RetaCardiomyopathy related to human immunodeficiency virus (HIV) infection is an uncommon but important cause of heart failure in young people and is frequently late recognised . We report the case of a young woman with HIV infection diagnosed in 2021 and treated with combination antiretroviral therapy, who presented with progressive breathlessness, tachycardia and hypotension. Echocardiography showed a dilated, globally hypokinetic left ventricle with severely reduced ejection fraction. Her condition deteriorated over the following weeks, and a multidisciplinary decision was taken to interrupt antiretroviral therapy while heart failure treatment was intensified. Persistent hypotension prevented the introduction of an angiotensin receptor-neprilysin inhibitor and a beta-blocker, and treatment was limited to ivabradine, torsemide, a mineralocorticoid receptor antagonist and empagliflozin. Partial improvement in left ventricular systolic function and reverse remodelling followed. This case illustrates the difficulty of separating HIV-related myocardial injury from antiretroviral cardiotoxicity, and the practical limits of guideline-directed therapy in the hypotensive patient.
Objective: To identify the percentage of patients with oral submucous fibrosis (OSF) among the patients with oral squamous cell carcinoma (OSCC) who presented at Nishtar Institute of Dentistry, Multan, Pakistan and to compare the demographical, clinical and habit-related characteristics of OSFpositive and OSF-negative patients. Methods: This cross-sectional study was conducted at the Department of oral and maxillofacial surgery, from June 2024 to July 2025. Total 182 OSCC cases were recruited by consecutive sampling through histopathologic diagnosis. Patients were clinically assessed for OSF and staged according to Haider et al. (2000) based on the extent of involvement and interincisal mouth opening. Analysis included age, sex, tumor site, histopathological grade, habit type, habit duration, and mouth opening. Results: OSF was present in 30.8% (56/182) of OSCC cases. There was no significant difference in mean age between patients with OSF-positive (47.6 ± 16.5 years) and OSF-negative (51.4 ± 10.1years) (p = 0.121). The most common tumor site was the buccal mucosa (54.9%), and there was a significant difference in site distribution according to the OSF status (p < 0.001). Patients with OSF had significantly reduced mouth opening compared to those with no OSF (15.0 ± 6.4 mm vs 40.6 ± 2.1 mm, respectively; p < 0.001). Habit type was significantly associated with OSF (p < 0.001) with betel quid (paan) chewing being more common among the cases with OSF. Conclusion: OSF was present in nearly one-third of OSCC cases in this cohort and was significantly correlated with the reduced mouth opening, specific tumor sites, betel quid use and poorly differentiated histology. The results in this study suggest that structured OSF screening should be included in routine clinical evaluation of OSCC patients in this patient population.
Objective: To assess trends and laboratory findings in sexual assault cases and determine their proportion to the overall forensic workload. Methods:This was a retrospective descriptive study that was carried out at the Forensic Science Laboratory at Mardan, KPK, Pakistan, between January 2023 and December 2025. A total of 904 forensic science laboratory cases were identified. Cases with incomplete records or pending reports (n= 105) were excluded. Cases involving alleged sexual assault were identified through medico-legal referral records and laboratory registration data, while seminal-fluid detection was used for forensic examination. The data sheets were prepared in Excel and analyzed using SPSS Statistics Version 26. Descriptive statistics (Percentages and frequencies) were calculated. Results:Out of 904 cases, 799 (88.38%) were analyzed. Sexual assault cases were 235 (29.41%).Seminal-fluid detection was positive in 80 (34.04%) cases and negative in 155 (65.96%) cases. Blood identification cases were the most common, accounting for 402 (50.31%) cases, followed by toxicology cases (137; 17.14%). The most common poison identified was phosphine. The number of cases increased from 263 (2023) to 348 (2025), showing an overall increase of 32.3%. Conclusion: Sexual assaults are a major forensic workload. The high proportion of negative seminalfluid detection findings highlights limitations in biological evidence detection and emphasizes the need to improve medico-legal practices.
