This study explores the potential of the triglyceride-to-high-density lipoprotein-cholesterol (TG/HDL-C) ratio and the triglyceride-glucose (TyG) index as alternative markers of glycaemic control in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Conducted on 91 adults with T2DM and CKD, data were obtained from fasting lipid profile, fasting plasma glucose (FPG), serum creatinine, and HbA1c levels. Statistical analysis demonstrated a strong positive correlation between HbA1c levels and both the TG/HDL-C ratio (r = 0.570) and the TyG index (r = 0.729), with both associations reaching a high level of statistical significance (p <0.001). The TyG index also remained independently significant in linear regression analysis. These observations highlight the potential of the TG/HDL-C ratio and the TyG index as effective, low-cost, and accessible surrogate markers for glycaemic control, especially valuable in low-resource settings where HbA1c testing may be limited. Both indices could help mitigate the risk of diabetic complications, especially cardiovascular disease, among individuals with CKD. Key Words: Triglyceride/high-density lipoprotein ratio, Triglyceride glucose index, HbA1c, Chronic kidney disease, Cardiovascular disease.
OBJECTIVE:To compare radiographic maintenance, disc degeneration, and functional outcomes between short-segment pedicle screw fixation (SPSF) alone and SPSF with fracture-level screws in thoracolumbar burst fractures (TLBFs). STUDY DESIGN:A retrospective comparative study. Place and Duration of the Study: Department of Orthopaedics, Daqing People's Hospital, Heilongjiang, China, from June 2015 to February 2025. METHODOLOGY:Adults with single-level T11-L2 TLBFs treated with posterior SPSF alone (control group) or SPSF with fracture-level fixation were reviewed. The Cobb angle and vertebral wedging index (VWI) were assessed at 1 week postoperatively and at final follow-up. Disc degeneration was graded on magnetic resonance imaging (MRI) after implant removal using the Pfirrmann classification. Pain and disability were evaluated using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Normality was assessed with the Shapiro-Wilk test. Continuous outcomes were compared with the independent samples t-test or Mann-Whitney U test, as appropriate, and categorical variables were compared with the chi-square test or Fisher's exact test. A two-sided p-value of <0.05 was considered statistically significant. RESULTS:A total of 137 patients were included and divided into two groups: the control group (n = 68) and the fracture-level group (n = 69), with a follow-up period of 12-96 months. Operative time was longer in the fracture-level group (p <0.001), whereas blood loss was similar between the groups (p >0.05). At final follow-up, the Cobb angle and VWI were lower in the fracture-level group (both p <0.001). Severe disc degeneration (Pfirrmann grades 4-5) was less frequent in the fracture-level group (6/30 vs. 19/36, p = 0.013). CONCLUSION:The addition of fracture-level screws to SPSF improved long-term sagittal alignment and maintenance of vertebral height and was associated with less severe postoperative disc degeneration. KEY WORDS:Thoracolumbar vertebrae, Spinal fractures, Pedicle screws, Intervertebral disc degeneration, Sagittal balance.
The study aimed to evaluate delays in emergency department (ED) arrival among stroke patients and to identify demographic factors that contribute to these delays. It was a cross-sectional study conducted at the Department of Neurology, Liaquat National Hospital, Karachi, Pakistan, from January to July 2024. A total of 174 patients attending the ED for acute stroke were interviewed. There were 112 men and 62 women, with a mean age of 60.54 ± 12.74 years. One hundred and twenty-six (72.4%) of these patients presented to the ED more than four hours after the onset of stroke symptoms. Factors associated with late arrivals included education level (p <0.001), place of residence (p = 0.043), distance travelled (p <0.001), stroke onset time (p = 0.002), referral from another hospital (p <0.001), and awareness of facilities providing acute stroke care (p <0.001). More than half of patients failed to reach the critical window for thrombolysis because of delays in arrival. Contributing factors comprise insufficient awareness and challenges in accessing care. Prompt community-focused measures are imperative to tackle these issues effectively. Key Words: Stroke, Emergency services, Thrombolytic therapy, Demography, Educational status.
