Background: Return to work (RTW) is widely used in occupational and rehabilitation research as a marker for recovery after illness. For cancer survivors, returning to employment may be influenced by demographic factors, comorbid conditions, treatment exposures, and job characteristics. Aim: We conducted a retrospective cohort study to evaluate determinants of RTW among Taiwanese workers newly diagnosed with gastric cancer and to examine whether RTW is associated with long-term survival. Methods: Using linked national databases, 4467 eligible workers diagnosed between 2004 and 2015 were followed for up to 11 years. Predictors of RTW at the 2- and 5-year time points were assessed with Cox regression, and survival differences by RTW status were evaluated using Kaplan–Meier methods. Results: Older age, male sex, selected comorbidities, receipt of chemotherapy or radiotherapy, and manual occupations were associated with a lower probability of RTW, whereas surgery and earlier pathologic stage increased the likelihood of returning to employment. After multivariable adjustment, stage I disease showed markedly higher RTW hazards compared with more advanced stages (hazard ratio [HR] = 4.67, 95% confidence interval [CI]: 2.99–7.31 at year 2; HR = 7.44, 95% CI: 4.12–13.43 at year 5). Across all stages, reemployed survivors demonstrated superior survival, and RTW remained associated with reduced all-cause mortality (adjusted HR = 0.49, 95% CI: 0.38–0.65). Conclusion: Interventions that address modifiable barriers and reinforce facilitators of RTW may support workforce reintegration and improve outcomes among gastric cancer survivors.
Background: Military underwater operations personnel are repeatedly exposed to hyperbaric environments and increased respiratory workload, which may influence pulmonary function over time. However, the association between years of diving service and detailed pulmonary function parameters remains unclear in military diving populations. Aim: To investigate the association between years of diving service and pulmonary function among military underwater operations personnel. Methods: This cross-sectional study enrolled personnel of the Underwater Operations Unit who underwent comprehensive pulmonary function testing, including spirometry and body plethysmography. Participants were categorized as either shorter-service (<10 years of diving service) or longer-service (≥10 years of diving service) divers. Pulmonary function parameters included static lung volumes and flow–volume loop-derived indices. Between-group comparisons were performed using the Mann–Whitney U test, and correlations between years of diving service and pulmonary function parameters were assessed using Spearman’s rank correlation analysis. Results: Most of the lung volumes and conventional spirometric indices did not differ significantly between shorter-service and longer-service divers. However, longer-service divers exhibited significantly lower functional residual capacity and reduced residual volume/total lung capacity expressed as a percentage of measured/predicted values. The forced expiratory volume in 1s/forced vital capacity ratio was also significantly lower in longer-service divers. Conclusion: Among military underwater operations personnel, longer diving service duration is associated with specific alterations in lung volume distribution and expiratory flow ratios, whereas overall ventilatory capacity remains preserved. These findings are consistent with functional respiratory adaptations rather than pulmonary impairment.
Background: Long-term real-world evidence regarding the efficacy and safety of micropulse transscleral cyclophotocoagulation (MPCPC) remains limited. Aim: To evaluate the 5-year efficacy and safety of MPCPC in refractory glaucoma. Methods: This single-center retrospective study evaluated 42 eyes of 30 patients who underwent MPCPC between January 1, 2019, and May 31, 2020. All procedures followed a standardized protocol using a 2.0 W power setting for 180 s. The primary outcome was surgical success, defined as an intraocular pressure (IOP) reduction of ≥20% from baseline. Secondary outcomes included changes in visual acuity, antiglaucoma medication burden, and the incidence of ocular adverse events. Results: Mean IOP significantly decreased from 28.9 ± 11.6 mm Hg at baseline to 24.4 ± 10.4 mm Hg at 12 months and 21.5 ± 11.5 mm Hg at 60 months (all P < 0.05). Success rates were 54.3% at 1 year and 51.7% at 5 years. In the multivariable Firth regression model, each 1 mm Hg increase in baseline IOP was associated with a 16% increase in the probability of 1-year success (odds ratio: 1.16; 95% confidence interval: 1.05–1.29; P = 0.0048). While the topical medication burden remained unchanged, oral acetazolamide use significantly decreased at 1 month ( P = 0.039). Visual acuity declined in 58.1% of eyes at 5 years, largely attributable to disease progression in this refractory cohort. No severe complications, such as hypotony or phthisis bulbi, were observed. Conclusion: MPCPC provides a sustained, long-term IOP-lowering effect with a favorable safety profile in a real-world refractory population. This study addresses a critical evidence gap by demonstrating treatment durability up to 5 years and identifying preoperative IOP as a key predictor of success in an ethnically Chinese cohort.
