was carried out using SPSS software version 23.0.
RESULTS: After four weeks, Group A (negative control) had a mean glucose level of
135.8 mg/dL, while Group B (positive control) showed a significantly higher level of
206.8 mg/dL (P=0.0001). Lycopene-treated Groups C and D exhibited reduced glucose levels of
177.1 mg/dL and 152.4 mg/dL, respectively, showed a statistically significant decrease compared
to the positive control (P=0.0001). CONCLUSION: The study revealed that lycopene
significantly lowered serum glucose levels, suggesting its potential as a safe, accessible, cost
effective, and community-friendly natural option for managing hyperglycemia.

WOUND INFECTION IN IMMUNE COMPROMISED PATIENTS WHO WERE OPERATED IN EMERGENCY DEPARTEMENT.

2025-07-02T13:47:20+05:00

AIM OF STUDY: To determine the wound infection in immune compromised patients
who were operated in Emergency department. STUDY DESIGN: Prospective observational
study. PLAC E & DURA TION: Two years’ study January 2018 to March 2020 conducted
at Liaquat University of Medical and Health Sciences / Jamshoro in department of surgery
PATIENTS & METHOD: The study comprises 100 patients. All were admitted from
Emergency department. All patients were evaluated fully after history & clinical
examinations and specific investigations pre operatively ,per operatively and post operatively
(CBC) complete blood count , C reactive protein , Blood culture , urine culture, IV cannula
Tip culture ,Pus culture and Sensitivity, ultra sound of abdomen, pelvis and Chest , X- ray
abdomen supine and erect posture ,X Ray chest PA view ,Urine DR, Protein A/G Ratio, level
of serum Albumin, Liver function Test (LFT) Serum ferritin , Lactate Dehydrogenase, Blood
urea, sugar, serum electrolyte, HBSAG, HCV, & HIV, PT, APTT, INR and ECG . Typhi dot,
Tuberculin test, Biopsy report and general assessment of the patients. Post operatively
Contrast iv and Oral C T scan if needed RESULTS: This was a hospital based case series
study of 100 patients, the maximum number of patients were in age group between 12 to 75
years. Out of 100 patients 33 patients were presented with age group between 12 to 34 year.
45 patients were presented with age group between 35 to 55 years. 22 patients were presented
with age group between 54 to 75 years. Out of 100 patients, 62 were operated through mid
line incisions, 25 patients were operated through right Para median incision. Out of 100
patients 10 patients were operated through Gird Iron incisions. Out of 100 patients 61 patient
present with serious discharge, 25 patients with Pus discharge, 10 patients with abdominal
dehiscence 4 patients presented with fecal fistula. Out of 00 patients 55 patients were
presented with serum Albumin level 2 gram ,22 patients were presented Serum Albumin level
2.5 gram ,13 patients were presented Serum albumin level 3 gram ,12 patients Were presented
serum Albumin level 3.3 gram Out of 100 patients 31 patient were presented hemoglobin 10
to 12 gram .44 patients were presented Hemoglobin 8 to 10 gram. 13 patients were present
HBA1c 7 to 8 gram. 12 patients were presented serum creatinine. Level between 2 to 3.
CONCLUSION: Patients were admitted and operated in emergency department, already
immune compromised, depleted, comorbid, anemic and edematous prone to developed wound
infection either superficial or deep if not treat as soon as possible patient can die systemic
complications.

UNIQUE PRESENTATION OF CARCINOMA OF TONGUE AND ITS MODALITIES OF TREATMENT.