Opioids are the most used intrathecal (IT) adjuvants in lower segment caesarean section (LSCS); however, they are associated with side effects for both mothers and neonates. Dexmedetomidine (Dex) is one of the novel drugs and has been used as an IT adjuvant with success. This meta-analysis aimed to assess the usefulness of IT Dex and IT fentanyl in patients undergoing LSCS. The included studies in this study reported the onset and duration of spinal block, opioid consumption, first request to analgesia, pain control, and adverse effects. Sensory block (SB) onset was significantly faster with IT Dex (95% CI: -0.43 -0.02, p = 0.03). The SB duration was significantly longer in the IT Dex group. Also, the first request for analgesia was considerably longer by 81.74 minutes in IT Dex (95% CI: 63.03-100.45, p <0.001). IT Dex fastens the SB onset and increases its duration compared to IT fentanyl in LSCS. It significantly increases the time to first analgesic request. IT Dex also resulted in a lower incidence of shivering than IT fentanyl. Key Words: Intrathecal dexmedetomidine, Fentanyl, Caesarean delivery, Opioid consumption, Sensory block, Motor block.
OBJECTIVE:To determine the efficacy of intradiscal gentamicin in preventing postoperative discitis in lumbar spine surgery. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Neurosurgery, Lady Reading Hospital Medical Teaching Institution, Peshawar, Pakistan, from January 2018 to April 2023. METHODOLOGY:Data were retrieved and analysed for patients who underwent open microdiscectomy of the lumbar spine performed by a single surgeon between January 2018 and April 2023. Cases operated until December 2020 did not receive intradiscal gentamicin and were grouped as non-gentamicin (NG), while those operated afterwards were grouped as gentamicin (G). Inclusion and exclusion criteria were strictly applied to reduce potential bias. RESULTS:A total of 295 patients underwent surgery. The NG group comprised 165 patients, and the G group 130 patients. There were 151 males (51%) and 144 females (49%), with ages ranging from 20 to 67 years (mean age: 43.4 years). L4-L5 was the most commonly affected level (59%), followed by L5-S1 (38%). The NG group showed a discitis frequency of 6.6% (11/165), whereas the G group had a significantly lower rate of 1.5% (2/130, p = 0.033). CONCLUSION:Intradiscal gentamicin may be effective in reducing the incidence of postoperative discitis following open microdiscectomy. KEY WORDS:Discitis, Infection, Gentamicin, Efficacy, Local antibiotics.
OBJECTIVE:To evaluate the association between Selenium (Se) and other micronutrients (iron, ferritin, copper, zinc, and vitamin B12) and the development of preeclampsia (PE), and to assess their predictive performance. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences, Istanbul, Turkiye, from October 2024 to March 2025. METHODOLOGY:A total of 166 singleton pregnancies were included in the study. Maternal blood samples were collected between 12 and 20 weeks of gestation to measure serum Se, iron, ferritin, copper, zinc, vitamin B12, and haemoglobin (Hb) levels. All participants were followed prospectively until delivery to evaluate the association between Se and PE and its predictive value alongside other biomarkers. Group comparisons were performed using the Mann-Whitney U test. Independent predictors of PE were identified using binary logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the discriminative performance of significant laboratory parameters. RESULTS:Fifty-nine women (35.5%) developed PE. Se and Hb levels were significantly lower, whereas ferritin levels were significantly higher in the PE group (p <0.001). In multivariate logistic regression analysis, elevated ferritin (OR: 1.047, 95% CI: 1.019-1.076, p = 0.001) and decreased Hb (OR: 0.523, 95% CI: 0.350-0.782, p = 0.002) were independently associated with PE, while Se was not an independent predictor. ROC analysis demonstrated acceptable discriminative ability for ferritin (AUC: 0.706), Hb (adjusted AUC: 0.72), and Se (adjusted AUC: 0.70). CONCLUSION:Elevated ferritin and decreased Hb levels were independently associated with the development of PE. Se was associated with PE in univariate analysis but did not remain an independent predictor after adjustment, suggesting that it may reflect underlying oxidative stress rather than act as a causal determinant. KEY WORDS:Preeclampsia, Selenium, Haemoglobin, Vitamin B12, Ferritin.
