D.G Khan Medical College

Background Peripheral neuropathy is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Objective To evaluate the relationship between plasma homocysteine levels and the severity of peripheral neuropathy in patients with T2DM. Methods A cross-sectional study was conducted at Sahiwal Teaching Hospital, Sahiwal, from November 2024 to July 2025, involving 325 patients with T2DM. Plasma homocysteine levels were measured, and peripheral neuropathy severity was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and nerve conduction studies (NCS). Results Elevated plasma homocysteine levels (>15 μmol/L) were found in 34.5% of patients. The prevalence of neuropathy increased with higher homocysteine levels, with 44.5% of patients with normal homocysteine levels exhibiting neuropathy, compared to 66.7% in those with mild elevation and 85.7% in those with severe elevation. A positive correlation was observed between homocysteine levels and neuropathy severity (r = 0.42, p <0.001). Multivariate regression analysis identified homocysteine as an independent predictor of neuropathy severity (β = 0.38, p<0.001), along with diabetes duration and glycated hemoglobin (HbA1c). Conclusion Elevated plasma homocysteine levels are associated with increased severity of peripheral neuropathy in T2DM patients. These findings suggest that homocysteine may serve as a biomarker for identifying T2DM patients at risk for severe neuropathy, with potential implications for early diagnosis and therapeutic interventions.

Objective: To compare the mean induction-to-delivery interval of Foley catheter versus misoprostol for induction of labor (IOL) in singleton term pregnancies. Methodology: This randomized controlled trial NCT07416487 (clinicaltrials.gov) was carried out at the Department of Obstetrics and Gynecology, Allama Iqbal Teaching Hospital, Dera Ghazi Khan, Pakistan, from February 2025 to July 2025. A total of 102 (51 in each group) pregnant females aged 18-40 years with a singleton term pregnancy, vertex presentation, intact membranes, and parity less than 4 undergoing induction of labour were included. Participants were allocated by lottery method with concealment to intravaginal misoprostol 25 μg every 4 hours up to four doses or an intracervical 16F Foley catheter inflated with 30 mL saline. Induction to delivery interval was recorded from the insertion of the Foley catheter or misoprostol until the delivery of the fetus (in hours). Results: In a total of 102 women the mean age was 27.5±5.5 years, with ages ranging from 18 to 40 years. The mean gestational age at induction was 39.4±1.3 weeks. Parity distribution was nullipara in 31 (30.4%), primipara in 21 (20.6%), and multipara in 50 (49.0%) women. Indications for induction were chronic hypertension in 33 (32.4%) women, gestational diabetes in 42 (41.2%), and congenital anomaly in 27 (26.5%). Induction-to-delivery interval differed between the study groups as women in misoprostol group had a shorter mean induction-to-delivery interval compared with those allocated to Foley catheter at 14.6±1.8 hours versus 18.5±2.7 hours (p<0.001). With regards to different indications for induction, induction to delivery interval remained significantly shorter among women in misoprostol group. Conclusion: Intravaginal misoprostol resulted in a shorter induction to delivery interval than the intracervical Foley catheter among women undergoing induction of labour for singleton term pregnancies.

Background: Drug-resistant tuberculosis (DR-TB) poses a major challenge to global TB control, with increasing incidence and poor treatment outcomes. Differences in resistance patterns between pulmonary and extrapulmonary TB remain inadequately explored. Objective: To evaluate the patterns and predictors of drug-resistant tuberculosis in pulmonary and extrapulmonary TB patients. Methodology: This was a comparative cross-sectional study conducted at Sialkot medical college Sialkot from march 2025 to march 2026 including 266 patients diagnosed with tuberculosis. Results: Drug-sensitive TB was more common in extrapulmonary TB (67.3% vs 60.3%), while MDR-TB (20.5% vs 16.4%) and mono-resistance (14.1% vs 10.9%) were slightly higher in pulmonary TB. Patients with DR-TB were older (44.8 ± 13.9 vs 40.6 ± 14.4 years) and had lower BMI (20.7 ± 3.1 vs 21.9 ± 3.3 kg/m²). Previous TB treatment (59.2% vs 26.2%), diabetes (36.7% vs 22.6%), HIV positivity (20.4% vs 11.9%), and malnutrition (53.1% vs 31.0%) were significantly associated with DR-TB. Multivariable analysis identified previous treatment (AOR 3.42), malnutrition (AOR 2.76), low BMI (AOR 2.21), diabetes (AOR 1.94), HIV (AOR 1.88), and age >45 years (AOR 1.67) as independent predictors. Conclusion: Drug-resistant TB is influenced by multiple factors, with prior treatment being the most significant predictor. Both pulmonary and extrapulmonary TB require equal attention in resistance surveillance and management strategies.

Background: Diabetic kidney disease may begin silently, and serum creatinine can remain normal during early renal injury. Urine albumin-creatinine ratio is a practical screening test for detecting early albuminuria before routine renal function markers become abnormal. Objective: To determine the diagnostic yield of urine albumin-creatinine ratio for detecting microalbuminuria among adult diabetic patients with normal serum creatinine and to assess its association with diabetes duration and blood pressure control. Methods: This diagnostic yield study was conducted at a tertiary-care hospital in Bahawalpur, Punjab, Pakistan. A total of 180 adult diabetic patients with normal serum creatinine were included through consecutive sampling. Patients with known chronic kidney disease, raised serum creatinine, urinary tract infection, pregnancy, fever, heart failure, or acute severe illness were excluded. Microalbuminuria was defined as urine albumin-creatinine ratio of 30–300 mg/g. Associations with diabetes duration and blood pressure control were assessed using chi-square tests. Results: Microalbuminuria was detected in 62 of 180 patients, giving a diagnostic yield of 34.4% with a 95% confidence interval of 27.9–41.6%. Microalbuminuria increased with diabetes duration, from 20.7% in patients with duration below 5 years to 50.9% in those above 10 years. It was also more frequent in patients with uncontrolled blood pressure than controlled blood pressure, 48.6% versus 24.5%. Both associations were statistically significant. Conclusion: Urine albumin-creatinine ratio identified early albuminuria in a substantial proportion of diabetic patients with normal serum creatinine. Longer diabetes duration and uncontrolled blood pressure were associated with higher microalbuminuria frequency