2025-07-02T13:50:11+05:00

BACKGROUND: Carcinoma of Oral cavity are most common problem all over the world
due to un hygiene conditions. AIM OF STUDY: To determine the Unique presentation of
carcinoma of tongue and its modalities of treatment. STUDY DESIGN: Prospective
observational study. PLACE AND DURATION: Two years’ study from January 2023 to
March 2024 Was Conducted at Oral and Maxillofacial surgery at dental department and
General surgery department at Liaquat University of Medical Health sciences jamshoro and
Hyderabad. PATIENTS AND METHODS: The study comprises 100 patients all were
admitted from Oral and maxillofacial surgery dental department and General Surgery
Department of Liaquat university of medical and Health Sciences jamshoro and Hyderabad.
The patients were evaluated fully after history, clinical examination and specific investigation
of Blood Complete Picture, Cytology of ulcer Edge biopsy of tongue ulcer and FNAC of
Cervical Lymph Node Biopsy X-ray Head, Neck and Chest, Ultra sound of neck Endo
luminal ultra sound, Contrast C.T scan of Head Neck and Chest, MRI of head, Neck, thorax
and PECT Scan and General assessment of the patients who were diagnosed malignant
tongue ulcers and bone scan. Base line investigations. Complete Blood Count, Blood Urea,
Blood sugar, HBSAG, Anti HCV, HIV Covid 19 and urine detail report. RESULT: In this
study of 100 patients of Carcinoma of tongue were in age group. Age range between 12 to 60
years .65 sixty five patients were presented age range between 12 to 35 years ,19patients
were presented with age range between 35 to 50 years and 16 patients were presented with
age range between 51 to 60 years .Out of 100 patients 60 patient were presented with Non
Healing ulcer ,16 patients were presented Non healing ulcer along with hard nodule of
tongue ,12 patients were presented with Non healing ulcer along with tongue nodule ,
bleeding , dysphagia with unilateral cervical lymph node enlargement , 12 patients were
presented with non-healing ulcer , hard nodule of tongue ,bleeding, dysphagia and with
bilateral cervical lymph node , Out of 100 patients 21 patients were presented in stage 1, 24
patients were presented in Stage 11 ,55 patients were presented Stage 111 and 1V . Out of 100
patients 21 patients were treated local excision 24 patients were treated partial glossectomy
along with selective and Modified Radical Neck dissection ,55 patients were treated on radio
and chemotherapy. CONCLUSION: Oral cavity problem now a day is a common world wide
due to eating of Most carcinogenic substance in diet may lead to damage normal Oral cavity
epithelium may lead Non Healing Ulcer, dysplasia and metaplasia then convert in to
malignancy.

HBV, HCV, AND HIV SEROPOSITIVITY: RISKS AND PREVENTION STRATEGIES.

2025-07-02T13:56:23+05:00

BACKGROUND: Serological testing serves as the frontline methodology for the diagnosis of
viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV) and human
immunodeficiency virus (HIV) infection, especially in cases where direct identification of the
pathogen is complicated. OBJECTIVE: Public screening and health monitoring of a
population using serological assays are vital from a public health perspective since these tests
identify both current and past infections. METHODS: This cross-sectional study diagnosed
150 patients for HBsAg, anti-HCV, and HIV antigen/antibody using rapid serum
immunochromatographic lateral flow assays. Each sample was processed using the enclosed
instructions, and test lines and control lines' marking were used to conclude on results
interpretation. Stratifications were made based on sex, age, region of residence, and transfusion
history. Relations of patient attributes and infection status were studied with Chi-square tests.
RESULTS: Within the cohort of 150 patients, the prevalence rates of HBsAg and HCV were
63.3% and 42.0% respectively. There was no statistically significant difference associated with
gender for positivity of HBsAg (p = 1.00), HCV (p = 0.60), or HIV (p = 0.36). There were also
no age group associations with positivity for any of the infections (HBsAg: p = 0.50; HCV:
0.38; HIV: 0.47). Area of residence was not significantly associated with infection status for
HBsAg (p = 0.92), HCV (p = 0.57), or HIV (p = 0.21). A significant association was observed
between a history of blood transfusion and HCV positivity (p = 0.023), and borderline
association for HIV (p = 0.062); for HBsAg no significant association was noted (p = 0.20).
CONCLUSION: The investigation exposed the examined population with concerning levels
of HBV and HCV seropositivity alongside notable associations between HCV infection and a
history of blood transfusions. The study illustrates the persistent danger of transfusion-related
infections and reinforces the need for stringent blood donation protocols, enhanced infection
control measures, and intensive epidemiological surveillance. Additional studies with broader
scopes, along with deeper analyses into the factors of risk are necessary for designing effective
health policy frameworks for prevention and proactive public health responses.

DEEP VENOUS THROMBOSIS PROPHYLAXIS, STANDARDS AND PRACTICES.