OBJECTIVE:To evaluate the correlation of computed tomography (CT)-measured optic nerve sheath diameter (ONSD) with clinical and laboratory parameters in adult cirrhotic patients with hepatic encephalopathy (HE), and to determine its association with in-hospital mortality. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Division of Intensive Care, Ondokuz Mayis University, Samsun, Turkiye, between January and December 2023. METHODOLOGY:This study included cirrhotic patients with HE identified from the medical records and admitted to the Emergency Department during the study period. Data collected included demographic characteristics, aetiology of cirrhosis, Glasgow Coma Scale (GCS), Child-Pugh and MELD scores, HE grade, prothrombin time (PT), international normalised ratio (INR), blood pH, ammonia and lactate levels, ascites grade, and right eye ONSD measured using cranial CT at admission. Correlation and univariate Cox regression analyses were performed. RESULTS:A total of 125 cases were analysed, with a mean age of 66.69 ± 12.36 years and an average hospitalisation period of 8.59 ± 7.8 days. The mean ONSD was 4.43 ± 0.84 mm. ONSD showed significant correlations with Child-Pugh score (r = 0.205, p = 0.022), HE grade (r = 0.261, p = 0.003), ascites grade (r = 0.178, p = 0.046), as well as with PT (r = 0.239, p = 0.007) and INR (r = 0.230, p = 0.010). Significant negative correlations were observed with GCS (r = -0.282, p = 0.001) and blood pH (r = -0.186, p = 0.038). Increased ONSD was associated with in-hospital mortality in univariate analysis (p = 0.048; HR = 1.29). CONCLUSION:Although the mean ONSD values were within the traditionally accepted normal range, relative variations in ONSD were significantly associated with disease severity markers and in-hospital mortality. CT-measured ONSD may therefore serve as an adjunctive parameter in prognostic assessment, warranting further prospective validation. KEY WORDS:Hepatic encephalopathy, Cirrhosis, Optic nerve sheath diameter, Intracranial pressure, Prognosis.
OBJECTIVE:To provide simulation-based medical education to undergraduate students and to evaluate its efficacy and feasibility in resource-constrained medical colleges. STUDY DESIGN:An observational study. Place and Duration of the Study: Psychiatry Unit, Mufti Mehmood Memorial Teaching Hospital, Gomal Medical College, Dera Ismail Khan, Pakistan, from June to July 2023. METHODOLOGY:Psychiatrists conducted teaching sessions using depression-based scenarios in accordance with the International Nursing Association for Clinical Simulation and Learning (INACSL) Healthcare Simulation Standards of Best Practice, with nurses trained and utilised as simulated patients. All fourth-year medical students (n = 87) taking their psychiatry rotation were divided into three groups after a short lecture on depression. One volunteer from each group was asked to take a history, perform relevant examinations, and devise management plans. Students received feedback from simulated patients, peers, and supervisors. All the students signed a consent form and completed pre- and post-session questionnaires on Confidence in Assessing and Managing Depression (CAM-D). A paired t-test was applied to analyse the change in confidence. RESULTS:Consultant psychiatrists, along with medical officers, conducted the session for two hours. Significant improvement in rapport development, history taking, examination, risk assessment, making a proper diagnosis, and management of depression was observed in students with a mean value of 4.43 ± 0.57 vs. 1.61 ± 0.49, 4.33 ± 0.63 vs. 1.66 ± 0.47, 4.43 ± 0.57 vs. 1.57 ± 0.51, 4.42 ± 0.60 vs. 1.63 ± 0.48, 4.36 ± 0.62 vs. 1.59 ± 0.55, and 4.41 ± 0.60 vs. 1.71 ± 0.45, respectively. A p-value of <0.001 was considered statistically significant. CONCLUSION:Simulation-based medical education is an acceptable and effective way of teaching psychiatry at the undergraduate level. It can be used to teach medical students a variety of common psychiatric disorders that they encounter during ward placement. It is feasible after minimal efforts and through proper training of simulation educators and simulated patients. KEY WORDS:Simulated patients, Students, Medical, Simulation training, Psychiatry, Depression.
