Objective: To compare maternal and fetal outcomes between booked women (≥3 antenatal visits) and unbooked women (no antenatal care), and to assess the association between antenatal care utilization and pregnancy outcomes. Methods: This descriptive observational study included 500 women aged 15–45 years delivering at Sohail Trust Hospital Jinnah Medical and Dental College, Karachi, between February 01, 2023 and July 31, 2023. Participants were categorized into booked (n=445) and unbooked (n=55) groups. Maternal and fetal outcomes, sociodemographic factors, and obstetric complications were analyzed. . Data were analyzed using SPSS 20, with chi-square tests for categorical variables. Statistical significance was set at p<0.05. Results: During the study period 500 women were interviewed out of which 89% (445) did receive antenatal care; whereas 11& (55) did not receive any antenatal care. In the booked population prevalence of anemia was 54.8%, 1.3% had gestational diabetes, 6.7 % had pregnancy induced hypertension, where as Anemia was more prevalent among unbooked women (65.5% vs. 54.8%) [1]. 10.9% (6) had PIH, 1.8% (I) had GDM. In the booked group 24 had cesarean sections while in un booked group 32.7% (18) had cesarean sections. As far as fetal outcome is concerned in booked group 15.7 % infants were horn having low birth weight, and 3.0 % were stillbirth, while in unhooked patients (13) 23.6'1t were Low birth weight. 3.6% (2) were stillbirth. Conclusion: Unbooked pregnancies are linked to higher rates of maternal anemia, operative delivery, and low birth weight. This emphasizes the need for regular antenatal visits and promotes the utilization of antenatal care to avoid the complications of pregnancy. There is also a need to improve the quality, availability and accessibility of antenatal care services, education level and socioeconomic status of women. Lack of antenatal care is associated with higher risk of adverse maternal and fetal outcomes. Strengthening antenatal care coverage could improve pregnancy outcomes. Keywords: Booked versus Unbooked Pregnancies, Maternal and Fetal Outcomes, antenatal care,
Aims and Objectives: To correlate clinical symptoms of empyema thoracis with treatment outcome. To analyze role of intra-pleural streptokinase in Empyema thoracis. Material and Methods: This cross sectional study was carried out at the department of pediatric medicine unit, UCHS and The Children Hospital, Lahore, spanning from December 10, 2022, to June 9, 2023. Non-Probability, Consecutive sampling technique was used. A total of 70 children who met the inclusion criteria were enrolled in the study. The patients were classified based on their need for various treatment options such as IV antibiotics with chest tube drainage, intrapleural streptokinase, and decortication surgery. The data was inputted and analyzed using SPSS version 25, stratified by age and gender in relation to treatment outcomes. A significance level of p≤0.05 was deemed as significant. Results: Of these 70 study cases, 55(78.6%) were male patients and 15(21.4%) were female patients. Mean age of our study cases was 7.6±4.6 years. According to clinical spectrum of empyema thoracis distribution, 70(100.0%) had fever, 59(84.3%) had respiratory distress, 61(87.1%) had cough, 42(60.0%) had hemoptysis and 32(45.7%) had chest pain. Conclusion: Prompt recognition and appropriate management of pneumonia can avert the progression to empyema. Utilizing antibiotics alongside chest tube placement and administration of streptokinase has shown to be a successful approach in addressing pyogenic empyema thoracis in children residing in resource-limited environments. Keywords: Parapneumonic Effusion, Complications, Clinical Spectrum, Outcome, Chest Tube.
Background: Psoriasis is a chronic inflammatory skin disease affecting a significantproportion of the global population. Narrowband ultraviolet B (NB- UVB) phototherapy is awidely used treatment modality. This study was carried out to systematically review theevidence on the efficacy and safety of NB-UVB phototherapy in adults with psoriasisvulgaris. Methods: A systematic literature search was conducted in five data bases (PEDro ,PubMed , Scopus , Web of Science, and the Cochrane Library) from January 2005 to April2024. Randomized controlled trials (RCTs) comparing NB-UVB with control interventionswere included. Methodological quality was assessed using the PEDro scale.