Objective: This study aimed to determine the effectiveness of extracorporeal Shock Wave Lithotripsy and retrograde Intrarenal Surgery on obtaining stone-free status for renal pelvic stones measuring 1-2 cm in diameter. Material & Methods: This quasi-experimental study was conducted at the Department of Urology, Khyber Teaching Hospital, Peshawar, where a total of 60 patients with renal pelvic stones measuring 1–2 cm were randomly assigned to two equal groups: ESWL (n = 30) and RIRS (n = 30). Stone clearance was assessed on the 7th postoperative day using ultrasound and X-ray KUB. Results: The mean age of participants in Group A (ESWL) increased to 41 years (SD = 10.67), while the mean in Group B (RIRS) increased to 42 years (SD = 9.09). For Group A (ESWL), the sample included 20 males and 10 females, representing 67% and 33%, respectively. For Group B (RIRS), 21 participants were males, and 9 were females, accounting for 70% and 30%, respectively. The Chi-square test results indicate no statistically significant difference between the two groups regarding gender ratio (p = 0.7813). The data indicated that the patients with renal pelvic stones of 1–2 cm were more likely to be stone-free after retrograde intrarenal surgery (RIRS) than after extracorporeal shock wave lithotripsy (ESWL). In the RIRS group, 73% were stone-free, while only 33% were stone-free in the ESWL group (p = 0.0019). Conclusion: The study finds that RIRS is more effective than ESWL for managing 1-2cm renal pelvic stones. RIRS achieves higher stone-free rates, especially when anatomical difficulties and challenges associated with ESWL are common, and it can precisely locate stones and utilize advanced laser treatment features.
We report a rare case of delayed methicillin-resistant Staphylococcus aureus (MRSA) infection following elective mini-open trigger finger release in a 55-year-old male with asthma receiving anti-interleukin (IL)-5 therapy. The patient initially recovered uneventfully but developed signs of infectious flexor tenosynovitis on postoperative day 36. Culture confirmed MRSA, and surgical debridement was required. The patient continued anti-IL-5 therapy throughout the perioperative period. Although a causal relationship cannot be established, this case raises awareness of a potential association between biologic therapy and delayed postoperative infection.
Background: Diabetes-related gastrointestinal dysfunction may predispose to anorectal disorders, yet sex-specific associations between glycemic abnormalities and hemorrhoids remain unexplored. Aim: To investigate associations between glycemic dysregulation (prediabetes, diabetes, metabolic syndrome [MetS]) and hemorrhoids using reciprocal regression analyses and identify potential sex-specific patterns. Methods: This cross-sectional study analyzed 4620 participants from a Taiwanese health examination database (2010–2017). Hemorrhoids were diagnosed via colonoscopy (39.6%) or clinical assessment, including medical history and digital rectal examination when indicated. Prediabetes and diabetes were defined per American Diabetes Association criteria; MetS per modified National Cholesterol Education Program Adult Treatment Panel III criteria with Asian-specific cutoffs. Multivariable logistic regression assessed associations, adjusting for metabolic and lifestyle factors, with false discovery rate correction for multiple comparisons. Results: Among 4620 participants (16.5% hemorrhoid prevalence), those with hemorrhoids were older and had higher prediabetes prevalence. In fully adjusted models, diabetes showed an association with hemorrhoids (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 1.08–3.70, P = 0.027). Gender-stratified analyses showed stronger point estimates in males (prediabetes: OR = 1.89; diabetes mellitus [DM]: OR = 2.27) compared to females (prediabetes: OR = 0.92; DM: OR = 1.11), although formal interaction testing did not reach statistical significance (sex × DM, P = 0.218), possibly due to limited statistical power in the female subgroup. Conclusion: This study provides preliminary evidence for male-specific associations between glycemic dysregulation and hemorrhoids (OR: 1.89–2.27), although findings did not withstand multiple comparison correction. While these hypothesis-generating results warrant validation in independent cohorts with a comprehensive assessment of bowel habits and menopausal status, they highlight the importance of considering biological sex in metabolic-anorectal disease research.