A good medication delivery system has a significant impact on patient safety and treatment, Nurses are directly involved in the delivery of medication. The purpose of this study was to examine the role of nurses in preventing medication administration errors. Purposive sampling was used in a crosssectional study at Liaquat University Hospital in Hyderabad, Jamshoro. A sample of 150 nurses was calculated through Raosoft software. Data was analyzed using SPSS version 23, with frequencies, percentages, and chi-square test applied. Among participants, 74.7% (112) were female. Most nurses 87.3% (131) demonstrated a good role in preventing errors. A significant association was found between nurses’ role and medication errors (p = 0.01), with a negative relationship (Phi = –0.209) using chi square test. The study concluded that nurses play a vital role in reducing medication errors and ensuring patient safety.
Objective: To determine the patterns of rotations of the central incisors and molars in maxilla, on cleft and non-cleft sites, in unilateral cleft lip and palate, and to investigate the impact of missing teeth on these rotations. Methods: A total number of 200 unilateral cleft lip and palate children, aged 7-10 years with completely erupted permanent central incisors and first molars in maxilla, prior to alveolar bone grafting and orthodontic treatment were incorporated. Patients with bilateral cleft lip and palate, syndromic cleft conditions, incomplete records, or fractured teeth on the casts were excluded. This cross-sectional study was carried out using a non-probability convenience sampling in the department of orthodontics, from December 2020, to January 2024. A horizontal line (HL) from buccal groove of right 1st molar to left 1st molar was drawn on the photographs of the maxillary cast. A perpendicular was made at the middle of this HL and angles between distal and mesial line angles of incisal edge were measured. To evaluate molars rotations; angles were measured between tangent connecting its disto-buccal and mesio-buccal cusps and the HL. Results: Missing lateral incisors were observed in 85.0% of patients. On the cleft side, 65.0% of maxillary central incisors exhibited disto-labial rotation, while 84.0% of first molars demonstrated mesio-palatal rotation. No significant association was found between missing teeth and incisor rotation (p = 0.979) or molar rotation (p = 0.267) on the cleft side. However, rotation patterns differed significantly between the cleft and non-cleft sides for both incisors (p < 0.001) and molars (p < 0.001), indicating marked asymmetry. Conclusion: The most frequently missing tooth on the cleft site was lateral incisor and patterns of rotation in maxillary central incisors and first molars in unilateral cleft lip and palate were significantly influenced by the cleft side rather than the missing teeth
In Pakistan, public hospitals historically have provided essential healthcare services to low-income populations and patients referred from rural areas since the last century. Yet, public hospitals’ capacity to deliver these services is increasingly jeopardized by a lack of funding, workforce shortages, and decreasing trust of the public as to the quality of care being provided. Trust is an important factor that affects how health services are used, patient satisfaction, and clinical outcomes.
Cone beam computed tomography (CBCT) is prevalent in maxillofacial imaging due to its high-resolution bone detail and quick, chairside operation that generally exceeds conventional CT in radiation dose efficiency. However, recent clinical claims about its effectiveness in oral squamous cell carcinoma (OSCC) are not fully supported by physics. Current verified literature (up to June 2026) clarifies that CBCT should be reserved for secondary purposes like bone invasion evaluation, surgical planning, and radiotherapy, and not as a primary tool for mucosal screening. Although it can match CT and MRI in detecting cortical erosion in very specific cases, it cannot identify early dysplasia or superficial OSCC because of its poor soft tissue contrast and unreliable gray scale values. While artificial intelligence and radiomics show potential for automated radiotherapy guidance, their validation remains insufficient, keeping MRI as the gold standard for assessing marrow infiltration and perineural spread.