OBJECTIVE:To characterise the neural correlates of anxiety in Alzheimer's disease (AD) using the amplitude of low-frequency fluctuations (ALFF) derived from resting-state fMRI. STUDY DESIGN:A cross-sectional study. Place and Duration of the Study: Department of Psychiatry, Tongde Hospital of Zhejiang Province, Affiliated to Zhejiang Chinese Medical University (College of Integrated Traditional Chinese and Western Medicine Clinical Medicine), Zhejiang, China, from May to November 2025. METHODOLOGY:Fifty-four participants were categorised into three groups: 20 AD patients with anxiety (AD-A), 14 without anxiety (AD-nA), and 20 healthy controls (HCs). Probable AD was diagnosed according to the NIA-AA criteria. Cognitive and anxiety symptoms were assessed using the Mini-Mental State Examination (MMSE) and Hamilton Anxiety Scale (HAMA). Based on normality testing, group comparisons were performed using Kruskal-Wallis tests, except for HAMA scores, which were normally distributed. All participants underwent fMRI scanning, and ALFF values were calculated. RESULTS:Groups did not differ in age or gender. HCs showed significantly higher MMSE scores compared to both AD groups. HAMA scores were significantly higher in the AD-A group than in the AD-nA group. In the AD-A group, there was a positive but non-significant correlation between MMSE and HAMA scores (r = 0.267, p = 0.255). Neuroimaging results revealed that compared to the AD-nA group, the AD-A group exhibited decreased ALFF in the left insula and left anterior cingulate cortex. Relative to HCs, the AD-A group showed decreased ALFF in the right fusiform gyrus. In contrast, the AD-nA group displayed decreased ALFF in the right lingual gyrus and left precuneus, alongside increased ALFF in the right dorsolateral superior frontal gyrus. CONCLUSION:The AD-A group shows a distinct pattern of intrinsic brain activity. In the AD-A group, ALFF is lower in the salience network than in the AD-nA group, and lower in the visual cortex compared to HCs; the AD-nA group shows complex ALFF changes. This suggests ALFF as a potential neuroimaging biomarker for neuropsychiatric symptoms in AD. KEY WORDS:Alzheimer's disease, Anxiety, Resting-state fMRI, Amplitude of low-frequency fluctuation.
OBJECTIVE:To assess the influence of subclinical hypothyroidism (SCH) on hormonal balance, metabolic parameters, and the expression patterns of thyroid-stimulating hormone (TSH), androgen receptor (AR), and proopiomelanocortin (POMC) genes in women with polycystic ovary syndrome (PCOS). STUDY DESIGN:A cross-sectional observational study. Place and Duration of the Study: Obs & Gynea Department, Shaikh Zayed Hospital, Lahore, Pakistan, from August 2024 to April 2025. METHODOLOGY:Women aged 20-40 years with PCOS and normal thyroid function (n = 35), PCOS with SCH (n = 35), and healthy women serving as controls (n = 35) were recruited. Clinical, anthropometric, and reproductive data were obtained. Biochemical and hormonal parameters were measured, including fasting glucose, lipid profile, glycated haemoglobin (HbA1c), luteinising hormone (LH), follicle-stimulating hormone (FSH), testosterone, TSH, free thyroxine (T4), and free triiodothyronine (T3). Quantitative PCR was performed for gene expression of TSH, AR, and POMC. Normality of the data was checked using the Shapiro-Wilk test with SPSS version 22. One-way ANOVA or the Kruskal-Wallis test was used to compare differences among the three groups, followed by Tukey's test or Dunn's test with Bonferroni correction for post hoc analysis. The chi-square test was used to assess associations between categorical variables. RESULTS:Women with PCOS-euthyroid and PCOS-SCH had significantly higher BMI (p <0.001) and irregular menstrual cycles (p <0.001) than the control group. TSH was higher (p <0.001) in the PCOS-SCH group (8.80 ± 1.31) compared to the PCOS-euthyroid (2.91 ± 0.56) and control (2.54 ± 0.55) groups. Patients in the PCOS-SCH and PCOS groups demonstrated higher levels (p <0.001) of LH (12.82 ± 1.02 and 13.79 ± 0.66 mIU/mL), testosterone (80.49 ± 6.81 and 100.27 ± 26.87 ng/dL), prolactin (36.37 ± 7.15 and 26.77 ± 2.24 ng/dL), and dyslipidaemia, as well as elevated HbA1c (6.04 ± 0.22 and 6.04 ± 2.0), compared to the control group. However, FSH was lower (p <0.001) in the PCOS groups. Gene expression analysis revealed higher (p <0.01) TSH expression in the PCOS-SCH group compared to the other groups. The median AR expression (2-∆∆CT) was significantly higher (p <0.05) in the PCOS-euthyroid group (2.12) compared to the control group (0.30). Similarly, median POMC expression (2-∆∆CT) was significantly higher (p <0.001) in both groups than in the control group. CONCLUSION:SCH in PCOS may worsen clinical, hormonal, and metabolic disturbances and is associated with elevated TSH, AR, and POMC gene expression, potentially increasing cardiometabolic and reproductive risks. Key Words: Polycystic ovary syndrome, Subclinical hypothyroidism, Gene expression, Androgen receptor, Proopiomelanocortin.