2025-07-02T13:59:12+05:00

BACKGROUND: Deep venous thrombosis is life life-threatened critical vascular condition
in which the formation of blood clots occurs in deep veins, especially in lower limbs that may
lead to pulmonary embolism and post-thrombotic syndrome. Despite standardized guidelines
and protocols for the assessment of DVT risk and its prophylaxis, utilization remained
suboptimal, especially in developed or underdeveloped countries OBJECTIVE: The current
study aimed to evaluate current practices regarding DVT risk assessment by using the Caprini
Risk Assessment Model (RAM) in hospitalized patients. Moreover, it also aimed to investigate
the implementation of prophylaxis. METHODS AND MATERIAL: A prospective clinical
study was held in two phases across multiple wards of tertiary care hospitals (Prime Teaching
Hospital & Kuwait Teaching Hospital) in Peshawar. A total of 271 patients were recruited in
Phase I and 340 patients in Phase II. Healthcare professionals received education about the
dangers of DVT and the significance of prompt prophylaxis. Posters were also displayed in the
ward for underlining the necessity of VTE prophylaxis. Data was collected through a structured
checklist based on Caprini RAM protocols and SPSS v.22 was used for data analysis.
RESULTS/FINDINGS: The findings revealed that in both phases of the clinical study, the
majority of patients were observed to be at moderate risk followed by a high risk of DVT.
Preoperative risk assessment was conducted for 84.1% of patients in Phase I and 86,2% in
Phase II but a small percentage of patients received prophylaxis in the first phase (22.1%).
Then in the second phase of study, a significant improvement was observed up to 56.5%.
Regarding the type of prophylaxis, mechanical prophylaxis was a commonly used intervention
in both phases. CONCLUSION: Significant improvements observed in phase II highlighted
the potential of structured interventions and also enhanced awareness among health care
providers. Furthermore, it may benefit patients' quality of life and overall, well-being by
reducing the burden of complications associated with DVT.

BIOPSY SITE AND HISTOPATHOLOGY IN DIAGNOSING BENIGN AND MALIGNANT GASTROINTESTINAL CONDITIONS.

2025-07-02T14:01:31+05:00

BACKGROUND: Gastrointestinal illnesses exhibit a broad range of histological findings, with
malignancies and benign ailments differing throughout age demographics. Precise
identification of biopsy kinds, locations, and histological results is essential for diagnosis and
treatment. OBJECTIVE: This study aims to investigate the distribution of benign and
malignant gastrointestinal lesions by age group, biopsy type, and histological results, as well
as their correlations. MATERIALS AND METHODS: A cross sectional study was conducted
on 159 patients undergoing gastrointestinal biopsies in Khyber Teaching Hospital, Peshawar.
Variables included patient age groups, biopsy types (colonoscopy, endoscopic), biopsy sites,
and histopathological diagnoses. Frequency, percentages, and chi-square tests were used to
evaluate associations, with logistic regression applied for malignancy prediction. RESULTS:
Most samples were endoscopic (88.7%), with the stomach site being the predominant location
(54.7%). Benign lesions constituted 87.4% of patients, whereas cancers represented 12%. The
greatest frequency of benign lesions occurred in the 20-30 age group (100% positive), but
malignancies were more prevalent in older demographics, however without any correlation
(p=0.168). Histopathologically, chronic non-granulomatous colitis (CNCG) was the most
prevalent benign finding, occurring in 43.3% of cases. Dyspepsia was a prevalent symptom,
occurring in 15.7% of cases. Substantial relationships were identified between benign status
and age group (p=0.024), however malignant status exhibited no significant link with age.
Logistic regression identified age and biopsy type were significant predictors of malignancy.
CONCLUSION: This study emphasizes the prevalence of benign gastrointestinal lesions in
younger individuals and the significance of age and biopsy type in assessing malignancy risk.
Histopathological examination is critical for correct diagnosis and clinical decision-making.

PERIOPERATIVE ANALGESIC PRACTICES AND POSTOPERATIVE PAIN MANAGEMENT IN OPHTHALMIC SURGERIES: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN PAKISTAN.