Objective: This study aims to compare mini-percutaneous cystolithotripsy and transurethral cystolithotripsy in children with bladder stones at our hospital. Materials and Methods: A total of 84 patients were divided equally (42 in each group) into two groups (A and B) based on self-selection of stone size, and the type of management was decided by the researcher after clinical examination. Mini-percutaneous cystolithotripsy was performed on patients in Group A utilizing a mini-nephroscope and a 15 Fr access sheath. 4.5/6 Fr or 6/7.5 Fr pediatric ureteroscopes were used to treat transurethral cystolithotripsy in patients in Group B. A Holmium YAG laser was used to break apart the stone. Results: Patients in group A had an average age of 8.38 ± 3.48 months, while those in group B were 8.30 ± 3.23 months old. Of the 84 patients, 49 (58.33%) were male and 35 (41.67%) were female, with a male-to-female ratio of 1.4:1. In my study, the mean operative time for group A (mini-percutaneous cystolithotripsy) was 31.43 ± 5.43 minutes, and for group B (transurethral cystolithotripsy), it was 39.52 ± 7.31 minutes, with a p-value of 0.0001. Conclusion: PCCL allows for easier fragmentation, quicker extraction of larger bladder stone fragments, fewer urethral complications, and reduced operative time. Keywords: Urinary bladder calculi, Lithotripsy, Operative time.
Background: Head and neck squamous cell carcinoma (HNSCC) is characterized by pronounced molecular heterogeneity, immune microenvironment dysregulation, and limited therapeutic options in advanced human papillomavirus (HPV)-negative diseases. System-level approaches may facilitate the identification of core pathogenic mechanisms and clinically applicable therapeutic strategies. Aim: This study aimed to elucidate system-level mechanisms underlying HNSCC and to identify potential drug repurposing candidates using an integrative systems biology and pharmacology approach. Methods: Transcriptomic data from the Gene Expression Omnibus dataset GSE148944 (61 HNSCC tumors and 6 normal tissues) were analyzed. Differentially expressed genes (DEGs) were identified using |fold change| ≥ 2 and an adjusted P value ≤ 0.05. Hierarchical systems biology networks (HiSBiNs) quantify perturbations across genes, pathways, subsystems, and system levels using the Kyoto Encyclopedia of Genes and Genomes and meta-z scores. Drug–gene networks integrated DEGs with DrugBank/BindingDB data. Pharmacophore-guided virtual screening of FDA-approved drugs was conducted using Homopharma/SiMMap and iGEMDOCK. Results: We found 271 upregulated and 36 downregulated DEGs, including SPP1 , ARG1 , MS4A1 , CXCL13 , and SPINK5 , linked to immune regulation and tumor microenvironment. HiSBiN highlighted the immune system (meta-z = highest), and the signaling pathways were the most perturbed. The top candidates were rituximab, tocilizumab, and dasatinib. Conclusion: This integrative hierarchical systems biology and pharmacology framework elucidated the system-level mechanisms underlying HNSCC and identified hypothesis-generating drug repurposing candidates that warrant further experimental validation, providing a computational foundation, rather than definitive recommendations, for precision therapeutic development, especially in betel nut–prevalent regions, such as Taiwan, where HPV-negative HNSCC predominates.