Cancer is one of the leading causes of disease-related death and treatment-associated morbidity in children with an increasing trend in recent decades worldwide1. The diagnosis of childhood cancer not only affects the life of the child but also impacts the lives of the caregivers as well. Children with cancer and their parents often experience symptoms of stress, anxiety, or depression. Many parents of children with cancer have used religious coping in many parts of the world including North and South America, Europe, Middle Eastern, Africa and Asia1-8. Religion is a law established by Allah and it leads people to peace, goodness, blessings, and salvation in this world and in the hereafter9. Religious coping is a means of seeking Allah’s help, trusting and taking refuge in Allah, finding solace in religious provisions/teachings, and praying/worshiping more than usual during stressful events of life such as illness, calamity, death, or circumstances where a person is helpless2-10. Herein, we discuss the religious coping strategies of Singaporean parents of children with cancer to draw attention to the importance of religion and religious coping. Although many studies have been reported on religious coping strategies of parents of children with cancer in the United States, Western, and Middle Eastern countries, there are limited studies on this subject in Singapore. Fourteen (25.4%) of the 59 Singaporean parents of pediatric cancer patients used some form of spirituality such as formal prayer, laying on of hands, seeking help from a bomoh, and temple medium11. Tan et al12 noted that Singaporean mothers of children with cancer turned to spirituality and well supported by spirituality. Parents believed that the diagnosis of cancer was part of a Divine plan. Spirituality through prayer was an active emotion-focused coping strategy, and belief in Divinity gave parents a sense of hope. Religious practices also helped parents to process complicated emotions and decrease the burden of caregiving12. Leow et al13 found that spiritual-related interactions scores of Singaporean caregivers of patients with cancer increased from baseline to 2 months. Caregivers with higher social support satisfaction and who had a religion predicted higher quality of life. Non-Chinese caregivers, caregivers who had been in the home hospice for a longer duration, and caregivers and patients who had a religion had higher spiritual perspective scale scores13. The majority of the South Asian parents of children with cancer, regardless of their religious affiliation, mentioned about the significance of prayer and other religious practices in helping them cope with their child’s diagnosis, treatment, and recovery. They emphasized their faith in Allah and often read verses from holy texts (e.g., the Quran and Gita) relating specifically to asking for recovery from disease and pain, which in itself was viewed as part of managing the health situation14. In conclusion, we would like to emphasize that religious coping is frequently used by Singaporean parents of children with cancer due to its psychospiritual and mental benefits. Second, we believe that health professionals should recognize and respect parents' religious and spiritual needs and encourage parents to use religious coping strategies. Lastly, we recommend that multicenter and comprehensive studies on religious coping of parents of children with cancer should be conducted in societies with different sociocultural characteristics. These studies will guide health professionals and will be useful for parents of children with cancer in clinical practice. Author Contributions Conceptualization, HÇ; Writing–original draft, HÇ; Writing–review & editing, HÇ. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author received no financial support for the research, authorship, and/or publication of this article. Ethical Approval This study was a review of published literature and no ethical approval required. Keywords: Childhood cancer, Parental religious coping, Spiritual support, Psychosocial impact, Singaporean caregivers
Background: Rheumatic heart disease (RHD) involves the mitral valve in 50–60% of cases. Long-term mitral valve pathologies cause multiple sequelae in the form of atrial fibrillation, pulmonary hypertension, and heart failure. Sildenafil has been used as a therapy for the control of pulmonary hypertension, with emphasis on the perioperative period. Aim: To investigate the influence of oral administration of sildenafil at different durations on intraoperative and postoperative pulmonary hypertension and to compare these effects with preoperative pulmonary pressures. Methods: This comparative cross-sectional study was conducted at Department of Cardiac Surgery, King Edward Medical University/ Mayo Hospital Lahore between July 2024 and January 2025. Patients were divided into 2 groups. Patients enrolled in the short course of sildenafil were administered oral Sildenafil 50mg/5ml, 3 times a day for 2 days before surgery. And in the long course, the same regimen was given for 7 days. Results: A Mann-Whitney U test showed that there was no significant difference in the preoperative mean pulmonary artery pressures between the groups receiving the short and long course of oral sildenafil (p-value 0.890). The reduction in mean pulmonary artery pressures from preoperative to postoperative was analyzed to be 16.46 ± 4.13 for the short course whereas it was 24.83 ± 5.04 for the long course and the difference between these two results was found to be statistically significant (p< 0.05, p< 0.001). Conclusion: Sildenafil has been shown to be effective in the perioperative management of pulmonary hypertension in mitral valve surgery with longer duration of sildenafil administration leading to greater reduction in pressures. Keywords: Rheumatic Heart Disease, Pulmonary Hypertension, Mitral Valve Surgery, Sildenafil, Perioperative Care.