2025-07-02T14:04:31+05:00

BACKGROUND: Effective perioperative and postoperative pain management is essential for
ensuring optimal recovery and patient satisfaction in ophthalmic surgery. However, analgesic
practices often vary depending on the type of surgery and institutional protocols.
OBJEVCTIVE: This study aimed to evaluate perioperative therapy, analgesic use, and their
associations with different ophthalmic surgical procedures in a tertiary care hospital setting.
METHODS: A descriptive cross-sectional study was conducted among 231 patients
undergoing various ophthalmic surgeries. Data were collected regarding demographic
characteristics, ASA physical status, perioperative medications, and postoperative analgesic
use. Frequencies, percentages, means, and standard deviations were calculated. Associations
between type of surgery and analgesic administration were examined. RESULTS:
The study population had a mean age of 67 ± 14 years, with 54.1% males. ASA II status was
most prevalent (64.5%). Preoperative sedatives were administered to only 45.9% of patients.
Atropine (80.1%) and neostigmine (80.5%) were the most common intraoperative agents.
Postoperative analgesia was not administered in 45.9% of patients. Diclofenac (26.8%) and
metamizole sodium (29.9%) were the most frequently used analgesics. Analgesic use was
highest among patients undergoing enucleation (83.3%) and evisceration (80.0%), while
cataract surgeries had the lowest (10.0%). A single dose on the first postoperative day was the
most common pattern (52.8%). CONCLUSION:
Analgesic use following ophthalmic surgery is inconsistently applied, with nearly half of
patients receiving no pain relief. Invasive procedures showed higher analgesic needs,
highlighting the need for standardized, procedure-specific pain management protocols to
ensure adequate postoperative care.

EVALUATION OF ANTIBIOTIC SUSCEPTIBILITY PATTERNS OF BACTERIAL PATHOGENS IN CLINICAL SPECIMENS.

2025-07-02T14:06:52+05:00

BACKGROUND: The prevalence of bacterial resistance to antibiotics has escalated in recent
years. Resistance against Gram-negative bacteria (GNB) and Gram-positive bacteria (GPB)
has been documented. OBJECTIVE: This study investigated the frequency, antibiotic
susceptibility, and resistance mechanisms of clinical sample isolates from Department of
Pathology.MATERIAL AND METHOD: This study investigated the frequency, antibiotic
susceptibility, and resistance mechanisms of clinical sample isolates from Department of
Pathology. Aseptically collected 793 bacterial isolates from wound swabs, urine, blood, central
venous pressure line tips, and respiratory specimens to grow on CLED or Blood agar for 24
hours at 37°C. The isolate will be identified using microbiological methods after culture.
RESULT: From wound samples, which included pus, swabs, and tissue, 237 bacterial isolates
were identified: Enterococcus species (n=59, 24%), Enterobacterales (n=148, 62%), and
Pseudomonas aeruginosa (n=30, 12%). The urine sample produced a uniform distribution and
quantity of isolates. In blood and CVP line tip cultures, 168 bacterial isolates were detected,
including Acinetobacter species (n=37, 22%), Enterobacterales (n=56, 33%), and Salmonella
Typhi (n=75, 44%). Included were Escherichia coli (n=8, 5.2%), Acinetobacter species (n=46,
30%), Klebsiella pneumoniae (n=20, 13.2%), and Pseudomonas aeruginosa (n=77, 50%).
Whereas Ciprofloxacin resistance varied from 65–68% across locations, pus swab and urine
isolates were resistant to Penicillin (75%) and Ampicillin (97%). Respiratory samples were
moderately resistant to Ciprofloxacin (65.2%) and Gentamicin (52.8%) but low to Polymyxin
B (6.2%) and Tigecycline (13.7%). These results show extensive first-line antibiotic resistance
and continued vulnerability to last-resort medicines. CONCLUSION: This study shows that
diverse clinical specimens often resist common antibiotics. The effectiveness of last-resort
medicines like Polymyxin B and Tigecycline shows their importance in treating multidrug
resistant diseases.

FUNCTIONAL OUTCOMES AFTER OPEN RELEASE OF GLUTEUS MAXIMUMS CONTRACTURE.