OBJECTIVE:To identify and characterise genetic variants associated with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) through whole-exome sequencing (WES), using the ClinVar database as the primary resource for variant evaluation. STUDY DESIGN:A case-control study. Place and Duration of the Study: Department of Gastroenterology and Hepatology, Ziauddin University, Karachi, Pakistan, from January 2022 to July 2024. METHODOLOGY:A total of 200 MASLD patients were recruited from Ziauddin Hospital. Out of 200 cases, six patients were selected along with six age- and gender-matched healthy controls. DNA was extracted from whole blood samples, followed by WES. Variants were classified using the ClinVar database, while gene-gene interactions were analysed using the GeneMANIA platform. Statistical analysis was conducted using SPSS version 28, applying appropriate descriptive statistics based on data distribution. RESULTS:Fourteen variants were classified as pathogenic, 10 as likely pathogenic, 181 as variants of uncertain significance, and 47 as drug response variants. The most frequent pathogenic variant in MASLD cases was SUMO4 rs237025 (83.3%), while PRKCQ rs2236379 was most prevalent in controls (66%). Additionally, variants associated with insulin resistance (PPP1R3A rs1799999) and drug response (KCNJ11 rs5219, PNPLA3 rs738409) were detected in both groups. Gene-gene interaction analysis highlighted strong physical interactions among pathogenic variants, particularly within the complementary pathway. CONCLUSION:This study represents the first WES-based exploration of MASLD in the Pakistani population, contributing novel insights from a region underrepresented in genetic research. Several gene variants were highlighted for their potential relevance to MASLD and associated metabolic traits. While these findings require further validation in larger cohorts, they provide a foundation for uncovering population-specific genetic markers for MASLD. KEY WORDS:MASLD, Whole-exome sequencing, ClinVar.
OBJECTIVE:To investigate the association between mortality and nutritional status, assessed using the Haemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and the Prognostic Nutritional Index (PNI), in patients with heart failure (HF). STUDY DESIGN:A descriptive analytical study. Place and Duration of the Study: Department of Cardiology, Gaziantep City Hospital, Gaziantep, Turkiye, from October 2023 to December 2024. METHODOLOGY:A total of 111 patients admitted to the coronary care unit due to decompensated HF were evaluated. Data on demographic characteristics, cardiac rhythm, ejection fraction, duration of hospitalisation, survival outcomes, haematological profiles, and biochemical parameters were recorded. HALP and PNI scores were subsequently calculated. The Mann-Whitney U test was used for intergroup comparisons, and the Pearson chi-square test and Fisher's exact test were used to compare categorical variables. The cut-off levels of the HALP and PNI scores were established, and their relationship with mortality was investigated. A ROC curve analysis was used to evaluate the predictive value of different indices for mortality. RESULTS:HALP (AUC = 0.700, 95% CI: 0.560-0.839; p = 0.020) and PNI (AUC = 0.770, 95% CI: 0.645-0.896; p = 0.002) demonstrated significant discriminative ability for mortality. The optimal cut-off values were ≤18.09 (sensitivity: 61.5%, specificity: 62.2%) for HALP and ≤41.30 (sensitivity: 61.5%, specificity: 61.2%) for PNI. HALP and PNI values had significant predictive value for mortality. CONCLUSION:The HALP and PNI scores, which reflect nutritional status, were associated with mortality and may provide supportive prognostic information in ICU patients with decompensated HF; however, they were not independent predictors in multivariate analysis. KEY WORDS:Heart failure, HALP, Prognostic Nutritional Index, Intensive Care Unit, Mortality.