Background: Spontaneous bacterial peritonitis is a serious infection that commonly occurs in patients having ascites due to cirrhosis of liver. Antibiotic therapy remains the cornerstone of treatment. The choice between oral and intravenous antibiotics can play a significant role its management outcome. Objective: To compare the efficacy of oral versus intravenous antibiotics in treating spontaneous bacterial peritonitis. Methodology: This prospective study was conducted at Department of Nephrology, University College of Medicine & Dentistry, The University of Lahore from 1st September 2024 to 28th February 2025. One hundred and sixty patients diagnosed with spontaneous bacterial peritonitis were enrolled. Patients were randomized into two groups: oral antibiotic treatment (group A) and intravenous antibiotic treatment (group B). Both groups received antibiotics appropriate for the suspected pathogens. Only uncomplicated SBP patients were included. The primary endpoint was clinical improvement, with secondary endpoints including survival, microbiological resolution, and adverse effects. Results: Both groups showed similar rates in clinical improvement (87.5% in group A vs. 89.2% in group B), survival (80.3% in group A vs. 82.5% in group B), and microbiological resolution (90.2% in group A vs. 92.4% in group B). Adverse effects, including Acute Kidney Injury, were more common in the intravenous group (10% vs. 3.5%). Conclusion: Oral antibiotics appear to be equally effective as intravenous antibiotics for the treatment of uncomplicated spontaneous bacterial peritonitis, with fewer side effects and lower healthcare costs. Intravenous antibiotics should be reserved for critically ill patients or those with severe or complicated infections. Keywords: Spontaneous bacterial peritonitis, Oral antibiotics, Intravenous antibiotics, Cirrhosis, Clinical outcomes, Acute kidney injury
Background: Piriformis syndrome is a neuromuscular disorder characterized by pain, paresthesia, and numbness in the gluteal region and along the distribution of the sciatic nerve. It is commonly managed using therapeutic interventions such as Muscle Energy Technique (MET). Objective: To determine the effects of muscle energy technique Efficacy of Therapeutic Exercise Protocols on Hip Range of Motion and Pain in Pregnant Women with Occupational Piriformis Syndrome Methods: A randomized clinical trial was conducted at THQ Kamoke, Gujranwala, with 28 participants selected through non-probability convenience sampling. After informed consent, participants were randomly assigned to either the MET group or the stretching exercise group. Interventions lasted eight weeks with three sessions per week. Outcomes were measured using the Numerical Pain Rating Scale (NPRS), Lower Extremity Functional Scale (LEFS), and a goniometer for hip internal rotation ROM. Pre- and post-intervention data were analyzed using SPSS 22. Results: Both groups showed significant improvements (p < 0.05) in pain, ROM, and function. NPRS scores improved from a mean of 6.27 to 0.14, LEFS from 0.14 to 6.13, and internal hip rotation ROM from 0.8 to 2.0. Post-intervention, stretching exercises showed slightly greater effectiveness than MET. Conclusion: The study found that stretching exercises and muscular energy techniques reduce pain, increase hip joint ROM and function in working pregnant women with piriformis syndrome. However, stretching exercise is more effective than muscle energy technique. Keywords: Muscle energy technique, Pain, Piriformis syndrome, Stretching exercises, Range of motion.
Background: Several surgical techniques are available to address segmental long-bone defects. Each technique has its own advantages and limitations. The Ilizarov bone plasty is a vital method for infected nonunion and compensating bone loss which has gained widespread popularity within the last few decades. Objective: To determine the role of the Ilizarov external ring fixator in gap non-union and bone loss management. Study Design: Observational study Place and Duration of Study: Department of Orthopaedics Unit-1, Chandka Medical College, SMBBU, Larkana from 1st October 2023 to 30th September 2024. Methodology: Sixty patients suffering from extensive tibial defects of more than ten centimetres were enrolled. The patients requiring bone gap union and bone loss management were included. Results: There were 43 males and 17 females with mean age 20.8±11.2. The mean bone defect value was 13.2±0.9 and anatomical shortening was 6.5± 0.8cm. The mean restoration of lower leg length was significantly higher as 88.8 ± 2.5%. The complications associated with the Ilizarov external ring fixator included highest presentation of skin inflammation up to 23.8% followed by recurrence of equinus in 18.3% and ankle stiffness presented in 11.6%. Conclusion: The Ilizarov external ring fixator has an efficient role in gap non-union and bone loss management. Keywords: Ilizarov, Management, Complications, Bone defects, Fixator.