2025-07-02T14:09:19+05:00

BACKGROUND: Fibrosis and shortening of the gluteal muscles characterize gluteal
Maximums contracture (GMC), a musculoskeletal disorder that causes limited hip motions and
functional constraints such trouble squatting. It is frequently seen in adolescents and children,
especially in underdeveloped areas. For moderate to severe instances, open surgical release is
the usual course of therapy; however, there is currently little information available on the
results of surgery in the local community. OBJECTIVE: To assess the functional outcomes
of open surgical release in patients with gluteal muscle contracture treated at Khyber Teaching
Hospital, Peshawar. METHODS: This retrospective cross-sectional research conducted in
District Headquarters Hospital, Batkhela, from January to December of 2024. Included were
100 patients, 50 of whom were male and 50 of whom were female, ages 6 to 14, who had been
diagnosed with gluteal muscle contracture and treated with open surgical release. Demographic
information, contracture laterality, involvement type, and functional level were examined in
clinical records. SPSS version 25 was used to analyze the data. To investigate correlations
between gender, age, contracture type, and functional results, statistical techniques included
one-way ANOVA, independent t-test, and chi-square test. RESULTS: Bilateral contracture
was more prevalent in female patients (p = 0.043) out of 100 patients (50 males and 50
females), with a mean age of 9.36 ± 1.69 years. Age differences across contracture types were
not statistically significant (p = 0.074). 58% of patients (n = 58) showed bilateral contractures,
whereas 42% (n = 42) had unilateral involvement. Bilateral contracture was found in 58% of
patients and unilateral in 42%. A significant association was noted between gender and
contracture laterality (p = 0.043). Males were more likely than females to have unilateral
engagement on the right side, although the difference was not statistically significant (p =
0.200). There was no significant difference in mean age between the bilateral and unilateral
groups (p = 0.710). CONCLUSION: Open surgical release offers positive functional
outcomes in children with GMC. Early surgical intervention improves mobility and quality of
life.

EFFICACY OF 0.01% ATROPINE EYE DROPS IN REDUCING MYOPIA PROGRESSION.

2025-07-02T17:38:52+05:00

BACKGROUND: Myopia is a widespread refractive error that is becoming more common in
young children and adolescents. Severe myopia predisposes individuals to degenerative ocular
problems, including retinal detachment and myopic maculopathy, necessitating early
management. Atropine eye drops at 0.01% may reduce myopia progression, although further
research is needed on their efficacy and safety. OBJECTIVE: To evaluate the safety and
efficacy of 0.01% atropine eye drops in controlling myopia progression in children.
METHODS AND MATERIALS: The Department of Ophthalmology, Medical Teaching
Institution-Khyber Teaching Hospital, Peshawar, Pakistan, conducted this quasi-experimental
study. This study included 44 children aged 6-12 with SER -1.00-6.00 diopters with myopia
progression > -0.50 diopters in the previous year. Every night for 18 months, participants were
randomly either 0.01% atropine eye drops or a placebo. Main results were SER and AL. The
data was analyzed with IBM SPSS (Version 25) and R. We used ANOVA to compare group
time and medicine. RESULTS: The results show that 0.01% atropine may help delay the
evolution of myopia, but the change was not statistically significant and should be examine
cautious. Primary outcomes were the changes in spherical equivalent refraction (SER) and axial
length (AL) over a six-month period. The intervention group showed a slower rate of myopia
progression compared to the control group. The mean change in SER in the intervention group
was -0.30 ± 0.18 diopters, while the control group showed a greater shift of -0.51 ± 0.22
diopters. Similarly, the increase in axial length was lower in the intervention group (0.14 ± 0.07
mm) compared to the control group (0.21 ± 0.09 mm). These findings reflect a trend toward
reduced progression in the atropine-treated group, although the differences did not reach
statistical significance (p > 0.05). CONCLUSION: These findings suggest a potential benefit
of 0.01% atropine in slowing myopia progression, though differences were not statistically
significant.

FREQUENCY AND ANTIBIOGRAM OF PSEUDOMONAS AERUGINOSA IN A TERIARY CARE HOSPITAL.

