Peoples University of Medical & Health Sciences for Women

Glioblastoma (GBM) remains the most common and lethal primary central nervous system tumor, with a median survival of only 14.6 months under standard care. The tumor’s characteristic "Warburg effect"—a dependency on aerobic glycolysis for energy—creates a metabolic vulnerability. This review evaluates the efficacy and safety of the ketogenic diet (KD) as an adjunctive metabolic therapy aimed at exploiting this glucose dependency. This PRISMA-compliant systematic review updates clinical evidence by synthesizing data from databases from 2000 to September 2025. We searched PubMed, Embase, Cochrane, and Web of science for human studies assessing the ketogenic diet (KD) in glioblastoma and high-grade gliomas. Primary outcomes included overall survival (OS), progression-free survival (PFS), feasibility, and adverse events. Study quality was assessed using Joanna Briggs Institute tools. Prospero registration: CRD420251232650. Forty-one studies were included, ranging from randomized trials to case series and abstracts, utilizing interventions such as the classic 4:1 ketogenic diet, Modified Atkins Diet, and calorie restriction. Adherence was high (> 75

Abstract Background Traditional nasal packing following septoplasty imposes significant patient morbidity, including pain, obligate oral breathing, and sleep disruption. Negative pressure drainage (NPD) represents a mechanistically distinct alternative, but no synthesis of comparative evidence existed prior to this review. Methods A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing NPD with nasal packing following septoplasty was conducted in accordance with PRISMA 2020 (PROSPERO: CRD420261297218). PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to January 2026. Primary outcome was postoperative pain. Secondary outcomes included nasal obstruction, complications, treatment efficacy, and cost-effectiveness. Risk of bias was assessed using RoB 2. Results Four RCTs comprising 315 patients were included, between 2014 and 2025. Risk of bias was rated as some concern in all the studies. NPD demonstrated a statistically significant reduction in postoperative pain at 24 h (MD = -2.36, 95% CI: -4.10 to -0.62), exceeding the minimum clinically important difference, though substantial heterogeneity was present (I² = 95.2%). NPD was associated with significantly lower nasal obstruction scores in the immediate postoperative period. Adhesion rates trended lower with NPD (2.8% vs. 6.5%; RR = 0.50, 95% CI: 0.14 to 1.83) without reaching significance. Overall treatment effectiveness was comparable between groups (RR = 1.07, 95% CI: 0.99 to 1.16). NPD was associated with substantially lower per-patient costs in one study. Conclusion NPD offers clinically meaningful early postoperative pain and comfort advantages over traditional nasal packing with equivalent efficacy and an acceptable safety profile. The evidence base remains limited to four single-country trials, and adequately powered RCTs are needed before definitive practice recommendations can be made.

Suprasellar meningiomas are classically removed through several different surgical transcranial approaches, including the pterional transsylvian route. Recently, the indications for the transsphenoidal technique, traditionally proposed only for the treatment of intrasellar lesions, have been extended to include lesions located in the supra- and parasellar areas and, among them, suprasellar meningiomas. We describe the surgical technique for the purely endoscopic endonasal transsphenoidal approach to suprasellar meningiomas. To evaluate the endoscopic endonasal technique in resection of suprasellar meningiomas and to elucidate the factors that favor this approach selection. This is a prospective study of collected data of Nineteen consecutive patients who underwent endoscopic endonasal approach (EEA) for suprasellar meningiomas (SSM) at our institution. The details of the surgical technique have been described. In this study, we analyze a series of consecutive patients who underwent endoscopic endonasal resection of SSM, evaluating both preoperative radiological parameters and intraoperative findings. We introduced new imaging predictive factors that may facilitate surgical planning and improve patient selection for EEA. Additionally, we assessed the impact of tumor size and consistency on the surgical time, extent of resection, and postoperative complications, with a particular focus on cerebrospinal fluid (CSF) leak rates and visual outcomes. Gross total removal of the lesion, without the need for brain retraction and with minimal neurovascular manipulation, was achieved in 18/19 (94.7

BACKGROUND Triple-negative breast cancer (TNBC) is an aggressive subtype with limited therapeutic options, primarily relying on chemotherapy, yet often leading to recurrence due to chemoresistance. Cancer stem cells (CSCs) contribute to tumor heterogeneity, resistance, and poor prognosis, but data in Pakistani populations are scarce. This study hypothesizes that a positive CSC phenotype independently predicts reduced pathological complete response (pCR) and inferior survival outcomes. AIM To investigate CSC markers' association with chemotherapy response and survival in Pakistani TNBC patients. METHODS Retrospective cohort study at Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan, including 256 women with TNBC from January 2015 to December 2022. CSC markers (CD44 high, CD24 low, aldehyde dehydrogenase 1 positive) were assessed via immunohistochemistry on pre-treatment biopsies. Outcomes: pCR to neoadjuvant chemotherapy, overall survival, disease-free survival. Data were analyzed with multivariable logistic regression and Cox proportional hazards models, adjusting for age, tumor grade, and stage. RESULTS The CSC-positive phenotype was identified in 26 patients (10.2%). Compared to negative cases, positive cases had lower pCR rates [5.0% vs 51.8%; adjusted odds ratio = 0.05, 95% confidence interval (CI): 0.01-0.39, P = 0.004]. The positive phenotype was associated with poorer overall survival (adjusted hazard ratio = 4.35, 95%CI: 2.43-7.79, P < 0.001), with a median overall survival of 19 months vs 27 months. No association with disease-free survival was observed (hazard ratio = 0.86, 95%CI: 0.43-1.73, P = 0.675). CONCLUSION CSC markers are associated with reduced chemotherapy response and inferior overall survival in Pakistani TNBC patients. These findings suggest their potential as prognostic biomarkers and highlight the need for future research into targeted strategies, such as proteomic profiling and Proteolysis Targeting Chimeras technology, to overcome chemoresistance in this population.

Background: Snakebite envenoming remains a significant yet neglected public health problem in tropical countries, particularly in rural South Asia. This study aimed to identify demographic characteristics, management practices, and the determinants of poor treatment outcomes among snakebite patients in Sindh, Pakistan. Methods: A prospective cohort study was conducted at Peoples Medical College Hospital (PMCH), Shaheed Benazirabad, Sindh, Pakistan, from July 1, 2023, to June 30, 2024. A non-probability purposive sampling technique was used for data collection, and all consecutive patients presenting with confirmed or suspected snakebite were included. Data were collected through a validated study tool on demographics, pre-hospital management, hospital care, and treatment outcomes. Categorical variables were tested with the Chi-square test, and Kaplan-Meier survival analysis was used to test the effect of exposure-to-reporting time and hospital stay time on outcomes using IBM SPSS V29. Results: A total of 320 patients were included; 74.7% were male, and 98.4% were from rural areas. Most victims were aged 20-29 years (31.9%) and engaged in farming or manual labor (67.2%). Nearly half (49.7%) of the bites occurred during summer. Delayed hospital presentation was common, with 22.8% arriving after six hours of the bite. The overall poor-outcome rate was 10.9%, and mortality was 1.9%. A significant association was found between exposure-to-reporting time (p = 0.040) and hospital stay duration (p < 0.001) with treatment outcomes. Conclusion: Delayed presentation to the hospital and prolonged hospitalization were major predictors of poor outcomes following snakebite. Strengthening emergency referral systems, ensuring timely antivenom availability, and promoting community awareness are essential to reduce morbidity and mortality in snakebite-endemic regions of Pakistan.