Background: Telemedicine has evidently proven to have substantial effect in areas of underserved rural population and can serve as an alternate for the treatment of the chronic disease patients. Aim: To assess the role of telemedicine in rural areas for providing doorstep medical treatment to the elderly and chronic disease patients. Study Design: Prospective study Place and Duration of Study: Ziauddin University, Karachi from 1st July 2024 to 31st December 2024. Methodology: This was performed in the rural far-flung areas of Sindh (Tharparkar, Dadu and Khairpur Mir’s) where not even a rural health care center was provided for a larger catchment population. A total of 1200 elderly cases diagnosed with chronic diseases including diabetes, hypertension as well as cardiovascular diseases and age between 55-75 years were enrolled. They were divided in two groups; each comprised 600 cases (200 from each district). One was considered as control (Group 1) while the other was the experimental group (Group 2). Results: The mean age of the patients in the group 1 and 2 was measured as 61±9.1 and 63±10 years respectively. The majority of the patients in both groups were hypertensive at baseline clinical measurements followed by diabetic and cardiovascular patients. Both groups consolidated results were compared and it was observed that treatment success rate as well as patients stability were not significantly variant within group 1 and 2 (p value 0.87) while there was a significant increase in patients satisfaction in group 2 though telemedicine’s counselling and education. Conclusion: Telemedicine is a transformative solution for chronic disease management in resource-limited rural setting. It demonstrates that remote healthcare interventions can enhance treatment adherence, improve quality of life and address critical access issues. Keywords: Telemedicine, Rural area, Doorstep, Chronic disease
Background: Hypoglycemia is a serious and preventable complication in hospitalized diabetic patients, often resulting from treatment with insulin or insulin secretagogues. Effective inpatient monitoring and timely intervention are crucial for minimizing adverse outcomes. Aims: To evaluate current inpatient practices for monitoring and managing hypoglycemia in diabetic patients at Lady Reading Hospital, Peshawar, and to compare these practices with National Guidelines for Management of Hypoglycemia in Hospitalized Patients. Methods: A clinical audit was conducted from July to December 2024, reviewing 150 diabetic patient records with at least one hypoglycemic episode (blood glucose <70mg/dL). Data were collected using a structured proforma aligned with national standards and analyzed using SPSS v25.0. Parameters assessed included monitoring frequency, timeliness of treatment, reassessment, documentation, and preventive strategies. Results: A total of 212 hypoglycemic episodes were recorded. While blood glucose rechecking within 30 minutes post-treatment showed 81.1% compliance, timely treatment initiation within 15 minutes was noted in only 33.5% of cases. Preventive measures and care escalation were documented in just 42% and 29.3% of cases, respectively. Conclusion: Although some aspects of hypoglycemia management at LRH show acceptable adherence to guidelines, significant gaps remain, particularly in early intervention and documentation of preventive strategies. Keywords: Hypoglycemia management, inpatient diabetes care, clinical audit, guideline adherence, blood glucose monitoring
Background: Mortality alone does not provide a clear picture of the illness burden experienced by individuals in various communities. The prevalence of CKD is increasing with an estimated global prevalence of 13.4%. However, in Pakistan, the prevalence was found to be 16.6%. DALYs are very useful in deciding how health resources should be distributed. Objectives: To highlight the importance of effective management strategies for patients with CKD in Pakistan and thus provoke the government and private sector to take specific measures thus reducing disability associated with CKD and increasing life expectancy. Material and Methodology: A cross-sectional comparative study was conducted in Nephrology Department of Nishtar Medical University Hospital, Multan. Questionnaire data on demographics, morbidity, and disability were analyzed using SPSS v22. Results: Out of 110 Chronic kidney disease patients, 62 were male (56.4%) and 48 were female (43.6%). The majority of patients were married. Most females were housewives and most men were unemployed. The sample size consisted mostly of participants which had an educational background ranging from illiterate to matriculation (75.4%). Only 24.5% had intermediate or higher education. Most patients spent 10–40k/month; fewer spent over 60k, then 40–60k. Most lacked CKD family history and were non‑smokers. 71.8% had ankle/feet swelling; 62.7% experienced skin itching, tingling, numbness. Conclusion: All CKD patients had ≥1 disability. Fatigue/exhaustion was the most common physical issue; depression, mood fluctuations, and mental confusion were the main functional disabilities. Most were low socioeconomic/educational and diagnosed late. Keywords: Chronic kidney disease, DALYs, Disability, Morbidity
Folate deficiency can significantly increase the risk of stroke by elevating serum homocysteine levels, a risk factor that is often underrecognized in younger patients. We report the case of an 18-year-old male who presented to the emergency department with acute right-sided weakness, slurred speech, and facial drooping. Notably, the patient had no history of smoking, hypertension, or other conventional cerebrovascular risk factors. Laboratory evaluation revealed markedly elevated homocysteine levels, implicating underlying folate deficiency as a primary contributor. In the absence of deep vein thrombosis, drug abuse, or other common etiologies, this case highlights the critical role of folate status in stroke risk and underscores the importance of considering metabolic factors in young, otherwise healthy individuals presenting with ischemic stroke.