2025-07-03T11:38:16+05:00

BACKGROUND: Pseudomonas aeruginosa is a significant cause of healthcare-associated
infections, with rising antimicrobial resistance posing a global public health challenge.
OBJECTIVE: This study aimed to evaluate the frequency, antibiogram, and gender-based
distribution of P. aeruginosa isolates in a tertiary care hospital in Pakistan. METHODS: This
cross-sectional study was conducted from January to December 2023. Clinical samples were
collected from 502 patients and processed using standard microbiological techniques.
Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method,
and data were analyzed for gender-based differences and resistance patterns. RESULTS: The
majority of patients were male (60.6%, n=304), while females accounted for 39.4% (n=198).
Blood samples were the most common (53.4%, n=268), followed by tissue and fluid samples
(14.3%, n=72 each). The medical ward contributed the highest number of samples (59.6%,
n=299, p=0.004). Meropenem exhibited the highest sensitivity (90.4%, n=454), while
Levofloxacin showed moderate sensitivity (65.9%, n=331, p<0.001). Gender-based differences
were observed, with males showing higher sensitivity to Levofloxacin (224 vs. 112) and Co-
trimoxazole (285 vs. 162, p<0.001). Resistance rates for Capreomycin (48.8%, n=245) and
Minocycline (25.1%, n=126) were higher in females. Significant differences in sample
distribution and susceptibility patterns were noted across genders and wards.
CONCLUSIONS: This study highlights the high burden of P. aeruginosa infections and
antimicrobial resistance in Pakistan, emphasizing the need for antimicrobial stewardship
programs and gender-sensitive approaches to infection control. Targeted interventions in high-
burden wards are essential to mitigate the impact of resistant infections.

EVALUATION OF TIME OF DELIVERY IN SMALL FOR GESTATIONAL AGE (SGA) FETUSES: EFFECT ON NEONATAL OUTCOMES.

2025-07-02T14:19:45+05:00

OBJECTIVE: The objective of this research is to assess the effect of delivery time on the neonatal outcomes of small for gestational age (SGA) fetuses using a cohort of 385 subjects at a tertiary care facility. METHODS: Retrospective cohort study was performed on 385 SGA infants born in a tertiary care center. Patients were divided according to the gestational age at delivery into early preterm (<34 weeks), late preterm (34-37 weeks), and term (>37 weeks). Neonatal outcomes, such as Apgar score, NICU admission, RDS, sepsis, and perinatal death, were compared between these categories. RESULTS: 95 (24.61%) of the 386 SGA fetuses were delivered early preterm, 134 (34.71%) late preterm, and 157 (40.67%) at term. Neonatal complications were higher in early preterm group significantly, with 77.9% needing NICU admission against 55.2% in late preterm and 19.7% in term delivery (p < 0.05). Incidence of RDS was 56.3% in early preterm, 38.1% in late preterm, and 10.2% in term delivery. Perinatal mortality was 10.5% for early preterm, 3.7% for late preterm, and 1.3% for term deliveries. CONCLUSION: Delay of delivery of SGA fetuses after 34 weeks greatly minimizes neonatal complications and mortality. Individualized evaluation, however, is required to counterweigh risks of intrauterine compromise against complications of preterm delivery.

PREVALENCE AND RISK FACTORS OF PRE-ECLAMPSIA IN PREGNANT WOMEN: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL.

2025-07-02T17:21:32+05:00

BACKGROUND: Pre-eclampsia (PE) significantly contributes to maternal and perinatal
mortality rates and is particularly prevalent in resource-limited regions. In rural Pakistan, where
healthcare disparities are pronounced, there is a lack of comprehensive data regarding PE
epidemiology. OBJECTIVE: This study aimed to determine the prevalence, risk factors, and
clinical outcomes associated with PE among pregnant women in rural Sindh, Pakistan.
METHODS: A cross-sectional study conducted at a tertiary care facility enrolled 1,800
pregnant participants. PE was identified using ACOG guidelines. Researchers collected
sociodemographic information, medical histories, and pregnancy outcomes using structured
questionnaires and clinical assessments. Adjusted odds ratios (aOR) were calculated using
multivariable logistic regression. RESULTS: The prevalence of PE was found to be 6%,
exceeding the rates observed in urban Pakistan (4–5%). Key risk factors included primigravida
status (aOR = 2.5, 95% CI: 1.6–3.8), chronic hypertension (aOR = 4.2), and obesity (aOR =
3.8). A family history of PE increased the risk by twofold (aOR = 2.1). The rural healthcare
landscape revealed stark inequalities: 70% of PE patients lived more than 50 km from
healthcare facilities, with 58% of these individuals having low household incomes.
Complications linked to PE included eclampsia (11.1% compared to 0.4% in non-PE
pregnancies), preterm delivery (50%), and low birth weight (44.4%). Only 35% of rural women
accessed four or more antenatal visits nationally. CONCLUSION: In rural Sindh, PE is driven
by biological vulnerabilities, poverty, and systemic deficiencies in healthcare. Immediate
action is required to address obesity, hypertension, and access to medical services. Community-
level screening, ensuring magnesium sulfate availability, and maternal education initiatives
could help mitigate preventable health issues. This research highlights the urgent necessity for
cohesive strategies to tackle PE in low-resource environments.