A 63-year-old obese male with severe ankylosing spondylitis (AS) underwent general anesthesia for total hip replacement. Despite apparently successful video-assisted intubation, the patient developed acute ventilation failure characterized by significant air leakage, elevated peak inspiratory pressure (PIP), and an abnormal end-tidal carbon dioxide (E t CO 2 ) waveform. Suction catheter insertion met resistance at approximately 30 cm, suggesting distal endotracheal tube (ETT) malposition, likely due to tracheal wall impingement caused by altered airway anatomy from severe kyphotic deformity. Prompt recognition, aggressive secretion management, and emergency reintubation using a video-assisted technique successfully restored ventilation. There was no desaturation during the event, but PIP increased to 44 cm H 2 O, and continuous air leakage was noted. This case report highlights the importance of early recognition of ETT malposition, the challenges of airway management in patients with combined AS and obesity, and the value of a structured, team-based approach using multimodal airway strategies.
Background: Depressive symptoms following acute myocardial infarction (MI) are associated with adverse cardiovascular outcomes. Although numerous studies have examined nonpharmacological interventions to alleviate post-MI depression, their results remain inconclusive. Aim: This systematic review and meta-analysis evaluated the effects of nonpharmacological interventions on depressive symptoms in patients after acute MI. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and six electronic databases were systematically searched to identify randomized controlled trials (RCTs) comparing nonpharmacological interventions with usual care in patients with post-MI depression. Data were extracted on intervention content, format, delivery setting, frequency, and duration. Meta-analyses were conducted using both random-effects and fixed-effects models, and subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity. Results: Thirteen RCTs involving 3267 patients were included. Compared with usual care, nonpharmacological interventions exerted significant immediate and intermediate effects on post-MI depression, with standardized mean differences of −0.29 (95% CI: −0.45 to −0.13, P < 0.001) and −0.28 (95% CI: −0.42 to −0.14, P < 0.001), respectively. Subgroup analyses indicated that psychological interventions, relaxation training (RT), weekly intervention frequency, session durations of ≤30 min, total durations of ≤3 months, and delivery by nurses or psychologists were associated with greater effectiveness. Conclusion: Nonpharmacological interventions, particularly RT and psychological therapies, significantly reduced depressive symptoms in patients with MI at the end of the intervention period. Additional RCTs are determined to clarify how differences in intervention type, intensity, and delivery format contribute to variability in treatment outcomes.
Background: The rapid emergence of healthcare-associated infections is rising, driven by diverse etiologic agents whose evolving antimicrobial resistance poses a growing threat to global healthcare. Therefore, combination strategies integrating antibiotics with silver nanoparticles (AgNPs) have attracted increasing attention as a potential means of restoring antibacterial efficacy. Aim: This study aimed to synthesize and validate polyelectrolyte-coated AgNPs and evaluate their synergistic antibacterial effects with aminoglycosides against healthcare-associated pathogens. Methods: Alginate- and chondroitin sulfate-coated AgNPs were synthesized using glucose as a green reducing agent. NP formation was confirmed by physicochemical characterization, followed by cell-based cytotoxicity assessment. The antibacterial activity of AgNPs, alone or in combination with amikacin or tobramycin, was evaluated against six healthcare-associated infection (HAI)-related pathogenic bacterial species. Results: Physicochemical analyses confirmed the formation of spherical metallic AgNPs. Both AgNP formulations showed minimal cytotoxicity at silver concentrations ≤40 ppm but exhibited limited antibacterial activity when used alone. In contrast, combinations of aminoglycosides with AgNPs exhibited species-dependent synergistic effects, with tobramycin–AgNP combinations consistently demonstrating synergistic effects against all six HAI-related pathogenic bacterial species. Conclusion: AgNP–aminoglycoside combinations represent a promising therapeutic strategy for HAI bacterial infections and may help reduce the reliance on the development of novel antibiotics.