The global health paradigm has been profoundly changed by the COVID-19 pandemic. It was also the crucible of crisis and a rare catalyst for systemic reflection for Pakistan. With a legacy of fragmented healthcare delivery, low health expenditures, and pervasive health inequities, a country was forced to face down all fronts, from the fragility of supply chains and of overworked hospitals, to digital divides and misinformation. However, out of this adversity, there was a generational opportunity to transform Pakistan’s public health infrastructure at its core. A future-proof health system will not just want to control disease, it will be based on equity, powered by data, driven by prevention, and shock-resilient.1, 2. Rethinking Public Health as A National Development Priority Public health must rise from the periphery to the center of national development following the pandemic. This begins with political will. Currently, Pakistan’s health expenditure (around 1.2% of GDP) is one of the lowest in the region. It needs increased, sustained investment as well as strategic spending. We also have to channel funds not just to tertiary care institutions but also to community-level infrastructure, maternal and child health services, non-communicable disease (NCD) prevention, and health literacy. As climate resilience, food security, education, and other public health needs are a part of the development agenda, not only.3. From Hospital-Centric to People-Centric Care Pakistan has always had a model of healthcare in favour of urban and hospital-based care. But the pandemic emphasised the importance of distributed, community-driven services. The backbone of health service delivery must be the revitalized Basic Health Units (BHUs), mobile clinics, and telemedicine that will strengthen the Primary Health Care (PHC) network. These services must integrate preventive care, early disease screening, immunization outreach, and nutrition support. However, programs like the Sehat Sahulat Card under the rubric of Universal Health Coverage (UHC) are a promise, and their coverage, efficiency, and equity need to be evaluated independently and continuously improved.4. Harnessing Data, Technology, and Innovation Digital health systems showed their potential to be used in real time during COVID-19 through dashboards, contact tracing apps, and genomic surveillance. These tools must now be institutionalized in Pakistan. An electronic medical records system would be created across provinces and health facilities to allow better disease surveillance, resource allocation, and continuity of care for patients. At the same time, investment in digital health literacy and protection of data privacy must be made. Further democratizing health access can be accomplished through the integration of AI-based diagnostics, drone-assisted delivery in remote areas, and low-cost point-of-care devices.5. Rebuilding the Health Workforce with Equity and Dignity The pandemic also exposed Pakistan’s structural vulnerabilities of its health workforce, especially frontline workers, nurses, and lady health workers, to disproportionate burdens of work with insufficient protection and compensation. Pakistan has a low health worker-to-population ratio compared to WHO benchmarks. A transformative vision will also need a national strategy for increasing the size of the workforce, fair remuneration, gender equity in employment, and continuous professional development. Partnerships with medical and public health universities should also foster a new generation of trained epidemiologists, biostatisticians, and health management graduates ready for the 21st century.6. Putting Public Health in the Heart of Multisectoral Governance The social determinants of health are public health; they include clean water, air quality, food security, housing, education, and gender rights. Therefore, inter-ministerial collaboration is non-negotiable. There must be alignment of health objectives in the policies of the ministries of planning, environment, education, and agriculture. Walkability and air pollution should be part of urban planning; climate change mitigation has to take into account vector-borne diseases; health literacy should be part of school curricula. Only through systems-level integration can Pakistan have health in all policies7. Resilience, Trust, Accountability: The Road Ahead Resilient systems, transparent governance, and public trust will be the key to a truly transformed public health landscape in Pakistan. Transforming from a conventional corporation requires civil society, academia, and the private sector to be co-creators in the process. Reinvigoration of regulatory mechanisms for health service quality, ethical data use, pharmaceutical safety, and research oversight is needed. Misinformation must be countered and trust in science