OBJECTIVE:To assess surgical management strategies for recurrent laryngeal nerve (RLN) invasion in patients with locally advanced thyroid cancer, with particular emphasis on the use of intraoperative neuromonitoring (IONM) and its influence on nerve preservation. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkiye, from January 2021 to January 2023. METHODOLOGY:A retrospective analysis was conducted on 24 patients with RLN invasion who underwent thyroid surgery. Surgical decision-making-whether to preserve or resect the RLN-was guided by IONM findings and the extent of tumour invasion. Postoperative vocal cord function was assessed using fibreoptic laryngoscopy at multiple intervals. Qualitative data were presented as frequencies and percentages. RESULTS:In 17 patients, the RLN was preserved using sharp dissection, with varying degrees of nerve wall involvement. Temporary vocal cord dysfunction was observed in some patients but resolved within six months. In three patients with >50% RLN circumferential invasion, nerve resection without reconstruction was performed. RLN reconstruction using the ansa cervicalis was achieved in two cases. No cases of local recurrence were reported during follow-up. CONCLUSION:RLN preservation using IONM-guided shaving techniques can be a safe and effective alternative to nerve resection in selected patients with functional preoperative vocal cords. Partial nerve resection may also be feasible without compromising oncological safety. These findings highlight the importance of individualised surgical planning and suggest the need for standardised protocols in managing RLN invasion. KEY WORDS:Thyroid cancer, Recurrent laryngeal nerve, Neuromonitoring.
OBJECTIVE:To determine whether there is any change in ipsilateral radial artery (RA) diameter following access for transradial coronary angiography and to assess any gender-related association with post-procedural radial artery stenosis (RAS) within 12 hours of the procedure. STUDY DESIGN:An observational study. Place and Duration of the Study: Adult Cardiology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan, from January to April 2025. METHODOLOGY:Pre- and post-procedure ultrasound within 12 hours of RA was performed on patients undergoing invasive coronary angiography. Diameter measurement was performed using ultrasound. Patient procedure and demographic data were recorded in pro forma forms. The difference between pre- and post-test scores was calculated and checked for normality, using a paired t-test. RESULTS:This study comprised 50 patients, of whom 44% (n = 22) were female, and 56% (n = 28) were male. The mean age was 59.58 years. Mean post-procedure RA diameter was 2.59 mm compared with 2.55 mm pre-procedure, consistent with an overall vasodilatory response, particularly in female patients, as 64% (n = 16) of those with increased post-procedure RA diameter were female, compared with 36% (n = 9) males in this group. CONCLUSION:Transradial access for coronary angiography is not associated with RAS. There is no association of female gender with RAS in the studied subset of Pakistani patients over 12 hours. KEY WORDS:Coronary angiography, Transradial access, Radial artery diameters, Ultrasound vasodilatory response.
OBJECTIVE:To investigate the value of combining contrast-enhanced CT radiomic features, CT subjective features, and clinical information for preoperative prediction of visceral pleural invasion (VPI) in non-small cell lung cancer (NSCLC). STUDY DESIGN:A descriptive study. Place and Duration of the Study: Department of Radiology, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China, from March 2022 to March 2024. METHODOLOGY:This study included 326 NSCLC patients who underwent surgery at two hospitals, which were used as the training and validation sets. A radiomics signature was constructed by extracting and selecting tumour radiomic features. Clinical characteristics were selected through univariate and multivariate logistic regression to construct a clinical model. A nomogram was developed by integrating the radiomics signature with clinical features. The models' performance in predicting VPI was evaluated using the area under the ROC curve and calibration curve. RESULTS:Ten radiomics features and four CT subjective features were identified as significantly associated with VPI. In the training and validation sets, the AUC values for the clinical model, radiomics signature, and nomogram were 0.854, 0.898, 0.937, and 0.706, 0.837, 0.852, respectively. The nomogram exhibited the highest AUC in both sets, and the calibration curve showed good consistency. CONCLUSION:The integration of CT radiomics features, CT subjective features, and clinical information can effectively predict VPI in NSCLC patients, thereby facilitating clinical decision-making. KEY WORDS:Non-small cell lung cancer, Visceral pleural invasion, CT radiomics.
