Shaikh Zayed Medical College and Hospital

Background: This study's objective is to evaluate the 25-year mortality trends in the US population from pancreatic cancer that is exacerbated by alcoholism and smoking. Pancreatic cancer is still one of the deadliest tumors in the United States, despite improvements in detection and treatment. Its known modifiable risk factors include alcohol consumption and smoking, which account for around 20–30% and less than 5% of cases, respectively. Given that almost 80% of smokers also drink, these two characteristics typically overlap. Although both are classified as contributory causes of mortality, the precise combined burden of smoking and alcohol-related pancreatic cancer fatalities has not been fully characterized. Methodology: For people over 45 with pancreatic cancer (ICD-10: C25), concomitant alcohol abuse (F10), and smoking abuse (F17), data from the CDC WONDER database (1999–2023) was studied. Age, sex, race, Hispanic origin, U.S. Census area, and 2013 urbanization categories were used to stratify age-adjusted mortality rates (AAMRs) per 100,000. Joinpoint regression (JPR) analysis was used to determine annual percentage changes (APCs). The significance level was set at P <0.05. The Ljung-box test was used to assess the Autoregressive Integrated Moving Average (ARIMA: 1,1,0) models used to anticipate annual AAMRs through 2024. Results: Pancreatic cancer was the primary cause of 47,333 deaths in the US between 1999 and 2023; smoking and alcoholism were found to be contributory factors (overall AAMR = 14.09). By 2035, AAMR is predicted to be 30.61 with p = 0.91. Black people made up 10.94%, white people 87.23%, non-Hispanics 96.24%, and men 61.93%. Between 2001 and 2005, mortality increased significantly, with an APC of 63.96 (p=0.001). Males showed an even steeper significant rise from 2001 to 2004 with APC = 82.90, p<0.001, while females showed a dramatic significant surge from 2001 to 2005 with APC = 63.90 (p = 0.003). From 2001 to 2005, non-Hispanic people showed a sharply significant increase (APC = 65.21, p = 0.00). Significantly, the Northeast experienced a sharp increase between 2002 and 2004 (APC = 164.77, p<0.001). Among Urbanization categories, Medium Metro areas recorded the highest early APC =80.57, p = 0.003. White individuals showed a significant surge 2001–2005 (APC = 66.87, p = 0.0012. Highest AAMRs were in Delaware (66.7), Michigan (51.5) and Vermont (50.5); lowest in California (0.9), Alabama (9.4), and Georgia (11.4) Conclusion : The findings indicate that, despite notable demographic and geographic variations, mortality rates have remained high over the past 20 years and will continue to grow by 2035. In order to reduce the significant estimated future mortality toll, targeted campaigns and new legislative initiatives are essential. These findings call for increased cessation and prevention efforts countrywide.

Background: Liver cirrhosis (LC) remains a major global health challenge, characterized by recurrent inflammation, repair, and fibrosis. The systemic inflammatory response index (SIRI), a novel biomarker integrating neutrophil, monocyte, and lymphocyte counts, has shown prognostic potential in several conditions, but its role in critically ill cirrhotic patients has not been fully defined. Aim: The aim of this study was to evaluate the prognostic value of SIRI and its association with in-hospital mortality among critically ill cirrhotic patients. Methodology: This retrospective cohort study analyzed ICU-admitted cirrhotic patients (2008–2019) using the MIMIC-IV database. SIRI was calculated as neutrophils × monocytes/lymphocytes and stratified into high (≥4.35) and low (<4.35) groups. Demographic, clinical, and laboratory data were extracted. Statistical analyses included chi-square tests, multivariable logistic regression adjusted for confounders, ROC curve analysis, and Kaplan–Meier survival curves with log-rank testing. Results: Among 2,344 patients (61.2% male; mean age 58.7±12.9 years), 668 (28.5%) died during hospitalization. Non-survivors were older, had more comorbidities, and had significantly higher SIRI values (6.8 vs. 4.2, p<0.001). Elevated SIRI independently predicted in-hospital mortality (OR 1.007, p=0.027) alongside age, albumin, SOFA score, and SpO₂. ROC analysis showed moderate discrimination (AUC=0.646, cutoff 4.35; sensitivity 69.3%, specificity 53.3%). Kaplan–Meier analysis confirmed worse survival in patients with high SIRI (p<0.001). Conclusion: High SIRI (≥4.35) is significantly associated with increased in-hospital mortality in critically ill cirrhotic patients. As a readily available and cost-effective biomarker, SIRI may serve as a useful tool for early risk stratification and clinical decision-making in this high-risk population.