Background: Long COVID commonly features cognitive “brain fog,” and vascular involvement has been implicated. Enhanced external counterpulsation (EECP), approved for angina and heart failure, may improve cerebral perfusion, but evidence for post-COVID symptoms remains limited. Aim: To evaluate the physiological and psychological effects of EECP in patients with long COVID–related brain fog, focusing on cerebral blood flow (CBF) and symptom severity. Methods: Five adults (≥18 years) with persistent post-COVID brain fog received 15 h of EECP over 8 weeks. Prefrontal cerebral perfusion was assessed using near-infrared spectroscopy (NIRS), and symptoms were measured using the Brain Fog Scale (BFS) at baseline, midpoint, and post-intervention. Correlation analyses and generalized estimating equations (GEE) were performed. Results: All participants completed the protocol. Prefrontal cerebral blood flow increased from baseline to post-intervention, while BFS total scores decreased. EECP exposure correlated positively with cerebral blood flow ( r = 0.342; P = 0.002) and negatively with BFS severity ( r = −0.418; P = 0.001); cerebral blood flow was also inversely correlated with BFS scores ( r = −0.354; P = 0.017). GEE showed significant perfusion increases at the third, fifth, and ninth treatment hours ( P < 0.01), with a borderline BFS-perfusion association ( B = −0.09; P = 0.051). Conclusion: EECP was associated with increased NIRS-derived cerebral perfusion and improved brain fog symptoms in long COVID. Given the small, uncontrolled design, causal inference is limited; larger controlled studies are needed to confirm these preliminary findings.
Objective: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detecting anterior cruciate ligament (ACL) tears, using arthroscopy as the gold standard. Material And Methods: We conducted this cross-sectional validation study in the Orthopedics Department at Khyber Teaching Hospital, Peshawar. A total of 296 patients were enrolled. All participants underwent knee MRI and were compared with arthroscopic findings, which served as the reference standard. Diagnostic parameters and overall accuracy were calculated. Statistical analysis was performed using SPSS 25. Results: Of the 296 patients, MRI detected ACL tears in 172 (58.1%) cases, while arthroscopy confirmed tears in 197 (66.6%) cases. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI were 70.1%, 65.7%, 80.1%, and 52.4%, respectively, with an overall diagnostic accuracy of 68%. A statistically significant association was observed between MRI and arthroscopy findings (p< 0.01). The ROC curve demonstrated fair discriminative ability of MRI. Conclusion: MRI exhibits moderate diagnostic accuracy in detecting ACL tears, with a reliable predictive value when results are positive. However, its limited sensitivity and specificity in this context highlight the need for cautious interpretation, especially in MRI-negative cases. Arthroscopy remains the definitive diagnostic tool, particularly for ambiguous or complex injuries. Keywords: Anterior Cruciate Ligament Injuries, Magnetic Resonance Imaging, Arthroscopy
Objective: This study aimed to assess medical students' engagement levels and identify socio-demographic factors associated with participation. Materials and Methods: A cross-sectional study was performed at a single medical college using self-reported surveys to assess student engagement across different age groups, genders, and academic years. Data were analyzed to determine the prevalence of "Good," "Neutral," and "Poor" engagement levels, with P < 0.05 set as the cutoff for statistical significance. Results: Most students (63.75%) exhibited a neutral level of engagement, while 20% demonstrated high engagement and 16.25% reported low engagement. Significant correlations were found between engagement and demographic variables (P < 0.05); notably, high engagement was most common among 21-year-olds (47.7%) and third-year students (59.6%), whereas engagement decreased significantly in older students and those in their fourth year of MBBS. Female students also reported significantly higher "Good" engagement (36.9%) compared to their male counterparts (1.31%). Conclusion: Engagement levels notably decline as students advance through their medical education and age. Although the study is limited by its single-center, cross-sectional design, these findings highlight the importance of targeted interventions to sustain student motivation in the later stages of medical training. Keywords: Student engagement, Modular Teaching System, Impact of Assessment Weightage, student motivation