PREVALENCE OF RISK FACTORS OF UMBILICAL CORD PROLAPSE IN LABORING WOMEN: A MULTICENTER CROSS-SECTIONAL STUDY.

2025-07-02T17:18:50+05:00

BACKGROUND: Umbilical cord prolapse (UCP), a rare but life-threatening obstetric
emergency, is linked to increased perinatal mortality and morbidity. Although previous studies
have established risk factors, multicenter data concerning their prevalence and effect are scarce.
AIMS: The aims of this study were to establish the prevalence of maternal, fetal, and obstetric
risk factors for UCP and also to assess their correlation with maternal and neonatal outcomes.
METHODS: Multicenter cross-sectional study in eight tertiary hospitals over five years. UCP-
confirmed laboring women (n=150) were compared with matched controls with no UCP
(n=300). Demographic data, fetal presentation, obstetric interventions (such as amniotomy),
and outcomes (APGAR score, NICU admission, delivery mode) were compared using chi-
square tests and multivariate logistic regression. RESULTS: Non-cephalic fetal presentation
(OR=6.2, 95% CI: 3.8–9.9), multiparity (OR=2.4, 95% CI: 1.5–3.8), polyhydramnios (OR=4.1,
95% CI: 2.3–7.4), and amniotomy (OR=3.0, 95% CI: 1.7–5.2) were risk factors for UCP.
Neonates within the UCP group had lower 5-minute APGAR scores (7 vs. 9, p<0.001) and
higher NICU admission rates (32% vs. 8%, p<0.001). Cesarean delivery was more common in
UCP cases (88% vs. 25%, p<0.001). CONCLUSION: Multiparity, amniotomy,
polyhydramnios, and non-cephalic presentation are significant non-modifiable and modifiable
risk factors for UCP. These results highlight the importance of strict intrapartum surveillance
of high-risk pregnancies and aware decision-making during obstetric procedures.

CORRELATION BETWEEN HBA1C LEVELS AND THE PROGRESSION OF DIABETIC NEPHROPATHY IN TYPE 2 DIABETES MELLITUS PATIENTS.

2025-07-02T14:30:19+05:00

BACKGROUND: Diabetic nephropathy (DN) is a leading complication of type 2 diabetes
mellitus (T2DM), with glycemic control playing a pivotal role in disease progression. This
meta-analysis evaluates the association between HbA1c levels and DN progression in T2DM
patients. METHODS: We systematically reviewed 20 studies (14 cohorts, 5 RCTs, 1 meta
analysis) comprising 48,050 participants from diverse regions (South Asia, East Asia, Western
countries). Primary outcomes included albuminuria progression, eGFR decline, and end-stage
renal disease (ESRD). Random-effects models were used to pool effect sizes (OR/HR) with
95% CIs, and heterogeneity was assessed via I² statistics. RESULTS: Elevated HbA1c showed
a strong, dose-dependent relationship with DN progression. Each 1% increase in HbA1c was
associated with 25–40% higher odds of albuminuria progression (pooled OR: 1.65, 95% CI:
1.50–1.82, I² = 72%). For eGFR decline, HbA1c >7% conferred a 30–80% greater hazard
(pooled HR: 1.52, 1.35–1.72, I² = 58%), while HbA1c >8.5% increased ESRD risk 2- to 4-fold
(pooled HR: 2.20, 1.85–2.62, I² = 65%). South Asian populations exhibited the highest risks
(e.g., OR: 3.10 for HbA1c >9% in Pakistan). Adjustments for hypertension and diabetes
duration were consistent, but socioeconomic factors were less frequently addressed.
Renoprotective medications (e.g., SGLT2 inhibitors, RAS blockers) attenuated HbA1c
associated risks. CONCLUSION: HbA1c is a robust, modifiable predictor of DN progression
in T2DM, with risks escalating above 7–8%. Regional disparities underscore the need for
tailored glycemic targets. Intensive control, combined with renal-protective therapies, may
mitigate DN risk, particularly in high-burden populations.