strengthened through public engagement campaigns, using media, religious leaders, and educational institutions.8. CONCLUSION Pakistan stands at a crossroads. Although tragic, the pandemic showed the fragility and potential of its health systems. This is the time for deliberate, visionary, and inclusive reform. It is not enough to say ‘business as usual’; that is simply unacceptable. The new public health framework ought to be reimagined with every Pakistani entitling to the right to health, prepared for the next pandemic, and progressing national well-being through resilience, equity, and innovation. The world is watching as the future waits. Keywords: Public Health, Health Systems, Digital Health, Universal Health Coverage, Health Equity
Background: Preoperative evaluation of frailty has typically relied on subjective measures and has evolved towards objective, standardized scales and tests. Patient frailty is one of the most important predictors for postoperative outcome, including mortality and morbidity. We sought to investigate whether patient frailty influences intensive care unit (ICU) outcomes following coronary artery bypass grafting (CABG). Findings from this study may provide important clinical implications in regard to the potential role of individualized preoperative evaluations and interventions for frail patients recovering from CABG in the ICU. Methods: 100 patients scheduled for elective isolated CABG between November 2024 and April 2025 were recruited in this observational study. Participants were divided into frail (n=50) and non-frail (n=50) according to the Essential Frailty Toolset (EFT). Preoperative, Intraoperative and Postoperative data was collected including parameters of 30-day mortality, duration of ICU stay, time on mechanical ventilation and postoperative arrhythmia. Result: Frail patients had a longer ICU stay (median 3.5 days vs 2 days, p=0.002), duration of mechanical ventilation (18 hours vs 11 hours, p<0.001) and postoperative arrhythmia (40% vs 20%, p=0.03) rate compared to non-frail patients. Furthermore, 5 frail patients developed postoperative stroke and none in the non-frail group did (p=0.02). The 30-day mortality was more common in frail patients (14% vs 2%, p=0.03). Frail patients were more commonly associated with surgical site infection, delirium and reoperation for bleeding, but these were not statistically significant. Conclusion: Frailty is a strong marker of poor ICU outcomes after CABG, correlated with more morbidity and higher incidence of 30-days mortality. Frail patients develop more complications during postoperative recovery, resulting in longer ICU length of stay and higher mortality rate. Keywords: Frailty, Coronary Artery Bypass Grafting (CABG), ICU Outcomes, Postoperative Complications, Essential Frailty Toolset (EFT).
Background: Esophageal varices are a common and life-threatening complication of liver cirrhosis, particularly in developing countries like Pakistan, where delayed diagnosis and limited access to endoscopic facilities pose significant challenges. Identifying non-invasive predictors can help stratify patients at risk, enabling timely intervention and better resource allocation. Objective: To determine the prevalence of esophageal varices in cirrhotic patients, identify strong clinical and laboratory predictors, and evaluate the utility of non-invasive parameters in guiding screening in resource-limited settings. Methods: This cross-sectional study was conducted at Sir Ganga Ram Hospital, Lahore, from December 2022 to October 2023. A total of 100 patients with clinically and radiologically confirmed liver cirrhosis were included. Demographic, clinical, laboratory, and ultrasound data were recorded. All patients underwent upper gastrointestinal endoscopy to confirm the presence and grade of esophageal varices. The association of non-invasive parameters such as platelet count, splenomegaly, portal vein diameter, Child-Pugh class, and serum albumin—with the presence of varices was analyzed. Results: Out of 100 cirrhotic patients, 71% were found to have esophageal varices. The majority had Grade II (39.4%) and Grade I (31%) varices. Significant associations were observed between the presence of varices and platelet count <100,000/mm³ (69%), splenomegaly (80%), portal vein diameter >13 mm (66%), and serum albumin <3.0 g/dL (60%). Most patients belonged to Child-Pugh class B (44%) or C (32%). Hepatitis C was the leading cause of cirrhosis (58%). Conclusion: Esophageal varices are highly prevalent in Pakistani cirrhotic patients. Easily available non-invasive indicators such as thrombocytopenia, splenomegaly, low albumin, and increased portal vein diameter strongly correlate with the presence of varices. These predictors can guide targeted screening and reduce reliance on endoscopy in resource-limited settings.
