The Hayatabad Medical Complex is a large medical complex and hospital located in the Hayatabad suburb of Peshawar in Khyber Pakhtunkhwa, Pakistan. The second largest hospital in the city, it is a medical postgraduate training centre. The hospital provides medical and surgical specialties in the fields of optometry, cardiology, paediatrics, physiotherapy, plastic surgery, psychiatry, as well as dentistry and skin treatment. Apart from the western parts of Peshawar, the hospital also serves patients coming from surrounding regions and neighboring Afghanistan for treatment..
OBJECTIVE:Propofol is widely used for gastrointestinal (GI) endoscopies but may cause respiratory depression and hemodynamic compromise when used alone. Adjuncts such as ketamine or esketamine and fentanyl-class opioids (fentanyl, alfentanil, and sufentanil) are used to optimize sedation, yet their comparative efficacy and safety remain uncertain. This meta-analysis evaluated ketamine or esketamine plus propofol (KP regimens) versus fentanyl/alfentanil/sufentanil plus propofol (FP regimens). METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Scopus, Cochrane Library, and Google Scholar from inception to February 2025 for randomized controlled trials (RCTs). Eligible studies included patients undergoing GI endoscopy (Population), receiving ketamine or esketamine with propofol (Intervention), compared with fentanyl-class opioids with propofol (Comparison), and reporting outcomes including propofol dose, comfort, adverse events, recovery time, or procedure time (Outcomes). Risk of bias was assessed with the Cochrane tool. Heterogeneity was evaluated using Cochran's Q test and the I2 statistic, and clinical heterogeneity was considered based on study design and population differences. Sensitivity analyses were conducted to test robustness of findings. RESULTS:Fifteen RCTs (1492 participants) were included. KP regimens significantly reduced total propofol use compared with FP (mean difference [MD] -0.42; 95% confidence interval [CI] -0.66 to -0.19; P = .0005), with greater benefit observed for esketamine (p for subgroup = 0.001). No significant differences were found in sedation (MD 0.01; 95% CI -0.40 to 0.43; P = .95) or pain scores (MD 0.24; 95% CI -0.18 to 0.65; P = .26). Safety outcomes were comparable across groups, with no significant differences in desaturation, nausea/vomiting, bradycardia, or tachycardia, except for hypotension, which was lower with KP (risk ratio [RR] 0.56; 95% CI 0.39 to 0.82; P = .003). Recovery and procedure times were similar between groups. CONCLUSIONS:Both KP and FP regimens are effective and safe for GI endoscopy. KP regimens reduce total propofol requirements and significantly lower the risk of hypotension, while showing comparable sedation quality, analgesia, and recovery profiles to FP. These findings suggest KP may offer safety and dosing advantages, though larger standardized trials are needed to confirm its clinical superiority.
Background: Prediabetes, a reversible high-risk state for type 2 diabetes, remains significantly underdiagnosed, hindering timely intervention. With Pakistan ranking third globally in diabetes prevalence, understanding physician practices is critical for prevention. This study assesses the attitudes of doctors towards the screening and management of prediabetes in adults at tertiary care hospitals in Peshawar. Objective: This study aims to assess the attitudes of doctors towards the screening and management of prediabetes in adults. Methodology: A cross-sectional questionnaire-based study was conducted from 26th March 2025 to 26th September 2025. A total of 106 doctors were recruited via convenience sampling technique. Exploratory Factor Analysis (EFA), t-tests, ANOVA, and regression analyses were used to determine the strengths of association with demographics, with p-value of < 0.05 was considered statistically significant. Results: In current study majority of the doctors have positive attitudes: 63.2% supported universal screening, 75.5% favored WHO/ADA guidelines, and 74.5% agreed evidence-based practice is effective. Nonetheless, psychological effects were perceived differently, and 35.8% of respondents believed that diagnosis might have adverse effects on mental health. Additionally, this study demonstrates that male doctors adhered more to guidelines than females (p = 0.04), and TMOs had more positive attitudes toward screening than registrars (p = 0.03). Higher qualifications were linked with concern about psychological impact of the diagnosis (p = 0.02). Conclusion: Doctors in Peshawar tended to have positive attitudes towards prediabetes screening, and management. Nevertheless, health systems, skills-based training, and localized guidelines should be enhanced to channel positive attitudes into effective preventive practice