Objectives: To evaluate variations in pro-inflammatory cytokine levels in the serum along with gene polymorphism and loss of bone mass in women after menopause. Methods: 81 females in their active reproductive life (ages 20 – 40 years) and 81 postmenopausal women (ages 50 years and above) took part in cross sectional study. Concentration of serum cytokines were analyzed by Enzyme-Linked Immunosorbent Assay. Genotyping for TLR4 (C1196T) SNP rs 4986791 was carried out using the PCR method and sequencing. Measurement of BMD was done by DXA scan (Hologic Discovery (QDR series) on hip bone, lumbar spine and femoral neck of recruited subjects. Anthropometric assessment was carried out. For quantitative variables Student ttest was used and linear correlation coefficient were done for qualitative variables (p<0.5). Chi –square and fisher exact tests were applied for comparison and association of qualitative variables among women of active reproductive age and women who passed their active reproductive age. pvalue of <0.05 would be considered statistically significant. Results: A meaningful correlation was identified among IL-1, and TNF-á with BMD at femur, hip bone and femoral neck. Study has identified frequency of both homozygous and heterozygous genotypes in osteopenic women. A 20% T allele higher rate of occurrence was found in women with low bone mass compared to normal women. We observed a negative and significant association with BMD and pro-inflammatory cytokines. Significant relationship between CT & TT genotypes was recognized with TNF-á and age. T allele exhibited strongly linked to low bone density. Conclusions: Serum cytokines enhances the forecast of bone loss in group of women experiencing menopause. Correlation of T allele was identified among osteopenic pre and postmenopausal women. Significant correlation between heterozygous (CT) and mutant genotypes (TT) was also noticed with age and TNFá, done by Pearson correlation coefficient.
Objective: To evaluate the impact of smokeless tobacco (ST) on the inflammatory biomarkers Interleukin-1? (IL-1?) and Alpha-2-glycoprotein-1(AZGP1) in saliva and serum of ST consumers and non-ST consumers. Methods: This cross-sectional analytical study recruited a total of 124 individuals (62 ST consumers and 62 controls) aged 18-65 years who were recruited at Isra University Hospital, Hyderabad, Pakistan. Clinical assessments included the pain visual analog scale (VAS), swelling (buccal vestibule), and limitation in mouth opening, Decayed-Missing-Filled Teeth (DMFT) index, tooth mobility, and staining. Enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum and saliva biomarkers. Independent t-tests, chi-square tests, and Pearson correlation coefficients were used to perform statistical analysis. Results: ST consumers exhibited markedly higher inflammatory markers. The IL-1? in saliva increased by 2.35-fold (42.8 ± 18.3 vs 18.2 ± 9.4 pg/mL, mean difference 24.6, 95% CI 19.8-29.4, p<0.001) and serum IL-1? by 2.81-fold (8.7 ± 4.2 vs 3.1 ± 1.8 pg/mL, mean difference 5.6, 95% CI 4.4-6.8, p<0.001). The level of AZGP1 in the saliva was higher (156.4 ± 52.7 vs 98.3 ± 31.2 ng/mL, mean difference 58.1, 95% CI 43.1-73.1, p<0.001), whereas serum AZGP1 was lower (24.6 ± 8.9 vs32.8 ± 7.1 ng/mL, mean difference -8.2, 95% CI -11.1 to -5.3, p<0.001). Strong dose-response relationships were determined between the duration/frequency of ST and the intensity of biomarkers (r=0.47-0.71, 95% CI ranging approximately 0.03-0.82 across individual correlations, p<0.001). Clinically, ST consumers had pain scores approximately four times higher and DMFT indices twice those of controls. Conclusion: ST consumption is significantly associated with elevated salivary and serum inflammatory biomarkers, which correlate with clinical deterioration.
Objective: This study aimed to assess the knowledge regarding rabies and its management among general practitioners in Pakistan. Methods: This cross-sectional study was conducted from March to December 2023 among general practitioners practicing in public and private clinics or hospitals in different cities of Pakistan. Using non-probability convenient sampling technique, a pre-tested structured questionnaires was administered among GPs to assess the knowledge and practices regarding rabies and its management. Descriptive statistics for frequency and percentage were acquired for all variables. Continuous variables are presented as mean ± SD. Independent t-test was used to compare mean knowledge and practice score and its association with demographic variables. Data was analyzed by using SPSS version 24. A P value <0.05 was considered statistically significant. Results: Out of total 500 general practitioners, 258 (51.6%) from public hospitals, and 108 (21.6%) had more than 10 years of experience. The overall mean age of the participants was 36.3 ± 7.8 years. General practitioners, (89.4%) correctly knew about the causative agent and (49.4%) about the vector of rabies. More than half of the general practitioners (53.4%) responded correctly that rabies prevention can be achieved using either cell culture vaccines or nervous tissue vaccines and (66%) had knowledge regarding anti-rabies vaccination schedule. Regarding management of dog bite wound (85.4%) had appropriate knowledge about irrigation and (27.4%) about suturing. Collectively (52%) general practitioners recognized the need to administer antibiotics along with tetanus antitoxin to patients with dog bite. Statistically no significant association was observed between knowledge and practice scores with socio-demographic characteristics. Conclusion: This study revealed that the knowledge of rabies and its management was inadequate among general practitioners of Pakistan. Frequent sessions on awareness and management of dog bite patients should be held for general practitioners to control and reduce the incidence of human rabies related deaths.