Background: Facemask ventilation (FMV) is a critical skill in airway management. Although the two-handed triple airway maneuver is often regarded as the gold standard, its complexity may limit consistent application in clinical practice. Aim: This study aimed to compare the ventilation efficacy of the one-handed E–C technique, two-handed jaw-thrust, and two-handed triple airway maneuver performed with a thenar eminence (E–V) grip in anesthetized adults. Methods: In this prospective, randomized, crossover study, 14 adult patients (American Society of Anesthesiologists I–III) undergoing elective surgery were enrolled in this study. After induction of general anesthesia and neuromuscular blockade, each patient underwent three FMV techniques in randomized order: one-handed E–C (Vt1), two-handed jaw-thrust (Vt2), and two-handed triple airway maneuver (Vt3). Tidal volumes (TVs) were recorded for each technique. Because the data were non-normally distributed, the Friedman test and the Wilcoxon signed-rank test with Bonferroni correction were applied. Results: The Friedman test showed a significant difference in TVs among techniques ( χ 2 = 16.57, P < 0.001). Both two-handed maneuvers produced significantly higher median TVs than the one-handed E–C technique (Vt1: 421.0 [347.0–468.5] mL vs. Vt2: 569.0 [496.3–628.5] mL; Vt3: 563.0 [489.3–626.3] mL; both P = 0.001). No significant difference was observed between Vt2 and Vt3 ( P = 0.57). Conclusion: Two-handed FMV techniques are markedly superior to the traditional one-handed E–C technique. A two-handed jaw-thrust using an E–V grip is as effective as the full triple airway maneuver and represents a simplified, equally efficacious option, particularly valuable in patients with cervical spine limitations.
OBJECTIVE: To assess the prevalence of sensorineural impairment in patients with type 2 diabetes and to explore the relationship between hearing loss and variables such as age, gender, HbA1C, and duration of diabetes. MATERIALS AND METHODS: This cross-sectional study was conducted from April to August 2025 and included patients with type 2 diabetes mellitus. Data were collected using the Hearing Handicap Inventory for Adults (HHIA) to screen for diabetes among individuals with hearing impairment. A non-probability convenience sampling method was used. Pure-tone audiometry (PTA) was employed to assess hearing. SPSS Statistics version 20 was used for data analysis. The chi-square test was used to assess associations, with results presented as frequencies and percentages. RESULTS: The study included 195 patients with Type 2 Diabetes mellitus aged 25-65 years. Of these, 7.7% were found to have sensorineural hearing loss, which primarily affects higher frequencies (2-4 kHz) and is usually mild to moderate. Additionally, it was found that sensorineural hearing impairment was significantly (p<0.005) associated with diabetes duration, hypertension, poor glycemic control, and chronic kidney disease. CONCLUSION: In this study, SNHI was found in only a small portion of diabetic patients. HHIA responses showed that most participants faced minimal hearing-related issues, while a significant link was observed between SNI and the duration of diabetes, poor blood sugar control, hypertension, and chronic kidney disease. KEYWORDS: Pure Tone Audiometry, Sensorineural Hearing Impairment, and Diabetes Mellitus
Background: Inguinal hernia repair is one of the most performed surgical procedures worldwide. Despite advances in technique, recurrence remains a significant clinical concern. While factors such as smoking and chronic pulmonary disease have been implicated, the prognostic value of objective pulmonary function parameters remains unclear. Aim: This study evaluated whether preoperative forced expiratory volume in one second (FEV 1 ) is associated with recurrence after inguinal hernia repair. Methods: A retrospective cohort study was conducted on patients who underwent hernia repair at a regional teaching hospital in northern Taiwan between 2011 and 2017. Preoperative pulmonary function test results and long-term recurrence outcomes were analyzed. Cox proportional hazards models were used to evaluate the association between FEV 1 and recurrence. Receiver operating characteristic (ROC) analysis and Kaplan–Meier survival analysis were performed for risk stratification. Results: Among the 89 eligible patients (mean age: 74.18 ± 12.68 years), 18 (20.2%) developed recurrence during a median follow-up of 50 months. In multivariable Cox analysis, FEV 1 (% predicted) was independently associated with recurrence (hazard ratio: 0.965 per 1% increase; 95% confidence interval: 0.937–0.994, P = 0.018). ROC analysis identified an optimal cutoff of 74.21%, and Kaplan–Meier analysis demonstrated significant recurrence-free survival stratification based on this threshold (log-rank P = 0.002). Conclusion: Reduced preoperative FEV 1 was significantly associated with an increased hazard of recurrence following inguinal hernia repair. These findings suggest that objective pulmonary function assessment may provide incremental prognostic information, although larger prospective studies are needed to confirm these results.
