Chandka Medical College Sindhi: چانڈکا طبی ڪاليج, or CMC), established on 20 April 1973, is a public sector medical college located in Larkana, Sindh, Pakistan. It also provides post graduate training to doctors. It provides tertiary medical care facilities to upper Sindh and half of the Balochistan, and medical education for the students of Larkana Division.It is one of the constituent colleges of Shaheed Mohtarma Benazir Bhutto Medical University (SMBBMU). The school has a large and experienced faculty to support its mission of education, research, and clinical care. Faculty members hold appointments in the basic science departments and in the clinical departments of CMC Teaching Hospital as well as other offices in Larkana. There are approximately 100+ full-time faculty members consisting of demonstrators, assistant, associate, and full professors at CMC Larkana..
Medical education is transitioning from traditional didactic teaching to an integrated, technology-enhanced, self-directed model. Studies report high student satisfaction with digital resources, especially YouTube and artificial intelligence–based large language models (LLMs). However, limited comparative evidence exists on resource utilization patterns and their associations with academic performance. This study aims to identify the resources preferred by medical students, assess their satisfaction, and correlate usage patterns with academic performance in Pakistan. This cross-sectional study recruited 380 undergraduate medical students across Pakistan via convenience sampling. The data included demographics, usage frequency, and satisfaction levels for textbooks, institutional lectures, YouTube, LLMs, and medical websites. The primary outcome was the self-reported score in the most recent annual professional examination. Data were analyzed via the Mann–Whitney U test, the Kruskal–Wallis H test, and hierarchical multiple linear regression, controlling for sex, institution type, and year of study. Textbooks (55.8
ABSTRACT Gastroparesis is a sensorimotor condition characterized by delayed gastric emptying without any obvious mechanical obstruction. Common symptoms include early satiety, nausea, vomiting, belching, and bloating. The most frequent causes of gastroparesis are diabetes, idiopathic factors, and post‐surgical complications. Currently, the only FDA‐approved medication for treating gastroparesis is metoclopramide; however, due to its potential side effects, particularly extrapyramidal symptoms, there is increasing interest in safer, more tolerable alternatives, such as prokinetics, antiemetics, and fundic relaxants. Recent advancements in pharmacological agents have demonstrated variable efficacy in improving gastric emptying and gastroparesis‐related symptoms, although symptom improvement does not consistently correlate with changes in gastric emptying metrics. In addition to pharmacological treatments, non‐pharmacological approaches like gastric peroral endoscopic myotomy (G‐POEM) and neuromodulation techniques have demonstrated significant improvements in symptoms and gastric emptying. The current understanding of gastroparesis care is still limited, and the best practices in treatment remain uncertain. Future research should prioritize multicenter trials that involve large patient populations to explore emerging therapies and innovative techniques. In this review, we will discuss the existing standards of care, advancements in novel pharmacological, interventional, and neuromodulatory treatments for gastroparesis, as well as their clinical integration, limitations, and prospects.
Background:Hypertension and diabetes are among the most prevalent conditions in the world, which can severely affect the kidneys, especially when they occur together. This study analyzes mortality trends among the American population with hypertensive kidney disease (HKD) and diabetes. Methods:We carried out a retrospective analysis from 1999 to 2024 of nationwide mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. We included individuals with HKD diabetes (ICD-10 codes: I12, E10-E14) using a multiple cause of death approach (reporting any mention of the diagnosis as an underlying or contributing cause of death). We calculated the age-adjusted mortality rates (AAMR) per 100 000 population, and analysis based on year, gender, race/ethnicity, state, and urban/rural classification was performed. Joinpoint regression analysis was used to determine significant annual percent changes (APCs) in AAMR over the study period. Results:A total of 242 071 deaths among the patient population were reported, and analysis revealed a significant increase in the overall AAMR for mortality related to HKD and diabetes, rising from 1.1 per 100 000 in 1999 to 4.9 per 100 000 in 2024. Men consistently showed higher AAMRs (overall 2.4) compared to women (overall 2.0). Among racial and ethnic groups, the highest overall AAMR was observed in the non-Hispanic Black or African American population (6.9). States that showed the highest AAMR included California, South Carolina, Texas, Mississippi, and the District of Columbia. Additionally, nonmetropolitan areas demonstrated a generally higher AAMR (2.6) compared to metropolitan areas (2.5). Conclusions:HKD-related mortality among diabetic Americans surged between 1999 and 2024, with gender, race/ethnicity, and geographic location disparities, especially in nonmetropolitan areas. Targeted health strategies and interventions are vital to reducing mortality and addressing these disparities.
BACKGROUND:Acute cholangitis is a potentially life-threatening infection of the biliary tract and its mortality rate is between 10%-30%. Early risk stratification is essential for the best possible outcome. Serum albumin, an index of the inflammatory and nutritional state, has been associated with adverse outcome in various acute conditions. AIM:To assess the value of hypoalbuminemia as a predictor of mortality in acute cholangitis. METHODS:A systematic search of PubMed, Web of Science, Semantic Scholar, Cochrane Library, and Google Scholar was performed up to May 2025. Eligible studies included adults diagnosed with acute cholangitis and reported mortality outcomes stratified by serum albumin levels. Data extraction was conducted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95%CI were calculated using a random-effects model. Heterogeneity was assessed with the I² statistic, while publication bias was evaluated through funnel plot symmetry and Egger's regression test. RESULTS:Eight retrospectively assembled cohort studies enrolling a total of 2215 of patients with acute cholangitis were incorporated in this meta-analysis. Mean age of the patient was greater than 65 years. Among them, 52.2% were males. Out 2215 patients, 242 (10.9%) died. Hypoalbuminemia was highly associated with increased mortality. Dichotomous outcome analysis demonstrated strong evidence of association between hypoalbuminemia and mortality (OR = 8.02, 95%CI: 3.41-18.83; P ≤ 0.001; I² = 50%). Continuous outcome analysis demonstrated a 23% increased risk of mortality associated with every 1 g/dL fall in serum albumin (OR = 0.77, 95%CI: 0.64-0.93; P = 0.005; I² = 66%). All the incorporated studies were of high methodological quality with minimal evidence of publication bias. CONCLUSION:Hypoalbuminemia on hospital admission is a strong and independent predictor of death in patients with acute cholangitis. Admission serum albumin measurement provides a simple, cost-effective, and universally available method of early risk stratification. Prospective studies in the future need to examine whether correction of hypoalbuminemia improves clinical outcomes.
BRCA mutations are well established in breast and ovarian cancers and increasingly recognized in colorectal cancer (CRC), particularly BRCA1 . Dual BRCA1/2 pathogenic variants in CRC remain exceptionally rare. We report a case of early-onset CRC in a young male harboring pathogenic variants in BRCA1 , BRCA2 , and POLE , with no personal or familial cancer history. This mutational triad suggests convergence of homologous recombination deficiency and impaired DNA proofreading, resulting in a hypermutated phenotype. The case may represent a novel molecular CRC subtype and underscores the importance of broad-panel germline testing in young patients, with implications for poly (ADP‑ribose) polymerase and immune checkpoint inhibitor therapy.