Escherichia coli (E. coli) is a leading cause of urinary tract infections (UTIs) and diabetic foot ulcers, especially in individuals with weakened immune systems. Pathogenic strains (PEC) employ virulence genes including fimH, hlyA, usp, traT, and papC to establish infection, evade immune responses, and cause tissue damage. However, despite its clinical significance, there is a lack of integrative studies profiling virulence genes and identifying mutations in PEC, which may contribute to pathogenicity, antimicrobial resistance, and limitations in targeted therapy. In this study, 210 E. coli isolates were collected from diabetic patients with UTIs or foot ulcers at Hayatabad Medical Complex (HMC), Peshawar. Identification was performed through biochemical profiling and confirmed via PCR targeting 16S rRNA. Antibiotic resistance was assessed using the Kirby-Bauer disk diffusion method. The presence of virulence genes was detected by PCR, and sequencing data were analyzed using bioinformatics tools such as Multiple Sequence Alignment, PROVEAN, InterProScan, and SWISS-MODEL. A significantly higher prevalence of all five virulence genes was observed in diabetic isolates (fimH OR = 2.63; hlyA OR = 3.17; usp OR = 3.57; traT OR = 3.31; papC OR = 3.45; p < 0.001). Several mutations were identified, with PROVEAN predicting deleterious mutations including V20G (FimH), S130L (HlyA), G3R (USP), G1V and Q104L (PapC), and E27K (TraT). Structural modeling revealed localized conformational shifts, while InterProScan indicated conserved functional domains. Phylogenetic analysis showed that mutated genes formed distinct clusters, pointing to evolutionary divergence. This study emphasizes the value of molecular monitoring and the development of targeted therapies to control antibiotic-resistant E. coli infections in diabetic patients.
Preterm neonates, especially those with extremely low birth weights, frequently develop patent ductus arteriosus (PDA). Timely intervention is necessary because persistent PDA can lead to significant morbidities and increased mortality. The purpose of this meta-analysis was to evaluate the safety and effectiveness associated with transcatheter closure compared with surgical ligation for PDA in neonates. We systematically searched PubMed, Embase, and Cochrane from inception to July 2025 for studies (randomized and observational cohorts) comparing transcatheter PDA closure and surgical PDA ligation in infants with PDA. Primary outcomes were all-cause mortality, bronchopulmonary dysplasia, periventricular leukomalacia, and intraventricular hemorrhage. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed using I 2 statistics. Transcatheter closure was associated with lower hemodynamic instability (RR: 0.22; 95% CI: 0.09–0.53) and lower all-cause mortality (RR: 0.34; 95% CI: 0.23–0.49) among 5598 neonates. It was also associated with fewer cases of periventricular leukomalacia and shorter neonatal intensive care unit (NICU) stays. No significant differences were observed in total hospitalization, complications, intraventricular hemorrhage, or bronchopulmonary dysplasia. Sensitivity analyses indicated low heterogeneity and consistent findings across studies. Transcatheter PDA closure was associated with lower mortality, improved hemodynamic stability, and shorter NICU stay compared with surgical ligation, while maintaining a comparable safety profile. Because most included studies were observational, these associations should be interpreted cautiously rather than as causal effects.
Impaired gait speed (GS) is a powerful predictor of disability and mortality in congestive heart failure (CHF), yet molecular determinants of this functional decline remain poorly defined. Existing studies have focused largely on cardiac parameters, leaving a critical gap in identifying biomarkers that capture multisystem involvement. Here, we investigated plasma osteonectin (OSN), also known as secreted protein acidic and rich in cysteine (SPARC), as a novel biomarker for impaired GS in a cohort of 286 CHF patients. We evaluated cardiac function (LVEF), GS, and plasma levels of OSN, zonulin (gut permeability marker), and C-reactive protein (CRP). CHF patients exhibited significantly elevated OSN, zonulin, and CRP, all inversely correlated with GS (p < 0.0001). Multivariable adjusted analysis revealed a robust independent dose-response relationship, where every 0.1 m/s decrease in GS was associated with a significant increase in plasma OSN levels (t = 6.614, p < 0.0001). ROC curve analysis further confirmed this relationship, with OSN demonstrating high diagnostic accuracy (AUC = 0.822) for identifying poor functional performance. In the poor GS subgroup, OSN and zonulin were uniquely linked to CRP (p < 0.0001), suggesting a potential association between gut-barrier dysfunction, systemic inflammation, and OSN-related musculoskeletal remodeling. Collectively, these findings suggest that plasma OSN is an independent biomarker of functional impairment in CHF. While the cross-sectional design limits causal inference, OSN represents a promising tool for risk stratification and a potential therapeutic target to mitigate mobility loss in CHF.