This retrospective study evaluated angiographic, procedural, and in-hospital outcomes of chronic total occlusion percutaneous coronary intervention (CTO-PCI) at Aga Khan University Hospital, Karachi, Pakistan, from January 2020 to December 2022. Among 55 patients with at least one identified CTO, 38 presented with low left ventricular ejection fraction (LVEF) and 17 with normal LVEF. Despite a high prevalence of complex lesions (elevated J-CTO scores), the procedure was successful in 50 cases (91%). There were no significant diffe-rences in outcomes between successful and unsuccessful CTO-PCI cases relative to the studied variables. Key Words: Chronic total occlusion, Left ventricular ejection fraction, Percutaneous coronary intervention outcomes.
OBJECTIVE:To characterise the clinical presentation, diagnostic spectrum, and management challenges of primary immunodeficiencies (PIDs) in Pakistan, with an emphasis on barriers to early diagnosis and optimal care in a resource-limited setting. STUDY DESIGN:A descriptive cross-sectional study. Place and Duration of the Study: Department of Immunology, Armed Forces Institute of Pathology / AFBMTC / CMH / NUMS, Rawalpindi, Pakistan, from September 2021 to September 2024. METHODOLOGY:Patients with PIDs were evaluated. Clinical characteristics, disease distribution, warning signs, consanguinity, family history, gender, and bone marrow transplantation were analysed. Age at diagnosis and diagnostic delay were reported as descriptive statistics. RESULTS:A total of 185 patients with PIDs were diagnosed, including 116 (63%) males and 69 (37%) females. Parental consanguinity was reported in 144 (78%) cases, while 62 (34%) had a positive family history of PIDs. The most common category was phagocytic defects identified in 63 (34%) patients, followed by humoral defects in 51 (28%), combined immunodeficiencies in 39 (21%), complement deficiencies in 26 (14%), and other PIDs in 6 (3%). The mean age at diagnosis was 7.4 ± 9.3 years (0.1-38 years), with a mean diagnostic delay of 3.5 ± 4.7 years. Bone marrow transplantation was performed in 21 (11%) patients, with an overall survival rate of 80%. CONCLUSION:PIDs are underdiagnosed in Pakistan due to limited awareness, lack of newborn screening, inadequate diagnostics, and high consanguinity. Improved clinician training, expanded diagnostic capacity, and a national PID registry are essential for earlier diagnosis and better outcomes. KEY WORDS:Bone marrow transplant, Consanguinity, Diagnostic delay, Inborn error of immunity, Jeffrey Model Foundation warning signs, Primary immunodeficiencies.