Type 2 diabetes mellitus (T2DM) has long been recognized as a multifactorial metabolic disorder driven by genetic susceptibility, lifestyle choices, and environmental influences. In recent years, however, increasing evidence has highlighted a less acknowledged yet highly significant contributor chronic psychological stress1. While the public health discourse often focuses on obesity, poor diet, and physical inactivity, the silent role of stress as a precipitating and aggravating factor in T2DM deserves urgent attention2. The human stress response, mediated by the hypothalamic pituitary adrenal (HPA) axis and the sympathetic nervous system, is an adaptive survival mechanism. However, when stress becomes chronic, this system remains persistently activated, leading to prolonged secretion of cortisol and catecholamines3. These hormonal changes promote insulin resistance, dysregulated glucose metabolism, and visceral fat deposition hallmarks of T2DM. Furthermore, stress-induced inflammation contributes to beta-cell dysfunction, impairing the pancreas’s ability to regulate blood sugar effectively4. Real-world data reveal that individuals in high-stress occupations, those experiencing financial strain, or those facing chronic caregiving responsibilities have a disproportionately higher incidence of T2DM. This association is further exacerbated in developing countries like Pakistan, where socioeconomic instability, urban crowding, and limited mental health support amplify stress exposure. The result is a vicious cycle: stress worsens glycemic control, and poor glycemic control fuels emotional distress, leading to deteriorating health outcomes5,6. Despite this growing body of evidence, clinical guidelines for T2DM prevention and management rarely incorporate structured stress assessment and management strategies7. Incorporating routine screening for stress levels, providing access to cognitive-behavioral therapy, mindfulness training, and community-based support systems could substantially improve disease outcomes. Addressing mental health is not an optional adjunct to diabetes care it is an essential component8,9. Public health campaigns must shift towards a more integrated approach, recognizing that stress is not merely a psychological burden but a biological risk factor with tangible consequences10. Without acknowledging and addressing stress as a driver of T2DM, efforts to curb the global diabetes epidemic will remain incomplete. In the era of holistic and preventive medicine, the time has come to bridge the gap between mental health and metabolic health, placing stress management at the forefront of diabetes prevention strategies11,12.
Background: Coagulase-negative staphylococci (CoNs) have emerged as significant pathogens in bloodstream infections, particularly in hospital settings. Their increasing antibiotic resistance poses a major clinical challenge. Objective: To assess the prevalence, antibiotic resistance patterns, and demographic distribution of CoNs isolates in blood culture samples, along with the association of multidrug resistance (MDR) with gender and hospital units. Study Design & Setting: This cross-sectional study was conducted in a tertiary care hospital, analyzing blood culture samples from 350 patients. Materials and Methods: Blood samples were cultured to identify CoNs isolates. Antibiotic susceptibility was determined using the disk diffusion method. Resistance patterns were categorized by antibiotic class, and MDR was defined as resistance to three or more antibiotic classes. Data were analyzed using the chi-square test, with p < 0.05 CoNsidered statistically significant. Results: CoNs was detected in 30.3% of blood culture samples. Resistance was highest for penicillin (80%), amoxicillin (75%), and ceftriaxone (65%), with significant associations for beta-lactams and aminoglycosides (p < 0.05). MDR was more prevalent in CoNs cases (54.7%) compared to non-CoNs cases (24.6%) (p < 0.001). ICU had the highest CoNs prevalence (37.7%), followed by general wards (23.6%). No significant gender-based differences in antibiotic resistance were observed. Conclusion: CoNs infections are common in hospitalized patients, particularly in ICUs, with high resistance to beta-lactams and aminoglycosides. The high prevalence of MDR necessitates stringent antibiotic stewardship and infection control measures. Keywords: Antibiotic Resistance, Blood Culture, CoNs, Hospital-Acquired Infections, Multidrug Resistance, Prevalence
Background: Thalassemia major is a severe hereditary blood disorder highly prevalent in Punjab, Pakistan, due to high consanguinity and limited screening programs. This study investigated its epidemiology, treatment challenges, and proposes preventive strategies to reduce disease burden. Aim of Study: To quantify the disease burden, healthcare challenges, and socioeconomic impact of thalassemia in Punjab, Pakistan, and propose evidence-based control strategies. Methodology: Current: Cross-sectional observational study was conducted from January 2022 to December 2023. Total 100 thalassemia major patients registered at DHQ Sahiwal’s Thalassemia Centre were enrolled. Data on demographics, clinical parameters, treatment adherence, complications, and family histories were collected via structured questionnaires and medical records. Blood samples were analyzed for ferritin levels and transfusion frequency. Results: Among 100 thalassemia major patients, 64% were diagnosed before age 2, and 78% had parental consanguinity. Only 58% received regular iron chelation therapy, and 21% had transfusion-transmitted infections. Financial burden was reported by 85% of families, while awareness of carrier screening and prenatal diagnosis was low (18% and 12%, respectively). Conclusion: Thalassemia major poses significant clinical and economic challenges in Punjab. Early diagnosis, inadequate treatment access, and poor preventive awareness highlight the urgent need for integrated screening, counseling, and support programs to reduce disease burden. Keywords: Thalassemia, Pakistan, Punjab, Consanguinity, Iron Overload, Public Health, Hemoglobinopathy, Genetic Screening.