Objective: To determine the knowledge and attitude of healthcare workers (HCWs) regarding monkeypox (MPOX) and assess the association between knowledge and attitude among HCWs in Karachi. Methods: The study was conducted as an analytical survey surveying the HCWs of Karachi from 1st December 2024 to 28th February 2025 to determine knowledge and attitude of HCWs regarding MPOX. Results: A total of 380 responses were analyzed (response rate=77.3%; mean age=39.6 ± 9.5 years). The median knowledge score was 14.5 (IQR: 12.7-16.2), with higher awareness of the zoonotic origin of MPOX (87.6%), use of antivirals (>70%), and lower awareness regarding the spread from infected animals to humans (62%). There were significant knowledge-attitude correlations, and the willingness to learn about MPOX transmission (r=0.602). Conclusion: The current study provides new evidence on MPOX awareness and identifies knowledge gaps among HCWs from a metropolitan city of Pakistan (Karachi). The findings demonstrated an average knowledge score about MPOX, indicating existing awareness alongside important knowledge gaps, emphasizing the necessity of enhanced education and preparedness initiatives
Objective: This study attempted to explore the relationship between Systemic immune-inflammation index (SII) and severity of Diabetic foot ulcer (Wagner grades I-V) and compared the discriminating power of SII with HbA1c. Diabetic foot ulcer (DFU) is a serious complication of Type 2 diabetes, caused by neuropathy, ischemia, infection and chronic inflammation. Systemic immune-inflammation index is a combination of three hematological parameters reflecting innate immunity, adaptive regulation and thrombosis. SII is used to predict outcomes in cancer and cardiovascular disease, but its association with severity of DFU is not established. Methods: The study design was analytical cross-sectional study, carried out in two tertiary care hospitals of Dow University of Health Sciences (DUHS) during June to November 2024. We enrolled 100 adults with type 2 diabetes and DFU. Data on demographics, HbA1c, and complete blood counts were collected. The severity of DFU was estimated according to the Wagner classification and SII was calculated. Descriptive statistics, correlation tests, trend analysis, multiple linear regression for hospital stay and ROC curves of severe DFU (Wagner 3) were conducted. Results: The results showed that SII levels are significantly higher as the Wagner grade increases (p<0.001) and were moderately correlated with the ulcer severity (r=0.573, p<0.001). SII showed weak correlation with HbA1c (r=0.234, p=0.019). The ROC analysis showed that SII could discriminate between severe DFU (0.851, good) more than HbA1c (0.739, fair). SII was a positive predictor of longer hospital stay (p=0.001) in regression analysis, and a negative association between infection and hospital stay was observed. Conclusions: SII is highly correlated with the severity of DFU and has a greater discriminative power than HbA1c. SII can be used in low-resource areas to s
Objective: To determine the severity and associated factors of cyberchondria among patients visiting the outpatient department of a tertiary care hospital in Karachi, Pakistan. Methods: A cross-sectional analytical study was conducted at Sohail Trust Hospital, Karachi, which is a tertiary care private hospital in Korangi, from March 2024 to November 2024. A total of 361 participants were recruited through non-probability purposive sampling. Data was collected using a semistructured questionnaire comprising socio-demographic variables, the Hospital Anxiety and Depression Scale (HADS-14) and the cyberchondria Severity Scale (CSS-15). Binary logistic regression analyses were performed to determine associations. P-value <0.05 was considered statistically significant. Results: Of the 361 participants, A total of 361 participants were included, with a mean age of 31.4 ± 9.2 years. The mean CSS-15 score was 34.8 ± 7.1, while the mean HADS anxiety and depression scores were 9.1 ± 3.8 and 8.4 ± 3.5, respectively. Using the sample median CSS-15 score of 34, participants were classified into lower- and higher- severity groups for binary analysis. Younger age, female gender, higher educational attainment, marital status, and lack of trust in general practitioners were significantly associated with higher cyberchondria severity. Conclusion: Higher cyberchondria severity was associated with sociodemographic and psychological factors. These findings emphasize the urgent need for interventions aimed at improving digital health literacy and strengthening physician to patient trust in clinical settings.