Objective: To compare the effectiveness and safety of 400 mg of sublingual and per rectal Misoprostol when given 1 hour prior to abdominal Myomectomy in reducing intraoperative blood loss. Material and Methods: A quasi-experimental study involving women with uterine leiomyoma was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, including patients who underwent abdominal myomectomy. Participants were enrolled after providing informed consent and were randomly assigned to either group 1, which received 400 mg of misoprostol rectally, or group II, which received 400 mg of misoprostol sublingually one hour before surgery. A total of 48 participants were enrolled. The primary outcome measures were intraoperative blood loss and the difference between preoperative and postoperative hemoglobin levels; secondary measures included postoperative febrile morbidity, gastrointestinal complaints, and other side effects. All data were stored and analyzed using SPSS 20. A p-value of <0.05 was considered statistically significant. Results: The mean age of patients in group 1 (per rectal) was 32.6 (± 4.8) years, and in group 2 (sublingual) it was 33.8 (± 4.5) years. The mean parity in group 1 was 1.8 (1.3), while in group 2 it was 1.3 (1.2). The mean uterine size in group 1 was 17.6 (2.3) cm, and in the per rectal group, 15.8 (2.2) cm. Blood loss during the myomectomy procedure was 342.8 (154.6) ml in group 1 and 386.5 (118.3) ml in the sublingual group. Complications of misoprostol were very rare and minor, such as nausea and uterine cramps. Conclusion: Sublingual misoprostol is an effective and safe agent for reducing blood loss during abdominal myomectomy. When compared with the use of the same dose of per rectal misoprostol given 1 hour before surgery, it did not show a significant difference; however, the ease of administration via the sublingual route is favored and acceptable to women in the Asian community. Keywords: Sublingual Misoprostol, Intraoperative Blood Loss, Myomectomy
Objective: To determine the Diagnostic accuracy of sonourethrography (SUG) in the diagnosis of anterior urethral stricture, taking retrograde urethrogram (RUG) as a reference standard Materials and Methods: This cross-sectional study was performed at the Radiology Department of the Combined Military Hospital (CMH) in Peshawar, Pakistan, from November 3, 2022, to May 3, 2023. A total of 104 clinically suspected cases of anterior urethral stricture were included. Male patients aged 15–65 years presenting with lower urinary tract symptoms for at least one week were enrolled. Patients with posterior urethral strictures, allergies to contrast media, or severe perineal conditions were excluded. SUG was conducted using a Toshiba Xario 200 Doppler scanner, with RUG serving as the gold standard for confirmation. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, were calculated using SPSS version 25. Results: The average age of participants was 37.80 ± 9.245 years. SUG identified strictures in 32 patients, with 71.8% located in the bulbar urethra and 28.1% in the penile urethra. Severity assessment showed 65.6% of strictures as mild, 28.1% as moderate, and 6.25% as severe. Average stricture lengths were 2.1 ± 0.31 mm on SUG and 2.8 ± 0.46 mm on RUG. SUG demonstrated a sensitivity of 97%, specificity of 96%, PPV of 91.2%, NPV of 98.6%, and a diagnostic accuracy of 96.1%. Conclusion: Sonourethrography is a dependable diagnostic tool for anterior urethral strictures, showing excellent sensitivity and specificity. Its superior ability to evaluate stricture length and severity makes it a crucial modality for clinical practice. Keywords: Sonourethrography, Retrograde Urethrography, Diagnostic accuracy