A-CROSS SECTIONAL CLINICAL ASSESSMENT ON MENTAL HEALTH AND NEURODEGENERATIVE SYMPTOMS IN RETIRED INDIVIDUALS.

2025-07-06T15:20:09+05:00

ABSTRACT
BACKGROUND: Retirement is a critical life transition that can impact cognitive health,
potentially contributing to neurodegenerative symptoms. Early detection of cognitive decline
in retired individuals is essential for timely intervention. This study assesses cognitive function
and neurodegenerative symptoms using the Mini-Mental State Examination (MMSE) and
Dementia Rating Scale-2 (DRS-2) in retired individuals. METHODS: After study approval
(24/IMCH/034), this cross-sectional study was conducted between January 2024 to July 2024
on 90 retired individuals (mean age: 68.5 ± 5.4 years) using questionnaire based consecutive
data collection technique following an informed consent. Cognitive function was evaluated
using MMSE and DRS-2. The association between cognitive scores and socio-demographic
variables was analyzed using chi-square tests, Pearson correlation, and multivariate regression.
A p-value of <0.05 was considered statistically significant. RESULTS: The mean MMSE
score was 24.1 ± 3.7, with 31.1% of participants showing cognitive impairment (MMSE <24).
Cognitive decline was significantly associated with age (r = -0.42, p = 0.003) and years since
retirement (r = -0.37, p = 0.008). The mean DRS-2 score was 121.3 ± 9.2, with impaired
individuals showing lower scores in memory (p = 0.002), attention (p = 0.004), and
conceptualization (p < 0.001). Hypertension (OR = 2.6, p = 0.009) and social isolation (OR =
3.1, p = 0.004) were independent predictors of cognitive impairment. CONCLUSION:
Cognitive impairment and neurodegenerative symptoms are prevalent in retired individuals,
with chronic illnesses and social isolation being key risk factors. MMSE and DRS-2
assessments provide valuable insights into early cognitive decline, highlighting the need for
targeted mental health strategies post-retirement.

BURDEN OF DECOMPENSATED LIVER DISEASE IN PAKISTAN: AN EPIDEMIOLOGICAL EVIDENCE.

2025-07-03T11:30:44+05:00

BACKGROUND: Decompensated liver disease (DLD) is a leading cause of morbidity and
mortality in Pakistan, driven primarily by viral hepatitis, metabolic dysfunction-associated
steatotic liver disease (MASLD), and alcohol-related liver injury. Despite its high burden,
comprehensive epidemiological data remain scarce. This meta-analysis synthesizes available
evidence to quantify the prevalence, etiological distribution, and clinical outcomes of DLD in
Pakistan. METHODS: A systematic search was conducted across PubMed, Google Scholar,
and Pakistani medical journals (2000–2023) for studies reporting DLD prevalence, etiology,
complications, or mortality. Pooled estimates were calculated using random-effects meta
analysis, with subgroup analyses by etiology and region. RESULTS: Among 18 eligible
studies (n=19040 patients), the pooled prevalence of DLD in cirrhotic patients was 15.6%
(95% CI: 12.4–19.2%), with HCV (63.5%), HBV (18.7%), and MASLD (12.1%) as leading
causes. The 1-year mortality rate was 47.3% (95% CI: 41.5–53.2%), with variceal bleeding
(32%), hepatorenal syndrome (24%), and sepsis (19%) as major contributors. DLD accounted
for 9.8% of hepatology admissions, with significant regional disparities higher in Punjab
(17.1%) and Sindh (14.5%) compared to Khyber Pakhtunkhwa (10.3%).
CONCLUSION: Pakistan faces a severe and growing burden of DLD, predominantly due to
untreated viral hepatitis and rising metabolic risk factors. Delayed diagnosis, restricted access
to antiviral medications, and insufficient transplant services worsen patient outcomes.
Immediate public health actions, such as broadening HCV screening, providing affordable
direct-acting antivirals (DAAs), and implementing strategies for preventing MASLD, are
essential for alleviating this crisis.