Objectives: To evaluate the antibiofilm activities of natural compound, Mango Leaf Extract (MLE) and Pomegranate Peel Extract(PPE) against Staphylococcus aureus and Streptococcus Mutans. Also use the MLE and PPE in combination so we aim to evaluate the synergistic activity of these two compounds against Staphylococcus Aureus and Streptococcus Mutans as an antibiofim agent because biofilm formation is the main virulence factor of microorganisms to provide resistance against antibiotics. Methods: 96 well plate method is used to evaluate biofilm forming activity of organism as well as used for evaluating antibiofilm forming activity of mango leaf extract and pomegranate peel extract individually and in combination. Results: The individual antibiofilm concentrations of pomegranate and mango leaf extract were 41.66 ± 11.78 mg/ml and 20.83 ± 5.89 mg/ml, respectively against Staphylococcus Aureus. However, when combined, the effective antibiofilm concentrations dropped to 3.46 ± 2.38 mg/ml (pomegranate) and 3.56 ± 2.41 mg/ml (mango leaves). Whereas the antibiofilm activity of PPE & MLE against Streptococcus Mutans individually were 33.3 ± 3.33 mg/ml and 16.66 ± 5.88 mg/ml, respectively. However, in combination, the required concentrations decreased significantly antibiofilm activity to 8.36 ± 2.92 mg/ml for pomegranate peel and 3.61 ± 2.38 mg/ml for mango leaves. Both gram positive cocci show significant resistance against tested antibiotics. Conclusion: Mango leaf extract and Pomegranate peel extract has shown good antibiofilm activity against Staphylococcus Aureus and Streptococcus Mutans individually as well as in combination shows synergistic activity. Whereas both organisms show resistance against conventional antimicrobial agents. We can use MLE and PPE as an antibiofilm individually as well as in combination. In this way provide the alternative adjuvant product with the conventional antibiotic which is free from adverse effect as well as cost effective and have alternate option to minimize resistant microorganism survival.
Objective: To compare the effectiveness of the two different preoperative nebulization, “Magnesium Sulphate” and “2% Lidocaine” for minimizing the frequency and intensity of post-procedural throat pain among individuals undergoing scheduled laparoscopic cholecystectomy managed with general anesthesia. Methods: A prospective randomized controlled trial (RCT) was carried out on 60 patients aged between 18-65 years admitted for elective Laparoscopic Cholecystectomy (LC) in the Civil Hospital, Anesthesiology, Surgical Intensive Care and Pain Management Unit from July to December 2025. Trained investigators recruited patients who were eligible for inclusion in the study by taking there informed consent form; followed a consecutive non-probability sampling. Patients were split into two groups. Group A (n = 30) were nebulized with magnesium sulphate preoperatively while Group B (n =30) nebulized with lidocaine. . Evaluation parameters included the frequency of postoperative sore throat at various intervals and pain severity measured at 24 hours.statistical were analyzed statistically with significance set at p < 0.05. Results: Baseline demographic and clinical characteristics were compared between the two group showing no significant Variation (p > 0.05). When evaluating post-operative outcome, patient treated with magnesium sulphate had significantly lower rate of postoperative throat discomfort than lidocaine The magnesium sulphate group experienced mild postoperative sore throat in 6.7% patients with none of them reporting a moderate or severe sore throat, compared to lidocaine group experiencing a mild to moderate pain in 43.3% of sore throat. Conclusion: Preoperative nebulization with magnesium sulphate demonstrate superior efficacy in minimizing the postoperative sore throat which occurred in the patients of elective laparoscopic cholecystectomy after general anesthesia than nebulized lidocaine 2% nebulization. Magnesium sulphate nebulization is an easy to use, safe and cost-effective approach which can be incorporated into routine anesthetic management, to improve patient comfort postoperatively.