Background: Gestational diabetes mellitus (GDM) is a major pregnancy complication associated with maternal and neonatal morbidity if inadequately managed. Guidelines recommend universal screening, evidence-based diagnosis, structured management, and consistent follow-up, yet adherence in low- and middle-income countries remains inconsistent. Objective: To evaluate compliance with national guidelines for screening and management of GDM in antenatal clinics at two tertiary care centers in Pakistan. Methods: A retrospective audit was conducted from January 2024 to January 2025 at Sheikh Zayed Hospital, Rahim Yar Khan, and Ittefaq Hospital Trust, Lahore. Three hundred antenatal records were reviewed using a structured proforma based on national and international guidelines. Standards assessed included risk-based screening at booking, universal oral glucose tolerance test (OGTT) at 24–28 weeks, correct diagnostic thresholds, lifestyle counseling, self-monitoring of blood glucose (SMBG) education, pharmacological therapy initiation, and follow-up documentation. A benchmark of ≥90% was applied. Results: Risk-based booking screening achieved 90.6% compliance, meeting the standard. Universal OGTT was performed in 84.0% of women, with lower uptake in the public hospital. Diagnostic thresholds were correctly applied in 91.0% of cases. Management compliance was suboptimal: lifestyle counseling was documented in 83.0%, SMBG education in 78.7%, and pharmacological therapy in 84.6% of eligible women. Follow-up documentation reached 85.0%, while postpartum OGTT scheduling was lowest at 65.7%. Private-sector performance was consistently higher, though both sites showed deficiencies. Conclusion: Screening and diagnostic practices were largely compliant, but gaps in management, education, and follow-up remain. Targeted interventions, improved documentation, and re-audit are essential to enhance outcomes for women with GDM. Keywords: Gestational diabetes, audit, screening, management, Pakistan
Objective: The purpose of this research was to identify the optimal oral thyroxin dosage for individuals with benign thyroid disorders who had undergone a complete thyroidectomy. Methods: Included in the study were 75 adult patients who had a complete thyroidectomy for noncancerous thyroid issues. Initially, they were prescribed 75 µg of thyroxine and were then given further doses every two months until they reached euthyroid state on two separate visits. Age, sex, weight (both actual and lean), body mass index (BMI), and biochemical data (triiodothyronine, thyroxine, thyroid-stimulating hormone) were all assessed at this point. All data were analyzed using SPSS 23.0. Results: There were majority 47 (62.7%) males and 28 (37.3%) females among all cases. Mean age of the cases was 43.7 years. Majority of the cases had nodular colloid goiters, followed by ashimoto’s thyroiditis, lymphocytic thyroiditis and follicular adenoma. Optimal thyroxine dose was best predicted by BSA (0.895, P < 0.01) and LBM (0.899, P < 0.01), but body weight (0.754, P < 0.01) and BMI (0.478, P < 0.01) were also strong predictors. The patient's age was the least significant factor in our study (r = 0.104, P < 0.01). The correlation between gender and thyroxine dosage was not statistically significant. The average dosage of thyroxine for each patient was 1.64 µg/kg of body weight. Conclusion: Based on our findings, thyroxine replacement that takes BSA or LBM into account is superior to that which solely takes BMI or weight into account. Keywords: T4 dose, total thyroidectomy, benign thyroid disorders, thyroxine dose, BMI, BSA, IBM