OBJECTIVE:To evaluate the short-term safety and effectiveness of monopolar transurethral resection of the prostate (M-TURP) versus monopolar transurethral enucleation of the prostate (M-TUEP) in a tertiary-care urology unit. STUDY DESIGN:A descriptive study. Place and Duration of the Study: Department of Urology, Aga Khan University Hospital, Karachi, Pakistan, from July 2024 to July 2025. METHODOLOGY:Fifty men aged ≥40 years with symptomatic enlarged prostate who had undergone either M-TURP (n = 25) or M-TUEP (n = 25). Preoperative demographics, International Prostate Symptom Scores (IPSS), uroflowmetry parameters, laboratory values, and ultrasound findings were recorded. Operative variables and postoperative outcomes, including haemoglobin drop, electrolyte changes, complications, capsular perforation, irrigation duration, IPSS, maximum and average flow rates (Qmax and Qave), trial without catheter success, and quality of life, were assessed. Independent t-tests, paired t-tests, and chi-square tests were applied where appropriate. RESULTS:Baseline characteristics were statistically similar between groups. Significant improvements were observed postoperatively in IPSS (27.18 to 4.50), Qmax (6.76 to 18.65 ml/sec), Qave (3.11 to 11.29), and postvoid residual volume (189.64 to 69.70) across the entire cohort (p <0.001). No significant differences were found between M-TURP and M-TUEP regarding haemoglobin drop, transfusion requirements (2 vs 1, p = 0.55), or electrolyte changes (137 ± 18.2 vs. 136.6 ± 4.3, p = 0.389). Capsular perforations were fewer in the TUEP group compared to the TURP group (2 vs. 9, p = 0.037). More catheters were successfully removed in the TUEP group versus the TURP group (24 vs. 17; p = 0.023), indicating better functional outcomes with TUEP. The overall complication profile also showed no statistically significant differences. Conclusion: M-TUEP is safe in short-term clinical effectiveness comparable to M-TURP. As a monopolar technique requiring no additional equipment, it offers a practical alternative in low-resource settings. Key Words: Benign prostatic hyperplasia, Lower urinary tract symptoms, Transurethral resection of the prostate, Transurethral enucleation of the prostate, Monopolar enucleation, Monopolar resection, Prostate surgery, Uroflowmetry, International Prostate Symptom Score, Feasibility study.
OBJECTIVE:To measure the dimensions of the anterior cruciate ligament (ACL) in young adults and assess variations based on the demographic profile of patients. STUDY DESIGN:A cross-sectional observational study. Place and Duration of the Study: Department of Orthopaedics and Spine Centre, Ghurki Trust and Teaching Hospital, Lahore, Pakistan, from January to July 2024. METHODOLOGY:A total of 40 participants aged 18-30 years without prior knee surgery or chronic conditions were enrolled. Magnetic resonance imaging (MRI) was used to measure the length and width of the ACL. Statistical analyses, including t-test and correlation analysis, were performed; a p-value < 0.05 was considered statistically significant. RESULTS:The mean ACL length was 37.89 ± 3.02 mm. Males had significantly longer ACLs (38.61 mm) than females (35.72 mm, p = 0.007). No significant gender differences were observed in ACL width. A significant positive correlation (r = 0.450) was found between ACL length and width. CONCLUSION:Preoperative measuring of the ACL dimensions personalises surgical approaches and rehabilitation strategies for ACL injuries, emphasising the need for gender-specific considerations in clinical practice. KEY WORDS:Anterior cruciate ligament, Anterior cruciate ligament dimensions, Young adults, Magnetic resonance imaging, Gender differences.
OBJECTIVE:To assess pain relief, neurological outcome, radiographic fusion, and perioperative complications after anterior cervical discectomy and fusion (ACDF) at 12 months. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Neurosurgery, MTI-Mardan Medical Complex, Mardan, Pakistan, from January 2022 to June 2024. METHODOLOGY:ACDF was performed in adult patients who had symptomatic cervical disc disease, which was MRI-confirmed and not responding to conservative treatment. The Visual Analogue Scale (VAS) was used to examine neck and arm pain, and the modified Japanese Orthopaedic Association (mJOA) to evaluate neurological functioning. Radiographic fusion was assessed at 12 months by dynamic flexion/extension radiographs and CT in equivocal cases. Preoperative and postoperative outcomes were compared using a paired sample t-test, and exploratory subgroup analyses were performed based on presenting diagnosis and implant type. RESULTS:A total of 200 patients were included (mean age 47.1 years; 71.5% male). Single-level surgery was performed in 93.5% of patients. At 12 months, radiographic fusion was achieved in 90.5% of patients. There was significant improvement in mean neck pain, arm pain, and mJOA scores after surgery (p <0.001). The diagnostic groups had broadly similar clinical outcomes. The total complication rate was 19.5%, with transient dysphagia being the most frequent (14.5%). CONCLUSION:ACDF was associated with substantial pain relief, neurological recovery, and high fusion rates at 12 months with acceptable complication rates. KEY WORDS:ACDF, Cervical radiculopathy, Cervical myelopathy, Fusion, Dysphagia.