Objective: To evaluate quality of life among post-treatment OSCC patients and identify clinical and treatment-related factors affecting quality-of-life outcomes using the EORTC QLQ-H&N35 questionnaire. Methods: This cross-sectional study was conducted at Darul Sehat Hospital and Abbasi Shaheed Hospital, Karachi, over six months after institutional approval. A total of 70 post-treatment OSCC patients were included using non-probability convenience sampling. Results: Most patients were male and married, with a large proportion belonging to the low socioeconomic group. Patients with buccal mucosa tumors had significantly higher difficulty in swallowing, dry mouth, pain, anxiety, and weight loss scores compared with other tumor sites. Stage IV disease was associated with significantly worse swallowing difficulty, pain, anxiety, and weight loss. Restricted mouth opening was significantly associated with poorer scores in swallowing, dry mouth, mouth opening, sticky saliva, pain, chewing, anxiety, and weight loss. Patients receiving surgery plus radiotherapy reported significantly worse quality-of-life scores than those treated with surgery alone, particularly for swallowing difficulty, dry mouth, pain, chewing, anxiety, and weight loss. Conclusion: Quality of life among post-treatment OSCC patients was significantly affected by tumor site, tumor stage, mouth-opening status, and treatment modality. Patients with advanced disease, restricted mouth opening, buccal mucosa involvement, and combined treatment experienced greater symptom burden. Targeted supportive care focusing on pain control, oral function, nutrition, and psychological support is recommended to improve post-treatment quality of life.
Objective: To evaluate the speech outcomes following superiorly based pharyngeal flap surgery in non-syndromic cleft lip and palate patients using perceptual speech assessment. Methods: This study was conducted on 22 patients operated between 1st January 2022 and 31st December 2022 by a senior surgeon. The sample included 14 males and 8 females aged 9–27 years. Patients with repaired cleft lip and palate diagnosed with VPI by speech-language pathologists were included. Patients with syndromes, hearing impairment, submucous cleft palate or who developed any postoperative complications were excluded from the study. The assessment of speech was performed by two speech-language pathologists one week preoperatively and 12 months postoperatively. Preoperative pharyngoscopy was also carried out by an ENT surgeon to assess the gap between the velum and posterior pharyngeal wall. Results: Among 22 patients, hypernasality was absent in 2, mild in 6, moderate in 10, and severe in 4 patients preoperatively. Following surgery, the severity of hypernasality markedly improved, with postoperative assessment demonstrating absent hypernasality in 2 patients, mild in 5, moderate in 1, and no patients exhibiting severe hypernasality. These findings indicate a substantial postoperative reduction in the severity of hypernasality among the majority of patients. Similarly, speech turbulence was graded as mild in 3 patients, moderate in 8, and severe in 11 patients preoperatively. While, postoperative evaluation showed that there was considerable improvement, with turbulence reducing to mild in 13 patients, moderate in 7, and severe in only 2 patients. Overall, the surgical intervention resulted in significant improvement in speech quality and reduction in turbulence in most patients.Out of the 22 patients, 20 demonstrated noticeable improvement in speech following the procedure. Conclusion:The superior based pharyngeal flap which is tailored to each patient helps to improve velopharyngeal insufficiency and hence speech in patients affected with cleft lip and palate.
One of the most common conditions is dental caries, infect individuals across all age groups and impacting overall health and quality of life. It results from acid production by bacterial fermentation of dietary carbohydrates, leading to demineralization of tooth structure. Early signs include white spot lesions, which indicate initial enamel breakdown. Early and accurate detection is essential for effective prevention, timely intervention, and minimally invasive management. Traditional diagnostic methods, such as visual-tactile examination and radiography, have limitations in detecting early or subsurface lesions. Recent advancements have introduced modern, non-invasive techniques, including fiber-optic trans illumination, laser fluorescence, electrical resistance measurements, optical coherence tomography, and artificial intelligence-based systems. These technologies enhance diagnostic accuracy and enable detection at earlier stages. This review highlights current and emerging caries detection methods and emphasizes the importance of combining multiple diagnostic approaches to improve clinical decision-making and support preventive dental care.