Background: Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by impaired movement and posture due to early brain damage, leading to substantial motor disability and dependence in daily activities. While traditional physical therapy (PT) has long been the standard for rehabilitation, robot-assisted therapy (RAT) has emerged as a promising approach offering repetitive, precisely controlled movements that may enhance motor learning and neuroplasticity. However, comparative evidence on their relative efficacy remains limited. Objective: To compare the effectiveness of RAT versus traditional PT in improving gross motor function, functional independence, and reducing spasticity in children with CP. Methods: A double-blind, randomized controlled trial was conducted with 60 children aged 4–12 years diagnosed with CP, allocated equally to RAT or PT groups. Interventions were administered three times weekly over eight weeks. Primary outcomes were changes in Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) scores; secondary outcome was spasticity reduction measured by the Modified Ashworth Scale (MAS). Statistical analysis included independent and paired t-tests, ANCOVA for baseline adjustments, effect sizes, and confidence intervals. Results: Both groups improved significantly across outcomes (all p<0.001), but the RAT group achieved greater improvements in GMFM (mean Δ12.5 vs Δ7.8; p=0.021; Cohen’s d=0.84), PEDI (mean Δ14.2 vs Δ9.5; p=0.038; d=0.76), and spasticity reduction (mean Δ–2.1 vs –1.3; p=0.009; d=0.65). No adverse events were reported. Conclusion: RAT demonstrated superior short-term efficacy over traditional PT in enhancing gross motor skills, functional independence, and reducing spasticity in children with CP, supporting its integration into pediatric rehabilitation programs.

Relay cropping is a sustainable and efficient cropping system that allows two crops to share part of the growing season, enhancing land use, resource efficiency, and profitability, especially under zero-tillage practices. A three-year field study (2021–22, 2022-23 & 2023-24) was conducted at the Cotton Research Institute, Khanpur, Southern Punjab, to compare the agronomic and economic performance of relay cropping of Brassica juncea (Super Raya) into standing cotton (Gossypium hirsutum L.) with their respective sole cropping systems. The experiment included: (1) sole cotton cropping, (2) sole Brassica cropping after cotton harvest, and (3) relay cropping where Brassica was sown in early October into standing cotton. Standard agronomic practices were followed across all treatments. Performance metrics included yield, income, production costs, profit margins, and profitability ratios were recorded and analyzed using standard protocols. Results showed that relay cropping consistently increased cotton yield by 11–23% across the three years. While Brassica yield slightly declined (by 10–15%) under relay cropping, total farm profit improved due to higher cotton yields and reduced input costs. Net profits in the relay system ranged from Rs. 6,000 to Rs. 8,000 higher per acre compared to sole cropping. Additionally, profit-to-cost ratios were superior in the relay system (up to 1.95) versus sole systems (as low as 1.01). Relay cropping also offered ecological benefits such as soil cover improvement and reduced erosion, while optimizing labor and input use. These findings indicated that relay cropping is a practical and economically viable approach for improving productivity and sustainability in semi-arid cotton-growing regions of Pakistan. In conclusion, relay cropping of cotton with Brassica (Super Raya) is a viable, sustainable, and economically superior alternative to conventional sole cropping systems in Southern Punjab. It increases cotton yields, enhances profitability, and supports resource conservation. This system is particularly suitable for small to medium-scale farmers seeking to improve income, productivity, and land use efficiency under semi-arid conditions.

Background: Depression is a common yet often underrecognized and treatable disorder among medical students. In Pakistani cohort there is limited research on barriers to accessing mental health care. This study aims to quantify the treatment gap in mental health conditions among Pakistani medical students, identify potential barriers to initiating mental health treatment, and explore demographic predictors influencing the reporting of these barriers. Methods: A cross-sectional study was conducted between March and July 2025 involving 144 medical students. Data collection utilized the barriers to access to care evaluation (BACE v3) and the Rosenberg self-esteem scale (RSES) questionnaires. Statistical analyses were performed using SPSS version 28 to ensure rigorous examination of the data. Results: The study examined the demographics, self-esteem levels, and barriers to seeking professional mental health care among 144 participants. The findings indicate that the majority 70.8% exhibited medium to high self-esteem, whereas approximately 29.2% reported low self-esteem. The most prominent barriers identified were attitudinal, 95.8% participants endorsing the preference to "solve the problem on my own," and stigma-related, 79.9% expressing concern about “what my family might think. Discussion: Thematic analysis further revealed key barriers, including stigmatizing beliefs, difficulty in disclosing personal issues, a reliance on self-management, and challenges in accessing professional help. Conclusion: Medical students face significant mental health challenges, often hindered by stigma and attitudinal barriers. Improving awareness, reducing stigma, and enhancing access to mental health services in universities are essential. Early intervention and supportive environments can help safeguard their mental well-being and academic success.